Your basic science coursework is complete! So you’re pretty much a doctor now, right? On paper, you know everything that there is to know to pass Step 1, and that’s what it takes to be a doctor... on paper…
All of a sudden, third year rolls around, and it is GO time. You are starting your clerkships, and caring for real patients! No longer will you be in a lecture-driven study bubble. No longer will your clinical exposure be limited to the occasional standardized patient or student-run clinic visit. You will treat real people every day. You will build the foundation of the rest of your career.
Without further ado, here is your survival guide to your first (and future) rotation(s):
- Appreciate the fact that as a doctor-in-training, you are doing something with meaning.
When you are studying to simply advance your knowledge, it is inherently a selfish act. Sure, you are doing it because you have the desire to help fellow human beings in need. But until rotations start, you are helping yourself first.
When clerkships start, a beautiful thing happens. You are utilizing your knowledge and going out of your way to heal someone. Whether or not you believe it, you are an integral part of a patient’s care team. As a medical student, because you have less of a time-crunched lifestyle compared to a resident, you might be called upon to spend an extended amount of time with a patient in need. It might be you who is changing a patient’s daily dressing, or explaining to them the importance of avoiding excess sodium intake.
- Be patient when time slows down or things seem wasteful on rotation.
While most of the time, it is wonderful to be the medical student on the team (constant learning and no true liability!), sometimes, it will be straight-up miserable. I always try to look for the best in things, but I would be lying if I told you you could get through all of medical school without a single crappy day.
Mine was an 8 hour lysis of adhesions that I was scrubbed into. Leaving was not an option, but neither was participating in the surgery due to its complexity. I was left standing there, hands gently folded on top of the drapes, trying occasionally to force some small talk with the attending and resident who seemed to have forgotten I was there. There was next to no learning opportunity. It felt like never-ending captivity.
Yours might be a primadonna attending who can’t round until she picks up her kids from soccer, and even though your work is done at 2 PM, rounds won’t start till 6 PM. Some days will be like this. Accept the fact that it cannot be a non-stop adventure, and do what you can to utilize down-time wisely.
- The everyday medical horses trump the esoteric zebra diseases.
Remember when your biochemistry professor was drawing amino acid structures as he explained the pathophysiology of maple syrup urine disease? Or the time you had to pin down that enzyme that was missing for each of your mucopolysaccharidoses? You asked yourself, “When am I ever going to have to know this?” When it comes to your rotations, common things are common! You will encounter much more run-of-the-mill heart failure than you will atrial myxomas. Community acquired pneumonia shows up in the ED a lot more than coccidiomycosis.
Build your familiarity and knowledge of the common diagnoses that you will encounter on your rotations. If neurology is your first rotation, wrap your brain around strokes and multiple sclerosis. If you start on OB/GYN, figure out your vaginitides (vaginitises?), basic physiologic changes of pregnancy, and pelvic inflammatory disease. For surgery, get familiar with hernias, gallbladder disease, and small bowel obstructions.
- Know EVERYTHING you can about your patient.
While your resident is likely carrying a census of 4-10 patients, you will probably be responsible for 1 or 2. It is essential that you know everything that there is to know about your patient! If you had no other responsibility as a student, this would be it. When you are doing your initial history and physical, get down deep and ask even the questions that seem superfluous. Know your patient’s lab values and how they are trending. Know his physical exam and how it has changed since yesterday. Is his type and screen expiring? Did his chest X-Ray get an official read? Did he throw up last night? What time he they spike a fever?
How can you possibly contain all of this information? It’s simple: Write it down. A chief resident told me there were two types of interns: those who he can trust, and those who don’t write things down. The same holds true for students. While you don’t want your presentations to be boring, long-winded, and read word for word from your note, you should at least have the information in an easily referenceable place so that when someone asks for a hemoglobin or urine output, you can quickly fire off the answer. When the attending wants information and the resident doesn’t have it, your resident might appreciate if you bail them out by being responsible for knowing EVERYTHING about your patient. That is your job.
Here is part 2 of our Rotation Survival Guide.