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Medical Student Perspectives: How to Be Successful in your Third-Year Clerkships

The third year of medical school is arguably one of the most important years of your medical career. It is also one of the most challenging and rewarding years at the same time. You will be surrounded by unfamiliar faces and environments, and just when you start to get the hang of things, you will switch rotations and start all over again! Despite the unfamiliarity, the year is full of excitement, and looking back, seems way too short. Having just finished up my core rotations, I now look back and wonder where the time went. So how do you make the most of your third year clerkships and impress your residents and attendings? Following are some helpful hints.

Ask for Advice
Get information regarding the clerkship from students who have gone before you. They can give you advice on which rotations are the most rewarding, which are somewhat malignant, and most importantly, what to expect. When you start your clerkship, make sure you have a sit-down meeting with both your residents and attendings to go over their expectations of you for the month. Be sure to arrange a mid-month evaluation to track your progress and identify areas of improvement. This meeting is your responsibility to initiate, and be firm that you would like specific suggestions for improving.

Work as a Team
Teamwork is one of the most important components of the third year. Your primary responsibility is to learn, but there is also a lot of work that needs to be done to ensure good patient care. Though it may not be fun, try to take on any “scutwork” (i.e., fetching lab results, discharge summaries, making social-work related phone calls) with grace and show your team that you are willing to help in whatever way. The right attitude will go a long way, not only with ensuring that the team runs smoothly, but with your evaluations as well.

Get Ready to Round
Rounding can make up the majority of your day. Typically students “pre-round” first and see their assigned patients alone, then “work round” with their residents, and then have “attending rounds” where they see all the patients with the attending. If you are just starting out, leaving about half an hour per patient in the mornings should be more than enough time to get all your work done. One word of caution: if you know your team is admitting patients the night before, expect to go in a little earlier than normal because you may be expected to pick up and present a new patient that was admitted overnight. Although many attendings will not expect you to present a patient that you did not admit, it can vary, and is better to be safe than sorry.

Be Prepared to Present
When making presentations during rounds, be sure you ask your attending how much detail he or she would like during your presentation and then adjust accordingly. You should be prepared to give a whole history and physical on rounds for a new patient. Old patients can be presented in the SOAP note format. The most important parts of your presentation and notes are the physical exam and the assessment and plan. By leaving yourself enough time in the morning, you will be able to think about the patient’s presentation and come up with your own plan. No one expects you to get this part right, but they do want to see that you made an attempt to come up with a care plan for your patient. Be prepared to explain “why” for anything you say or write. You will be asked questions regarding pathophysiology and treatment during rounds. While presenting can sometimes be scary, some of my best learning experiences have occurred during the questioning period during rounds. If you are asked a question regarding the physical exam about something that you forgot to check do not lie! Courteously respond that you did not check that area. You will be doing yourself and your patient a huge disservice by lying and you will inevitably get burned even more for lying than for not checking a specific physical finding.

Stay Organized
Stay as organized as possible on the wards. There is a myriad of information that you will need to have readily available during rounds. One of the toughest parts of the rotation is staying organized. You will have to experiment and find your own system. Ideally, all of the patient’s information from his or her current hospital stay should be kept on one single sheet of paper. You can also carry around things like the patient’s echocardiography report if it is very detailed and likely that someone will want to see the original. It is important to keep the previous lab values readily available, since you will frequently be asked to compare the current values to the last values. Templates for organizing patient information can be found on the web. Make check boxes for all the tasks that need to be done after rounds and check them off as you complete them.

Keep Up on Your Studying
Days on the wards can be exhausting. Another challenge of third year is making effective use of your time. Speaking from experience, it is essential that you set aside at least one hour every day for studying. Once you get home and have had dinner, it is not uncommon to feel like it is time for bed! Make it a priority to study every night in your review books and also about your patients’ specific conditions. Your grade is determined by both your evaluations on the wards and by the test, so do not neglect one to do well on the other. Great study resources include ACP’s MKSAP for Students 4 and Internal Medicine Essentials for Clerkship Students 2. One of the common medicine textbooks, like Cecil’s, Harrison’s, or ACP Medicine, will be a great resource for reading up on your patients’ conditions.

Do Not Be a Gunner
Attendings know a gunner when they see one and they do not appreciate this personality style. Patients and work should be evenly divided among the medical students. If an attending asks a question that is clearly directed to someone else, and that person does not know the answer, do not shout out the right answer. Wait to be asked or for the question to be offered to the group. There is also such a thing as rounding etiquette. It is poor form to make anyone on your team look bad during rounds. You are a team and should work together to make everything run smoothly. You may experience several scenarios such as the following: you present an assessment and plan during work rounds with your resident, however your resident corrects you and offers an alternative plan. When you offer that new plan in attending rounds, your attending corrects you and offers your original plan as the right course of action. In such a case, do not expose your resident as the source of erroneous information—take the criticism maturely and move on. You can hope that next time your resident will be big enough to admit when he or she is wrong.

Make Time for Yourself
It is important to continue doing the things that you love to do. You may not be able to exercise as much as you used to, but certainly several times a week is a reasonable goal. Be sure to take time for yourself, even if it just means “vegging” for a little while. Identify someone in your class that you can talk to about any issues you have. If you find yourself struggling emotionally or physically during the year, do not wait to get help. There are many people who have a lot of experience helping medical students.

Keep a Positive Attitude
The most important advice I can provide is to have a good attitude. By being willing and eager to learn, you will make your superiors willing and eager to teach. Volunteer to help whenever you can, because you never know what you will learn in any given situation. The more you see, the more you will remember. It is much easier to retain information about a disease after you have seen it in a patient rather than read about it in a book. Most of all, have fun! Third year is exciting. It is also probably the only time you will get to see such a broad range of medicine, providing a variety that you will not be able to experience once you are in practice.

Jacquelyn Coloe
Vice Chair, Council of Student Members
The Ohio State University School of Medicine, 2009

Back to July 2007 Issue of IMpact

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