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Medical Student Perspectives: How to Succeed During Your Clerkship Year

The third year of medical school will set the stage for your medical career. It is a year full of promise; it is a year full of hard work. You may start the year thinking that you already know which field you intend to pursue, but for most medical students, that idea will change at least once. You will have opportunities this year to experience and to see first-hand everything that goes on in the hospital, so take advantage! Now in my fourth year and looking back at my third year of medical school, I am utterly amazed at how quickly it goes by and how much I learned in what seemed like a very short year. Since hind-sight is 20/20, here are my thoughts on how to rock during your clerkship year, how to impress your attendings, and how to stay sane.

The Intimidation Factor
Do not worry! Every medical student is going to feel totally clueless at least 100 times this year. Remember, every great attending and resident that you work with started as a medical student. Most likely, they made the same mistakes that you will, they felt just as lost, and they were just as embarrassed about their lack of knowledge. The key is to remember that they got to where they are through a lot of hard work and a whole lot of studying, and so can you. No one expects you to know everything at the beginning of your rotation. Rather, the key is to demonstrate an increased knowledge base over the course of the months, reflecting that you are paying attention on teaching rounds and that you are avidly reading about the diseases you see when you get home.

Ask Questions
When you do not understand something that is being discussed, speak up. The number one reason that you are on the clerkship is to learn, so do not waste your time or the time of the team. Teaching rounds are not for the good of the attending Ė they are for you! This is your best chance to learn how to build a differential diagnosis, to interpret physical and laboratory findings, and to develop an assessment and plan. Questions will reflect active listening, interest in the subject being discussed, and will clarify difficult topics thus lightening the load of studying that you will have to do when you get home.

Show Interest
Get excited! This year is your chance to see what being a doctor is all about, and to see all of the aspects of medicine in its continuity. Try to approach each rotation with a positive attitude no matter which field you may already plan to pursue. Most important, do not express any disinterest you may have for your current rotation, as this attitude will be clear to your residents and attendings. A bad attitude will reflect itself in less interest on the part of the attendings and residents to teach you, a lower score on the shelf exam, and poorer evaluations. No matter how long some rotations may seem to drag on, especially during those cold winter months of perpetual darkness, keep in mind that this is an experience with opportunities to teach you something applicable to your later clinical practice. Stay positive, even if you have to feign it every once in a while.

The Early Bird Catches the Worm
The adage especially holds true in third year. See your patient, check in with the nursing staff covering your patient, check for new labs and imaging, and get your notes written before anyone else on your team has seen the patient. Then, check in with your resident before rounding with the attending. Find out if your patient will be having any tests or undergoing any procedures that you did not know about, and make sure that both of you are on the same page concerning the management of the patient. This is the single easiest way to avoid embarrassing moments while rounding.

Know Your Patient Better than Anyone Else
The medical student is the go-to-person when there is a question about a patientís past medical history. Memorize the patientís history, commit it to your memory, or write it on the inside of your sleeve if you cannot seem to remember it. This is a really easy way to shine, to appear interested, and to look like a hard worker. Also, if your patient is in the hospital for a COPD exacerbation but has a past medical history of rheumatoid arthritis, know the current status of both conditions and any physical findings that the patient has for either condition. This is a great way to practice the physical exam as it relates to different pathologies, and an even better way to reinforce the patientís information in your memory.

Make an Impression
It is one thing to try and make an impression on your residents and attendings, but do not forget to put just as much effort into making an impression on your patient. Check back in with your patient frequently throughout the day, ask them if there is anything that you can do to make them more comfortable, and make sure that they know your name. If your patients feel that you provide excellent care, then your attendings will definitely hear about it. This kind of feedback is priceless.

Everyone will make mistakes and look foolish during their third year, but the key is to bounce back. Remember that it takes a lot more than one bad day to hurt your evaluation grade, and that your failures will be small in comparison to your accomplishments if you continue to show up and work hard every day. The most successful students are those who learn from their failures and who do not make the same mistake again.

Dress the Part
If you do not know the answer, at least you can look like you do. Being a professional requires dressing like one, and many residents and/or attendings will assume a lot about the effort you will put into the rotation and your level of seriousness based solely on the way you physically present yourself. A sloppy dresser earns less respect and tends to receive poorer evaluations, despite how well he or she may answer questions on rounds.

Set Aside Time for Yourself
This year will be the hardest that you will have ever worked, and you need to schedule free time just as you schedule study-nights for yourself. Whether it is at the gym, watching your favorite television show, or participating in a recreational sports league, maintaining an outlet for yourself is going to make the difference between loving your third year and hating it. Moreover, staying sane will help you focus more clearly when it is time for work or study. Do not forget that residents/attendings are partially evaluating you as someone they may have to work with one day, so maintaining outside interests and hobbies often provides another opportunity for you to make a good impression. Most important, if you find yourself really struggling to handle the stress and emotion that the clerkship year can place on you, do not hesitate to seek help. Countless resources are available to help students in this situation.

The Take Home Message
Third year is going to transform you from a medical student to a soon-to-be clinician faster than you can imagine. Appreciate the year for what it is: a chance to figure out what you want to do with your medical career. Study hard, work hard, and keep in mind that the year will only be as fulfilling as you make it. As the year continues on, keep putting your best effort into each of your clerkships. Good luck, and I am sure that you will enjoy the year!

John Paul Henao
North Central Region Representative, Council of Student Members
Drexel University College of Medicine, 2009
Email: jph32@drexel.edu

Back to July 2008 Issue of IMpact

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