@IonClaws I'm just another medical student on clinical rotations (further ahead of you), but here's what I've learned so far:
1) Adjustment to the wards is hard for most students; it certainly was - still is! - for me. Just as FactorV says, one of the biggest difficulties is, the expectations are not always clear. The other major difficulty is, you'll have to adjust to every new rotation/service/resident/attending and their expectations. So my first advice is, try to be as flexible as you can.
2) Ask your residents and attendings what their expectations are. And yes, just as FactorV says, make sure they know where in your training you are.
2) Remember that it's all about the patients and not about you. I think once you fully process the idea it'll be so much easier not to take things personally. (Not that I'm saying that *you* are taking things personally, but many students do.)
3) Again, as FactorV says, let your intern/resident know when you have to leave for class/tutor group/lunch etc, don't just disappear. At all other times, even if there's nothing going on, don't leave and expect your residents to page/text you when "something interesting" happens - they won't, and not because they're being mean to you but simply because they're too busy taking care about patients (see above: it's not about you, it's about the patients) - instead, be within reach of your residents, sit with them in the workroom or nearby if there's not enough space in the workroom (unless they explicitly tell you to "go to the library and study" or something, which does happen sometimes).
4) Now, "following patients" and "taking ownership of patients" are actually a very important part of your learning and your evaluation. What "taking ownership of patients" means - specifically for internal medicine, but applicable to other clerkships - is 1) knowing your patients' problems and literally following up on them, and 2) making sure the things that your patients need happen in a timely manner. To start with, check on your patients at least once after the morning rounds (it's kind of obvious, and yet many students don't do this). Talk to the patient's nurses, see if there're any issues. Focus on your patients' issues and follow the relevant indicators. Patient spiked a fever last night? Follow their temperature (is he/she still febrile now? Is the temperature trending up/down?), labs (trend WBCs, check on cultures - call micro lab if cultures are taking too long) and report to your intern/resident whether there is anything new or if things are the same. If a consult was called, check if the patient was seen by the consult and whether they left a note on EMR; read consult notes and report to your residents whether there are any recommendations that will change the patient's management. Patient needs an imaging study? After your resident places the imaging order, call the appropriate radiology service to see what time the patient is scheduled to undergo the study, then see if that happens on time and call radiology if there are any significant delays, let your resident know if there are any issues (eg., patient was supposed to be NPO before abdominal CT but just had lunch), look for the images and radiology report on EMR after the study is done and let your intern/resident know when they are available and what the results are. Patient's heparin is being titrated? Make sure the scheduled PTT draws happen, follow up PTT results and let your residents know what they are (bonus points if you check your hospital's heparin guidelines and can suggest to your resident if the patient needs a heparin dose adjustment). Same for vancomycin: make sure trough draws happen at the scheduled times, hollow up the results, figure out if vancomycin needs to be redosed, report to your residents. Cardiac patient on aggressive Lasix diuresis? Make sure their BMPs and Mg are drawn on time, check lyte results, see if K and Mg need repletion, let your residents know. Patient's Foley came out this morning? Make sure he/she pees within the next few hours (and, for some services, find out how much), feel free to ask the patient's nurse, report the results to your residents. Etc.
In other words, "following patients" and "taking ownership of patients" means that students don't check out after morning rounds to read a shelf review book - or even UpToDate articles on their patients' conditions (which you should be doing, but it shouldn't be the only thing you do after morning rounds) - but rather be actively involved in implementing plan for the day and following up the results. Clinical rotations are different from preclinical classes in that, while you still have to do your book reading to learn the basics, most of your time should be spent being involved in patient care.
Imagine you're involved in medical care of a relative or a friend - what would you want to do for that person? What would you want to check on? Try to speed something up? Basically, you should aspire to 1) do everything an intern does for your patients (except for procedures and discussing sensitive topics like prognosis and goals of care etc) and 2) be the go to person for this patient's nurses and family - I don't mean to boast but my patients' nurses would start coming to me with any issues related to my patients within 2 weeks on a service, and patients' families would often ask me questions about patient's management, meds, procedures etc - even as we are standing in line at the hospital's cafeteria! - or, in one case, one of my patient's family members caught me in a hospital corridor and quite literally cried on my shoulder. Again, I'm sorry if it sounds like boasting, I'm by no means a perfect medical student, but my point is, you want to be *this* involved in your patients' care.
5) This should go without saying, be polite and patient with *everyone* - patients, families, physicians, nurses, social workers, respiratory techs, people you call for bed assignment etc. Because it's all about getting your patients the care they need.
6) Finally, adjustment to the wards may be harder to some people depending on their personality. It's easier for more assertive and extroverted people who are not afraid of talking to people and asking for things. I'm more of a wallflower myself, which means that I'm way out of my comfort zone on the wards most of the time. However, what helps me be more involved and more assertive is the idea that - and it bears repeating - it's not about me, it's about the patients. In other words, it's not about my comfort and sensitivities, it's about getting things done for my patients. When I look at it like that, however shy I may be, it's easier for me to talk to people and ask for the things my patients need.
