Average clinical experience?

[SilverCat]

I just started my third year clerkships, and I'm in family med now. This is my third week, and I've been with three different doctors so far. This week, I seem to have spent most of my time shadowing the doctor; I interviewed three patients total, the rest of the time, I just went in the room and watched the doctor. I also don't seem to be getting feedback on my presentations at all, and when I ask how I did or if I missed anything, the doctor just says, "It's fine." I feel like I miss a lot on the histories, and I'm still shaky when it comes to physical exams, but I've had no one observe me do a physical or take a history. I've also had almost no pimp questions from any of my doctors so far, while my classmates tell me they're pimped all the time. Is this normal? I know I'm just a lowly med student, but I don't think I'm being taught much.

Thanks in advance.

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[Psai]

thats how it is sometimes
take initiative, ask to see patients
read their notes and take it as a template for how you do notes
no one is going to watch you do a physical because you should have learned that in the first two years and some people just don't pimp

 

[Mountaineer12]

I've mostly been shadowing in peds clinic, too. I get to see a few easier cases a day and report back unless it's really busy. It gets a little tedious sometimes shadowing so much, but third year just seems so random that I'm just rolling with the punches for now. I tried asking to go watch something and got turned down lol I'll keep asking though. Worst they can say is no!

 

[SilverCat]

I tried being more proactive--asking to see patients--and that helps a bit. I guess I shouldn't complain, I only work from 9-3. I just felt surprised by how much more my classmates were being challenged by their preceptors than I was.

 

[KinesiologyNerd]

I feel like it's pretty site specific. My community preceptor lets me do a ton, but at the mothership they cherry pick "easy" patients for me. Survive and advance, I guess.

 

[Jlaw]

It will vary greatly between sites. Some rotations won't let you do anything, some let you do everything. They might be treating you with kid gloves since you're just starting third year. They are much more likely to turn you loose when you are nearing the end of third year when you know a little more and they can trust you to do simple tasks. You can ask for more responsibility but some preceptors will tell you straight up that they won't let you do X or Y. Sometimes because they don't trust students, but sometimes its just because they are busy and don't want you slowing them down.

 

[operaman]

Yeah it's early in the year and they're trying to balance their teaching responsibilities with their need to see a full clinic of patients without running hours behind schedule. Students are slow - hell I'm still slower than I'd like to be - so it can be tough.

You'll rarely get good feedback on presentations; the truth is that it's a process which takes time. I'm still working on it. I'm a lot better than I was as a student, but I'm still trying to improve. You can do a lot simply by self-correction and practice. Good goals would be:
1) Memorized - have all the info in your head so you don't need notes. Maintain eye contact at all times.
2) In order -- don't pepper your assessment throughout the HPI and Exam; just do it in order an by the book
3) Concise -- patients tell you all kinds of useless stuff; sift it down for your presentation
4) Tell your story with the end in mind. Craft your HPI so it artfully supports your diagnosis and leads the listener to the same conclusion while carefully considering the other top things on your ddx.

Physical exam stuff you really learn by doing. There are some great things online such as Stanford's physical diagnosis pages that really detail technique. You should also look through some of JAMA's Rational Clinical Exam articles that examine different exam maneuvers and how useful they really are. For now, work more on developing a system for your exams so they are both fast and thorough and done the same way every time so you don't miss anything. Technique will come with practice.

 

[SilverCat]

So you shouldn't be reading off notes when giving presentations?

 

[Psai]

So you shouldn't be reading off notes when giving presentations?

you should read off your notes if you want to bore everyone to death and show them that you are unable to pick out what's important

 

[JustPlainBill]

I just started my third year clerkships, and I'm in family med now. This is my third week, and I've been with three different doctors so far. This week, I seem to have spent most of my time shadowing the doctor; I interviewed three patients total, the rest of the time, I just went in the room and watched the doctor. I also don't seem to be getting feedback on my presentations at all, and when I ask how I did or if I missed anything, the doctor just says, "It's fine." I feel like I miss a lot on the histories, and I'm still shaky when it comes to physical exams, but I've had no one observe me do a physical or take a history. I've also had almost no pimp questions from any of my doctors so far, while my classmates tell me they're pimped all the time. Is this normal? I know I'm just a lowly med student, but I don't think I'm being taught much.

Thanks in advance.

As Chuin from Remo Williams: The Destroyer once said," If you are a good student, you can have a teaspoon of honey with your rice."...

What you are describing is nothing new -- happened to me at TCOM which was one of the top 25 in Primary Care at the time. It sucked -- most of my classmates were being taught things while others of us were schlepping behind the attending and trying to get any and all experience we could -- I did peds at the PCC and it plainly sucked -- I really came out of TCOM feeling like I didn't learn anything -- we were supposed to be so great but what I learned was that there's a big difference between being a good test taker with high board scores and being a good clinician.

For now -- take advantage of every opportunity you have -- I know it's hard when you get to shadow daily for a month and that's all you do with very little in the way of patient care -- but be self motivated and try to learn something new every day -- pick something that you think you suck at and try to improve it every day --

For example: Look at the reason for visit and come up with a 5 item differential before you even hit the door -- once you're in the door try to immediately assess -- Emergent vs non-Emergent then Sick vs Not-sick -- then listen to the history getting the OLDCARTS acronym info and then do the ROS with an idea of ruling in/ruling out the big, bad evil things that will kill the patient that should be in your differential....then start the PE and develop your diagnosis ---

So, in that little blurb, there's plenty to work on and more than enough to keep you busy in FM for a month...do the same for IM but now you get to do it for hospital work.....

Hope it helps -- remember that most of medicine, at least at TCOM anyway, is self-taught -- at one point in my medical student career, I almost asked them if I could do this by correspondence ---

good luck to you.

 

[starstarie]

I'm kinda in a similar situation, but I think the main thing to do when shadowing is try to anticipate what they are going to do/say. If you see a similar case on the schedule the next day or so, try to say something like "I saw you do XYZ yesterday for that patient, can I try today?" Or something like that.

There really is a lot you can learn by shadowing if you do it with a purpose. Pay attention to if they take notes/use the computer in the room, what types of ROS questions they ask, where they put their stethoscope, etc. And then compare among different people you work with and see what you like and don't like.

That's working so far for me.

I think it's just really early on and we don't know anything at all and they have other priorities that don't involve holding our hands right now.

 

[notbobtrustme]

So you shouldn't be reading off notes when giving presentations?

you can look off notes as long as you keep it concise and to the point. You can turn a 20 minute patient interview + 30 minute chart review into like a 3 minute presentation that gets all the salient points across.

 

[J ROD]

Beginning of 3rd year you can read your notes. At the end, you should be able to present mostly without looking except for numbers.

 

[clausewitz2]

Something I found helpful when starting third year was to take all the notes I made during a patient encounter, and just try to turn it into a single paragraph. Then I presented that paragraph. Obviously you need to have recorded various numbers and have some idea of extraneous physical exam findings if you are asked about them, but keep doing this until you can turn the patient encounter into a paragraph.

I am also sorry to hear your FM rotation is so low-key, honestly. I was thrown into the deep end on FM (my first of the year), but it definitely made me stronger for it. On my second day in clinic, I was told, "Alright, go in, you get ten minutes, then I'm coming in. Set an alarm if you have to, but you should be done by then." I got fifteen minutes if we had to use an interpreter (which at this clinic was about half the patients) and twenty if we needed a translator phone (there was a profound mismatch between the dialect of Nepali many of our patients spoke and whatever they speak in Kathmandu where most interpreters are from, so there was a lot of cross-talk to confirm comprehension). I was of course terrified for the first week or so of this and felt like the worst student in the world, but you know what? If you can learn to function under that sort of time constraint, everything is going to seem a lot less intimidating after that. The end result later on was that I was the only student in my rotation group allowed to see patients in the busiest gen surg clinic on my own because I was not slowing anybody down.

Agreed with others about being aggressive in seeing patients; keep an eye on the schedule, start with "Would you mind if I saw Mrs. X?" and if that goes well, progress to "I'll go ahead and see Mr. Y" with the aim of arriving at "I've got Ms. Z".