I do not like this idea. The problem is that unlike undergrad, even if you have 2 or 3 different orgo classes being taught concurrently, they are very similar in terms of content and experience. Medical school is not like that. Your rotations are not going to be the same as most of your classmates. For example, while you may all spend 12 weeks on internal medicine rotations, you will each be spending time with potentially hundreds of different residents and attendings, never mind at multiple different institutions. Also, people's perspectives are heavily modulated by their own personality. When I describe my medical school experience, a lot of people on SDN claim that it is out of the ordinary or that I was lucky, etc. I felt like I was a part of a clinical team. While not universal, on many rotations, I was depended on for small things and by MS4 I was carrying the team pager and 'functioning' as the team's intern on days that we didn't have an intern. I did a mountain of procedures and got a fair bit of hands on experience in the OR. By the same token, I had plenty of classmates that bitched and moaned continuously about how 'terrible' our clinical rotations were.
Now that I've been on the other side of things, I have a new set of observations. Our trauma service has typically 5-6 MS3s on at any given time and you should see how variable our course evaluations are. When you match those evaluations up with the students themselves, it is hardly surprising the results that you get. The people that are obviously excited to be there and are 'helpful' end up leaving good evals. Some others said, "there wasn't much for us to do." Which is odd given that we are one of the busiest trauma centers in the United States and the service is probably one of the fastest moving services in the country. But, those are the same students that make it very obvious that they are expecting residents and attendings to coddle them and spoon feed them. If you put yourself in a position to get lucky, you are far more likely to get 'lucky' than if you sit in the corner and expect other people to take care of you.
How to not look like an incompetent fool on rotations?
I just did evals for our medical students from February. Supposedly the clerkship director will edit/review them, but I kinda doubt it since what I wrote will be more detailed than he could ever write based on his interaction with them which was minimal.
I will only talk about surgery clerkships since that is what I know. A lot of this will apply to other clerkships that others can adapt. I can give specific examples for every single number below based on last month alone. These are very common issues.
To avoid being a bad student:
1) Show up on time
2) Look professional
3) Be available. You should never disapear and unreachable.
4) If asked to do something, either say, "Yes, I'll do it" or, "I don't feel comfortable with that, do you mind teaching me how to do it so I can do it next time?"
5) Do not ask "Anything that I can do right now?", ask, "How can I help?" or simply offer to do things, I hate scutting stuff to students, but if you offer to drop my notes off for me, or you feel comfortable finishing a dressing change on your own, if you say, "I can handle this" or just "I got this".
To be a good student:
1) Know your patients inside out and backwards. You are carrying less patients than your residents/attendings, you should know the details about your patient, even if they don't. You may not know what it means, but you should have the info available.
2) Always make an assessment, attempt to develop a plan. Start with a wide differential and focus in on the most likely diagnoses.
3) Read. Every night, even if it is for 15 minutes. Read about your patient or the procedure they are about to have or have had.
4) Be helpful. Getting labs, dropping notes in charts etc. Scut sucks, we all have to do it.
5) Tie and suture. I will walk anyone through how to do something, but I expect you to know the basics before showing up in the OR. If I show you how to do something, you should practice it at home and if you don't get it, ask me to show you again when we have down time.
To be a rock star:
1) Know your patients inside and out, but pay attention to what residents and attendings find important. Nobody will fault an MS3 for giving a laundry list of normal physical exam findings/labs, but eventually you have to learn to focus in on the important things so you can effectively communicate with colleagues down the road.
2) Develop skills. You are as useful as the skills that you posess. Things that an MS3 could potentially know how to do solo or with only resident observation:
a) Wet to dry dressings
b) Wound vac exchanges
c) Chest tube placements
d) Chest tube removals
e) Suturing - Simple, horizontal matress, vertical matress, sub Q, deep dermal, running
f) Central line placement
g) Central line removal
h) Fever workup
i) Getting outside hospital records
3) Learn to solve the common problems. Every rotation, go to the charge nurse on your main floor and ask them what the 10 most common intern calls are for. They should sound like this: Pain, fever, nausea, tachycardia, hypertension, electrolyte abnormalities etc. And then the specifics, Vascular: loss of previously dopplerable pulse, Gen Surg: change in abdominal exam findings etc. Then learn how to work up or manage those issues. As an MS4 on sub-I a good student will function like an intern. Those skills don't show up overnight, you have to develop them over time starting as an MS3.
4) Do not stop suturing or knot tieing. If you are interested in surgery, innate ability counts for something, but more important is practice. You should be able to do one handed ties left and right handed with ease. You should be efficient and accurate. When in conference, tie to your scrub bottoms or the chair next to you. If you have down time, have someone check your technique.
5) Think before cutting suture. What kind of suture are you cutting? Where are you cutting it? What is the purpose of this stitch? How many knots were tied? There is a logic behind suture tail length. While you will always have people that do things a particular way "just because", the vast majority will have a method behind their madness.
Helpful, but typically poorly implemented, so it means very little as a selling point.
