Clerkship Etiquette

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cpants

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Starting my rotations this summer. What are the unwritten rules for clinical rotations? What are some major faux pas to avoid? Any good stories of egregious etiquette breaches?

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Starting my rotations this summer. What are the unwritten rules for clinical rotations? What are some major faux pas to avoid? Any good stories of egregious etiquette breaches?

1. Don't make other students look bad in front of superiors. Same goes for residents in front of attendings, etc.

All specifics pretty much stem from there, plus working hard.
 
1. Don't lie.......EVER. If you missed, forgot or just decided not to do something...fess up. Because eventually you will get caught & your reputation in the hospital is kaput.

2. If an attending asks you a Q & you get it right because a resident told you/pimped you about it earlier, let the attending know.

3. Be nice to nurses. Not only 'cos they can & will save your butt, but you should be nice as it is.

4. Thank you cards to attendings should be done AFTER the evaluations are done.

5. Be sure to thank your residents as well, specially if they were nice, taught you something & didn't give you too much scut work.
 
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-Never ask a question for which you can (easily) look up the answer.
 
Agree with all of the above. Some others:

- Dress professionally at all times, and look as groomed as possible under the circumstances. Don't show up with wet hair or a 3 day stubble just because it gives you a few more minutes sleep.
- Show up on time for everything, even if you suspect your residents/attendings won't. You are allowed to wait for them, but never vice versa.
- Read up on patient's illnesses and be prepared to drop factoids about the ailment during rounds where appropriate so your attending thinks you give a damn.
- If anyone ever asks you if you want to do XYZ procedure or sit in on PRS operation the right answer is always an emphatic "yes".
- You are expected to know everything about your patient during the course of their hospital stay, so staying organized is key. Print out the forms from the medfools site to aid in keeping information in one place.
- Try to win over the scrub nurses/techs. They otherwise will make you scrub out and rescrub for contaminating yourself even if you are many feet away from the alleged object that you supposedly touched. It's a running gag to put med students in their place for some of them. A bit of pre-procedure banter can save you hours at the sink.
- There will be attendings/residents who dis/like you from day 1 for no apparent reason. Hard work and effort can win over a fraction of dissenters, but there will be people you are unable to please. You will learn that you have only so much control over subjective grading, and that there is some luck of the draw inherent in rotation grading. No point fighting it. You just dust yourself off and move on to the next rotation.
 
Regarding the other MS3s on your team:

Share the opportunities/cases with your fellow MS3s - don't be a hog. This isn't to say you shouldn't try to stand out (or that you should try to cover up) if there are lazy, timid, or otherwise uninterested people on your team. Just don't be a total DB and round on/look up articles or answers to questions for other peoples' patients without talking to them about it first. Don't surreptitiously scrub in and steal a case from your fellow students (especially once they are already scrubbed). Talk to the other students and try to come up with a rotation so that each person gets an opportunity to see what they are interested in and get some facetime with the attendings. If your team is rounding on another student's patient and something needs to be done for that patient, let that student deal with it, or ask them if they need your help. You wouldn't want someone scooping you on a patient that you had been following for the past week, would you?

You're not going to get along with everyone all the time, but by just being mindful that it's "not all about you," things will be a lot more pleasant. I've had the misfortune of experiencing each of the above scenarios on IM/surgery - this kind of behavior is completely unneccesary and frankly pisses me off...a couple of times to the point where I said something to the student about it. I try to go out of my way to "play nice" with the other kids in the sandbox - everyone should try to remember that they aren't the only med student on the team. With a little communication, you shouldn't run into these sorts of problems, unless someone is purposely trying to be a DB.
 
thank you cards for attendings? wtf? might as well just offer to perform oral.
 
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thank you cards for attendings? wtf? might as well just offer to perform oral.

I have written emails to attendings that I feel have done a stand out job in teaching me, but thank you cards are a little much. YMMV.

Two things that got me through my sub i with a resident who didnt like me were: the bottom line is patient care. I dont care what you think of me, the bottom line is patient care. You cannot fail me for a lack of enthusiasm when my work is up to par with everyone elses. In my case, my work was on an equal level with my partner in crime, and he didnt like the fact that I was not enthusiastic as he was about internal medicine.

Having said that, if someone decides to yell at you, call them on it. We are all adults and just because you are the lowest man on the totem pole does not mean you get to be yelled at indiscriminantly. If you dot your i's and cross your t's and ask not to be yelled at, noone can call you on anything.

In no way am I saying be arrogant and demand respect with a chip on your shoulder. Dont get all uppity with someone who yells at you. Politely ask them not to yell at you, or why they are yelling at you. There are few and far between areas in my two years of rotations that I've ever done so, but I personally draw the line at yelling, especially in front of other people.

Your clinical years are your time to learn what you want from it. YOU are going into debt because of this education so if you arent getting enough, ask for more. POLITELY.
 

2. If an attending asks you a Q & you get it right because a resident told you/pimped you about it earlier, let the attending know.

Yeah, I definitely disagree with this one. No need to justify getting a pimp question right. If you answer it right, just let it be. You can let the attending know that your residents are taking an active role in your education at a different time.
 
not that I needed a reminder, but this is why I hated 3rd year

there's no doubt I'll dislike large portions of my internship year as well, except that I don't need to wear a ****-eating grin on my face the whole time
 
thank you cards for attendings? wtf? might as well just offer to perform oral.

You beat me to it! I had the exact same thought.

Other tidbits that made 3rd and 4th year successfu:

1) It's not all about you. Especially important to remember if you are used to everything always being all about you.

2) Just showing up really is like 80% of the battle, especially as the year wears on. I absolutely second Law2Doc, who mentioned the importance of getting places on time/early, and always being (or at least seeming) interested.

3) Play well in the sandbox. You are not above holding the door for the janitor, putting on gloves and helping pick up some of the soiled linens, etc. And it's a big plus if you are aware enough to spin the surgeons (on anesthesia or if not scrubbed yourself) if the circulator is too busy/too lazy to do so.

4) Rarely is it your place to get in on the politics of a place. It may be vastly engrossing to listen to, almost to the point where you feel like commenting or getting yourself involved. Think this action through carefully.

5) Use common sense. I don't mean to be condescending. But you'd be surprised how far this will take you, and what your classmates think is appropriate; "please" and "thank you" are good, interrupting an attending is not, for example.

Have fun, and good luck!

dc
 
be interested. you can always take away something from each rotation.
 
thank you cards for attendings? wtf? might as well just offer to perform oral.

:thumbup: I've never even considered doing such a thing.

Yeah, the basic tips have been covered above. Don't screw over your peers. Don't pimp 'em and don't try to stand them up. Don't try to show up the residents either. The other stuff is manners. Look somewhat interested when you're not, etc.. And unless you're gunning for derm or rad onc or whatever, it's OK to not sell your soul to the devil to do well in a rotation you hate. Unless you're a total screw up, you'll pass, and move on to less crappy rotations. And as for impressing attendings in the rotations you do like, you don't have to be a tool. Your interest and motivation will show, so just go with that.
 
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1. Don't make other students look bad in front of superiors.

:thumbup:

During the first day of each new rotation, get the cell phone #s/pager #s of your classmates who will be on your team. That way, if you find out that rounds were unexpectedly moved up to 8:30 AM, instead of 9 AM like all your other classmates think, CALL THEM ASAP and let them know. That way, they don't stroll in half an hour late.

You'll look bad, too, if your resident figures out that you knew, but didn't clue in your fellow team members.
 
:thumbup:

During the first day of each new rotation, get the cell phone #s/pager #s of your classmates who will be on your team. That way, if you find out that rounds were unexpectedly moved up to 8:30 AM, instead of 9 AM like all your other classmates think, CALL THEM ASAP and let them know. That way, they don't stroll in half an hour late.

You'll look bad, too, if your resident figures out that you knew, but didn't clue in your fellow team members.

Yup.... I strolled in 45 minutes late for rounds yesterday.... and I was the only one that wasnt informed that they were moved one hour earlier. :mad:
 
A la the point about not getting caught up in politics...

Don't join in with the residents when they start bitching about anything hospital related. It's absolutely not your place. You don't know who might overhear the conversation, you don't know how the residents will view you and there's just nothing good that can come of it. Plus it's quickest way to kill any illusions of enthusiasm you might have fooled people with. Hell, just by not complaining will make you seem "pleasant". Your time to complain is with your fellow students at the bar on Saturday night.

It can't be said enough, just be courteous to everyone. It doesn't have to be fake or over the top, just give people the benefit of the doubt even if they won't return the favor.

Along the lines of being on time, the sooner you realize that you've lost control over your own schedule and you won't get it back until after residency, the better.

It's absolutely okay to make friends with the residents. The quickest way to have them realize you're more than just some drone is to ask them questions about themselves. On some rotations you're going to be spending A LOT of time with the same people, might as well have something to talk about other than hospital stuff.

It's also okay to talk to attendings beyond just patient care aspects. Just be more careful about humor and stories of your weekends.
 
. And it's a big plus if you are aware enough to spin the surgeons (on anesthesia or if not scrubbed yourself) if the circulator is too busy/too lazy to do so.

I dont know what this means, please explain?


Thank you
 
thank you cards for attendings? wtf? might as well just offer to perform oral.

I always gave thank you cards to attendings that I felt were really invested in my learning & were not just going through the motions. With so many horror stories about med students getting endlessly pimped, not taught anything having a "shadowing" experience etc it is a relief when you get one that you can use as a stepping stone into residency.

I suspect most attendings are still human & as such appreciate a thank you....as long as you do it AFTER evaluations are submitted, what's the harm, specially if you will probably not rotate w/ the same attending twice.
 
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FYI, it's their JOB to teach! If they've done a great job, I tell them at the end of the rotation that I really appreciated their teaching and I learned alot. If they were crappy, I just keep on walking.
 
FYI, it's their JOB to teach! If they've done a great job, I tell them at the end of the rotation that I really appreciated their teaching and I learned alot. If they were crappy, I just keep on walking.


Exactly.
 
Yeah, I definitely disagree with this one. No need to justify getting a pimp question right. If you answer it right, just let it be. You can let the attending know that your residents are taking an active role in your education at a different time.

Agree with your disagreeance. Usually, when residents tell you the answers to potential pimp questions, it's because they are trying to be nice and help you shine.
 
Some advice for the gunners (aka things that should be obvious but apparently aren't):

-Don't jump in when another student is being asked pimp questions

-Don't ever read up on other students' patients (unless specifically asked by a resident or attending to check on something - like a new lab value)

-Don't hog the new patients - if you get two admissions, that's one for you and one for your fellow student

-If a presentation is assigned to another student, don't read up on their topic beforehand.

-Don't come in on your day off.
 
Some advice for the gunners (aka things that should be obvious but apparently aren't):

-Don't jump in when another student is being asked pimp questions

-Don't ever read up on other students' patients (unless specifically asked by a resident or attending to check on something - like a new lab value)

-Don't hog the new patients - if you get two admissions, that's one for you and one for your fellow student

-If a presentation is assigned to another student, don't read up on their topic beforehand.

-Don't come in on your day off.

Um, they wouldn't be gunners (a pejorative term) if they didn't do these things. These kind of things are what makes them a gunner. So I'd say this isn't advice for the gunners, it's advice as to how not to become labeled a gunner (which should be the goal).
 
-Don't ever read up on other students' patients (unless specifically asked by a resident or attending to check on something - like a new lab value)

-If a presentation is assigned to another student, don't read up on their topic beforehand.

To clarify these points, you should absolutely read up on any topic or pathology you encounter on wards. That's how you learn, the rounding and conferences and didactics are just window dressing. But don't study up on a teammate's patient (like their specific history, lab values, procedure results, etc.) or specifically assigned topic in order to 'outshine' that person and earn a better grade.
 
Don't be a backstabber. It's better to be a team player than a teacher's pet. If your fellow students do not trust you, then chances are neither will your fellow residents.
 
To clarify these points, you should absolutely read up on any topic or pathology you encounter on wards. That's how you learn, the rounding and conferences and didactics are just window dressing. But don't study up on a teammate's patient (like their specific history, lab values, procedure results, etc.) or specifically assigned topic in order to 'outshine' that person and earn a better grade.

Depends on the attending. He may assign the patient to one med student but he pimps everyone on the patient's illness. It would behoove you in that case to study up unless you enjoy answering with, "Umm, I don't know."

Actually, I'd recommend reading up on all interesting cases anyway. Just don't answer unless asked if it happens to be the other medical student's patient.
 
To clarify these points, you should absolutely read up on any topic or pathology you encounter on wards. That's how you learn, the rounding and conferences and didactics are just window dressing. But don't study up on a teammate's patient (like their specific history, lab values, procedure results, etc.) or specifically assigned topic in order to 'outshine' that person and earn a better grade.

Yes, this is what I meant - by all means be familiar with various pathologies/treatments/etc as they come up on your teams. I meant don't read the individual patient's charts (new labs, etc).

Similarly for presentations - if a student is assigned to present a short discussion on ____ journal article, don't go out and read said journal article yourself and try to show them up
 
From a resident's perspective...

-Don't lie.

-Ask questions. Bonus points if you have read up on what you're asking about (obviously not necessary for something that has just come up). Use common sense about certain times when questions shouldn't be asked.

-If we offer to teach you something, don't say you're not interested, or that you already read about it.

-Printing out articles means nothing, just more paper for me to throw away...but referring to articles you have read and knowing how to apply the conclusions is evidence of a strong medical student.

-We don't mind that you plan on going into another field - but you are expected to recognize how our field is relevant to your preferred specialty, and direct your learning towards that.

-I don't care much about enthusiasm, but many residents do.

-We work with lots of medical students through the year, and there is no need to try to look better than your partner. It's better to make each other look good. I have no objection to recommending multiple students for Honors.

-If you want Honors, you have to go above and beyond the minimum every day. Volunteer for more work, more call, more patients, more reading. Take initiative and anticipate the needs of the team before we ask you to help with those needs. Before you ask to leave early, see if you can come up with a way to make the team's work easier - not just asking "is there anything I can do."

-When you have time, do physical exam elements on your patients that are not necessary from a management point of view (eg. fundoscopic exams on everyone). This will pay off when those skills are needed and you have confidence in what is "normal," or when you make an unexpected finding.

-Remember that you are here to learn, not just to get a good evaluation. If you are serious about learning (and unforunately many of your peers are not), good evaluations will follow.

-Accept that there are some people you will never be able to please.
 
And... maybe you should take some midol before heading out the door to greet the world.
 
1. Don't lie.......EVER. If you missed, forgot or just decided not to do something...fess up. Because eventually you will get caught & your reputation in the hospital is kaput.

According to "The House of God", you are supposed to do nothing but lie and make it look like you did stuff. :confused: ;)

Agree with your disagreeance. Usually, when residents tell you the answers to potential pimp questions, it's because they are trying to be nice and help you shine.

I have a personality flaw that won't allow me to take credit for something I don't deserve. I.e. for our assigned mini-rotation for our second year, we are supposed to write up full H&P's on a few patients. Our doc said that our papers were really impressive. I couldn't help but tell her that we were given a template that we just edited with our patient's data. :rolleyes: Conversely, this same flaw makes me frustrated when I don't get credit when it is due.

Thanks for the tips, guys. I'm starting to get a little anxious about 3rd year.
 
thank you cards for attendings? wtf? might as well just offer to perform oral.
:laugh:

I agree with those who say forget about a thank you note. Your attending will read it, maybe think "how nice", and toss it in the trash. There are much better (and still professional!) ways to show your appreciation. Most teaching faculty have annual performance reviews that probably include their educational activities. If you want to really thank an attending in a way that might actually count, write a letter to their department chairman detailing how good their teaching is. That will go into their file and possibly help them when they come up for review the next time.

Maybe some of the current residents could comment on whether residents are also reviewed based in part on their teaching activities. If so, it would be good for students to know that they could write a similar letter to the PD for an awesome resident's teaching.
 
Maybe some of the current residents could comment on whether residents are also reviewed based in part on their teaching activities. If so, it would be good for students to know that they could write a similar letter to the PD for an awesome resident's teaching.

Yes - such a letter would definitely be a good thing.
 
FYI, it's their JOB to teach! If they've done a great job, I tell them at the end of the rotation that I really appreciated their teaching and I learned alot. If they were crappy, I just keep on walking.

That's exactly what a thank you card does as well. :).
My initial point, although obviously not well communicated, was that IF someone decides to give their attending a card (& I do), it should be done AFTER the evaluations are in......I wasn't saying everyone should do it.
And about what QoQ said......no reason you can't do both.
 

My initial point, although obviously not well communicated, was that IF someone decides to give their attending a card (& I do), it should be done AFTER the evaluations are in......I wasn't saying everyone should do it.
And about what QoQ said......no reason you can't do both.
You can never go wrong with being thoughtful; I think thank you cards to attendings just weird some of us out a little. Maybe it's the power differential, I don't know. Anyway, I deleted the extra posts for you. :)
 
From a resident's perspective...

-Don't lie.

-Ask questions. Bonus points if you have read up on what you're asking about (obviously not necessary for something that has just come up). Use common sense about certain times when questions shouldn't be asked.

-Remember that you are here to learn, not just to get a good evaluation. If you are serious about learning (and unforunately many of your peers are not), good evaluations will follow.

Disagree with the above. There are situations in third year where lying is the only smart thing to do. I also learned very early on that the more questions you ask, the deeper and deeper hole you dig for yourself. Just keep your mouth shut and smile like a hyena. Also just trying to learn is definitely not sufficient or even necessary. Most important is to seem interested and enthusiastic. I've been told several times to stop reading uptodate on the wards because it wastes time.
 
clerkship etiquette, huh?
first off, classy med students extend their little finger whilst obtaining ABG's.
in my opinion there are 3 main purposes to each rotation: 1) learn as much as you can, 2) help the residents out with the daily work, and 3) show the attending that you know something.
in the same way that residents need to have nurses on their side, med students sort of need to have the residents on theirs. as a student, a surg resident once told me "if you make my job easier, i'll make you look good to the attending. win-win." it's usually not stated so overtly but it's sort of true. attendings often ask how students are doing or suggest areas to help them with; good feedback from the team is very reassuring.

this isnt' so much etiquette, but a piece of advice is to always check in with the intern before rounds... it's really part of their job to discuss questions you have about the plan and overnight events, and to point out what's important vs. what's not. this is an easy way to improve your presentations at rounds.
 
Do not answer your cell phone during rounds. The patient that is being presented may not be yours but that is still not a good excuse. Even if you display some manner of courtesy (by walking a few feet away from the group so that you won't disturb anyone), people will still noticed. If you are waiting for a very important call, at least give the resident (and maybe the attending) a heads-up that you are expecting a call.

If the intern suggest you read-up on a specific topic, and your senior resident tells you (on the same day) to read up on that same specific topic, do not act dumb when the attending ask you about that topic the next day during rounds.

The student later asked the attending why he didn't get honors for the rotation. :idea:
 
I'm a resident,

- its ok to ask questions, but too many especially ones you can look up are very very annoying
- if you disagree with a treatment plant, maybe ask why 'your' plan isnt the right course, listen and move on; the resident's are being supervised by attendings and also the residents most likely are right
- if you are asked to see a patient, try all you can to get the most information you can in the appropriate timely manner, even if there is a language barrier, most hospitals have translation methods in place ( might not apply everywhere) but I've had multiple students come back to me and say, "i can't speak spanish" and come back without a physical exam, or even trying to find a way to communicate; you may not think it is your job, but its reality and should deal with it.
- help out the residents with some scut, seriously you slow them down, just like residents slow down attendings and so on. Especially in places where you dont write notes and stuff, the resident is really taking a burden no matter how good you are (i've had excellent medical students, but they still slow me down a bit, and some REALLY slow me down)
- yes residents are there to teach, but they are there to learn also; so just work with the team
- personal pet peeve is when a student acts like they are way more sympathetic to patients needs than me, and they say something like 'arne't you gonna talk and comfort the patient'; beleive me I've probably already talked to the patient before you thought of the brilliant idea; telling me isn't helping you any
- work hard, like any other situation always helps
- be nice, probably the most important one, as a student, resident and attending, it will get you a long way and its just right

prob more stuff too, can't think of them all
 
The best thing you can do is be nice to everyone. This obviously includes your attending, residents, and interns, but also other students, nurses, social workers, pharmacists, etc. Your life will be much easier when others enjoy being around you.

Arrive on time (or a little early), smile, and at least seem relatively interested in what is going on. This is not hard to fake.

Look well put-together. It amazes me how many students arrive to work with wrinkled clothes, two days of scruff, etc. You're a professional, and even though society has gotten causal and lazy, you owe it to yourself and your patients to look like you took a shower and made an attempt to dress professionally. Plus, since just about everyone else thinks it's okay to be extra casual, you will look that much better.

Don't snipe. In other words, don't butt in and answer a question about another student's patient, or interrupt them when they are asked a question. It will happen to you at some point, and you will hate it. Don't do it to someone else.

Always be helpful, even if it involves "scut." I think scut is over-dramatized as being the worst thing ever. I don't think it is a big deal to perform menial tasks from time to time if it helps the resident get his or her job done faster or make their day go a little better. Being overly scutted when you could be learning is one thing, but helping with simple things during downtime or when your resident is overwhelmed is an important contribution. Basically, just be eager and helpful without being a suck-up (anyone who is even remotely observant will be able to detect the difference).

Read a little bit about your patients
. But even if you don't, you will probably be fine. Seriously, your fund of knowledge is enough to prevent you from looking like a total idiot when being pimped. And those attendings who are trying to make you look bad will do so regardless of how much you know. View reading as being for your own knowledge, not as a way to impress someone.

At some point in the afternoon, go back and see your patients. It doesn't have to be for a really long time, but go check on them when you aren't rushed (because like it or not, you are rushed in the morning when you are pre-rounding - and most know it). When you go back in the afternoon, I think it is just as important to focus on them as it is their care. In other words, it's okay to ask how their pain is or tell them that they will get a CT scan in the morning, but I think it is vital to ask if their family has visited or see if they have any questions. And once you have enhanced the doctor-patient relationship, they will open up to you and view your afternoon visits as a highlight of their day. And this is part of what being a great doctor is all about. The benefit, aside from helping your patients, is that your team will see your genuine compassion for those under your care. Everyone wins.

Don't leave before someone in charge says you can leave. If they are a good resident, they will do it without you hinting at it. But if you do have to hint, the classic "Is there anything else I can do to help?" usually works.
 
At some point in the afternoon, go back and see your patients.

I think this is a really important one, though not really 'etiquette' related just in terms of being able to really contribute to care as a student. Decisions get made before/during rounds, but things get lost in the shuffle between then and conference, discharges, orders get overlooked by nursing, etc. If your patient was supposed to get that foley out, or have a CT, have their diet advanced, whatever go back and make sure it actually happened or is scheduled to happen. This is the kind of bullsh*t that keeps people inpatient that extra day or two. You have the most free time of anyone on the team, use it to actually contribute if possible instead of bitching about 'standing around' with nothing to do.
 
Don't randomly tell your IM resident that, "OK, if there's not really anything going on, I'm going to leave and go to the gym now!" at 2:30p.m. (NOT on a post-call day). A med student did this to me and that was the ONE time I ever said anything bad about a med student and called the clerkship director...not to hate on him but just to let them know that hey, this person doesn't seem to understand the rules of a normal job/work, that you don't always get to determine your own work hours, and don't get to order around your supervisor(s).
 
Don't randomly tell your IM resident that, "OK, if there's not really anything going on, I'm going to leave and go to the gym now!" at 2:30p.m. (NOT on a post-call day). A med student did this to me and that was the ONE time I ever said anything bad about a med student and called the clerkship director...not to hate on him but just to let them know that hey, this person doesn't seem to understand the rules of a normal job/work, that you don't always get to determine your own work hours, and don't get to order around your supervisor(s).

Was he going into Ortho ?? :D
 
If there is down time, is it (in)appropriate to pull out a study book and read up for the shelf or even go online to Harrison's or something? Or is that viewed as a lazy thing and you should look busy at all times and read at home?
 
I read during down time and never had any issues as long as I was always ready to work
 
If there is down time, is it (in)appropriate to pull out a study book and read up for the shelf or even go online to Harrison's or something? Or is that viewed as a lazy thing and you should look busy at all times and read at home?
You will find that as time goes on, having a small prep book for whatever rotation you're on will help immensely. Today on FM I had to do a number of antepartum and well-kid checks. I just looked up what's required at each check (what needs to be assessed at 28 weeks, etc.) before the seeing the patients. I looked like a star to my resident because I caught all the high points.
 
If there is down time, is it (in)appropriate to pull out a study book and read up for the shelf or even go online to Harrison's or something? Or is that viewed as a lazy thing and you should look busy at all times and read at home?
I always have something to read. I'm not sure I'd go online though, just because it might look like you're fooling around checking your email or something. But you can't go wrong having a pocketbook or a few articles with you at all times. You're best off reading about your patients' diseases and/or their treatments during your downtime when you're with your team. Most attendings aren't going to care about prepping you for the shelf, so you may want to study for that when they're not around.
 
:thumbup:

During the first day of each new rotation, get the cell phone #s/pager #s of your classmates who will be on your team. That way, if you find out that rounds were unexpectedly moved up to 8:30 AM, instead of 9 AM like all your other classmates think, CALL THEM ASAP and let them know. That way, they don't stroll in half an hour late.

You'll look bad, too, if your resident figures out that you knew, but didn't clue in your fellow team members.

Along this same line, let your fellow classmates know if rounds have been moved to a later time. Especially if you are on surgery or another sleep-depriving rotation where an extra half hour or hour of sleep can mean a lot.
 
Don't randomly tell your IM resident that, "OK, if there's not really anything going on, I'm going to leave and go to the gym now!" at 2:30p.m. (NOT on a post-call day).

I am inclined to disagree with this. If you have already built up a good bank account with your resident, I would prefer if you take the initiative to say you are ready to go home. The key phrase is, "It's ok if I ...., right?"

Too often I see students hanging around between 3-5 pm doing nothing, and they do not have the gumption to call their intern and ask their permission to leave. You have precious little enough free weekday time as a student; don't be afraid to ask for a break if you are already in good standing with your team.
 
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