Clerkship tips

[DarkBluMage]

I’m starting clerkships this month and I’m super nervous. Any good tips or advice?

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[M&L]

Find out what the expectations are on the FIRST DAY.
Be very nice and polite with everyone - do you do not want to be a person who has a reputation of being a jerk to techs and nurses.
Start working through practice questions for shelf exams as soon as you start rotation.
Talk to your upper classmates about specific rotations.

 

[EthylMethylMan]

One of the most important skills you'll learn this year is how to paint a good clinical picture. This is key for patient presentations and note writing. You'll probably find early on that this is tricky to do, because for most patients (especially on wards), you'll have a ton of labs, imaging results, and consultant notes in front of you. You'll need to figure out what information is important to your assessment and plan for the patient. Get in the habit of actively asking yourself the following questions:

-What is/are the patient's main problem/problems for your service? (e.g. For the same septic patient, ID cares most about the gram-negative bacteremia, while nephro cares more about the ATN, and their notes will reflect that.)
-Did anything noteworthy happen overnight? The night team will probably tell you at signout, but it doesn't hurt to briefly check the night shift RN notes and vitals documentation as well if you have time. If nothing happened, just say "no acute events overnight, vitals stable" or something to that effect.
-What diagnostics relevant to the problem have resulted or are pending? (Relevant is the key word here; the cardiologists probably care more about the troponin, BNP, electrolytes, etc. more than the differential on the CBC. You could stand there for ages rattling off every result, so your job will be to filter out the junk and only present the useful stuff.)
-Any pertinent positives or negatives on physical exam? Keep it brief if the exam is normal, but be ready to elaborate on specifics if asked.
-Based on the above, how good or bad is the patient's clinical condition? Are they getting better or worse? Think of a way to sum this up in one or two sentences.
-What are the next steps that need to be taken? Include things like labs, radiology studies, consults, procedures, new meds, etc.

This kind of thinking will become second-nature eventually, but early on it'll probably be useful to actively go through these steps. With the info from these questions, you should be able to synthesize a pretty good presentation and a pretty good progress note.

Most importantly: if you don't know the answer to a question about a patient's physical exam, results, etc., just say that you don't know. DO NOT LIE.

 

[Billiam95]

1. clinical duties do not prepare you for the shelf exams.
2. evals from attendings and residents is 90% who you ask, the rest is how personable you are + how helpful you are. clinical acumen is a distant 4th.
3. don't argue with attendings/residents, even if you are right.
4. don't be late.

 

[Angus Avagadro]

One of the most important skills you'll learn this year is how to paint a good clinical picture. This is key for patient presentations and note writing. You'll probably find early on that this is tricky to do, because for most patients (especially on wards), you'll have a ton of labs, imaging results, and consultant notes in front of you. You'll need to figure out what information is important to your assessment and plan for the patient. Get in the habit of actively asking yourself the following questions:

-What is/are the patient's main problem/problems for your service? (e.g. For the same septic patient, ID cares most about the gram-negative bacteremia, while nephro cares more about the ATN, and their notes will reflect that.)
-Did anything noteworthy happen overnight? The night team will probably tell you at signout, but it doesn't hurt to briefly check the night shift RN notes and vitals documentation as well if you have time. If nothing happened, just say "no acute events overnight, vitals stable" or something to that effect.
-What diagnostics relevant to the problem have resulted or are pending? (Relevant is the key word here; the cardiologists probably care more about the troponin, BNP, electrolytes, etc. more than the differential on the CBC. You could stand there for ages rattling off every result, so your job will be to filter out the junk and only present the useful stuff.)
-Any pertinent positives or negatives on physical exam? Keep it brief if the exam is normal, but be ready to elaborate on specifics if asked.
-Based on the above, how good or bad is the patient's clinical condition? Are they getting better or worse? Think of a way to sum this up in one or two sentences.
-What are the next steps that need to be taken? Include things like labs, radiology studies, consults, procedures, new meds, etc.

This kind of thinking will become second-nature eventually, but early on it'll probably be useful to actively go through these steps. With the info from these questions, you should be able to synthesize a pretty good presentation and a pretty good progress note.

Most importantly: if you don't know the answer to a question about a patient's physical exam, results, etc., just say that you don't know. DO NOT LIE.

Absolutely agree. Saying "I don't know" only stings for a second. Giving the wrong answer will cause you to hand over your lunch to whomever is quizzing you.

 

[DarkBluMage]

Thank yall for taking the time to give me advice! I can see clerkships are going to a steep learning curve 🥴

 

[Angus Avagadro]

Find out what the expectations are on the FIRST DAY.
Be very nice and polite with everyone - do you do not want to be a person who has a reputation of being a jerk to techs and nurses.
Start working through practice questions for shelf exams as soon as you start rotation.
Talk to your upper classmates about specific rotations.

Great advice, but not foolproof. My wife's first rotation as a 3rd yr was surgery. She was expected to remove EVERY bandage, examine the wound and redress it. This told to all students on service. Her 1st yr resident gave her a patient to examine, a fresh post op lady who had a traditional vein stripping. The ace covering was stretched tight to compress the tissues to reduce swelling. She did as instructed, removed the ace bandage and gauze, then re dressed the wound. On rounds the Vascular surgeon asked who's patient this was. My wife gave report. When told of the wound check, the surgeon turned purple and shrieked at her. Although my wife graduated in the top 10% of her class, she somehow didn't make AOA. ( Same surgeon sat on the AOA comittee). It never mattered in the long run, but we always wondered.

 

[BSM_OTO]

1. clinical duties do not prepare you for the shelf exams.
2. evals from attendings and residents is 90% who you ask, the rest is how personable you are + how helpful you are. clinical acumen is a distant 4th.
3. don't argue with attendings/residents, even if you are right.
4. don't be late.

It's really this simple.

A lot of rotations are MASSIVE BS. Maybe an hour or two a day will be eventful/educational. The rest is either scutwork or sitting around. Make sure you take time to yourself to study for step 2/comlex2 as that's more important than BS evals. Learn to make conversation with attendings and residents, don't be intimidated. This is your chance to practice making a good impression for your aways.

 

[MDMechEngr]

It's really this simple.

A lot of rotations are MASSIVE BS. Maybe an hour or two a day will be eventful/educational. The rest is either scutwork or sitting around. Make sure you take time to yourself to study for step 2/comlex2 as that's more important than BS evals. Learn to make conversation with attendings and residents, don't be intimidated. This is your chance to practice making a good impression for your aways.

I know sarcasm does not travel well over the internet, but It sounds like you honored all 6 of your rotations.

 

[WhatAreMyChancesFriends]

I know sarcasm does not travel well over the internet, but It sounds like you honored all 6 of your rotations.

I mean I honored all my rotations by doing as they described, it's really preceptor and school dependent. Every preceptor I've had honored you clinically if you met the honors cut off on the shelf, so long as you were a personable, functioning person.

As such, OP's best advice would be from upperclassmen who have had the same preceptors and experience.

 

[esob]

The best insider tip for early clerkships is to be familiar with how to quickly get the info you need. For me, that was UpToDate and Visual Dx. By the time I got to clinical, I had a good idea about things, but there are no multiple-choice questions, so you need to be more specific. A classic example is when you pre-round on your patients, and perhaps you notice that the UOP is low. OK, now you need to put that patient into context and figure out the general flow of things when a pt with similar circumstances has low urine output. Is it an elderly male? Did the nurse do a PVR? Does the pt have a foley? UpToDate will have most of that info so that you can take a reasonable swing at answering the question when the attending says, "so what do you wanna do?" after you present 🙂

 

[operaman]

Echoing the above: your presentations are the primary way attendings know you. You’re going to suck at first. Work to get better each time. The good students improve; the bad ones keep doing the same stupid things they did on day one.

Also be sure you understand the grading rubric. Some schools weight things very differently. Most of the time it’s a combo of shelf and evals. Be sure to weight your time intelligently. At one school that may mean being more social with the team, while at another it may mean bugging out early to study for the shelf which is the only thing that matters there.

 

[Mr.Smile12]

There's a series of great posts that I'm compiling for an SDN Survival Guide (tentative working title). One comprehensive post that I like is FindersFee5's guide to clinical rotations . Send suggestions to me through DM/Conversations.

Check out the stickied posts or the right-sidebar resource links for more compiled advice from the moderators.

 

[BSM_OTO]

I know sarcasm does not travel well over the internet, but It sounds like you honored all 6 of your rotations.

Got the same exact eval skipping rotations than my buddies did sitting there 12 hours a day. Honor'd every single one except OB. Actually, people who worked 5x harder than me got much lower evals. I'm not proud of that, it's just the way the game works. It amazes me how students can't see thru this ****.

Look like you work hard in front of the right people, and then ask the right people for your evals. Your time is much better spent studying for boards and working on your life outside medicine instead of being someone's scut monkey. Maybe your rotations were better, but at my school, it's 80% useless scut monkey work. And the kids who end up bending over and doing it tend to get average evals. Attending's don't care enough to give fair assessments, it's way too subjective.

 

[operaman]

Got the same exact eval skipping rotations than my buddies did sitting there 12 hours a day. Honor'd every single one except OB. Actually, people who worked 5x harder than me got much lower evals. I'm not proud of that, it's just the way the game works. It amazes me how students can't see thru this ****.

Look like you work hard in front of the right people, and then ask the right people for your evals. Your time is much better spent studying for boards and working on your life outside medicine instead of being someone's scut monkey. Maybe your rotations were better, but at my school, it's 80% useless scut monkey work. And the kids who end up bending over and doing it tend to get average evals. Attending's don't care enough to give fair assessments, it's way too subjective.

I think a key factor is to determine who will be grading you. At my med school it was literally every attending and resident on service when you were there. I never sent anyone a eval request but they all sure did evals. Where I did residency, the students had to personally ask a certain number of residents and attendings for evals.

At a place like my residency, your approach makes a lot of sense; at my med school it would have likely been more difficult to pick and chose.

It really boils down to perception both of your ability as well as your personality. If you can deliver the goods on both fronts in less time then you can probably get away with targeting your evaluators and focusing your efforts there.

 

[esob]

Got the same exact eval skipping rotations than my buddies did sitting there 12 hours a day. Honor'd every single one except OB. Actually, people who worked 5x harder than me got much lower evals. I'm not proud of that, it's just the way the game works. It amazes me how students can't see thru this ****.

Look like you work hard in front of the right people, and then ask the right people for your evals. Your time is much better spent studying for boards and working on your life outside medicine instead of being someone's scut monkey. Maybe your rotations were better, but at my school, it's 80% useless scut monkey work. And the kids who end up bending over and doing it tend to get average evals. Attending's don't care enough to give fair assessments, it's way too subjective.

I think this is going to vary from clerkship to clerkship and school to school. For about half of my clinical rotations, I had no impact on who rated me. Another quarter allowed me to ask residents to add evals, but I couldn't prevent people from evaluating me even if I didn't work with them directly. The last 1/4 I was able to pick, and, in these scenarios, your strategy is the best approach.