FindersFee5's guide to clinical rotations

[FindersFee5]

Hey y'all,

I decided to start posting my guide to clinical rotations even though it's not complete yet. I think I'll try to post each section semi-regularly as I finish it, which has taken around 2-3 days per section so far. I'm also a lot less confident that the advice I'm giving here is the perfect advice, so I think that posting in stages will allow for good feedback for each new section!

Introduction

3rd year is tiring, emotionally and cognitively. It feels confusing and arbitrary. It’s very, very different from any prior schooling experience you may have had. A lot of the guides to succeeding in 3rd year often seemed to boil down to, “Don’t be an dingus and everything will work out okay.” Either that, or they’re way too specific and the things they’re telling you to do are incredibly obsequious, like that one guide that told students to apologize every time they spoke to somebody and buy coffee for their residents every week. My goal with this guide is to discuss a general framework for excelling in 3rd year that can be tailored to different personalities and then try to provide some very specific actionable items that can be taken on any clerkship.

Why do I feel justified writing this guide? Mostly because I’m overly analytical and I have a difficult time shutting that part of my brain down, and I have a pedantic streak a mile wide. With that being said, I did arrive at a few conclusions that were useful to me and might be useful to others as well. I’ve also had some people reach out to me for my advice on 3rd year and I figured it would be better to get this written up than sending a pretty similar reply to everybody asking

I did well by following the principles I’m going to lay out here. I received honors in all my 3rd year rotations – I had only a single performance evaluation the entire year (out of 5+ per rotation) where I was not given honors. Two notoriously hard-a** attendings called me ‘one of the best medical students they had ever worked with.’ A number of residents said that I was functioning at the level of an intern and gave me commensurate responsibilities. During feedback after my sub-i, a chief resident told me that multiple residents had independently expressed a desire to keep me for residency. An attending I worked with (totally unprompted) wrote a letter to my home PD telling him that he should definitely try to keep me.

That being said, I’m just one person, and this is all based on my limited experience. It’s entirely possible that I’ll revisit this as a resident or attending and will have totally different views on what makes a good med student from that perspective. I would obviously welcome any resident/attending perspectives here!

Priorities

One of the things you should do at the beginning of every clerkship is to look at the grading rubric. We were usually provided these with the rest of the introductory material, but sometimes it required a more thorough search to find. This seems obvious, but if you’re looking to earn a good grade, you should focus your efforts on the things required to do that. In general, this will break down into some version of clinical grades, OSCEs, observed patient encounters, and shelf exams. The most important things are usually clinical grades and the shelf exam. However, I did have one rotation where the OSCE was worth 30% of my grade – in this case, I obviously spent a lot more time preparing for that OSCE than I normally would have (which would have been approximately 0 minutes). Something that’s important to look at, and occasionally tricks students, is whether shelf exams are permissive for honors. What I mean by this is that on some rotations, the shelf was only 15 - 20% of the grade, but you needed a >85th percentile score to get honors on the rotation, no matter how good your other grades are. I had classmates who saw that the shelf was such a small part of their grade and ended up heavily prioritizing their clinical work and getting a high pass in the rotation even though they excelled on the wards.

Shelf Exams

I don’t think I have anything particularly enlightening to say about shelf exams. I tried using premade anki decks for the shelves but found that they were usually too disjointed for me to learn well from. Online Med Ed is useful for clinical knowledge but often less helpful for the specifics of a shelf. What I eventually settled on and did well with (>90th percentile on all shelves studied using this method) was a combination of in-depth UWorld and self-made anki cards. It’s also important to start early – on any rotation with a break before, I would do 30 UWorld questions a day for the week prior so that I could hit the ground running during the clerkship. Also use your time on rotation’s wisely. If you have downtime during the day, do questions or cards. The less work you take home, the better.

I usually only did 10 – 20 UWorld questions a day, so I took my time with them. Along with answering the questions and reading the whole explanation, I made sure that I knew what every single wrong answer was referring too, why it was wrong, and why the UWorld question writers chose to include that wrong answer. Learning the differentiating factors between similar pathologies is super important for the shelf. I would make anki cards for any fact I didn’t know or felt like I could easily forget.

I would also recommend doing all the practice NBMEs the day or two before the shelf. I usually didn’t take these under formal test day conditions, I did them in more of a casual ‘tutor’ mode. These don’t help much for knowledge acquisition, but it does a good job of priming your brain for NBME style questions.

The Wards

I’m not going to argue that clinical evaluations are fair representations of character or clinical acumen. That being said, a majority of the people evaluating you will do so in a pretty similar manner and it’s actually not as arbitrary as people believe. The reason it feels arbitrary is that evaluations are not entirely (or even primarily) based on medical knowledge. I discovered that there are three things of primary importance when being evaluated, which are, in order:

Likeability/professionalism > Usefulness > Clinical knowledge​

Do you see now why people get so upset about grades in 3rd year? There are TWO soft factors that are considered MORE important than all the things you’ve spent two years cramming into your brain. However, this is actually closer to how you’re going to be analyzed for the rest of your life, so it’s best to get used to it now.

I’ll go into more detail about each of these further in this guide, but there is one important caveat to remember: Being terrible in any one of these facets is enough to ensure a poor grade, even if you excel in the other two aspects.

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[AzBasRad]

Contrats on your solid performance. Your advice is pure gold! Myself and a few other classmates who did well also followed a similar path.

 

[Lawpy]

Going to add this to the directory 🐶

 

[FindersFee5]

Professionalism

I’ll tackle professionalism first because a lot of medical students treat it like a 4-letter word. Professionalism can essentially be boiled down to treat 3rd year like a job. At the risk of sounding like an old man, I’ve found that students who go straight through college to med school are more likely to have issues here. I think the reason a lot of non-traditional students tend to do better in the clinical years is that they’ve held actual jobs so they understand how you’re supposed to behave.

You have no idea how many times I saw fellow students arrive late, come in with food stained white coats, laugh loudly at memes while everybody else was working quietly, or share loud stories of their Friday night escapades in easy earshot. It sucks, but you are being constantly evaluated. These things get remembered. Many of these things seem super basic and obvious, but if it’s on the list, it’s something I’ve seen violated more than once.

Specifics of professionalism:

1. Be on time. This barely needs to be said… yet it’s also the most frequently broken rule. If you show up late once, 90% of people will forgive it and not think anything of it. Show up late twice and that ratio switches; most physicians will hold it against you. My general goal was to show up 5 minutes before I needed to be there when it was someplace I was familiar with and at least 10 minutes before if it was in a location I didn’t know.

2. Be neatly and professionally dressed. This doesn’t mean you need to look like a fashion icon (and I think in general, it’s probably safer if you don’t). The bare minimum is acceptable. For me, the bare minimum entails: clean clothes with no food/sweat stains, white coat laundered/bleached regularly to keep it white, clothes that fit, and appropriate level of formality. Always ask before wearing scrubs somewhere.

3. Speak clearly and at appropriate volume. If this is something you struggle with, practice. In general, when presenting on rounds you probably need to speak louder than you think is necessary to ensure the whole group can hear you, and when in the workroom should speak more quietly than usual.

4. Good posture. Don’t slouch, don’t shamble, but don’t stick your chest out and strut around either. Nobody likes ILS. If this isn’t something that’s been drilled into you, it will feel unnatural for a while. Practice. Posture is super important. These three things together (clothing, manner of speech, and posture) will do a TON towards making you seem like a competent and confident person even when you don’t know what you’re talking about. Most of what you are graded on in 3rd year is subjective; unconscious impressions are super important.

5. Don’t look at your phone. I know residents are constantly doing this, and most of the times I wanted to use my phone it was to look up something clinically relevant. That being said, I’ve overheard attendings trash-talk students for being on their phones. I don’t have a great memory, so I got in the habit of bringing around a small notebook with me and taking notes or writing things down that I wanted to look up later. Multiple attendings commented about how engaged this made me appear, even if I was basically using it for a less efficient version of the thing my classmates would do on their phones.

6. Know when and when not to talk. I may be a little extra-sensitive to this one because I get easily distracted by any conversation in my vicinity. But if all your residents are working, don’t try to make conversation with the residents or fellow students in the workspace. If you’re done with everything you need to do and want to hangout (totally acceptable!), let your residents know and go grab coffee/lunch/snack with whoever. I’ve never met a resident who will think negatively of you for that.

7. Don’t make fun of patients. For first and second years, this seems like a no-brainer. But patients do dumb, frustrating things. Residents (and sometimes even attendings) will poke fun at these things. It’s a valid coping mechanism. That does not mean you should participate. Humor in general is kind of risky in 3rd year and should be reserved until you’re very comfortable with your team.

8. Don’t complain. Again, this is going to be something that you’ll see your residents doing all the time, but it’s not something you should join in on for the most part. Many residents may feel that you haven’t ‘earned the right’ to complain yet because the workload of 3rd year is lower than residency. Complaining might feel cathartic but it will almost never improve somebody’s opinion of you. There are some people who can complain in an entertaining and fun way, but it’s safer to assume that that person is probably not you. Have a support network you talk to outside of the hospital for this.

Most of these tips are essentially things that say:

Don’t give anybody a specific reason to dislike you.​

Note that I didn’t write, “Don’t let anybody dislike you.” Some people are going to dislike you no matter what! We all bring tons of our own baggage to every relationship. But if you don’t give somebody any specific reason to dislike you, that general feeling of distaste usually won’t crystallize into anything more serious.

 

[cybermed2424]

This is great. I followed a lot of your step 1 advice, and really appreciated it. Thanks for always giving back to the community.


Just curious, have you decided what you're going into?

 

[FindersFee5]

This is great. I followed a lot of your step 1 advice, and really appreciated it. Thanks for always giving back to the community.


Just curious, have you decided what you're going into?

Applying plastics!

 

[IMG69]

Have any of you seen the MS3 guide created by Physicians? Can I post links here? It's fantastic covers every rotation and is very extensive. (sorry if this is slightly hijacking the thread btw)

 

[FindersFee5]

Have any of you seen the MS3 guide created by Physicians? Can I post links here? It's fantastic covers every rotation and is very extensive. (sorry if this is slightly hijacking the thread btw)

I would definitely be interested to see it, maybe post links here if available or you could PM me?

 

[IMG69]

I would definitely be interested to see it, maybe post links here if available or you could PM me?

Sent it to you

 

[Cath Up]

Applying plastics!

Hmmmm are you sure you're competitive? They have some pretty high step 1 filters.

jkjk

The professionalism/likeability>usefulness>clinical knowledge is so true! Your suggestions for appearing professional are also spot on.

Posture and NO PHONE are so important. IMO an attending (or anyone) shouldn't ever see you on your phone in the hospital. Too much room for interpretation.

 

[FindersFee5]

Have any of you seen the MS3 guide created by Physicians? Can I post links here? It's fantastic covers every rotation and is very extensive. (sorry if this is slightly hijacking the thread btw)

Got the chance to read through a bit of this, I think it's a great guide but honestly seems more like sub-i or even intern level material. It looks like it would be super helpful for the specifics of taking care of patients (which is obviously important to know as a 3rd year as well), whereas I'm trying to focus on the basics of how to function and excel in a medical team based environment. I think the target audience for this guide would probably be a rising second year/new third year.

Hmmmm are you sure you're competitive? They have some pretty high step 1 filters.

jkjk

The professionalism/likeability>usefulness>clinical knowledge is so true! Your suggestions for appearing professional are also spot on.

Posture and NO PHONE are so important. IMO an attending (or anyone) shouldn't ever see you on your phone in the hospital. Too much room for interpretation.

The phone thing is a tough conundrum because there are a ton of clinically relevant things I would LOVE to use my phone for! But the optics are not good.

 

[TheVisionary]

Awesome job with this post! I look forward to see what you say about usefulness. So far I have 4 clinical grades: two 5/5s and two 3.2s/5. It's kinda frustrating seeing the wide range of these evals! However thinking critically re your post it's obvious those two soft areas are probably what made the difference. While it'd be great if each parameter on the eval were scored independent of each other, I think the likert ratings are often made based on a "gestalt" of an impression of someone. I may have underestimated the role of professionalism. I think the formal nature of rotations are heightened in the inpatient setting, where I did score the 3s.

I sometimes get turned down by residents when I ask if I can do specific tasks. Don't know if it's a reflection of what they thought of me or if I asked about tasks that were inappropriate.

I think you can make an argument that composure is more important than clinical knowledge. Both attendings who gave me 3.2s said knowledge was good but ability to organize ideas orally could improve. Don't know if you have tips to share for how you stayed organized, if you got the time. Might be wrong to make this assumption, but I thought that this might be the most salient thing to perfect, since inpatient attendings on rounds only really directly observe you giving presentations.

 

[FindersFee5]

Awesome job with this post! I look forward to see what you say about usefulness. So far I have 4 clinical grades: two 5/5s and two 3.2s/5. It's kinda frustrating seeing the wide range of these evals! However thinking critically re your post it's obvious those two soft areas are probably what made the difference. While it'd be great if each parameter on the eval were scored independent of each other, I think the likert ratings are often made based on a "gestalt" of an impression of someone. I may have underestimated the role of professionalism. I think the formal nature of rotations are heightened in the inpatient setting, where I did score the 3s.

I sometimes get turned down by residents when I ask if I can do specific tasks. Don't know if it's a reflection of what they thought of me or if I asked about tasks that were inappropriate.

I think you can make an argument that composure is more important than clinical knowledge. Both attendings who gave me 3.2s said knowledge was good but ability to organize ideas orally could improve. Don't know if you have tips to share for how you stayed organized, if you got the time. Might be wrong to make this assumption, but I thought that this might be the most salient thing to perfect, since inpatient attendings on rounds only really directly observe you giving presentations.

I think you touched on something really important with the "gestalt" influencing all factors of the evaluation. Attendings (or at least those I've talked to about this) have a lot of evals to fill out and usually don't have that long to spend on them. One attending told me that he spends more time on students who really excel and those who really struggled, but often he's filling out these evaluations months after the students have finished their rotations. This is why a large part of my next section on likeability focuses on how to be memorable in a positive way.

With regards to actually staying organized, I'll talk more about that in the usefulness section, but the main advice is to develop a system and practice that system every time. You need routine you can fall back on, especially with more complicated patients.

However, being organized isn't enough - you also need to look organized, as you observed. That's where the posture and speaking tips are critical.

 

[FindersFee5]

Likeability

In this next section, I’ll discuss likeability. The first thing that’s important to remember is that it is impossible to make everyone like you. No matter who you are, no matter how great you are, there are going to be people who don’t vibe with you. It’s also really hard to be likeable without being authentic, so you shouldn’t try to be somebody you’re not just for the sake of a better grade. Figure out which authentic aspects of yourself work well. Here are a few tips that are more universal, though, and you can implement them no matter what kind of person you are. A lot of this next section came from The Culture Code by Dan Coyle – I definitely advise reading this book if you’re interested.

Specifics of likeability:

1. Learn/remember names. A quick digression: one of the hardest parts of 3rd year is the fact that you’re getting constantly shuffled through the hospital from one group of residents and attendings to the next, often not spending longer than two weeks with any team. It’s incredibly easy to fade into the background as just another med student and be forgotten 30 seconds after they meet you. These first few tips focus on subtle ways to be a more memorable. To understand this, we need to discuss why we remember some people and forget others instantaneously.

Memory is essentially an investment. The brain is constantly trying to figure out what it needs to encode and what it can erase. You remember somebody when they are salient. Salience can be for an obvious reason (they’re your clerkship director, your wife’s parents, some hot person in your anatomy class, etc). But another aspect of salience is future connection. When you are interacting with somebody, there are signs called belonging cues that demonstrate that you value this relationship and plan for it to continue in the future. The issue is that 3rd year is essentially set up in such a way that students have very low salience and negative environmental belonging cues, so you need to work extra hard to overcome these challenges.

One of the best things you can do is to learn everybody’s name. Seriously. Just learn the names and use them when appropriate (don’t do the sleazy salesman thing and overdo it). I saw so many of my fellow students, especially halfway through 3rd year and beyond, just not bother to learn names. It’s really obvious when that happens. It signals that you don’t care about this relationship and that it has no future. In this case, why should the other members on your team bother remembering you?

2. Greet people you know. Again, seems super simple. But greet the members of your team (by name) every morning when you come in. It doesn’t have to be a big artificial thing. “Hey, *****! How’s it going?” and a smile when you see somebody the first time each day goes a really long way towards showing them that you value that relationship. I was shocked by how often I saw fellow students slink into the workroom with barely a nod or grunt to the other people there. You don’t need to try to start a conversation. A simple, specific greeting is enough.

One other aspect of this is that you should do your best to remember the names of people you've worked with before. Say hi when you see them walking around the hospital! I would frequently greet multiple people from other teams in the mornings while rounding. Obviously don’t do this when anybody else is talking or if they look busy, but a lot of time on rounds is just walking. This is a perfunctory five second interaction, but it can be super powerful in maintaining that relationship. It also subconsciously demonstrates to your current team that you do value them and believe in a future beyond the one week you spend together.

3. Be a positive presence. This is sort of the flip side of the “Don’t complain” tip in the professionalism section. You don’t need to be smiling and happy and joyful all the time (and it will probably come off as psychotic if you did act that way) but you should try to be a generally positive presence.

4. Show interest in other’s lives. Another small thing that comes very naturally to some people and not so naturally to others (myself included). Try to remember little details about people’s lives outside the hospital, such as pets, kids, interests, etc. This makes conversation in the future much more natural if you encounter something that reminds you of one of their interests.

5. Demonstrate attention. Active listening is critical. Affirm what your team members are saying. If you’re the kind of person who takes everything in silently before replying, work on adding some nonverbal cues like head nodding to demonstrate attention. This is especially critical when you are being given feedback. Residents and younger attendings often seem uncomfortable when they need to give negative feedback, and you can make this situation less awkward for both of you by providing active listening cues throughout the conversation. Even if you’re really upset by what they’re saying, make it very clear that you’re listening. I know some students freeze in these situations, but this often comes across as you being angry or disagreeing with what you’re being told.

6. Don't interrupt. This should go without saying, but it’s definitely something I witnessed a lot. If you’re somebody who tends to interrupt it’s important to work on that habit now. The first step to fixing it is realizing that you do it, so be conscious of how you communicate, especially in groups.

7. Share genuine vulnerability. Studies have shown that sharing vulnerability is one of the fastest ways to forge a connection. I’ve noticed, however, that this can really backfire if it’s not authentic. There are few things more powerful than sharing genuine vulnerability, and few things more grating when faked. You also shouldn’t be overly self-effacing.

What this comes down to in the clinical realms is a few things: admit when you don’t know something or were wrong about something, ask for help when you don’t know how to do something, and be willing to talk about it when you’re struggling with something, whether that’s a difficult patient encounter, a bad outcome, or something happening in your life outside the hospital.

8. Give genuine compliments. I’m not saying you should be a brown-noser; some attendings and residents will fall for that and some won’t, but either way I don’t think it’s good for the soul. But you can and should take notice and tell people when they do something that genuinely impresses you. A compliment could be something as simple as telling another student that they presented a complicated patient really well or take the form of advice, such as asking an attending how they bring such a positive attitude every day even when things are hard and stressful. The prior comment about genuine vulnerability applies double to genuine vs. insincere compliments.

I don’t believe in karma, but I do think that giving props for other’s accomplishments cultivates an environment where work has meaning and recognition is present, which will eventually reflect well on you as well. When you’re a leader, I think compliments should be given publicly, but as a medical student I think compliments should be reserved for one-on-one interactions because people are sometimes a little embarrassed by receiving compliments, especially from those lower on the totem pole.

 

[Neopolymath]

Great posts. I had similar experiences and I don't feel that I can add much nuance to such a great guide philosophically.

I'm mostly posting to say I'm glad someone else noticed just how insane that one Japanese med student's guide was with that pathetic BS about coffee and apologizing and all kinds of weird ****. It was truly bizarre.

Rock on and good luck in March! I have enjoyed your posts over the years and look forward to hearing more about your career.

 

[Matthew9Thirtyfive]

Great posts. I had similar experiences and I don't feel that I can add much nuance to such a great guide philosophically.

I'm mostly posting to say I'm glad someone else noticed just how insane that one Japanese med student's guide was with that pathetic BS about coffee and apologizing and all kinds of weird ****. It was truly bizarre.

Rock on and good luck in March! I have enjoyed your posts over the years and look forward to hearing more about your career.

Yes, it was quite weird, but it’s also a different culture so you can’t really hate on it.

 

[Neopolymath]

Yes, it was quite weird, but it’s also a different culture so you can’t really hate on it.

If the guy said his advice was only relevant to certain cultures and not the US then it wouldn't bother me. Better or worse, this is an Americentric website and almost all the users are trying to do medicine in the US so the advice is almost always relating to that and assumed to be directed to that goal unless otherwise stated. The declarative nature of the user was almost, almost just as off-putting as the actual content lol. It read like med school in Asia for those with autism or something. (Please note that I'm not knocking autism as a challenge some individuals face in a world different than them...)

 

[FindersFee5]

Great posts. I had similar experiences and I don't feel that I can add much nuance to such a great guide philosophically.

I'm mostly posting to say I'm glad someone else noticed just how insane that one Japanese med student's guide was with that pathetic BS about coffee and apologizing and all kinds of weird ****. It was truly bizarre.

Rock on and good luck in March! I have enjoyed your posts over the years and look forward to hearing more about your career.

Agreed, although I think the weird thing was that multiple people on here pointed me to that guide as a great example of what to do in third year. It did have some good pearls, especially about how to be useful, but it was couched in a lot of information that could be actively harmful if an american student followed it to the letter.

 

[Matthew9Thirtyfive]

Agreed, although I think the weird thing was that multiple people on here pointed me to that guide as a great example of what to do in third year. It did have some good pearls, especially about how to be useful, but it was couched in a lot of information that could be actively harmful if an american student followed it to the letter.

Yeah some of it we have been specifically warned not to do lol.

 

[Lawpy]

Great posts. I had similar experiences and I don't feel that I can add much nuance to such a great guide philosophically.

I'm mostly posting to say I'm glad someone else noticed just how insane that one Japanese med student's guide was with that pathetic BS about coffee and apologizing and all kinds of weird ****. It was truly bizarre.

Rock on and good luck in March! I have enjoyed your posts over the years and look forward to hearing more about your career.

Idk what guide you're referring to but i'm glad i could be mostly blissfully ignorant. Doesn't seem to be found on SDN so i'm just gonna attribute it to different cultural views on 3rd year

 

[shouldvestudied]

Yes, it was quite weird, but it’s also a different culture so you can’t really hate on it.

I am fairly certain the guy was doing Med School in Australia, not Japan. He later moved to Japan to teach English after he decided to not practice medicine.

 

[Lawpy]

I am fairly certain the guy was doing Med School in Australia, not Japan. He later moved to Japan to teach English after he decided to not practice medicine.

Ooh i remember now.

 

[Neopolymath]

@FindersFee5 consider writing a post about research during third year from your perspective. Navigating the balance, approaching residents and attendings to establish relationships etc.

 

[FindersFee5]

@FindersFee5 consider writing a post about research during third year from your perspective. Navigating the balance, approaching residents and attendings to establish relationships etc.

That's a good idea! I'd be happy to work on that once I'm finished with this. I will say that Covid gave me a different perspective though because I was able to have almost 2 months off clinical duties to grind research, which definitely made things easier.

 

[FalconSlice]

I am fairly certain the guy was doing Med School in Australia, not Japan. He later moved to Japan to teach English after he decided to not practice medicine.

I believe he has (since finishing medical school) quit pursuing medicine and is now a pick-up artist based in Osaka living a minimalist lifestyle if I remember correctly.

 

[FindersFee5]

I believe he has (since finishing medical school) quit pursuing medicine and is now a pick-up artist based in Osaka living a minimalist lifestyle if I remember correctly.

I'll take "Novel sentences never written before" for 500, Alex.

 

[FalconSlice]

I'll take "Novel sentences never written before" for 500, Alex.

Haha RIP though

 

[ArdorAyurveda]

I like how you delve into the psychology of things, like remembering names in order to show that you're really interested in developing a working relationship with people.

Younger students (esp. the ones that went straight through college to med school) really struggle with the not looking at the phone thing, though. I think it's a combination of seeing attendings looking at their phone and also just being part of the Zoomer generation that grew up with the internet being ubiquitous.

I don't say anything to my classmates though because no one likes hearing that feedback without being prompted. But it really is such a bad look for us med students to pull out our phones, it really communicates a lack of awareness that 3rd year is on the job training, not a lecture where you can just zone out.

A lot of what you're saying is just social skills and social awareness 101. Failing to learn your colleagues names will never get you far in life, period. It's sad that there's a need for a guide in a people-oriented profession such as medicine, and yet here we are...you're really doing a major service by creating this guide though!

 

[FindersFee5]

I like how you delve into the psychology of things, like remembering names in order to show that you're really interested in developing a working relationship with people.

Younger students (esp. the ones that went straight through college to med school) really struggle with the not looking at the phone thing, though. I think it's a combination of seeing attendings looking at their phone and also just being part of the Zoomer generation that grew up with the internet being ubiquitous.

I don't say anything to my classmates though because no one likes hearing that feedback without being prompted. But it really is such a bad look for us med students to pull out our phones, it really communicates a lack of awareness that 3rd year is on the job training, not a lecture where you can just zone out.

A lot of what you're saying is just social skills and social awareness 101. Failing to learn your colleagues names will never get you far in life, period. It's sad that there's a need for a guide in a people-oriented profession such as medicine, and yet here we are...you're really doing a major service by creating this guide though!

Thank you! I tried to go a bit into the psychology of why names matter to demonstrate why it's worthwhile, because otherwise it's a really easy thing to let slip by the wayside. It can be hard to remember names. Furthermore, the benefits aren't immediately impactful/apparent and there's no outright punishment for forgetting (unlike what happens if you forget a medical fact).

Should hopefully be posting the Usefulness section tonight! I think that section has some of the most valuable tips this guide contains.

 

[Matthew9Thirtyfive]

I like how you delve into the psychology of things, like remembering names in order to show that you're really interested in developing a working relationship with people.

Younger students (esp. the ones that went straight through college to med school) really struggle with the not looking at the phone thing, though. I think it's a combination of seeing attendings looking at their phone and also just being part of the Zoomer generation that grew up with the internet being ubiquitous.

I don't say anything to my classmates though because no one likes hearing that feedback without being prompted. But it really is such a bad look for us med students to pull out our phones, it really communicates a lack of awareness that 3rd year is on the job training, not a lecture where you can just zone out.

A lot of what you're saying is just social skills and social awareness 101. Failing to learn your colleagues names will never get you far in life, period. It's sad that there's a need for a guide in a people-oriented profession such as medicine, and yet here we are...you're really doing a major service by creating this guide though!

Just FYI, looking at your phone is not a bad thing everywhere. The majority of attendings and residents at my school are fine with it from what I’ve been told from people who have done their whole clerkship year. As long as you’re looking something up or studying, it’s fine.

So I think you need to just see what the culture is where you’re at.

edit: holy typos Batman

 

[ohmanwaddup]

Just commenting to say it is wild how different grading is at different schools. for my school honors is a 90th percentile on the Shelf. That's it. nothing else

As someone who is getting great evals, but getting 75th-80th percentile on the shelves and thus has zero honors, I've pulled out almost all my hair in frustration at this system.

 

[Lawpy]

Just commenting to say it is wild how different grading is at different schools. for my school honors is a 90th percentile on the Shelf. That's it. nothing else

As someone who is getting great evals, but getting 75th-80th percentile on the shelves and thus has zero honors, I've pulled out almost all my hair in frustration at this system.

Some SDNers would desperately envy your school's grading policy. That way they can spend most of the day doing UWorld and leave early

 

[ohmanwaddup]

Some SDNers would desperately envy your school's grading policy. That way they can spend most of the day doing UWorld and leave early

Funny how different people can feel about something.

As someone who was bottom 25% of my class preclinical I'm psyched to be doing so much better, but it just sucks that my school doesn't have a high pass and such a high bar for honors, so my massive improvement basically means nothing.

 

[ArdorAyurveda]

Just FYI, looking at your phone is not a bad thing everywhere. The majority attendings and residents at my school are fine with it from what I’ve been told from people who have don’t their whole clerkship year. As long as you’re looking something up or studying, it’s fine.

So I think you need to just see what the culture is where you’re at.

Fair, institutional culture will always trump general advice

 

[FindersFee5]

Usefulness

Most of the previous sections are very general advice that can be applied to any work environment. In this next section, we’ll dive a little bit more into the nitty gritty of clinical work and talk about how you can carve out a useful niche for yourself as a medical student.

What does ‘usefulness’ mean? I agree that it’s a clunky term, but it fits the sometimes clunky role of medical student. A resident once told me, “A useful medical student understands what needs to be done and is able to do it.” I thought this was a good definition as it clearly encompasses two aspects: independent self-delegation of tasks, and ability to perform said tasks. Where students go wrong a lot of the time is focusing too much on the second part without thinking enough about the first. This brings me to my list of tips which first focus on figuring out what needs to be done, then on how to accomplish tasks in the hospital, and finally a few general things that I found useful.

1. Checkboxes. The best way to learn what needs to be done is by observing residents; almost every resident has some system of noting important information and action items for their patients. I learned primarily by copying residents. Observe the kind of things they write down during rounds and try to figure out the patterns behind what’s important enough merit writing down. A couple times at the beginning of the year, I asked residents to save their annotated lists so that I could look over them at the end of the day and see how they organized things. Everybody has different organization systems that work for them. It’s important to figure out what works best for you.

At the beginning, write down everything that might be important. If you’re the only student on the team, write down everything that is discussed on rounds for all the patients, not just your own, in case there is something with another patient that you can help out with. The dynamics of following patients who aren’t ‘yours’ when there are multiple med students on a team gets a little bit more complicated and is best handled on a case by case basis.

This brings me to another important concept that is prevalent throughout medical education: streamlining information transfer. At the beginning, you’ll write everything down. As you go along, however, try to write less and less until you are no longer writing enough. For instance, at the beginning you might write down “Pull R lower abdominal JP drain if < 10 mL output by 1600 today,” which could evolve to “Pull drain @1600” once you already understand the common prerequisites. Maybe you try to get even more efficient and just put a check box next to “Drain,” but realize that you no longer remember when or what you’re supposed to do and need to ask somebody. In this case, you’ve now ascertained the minimum amount you can write while still conveying the necessary information to yourself.

2. Take initiative. Rounds are over, and you now have a list of things that need to be done for your patients today! It seems like a lot of residency is about triaging tasks by what is most important or time sensitive in the face of an overwhelming workload. When you start 3rd year, though, your workload is often minimal and efficiency is not the primary concern. Getting anything done is your number one goal right now.

Therefore, take a look at your list and try to figure out which items on it are things that you could accomplish independently. At the beginning of the year, this might only be something like requesting records from an outside hospital, calling a patient’s family with updates on their condition, or chatting with a patient to get a more complete social history. Even so, ask/tell your resident that you would like to do that thing, do it, and then check it off your list. Repeat until all such tasks are complete.

A quick digression into scut work: some medical students see things like what is listed above as scut work. I disagree strongly with that – all of those tasks are patient care related and you will need to be able to perform them in your future career. Maybe it’s not the exciting world of saving lives you thought you signed up for, but these are all essential tasks. In addition, residents are more likely to teach you the exciting stuff when you make their lives easier by handling some of the more mundane tasks.

Next, look at your list and try to see if there is anything that you don’t currently feel comfortable with, but likely could if you had the chance to observe and practice under supervision a few times. This could be something like pulling a drain, doing inhaler discharge teaching, or removing stitches. Ask the resident if you could tag along, and if it’s something you’ve seen before, ask if you can try it. Once you feel comfortable with a task and you’ve demonstrated competence to the team, these tasks now move into the list of things you can accomplish independently. Medical training is essentially a never ending progression of increasingly complex tasks you handle independently.

Throughout the day, periodically check on new results and let your team know if something you were waiting on comes back. Keep an eye on what hasn’t been done as well. If you have something on your list that seems important but is beyond your scope of practice (like an art line or LP) and it hasn’t been done by mid-afternoon, definitely call your intern or residents attention to it. Sometimes that’s because you didn’t understand the decision that was made and that thing actually didn’t need to be done today, but often it’s just because they’re busy and forgot. They’ll be grateful that you reminded them!

3. Talk to your patient’s nurse. This is a really simple one that gets missed a lot. When you’re pre-rounding in the mornings, talk to the overnight nurse and ask if anything happened. You’ll pick up little tidbits that aren’t anywhere in the record but may end up becoming important, like a patient not eating, mental status deterioration, or failure to void. Also, especially early in your clinical training, the nurses will be able to give you a much better sense of the clinical gestalt of the patient than looking at numbers and notes in the EMR. Learning to correlate the objective data, the nurse's report, and your interactions with the patient into a coherent picture is an important skill.

4. Anticipation. One of my favorite seniors once said, “A good intern solves problems. A great intern anticipates problems before they come up.” This is a more advanced skill: I can’t think of a single time I anticipated something my residents didn’t until my very last rotation of 3rd year, despite having much more time dedicated to the patients I was following. But it’s a skill that's honed through conscious experience and the process of building it should start as soon as possible.

The most obvious type of anticipation is a clinical anticipation. An example of this would be keeping a close eye on a patient with a history of alcohol abuse admitted for an elective surgery with concern for withdrawal. Often, clinical forecasting takes a less obvious form. When there are medical decisions being made that you don’t understand, they may be anticipatory tests or treatments. It is important to take careful note of these situations; with similar patients in the future, you should try to figure out whether the same anticipatory care would be appropriate. When a complication does arise, try to figure out how it could have been avoided with the information you had at the time and what steps you could take to avoid that complication with future patients. Many of these steps are encoded in organizational DNA as standardized order sets and protocols, but there are also a great variety of edge case pitfalls that can be recognized and avoided by the astute physician.

Another place that anticipation has an important role is in predicting barriers to discharge. Whether your patient is discharged this afternoon or tomorrow morning often doesn’t matter that much to you, but it matters a great deal to the patient and the hospital. Observing common barriers to discharge, ascertaining whether your patients may face such barriers, and preemptively acting to remove those barriers is a skill that is guaranteed to impress attendings.

4. Presenting. Presenting is possibly the most important skill you’ll learn on the wards, but it’s also a totally novel, stress-inducing, and seemingly arbitrary exercise. I’ll discuss a few tips for presenting, and then also address why some of that seeming arbitrariness occurs.

First, when presenting, refer back to the professionalism section on appropriate posture and volume. Quiet students will often be told to speak up once or twice, but if they return to their baseline volume after that the attending will just let them drone away at a sub-audible volume and mentally assume the worst. Try to avoid filler words when possible. If you’re presenting and nobody is interrupting, assume that you’re doing a good job and don't second guess – this is one of the most nerve-wracking aspects.

I’m not going to try to get into the nitty-gritty of exactly how to present as that will differ with different attendings and services. What’s important is that you develop a system that makes sense to you and allows you to cover all the necessary information in an organized way, and then practice it. Bruce Lee said, “I fear not the man who has practiced 10,000 kicks once; I fear the man who has practiced one kick 10,000 times.” Practice until your system is so deeply ingrained you could give a presentation 30 seconds after rolling out of bed. Having a standardized organizational style is the most important thing you can do to make sure you don’t forget details while presenting.

Especially at the beginning of the year, it’s helpful to rehearse your presentation by yourself a few times before you give it. Take 10-15 minutes in the morning, go somewhere out of the way, and practice. Don’t try to memorize it word for word but do practice your system. Going through the whole presentation often lets you spot gaps and helps with performance anxiety.

When you first work with a new team or new attending, give a very formal presentation. A new attending doesn’t know you, they don’t know your clinical acumen, and so they don’t have a reason yet to trust that you will include anything relevant. An initially formal and comprehensive presentation demonstrates to the attending that you are able to gather all the necessary data. On subsequent days, gradually eliminate non-essential information from your presentations. This is another area of medicine where streamlining is essential. Shorten your presentations until you start missing important details – you’ll know you’re missing essential data when residents/attendings ask about something you didn’t report. You should not be the student giving a 30 minute presentation on the patient who has been straight chillin for a week. The end goal is to have your presentations be the same length as resident presentations, while also ensuring that your attending does not need to ask for any additional information at the end.

Make sure you continue to report pertinent positives AND negatives. If you are asked about something that you chose not to discuss in your presentation, such as a normal lab value, try to figure out why that information was essential to the patient’s care. If you can’t figure it out, ask!

That brings us to the seemingly arbitrary nature of what attendings care about. Sure, there are some attendings with silly fetishes, like my peds attending who always wanted us to know what breed a patient’s dog was. But for the most part, when they ask about something, it’s because it is going to change their management of the patient. Maybe you have two seemingly similar patients and the attending wants you to present the creatinine trend for one of them every day but doesn’t care when you don’t report it for the other. Find out what the difference between them is! Exploring when and why attendings care about seemingly minor details is one of the most important things you can do to build your clinical acumen.

5. Feedback. If your school is anything like mine, I’m sure that you’re constantly hearing about feedback. We were told that we should be given mid-rotation and summative feedback from every member of the team. To the surprise of no one, this occurred approximately… never. When I did receive feedback, it was often perfunctory and not actionable, the classic, “You’re doing fine.”

There were two things I did to make my feedback sessions more useful. The first was to ask for feedback early and in advance. Sometime in my first week, I would ask, “Hey, if you have any time tomorrow, do you think we could go over some things I can improve on?” This reminds the resident or attending that you are looking for feedback, it’s asked in a considerate way that makes it clear you value their time, and it gives some time for them to think of appropriate things to tell you.

The second thing I did was to prepare my own thoughts. I would critically appraise my performance thus far and look for things I was dissatisfied with. Then, if the person giving feedback didn’t have anything specific to tell me, I would specifically ask for tips about how to improve those problematic aspects. Finally, I would discuss some simple and achievable goals I had for the next week. By articulating my goals, there were always clear things to discuss when the end of rotation feedback session came.

Another important thing to remember is that you’re constantly receiving small doses of feedback. Take note of these micro-feedback sessions and make sure to incorporate what you’ve learned into your practice. Try your best not to make the same mistake twice.

 

[longhaul3]

This is a good post. I will share my perspective as a resident. After rounds, my priorities are procedures first, then calling consults, then orders, then notes. Consults that come in during the day are triaged appropriately and range from ultra stat to excruciatingly mundane. As a med student you have two good ways to be useful: start at the top and help me with the high-priority things, or start at the bottom and check off all the little boxes you can on your own.

If you want to help out with high-priority things, you can be useful by gathering the supplies, informing the nurse, drawing up the paperwork for the consent/identifying a contact for consent if applicable, positioning the patient if you know what you're doing. You may not know how to place a central line or art line, but if you've seen one before you can gather the supplies. As a bonus, I am much more likely to let you do the procedure or participate if you show that initiative—it tells me you have some understanding of what's going on and you're willing to do the legwork for the reward. (It's the same in residency—junior residents who show up to the OR early, read about the case, position, etc. are the ones who get to scrub.)

One thing med students can do that is very helpful is calling consults. Most med students cannot do this independently for most consults, because they don't fully understand the patient and the reason for consult, but good students can. These are high-priority tasks because we don't want to burden the consulting service with a consult at 4pm when we talked about it at 7am. Side note, this is why I hate getting consults from medicine and neurology, because they round until 3pm and then call me with a consult, although it's not usually the resident's fault that they were rounding until 3pm.

Almost everything below that on the priority list is fair game for an enterprising med student to do independently. If there's a new routine consult, review the chart, go see the patient, and draft a note. It doesn't take an MD to figure out how to get outside records or upload outside imaging.

Lastly, I think it's very important that med students do this kind of work, including scut work, because lazy/underprepared/entitled med students turn into incompetent residents. I don't want to work with, supervise, or get consults from incompetent residents. There is a culture at my institution that coddles med students; residents always send them home early, encourage them to prioritize shelf exams, shelter them from scut work, etc. It is a very highly regarded med school, but the students are soft. The culture would be popular on this forum but I rarely encounter a med student I would want to work with as a resident, and we rarely match home applicants in our program.

 

[Lawpy]

Man this guide is awesome, if not the best.

 

[FindersFee5]

This is a good post. I will share my perspective as a resident. After rounds, my priorities are procedures first, then calling consults, then orders, then notes. Consults that come in during the day are triaged appropriately and range from ultra stat to excruciatingly mundane. As a med student you have two good ways to be useful: start at the top and help me with the high-priority things, or start at the bottom and check off all the little boxes you can on your own.

If you want to help out with high-priority things, you can be useful by gathering the supplies, informing the nurse, drawing up the paperwork for the consent/identifying a contact for consent if applicable, positioning the patient if you know what you're doing. You may not know how to place a central line or art line, but if you've seen one before you can gather the supplies. As a bonus, I am much more likely to let you do the procedure or participate if you show that initiative—it tells me you have some understanding of what's going on and you're willing to do the legwork for the reward. (It's the same in residency—junior residents who show up to the OR early, read about the case, position, etc. are the ones who get to scrub.)

One thing med students can do that is very helpful is calling consults. Most med students cannot do this independently for most consults, because they don't fully understand the patient and the reason for consult, but good students can. These are high-priority tasks because we don't want to burden the consulting service with a consult at 4pm when we talked about it at 7am. Side note, this is why I hate getting consults from medicine and neurology, because they round until 3pm and then call me with a consult, although it's not usually the resident's fault that they were rounding until 3pm.

Almost everything below that on the priority list is fair game for an enterprising med student to do independently. If there's a new routine consult, review the chart, go see the patient, and draft a note. It doesn't take an MD to figure out how to get outside records or upload outside imaging.

Lastly, I think it's very important that med students do this kind of work, including scut work, because lazy/underprepared/entitled med students turn into incompetent residents. I don't want to work with, supervise, or get consults from incompetent residents. There is a culture at my institution that coddles med students; residents always send them home early, encourage them to prioritize shelf exams, shelter them from scut work, etc. It is a very highly regarded med school, but the students are soft. The culture would be popular on this forum but I rarely encounter a med student I would want to work with as a resident, and we rarely match home applicants in our program.

This is a great point about helping to gather supplies for procedures. I'm going to edit my original post to include a little section on helping out with "high-priority things," as you called them. I usually kept a small notebook with me and would write down all the supplies needed for a procedure when I saw it performed the first time, so that the next time that procedure happened I could independently assemble all the supplies and I wouldn't be missing anything.

 

[hmockingbird]

An additional tip about presentations (and notes): the first step is just to organise the information. Really internalise what goes where. (Generally,) Subjective is for what’s reported to you from the patient and Objective is the “hard data”. For example, your exam and/or vitals don’t belong under ROS. Your patient’s description of their abdominal pain doesn’t belong in the abdominal exam. The Assessment should not be restating info from the other sections but your analysis of what’s going on (you can use that data to support your assessment but it shouldn’t just be, “this is a 19yo F presenting with RLQ abdominal pain with leukocytosis” — that tells me nothing new. But “this is a 19yo F presenting with suspected appendicitis as evidenced by...” is great). Then your Plan is the steps you’re taking based on your Assessment. These are all simple mistakes I’ve seen new third years make. And it is a whole new system of communication to learn so I am not surprised by these mistakes. That would just be my tip for going into your first rotations... before you even focus on pertinent and not pertinent make sure you have the organisation down first.

 

[Matthew9Thirtyfive]

This is a good post. I will share my perspective as a resident. After rounds, my priorities are procedures first, then calling consults, then orders, then notes. Consults that come in during the day are triaged appropriately and range from ultra stat to excruciatingly mundane. As a med student you have two good ways to be useful: start at the top and help me with the high-priority things, or start at the bottom and check off all the little boxes you can on your own.

If you want to help out with high-priority things, you can be useful by gathering the supplies, informing the nurse, drawing up the paperwork for the consent/identifying a contact for consent if applicable, positioning the patient if you know what you're doing. You may not know how to place a central line or art line, but if you've seen one before you can gather the supplies. As a bonus, I am much more likely to let you do the procedure or participate if you show that initiative—it tells me you have some understanding of what's going on and you're willing to do the legwork for the reward. (It's the same in residency—junior residents who show up to the OR early, read about the case, position, etc. are the ones who get to scrub.)

One thing med students can do that is very helpful is calling consults. Most med students cannot do this independently for most consults, because they don't fully understand the patient and the reason for consult, but good students can. These are high-priority tasks because we don't want to burden the consulting service with a consult at 4pm when we talked about it at 7am. Side note, this is why I hate getting consults from medicine and neurology, because they round until 3pm and then call me with a consult, although it's not usually the resident's fault that they were rounding until 3pm.

Almost everything below that on the priority list is fair game for an enterprising med student to do independently. If there's a new routine consult, review the chart, go see the patient, and draft a note. It doesn't take an MD to figure out how to get outside records or upload outside imaging.

Lastly, I think it's very important that med students do this kind of work, including scut work, because lazy/underprepared/entitled med students turn into incompetent residents. I don't want to work with, supervise, or get consults from incompetent residents. There is a culture at my institution that coddles med students; residents always send them home early, encourage them to prioritize shelf exams, shelter them from scut work, etc. It is a very highly regarded med school, but the students are soft. The culture would be popular on this forum but I rarely encounter a med student I would want to work with as a resident, and we rarely match home applicants in our program.

The “just send me home early” sentiment is huge on r/medicalschool and it bothers me because there’s a lot that we can be doing usually. I get if there is literally nothing a med student can do independently and the resident can’t break away to do something, then yeah sending them home to let them study makes sense. But the whole point of clerkship is to be part of the team and to learn what goes into that specialty.

 

[ohmanwaddup]

As someone who has been preceptor only, this all makes me really nervous for 4th year.

I’m going to look like a baboon during my sub-Is

 

[IWishIWasBuff]

Any advice regarding "likeability" for someone who is just introverted and...bland? What I mean is that I don't typically start conversations. I don't talk unless talked to. I'm horrible at kissing ass. I can be polite and professional but simply I don't talk much because I typically don't know what to talk about. I don't have any interesting hobbies, I don't follow mainstream sports, I don't watch many mainstream TV/shows, I've never used IG or similar social media, and so on.

I'm only a first year but I see this as a point of weakness and I want to work on this before getting into clinicals because it seems like likeability is a huge factor. I've seen some of my classmates strike up conversations, sweet talk, and are seemingly effortlessly charismatic.

 

[Matthew9Thirtyfive]

Any advice regarding "likeability" for someone who is just introverted and...bland? What I mean is that I don't typically start conversations. I don't talk unless talked to. I'm horrible at kissing ass. I can be polite and professional but simply I don't talk much because I typically don't know what to talk about. I don't have any interesting hobbies, I don't follow mainstream sports, I don't watch many mainstream TV/shows, I've never used IG or similar social media, and so on.

I'm only a first year but I see this as a point of weakness and I want to work on this before getting into clinicals because it seems like likeability is a huge factor. I've seen some of my classmates strike up conversations, sweet talk, and are seemingly effortlessly charismatic.

If you’re only a first year, the best thing for you to do is just start conversations with people now. It just takes some practice. Any time you have an in person thing at school, just start a convo. About anything. Ask people about themselves and then listen.

 

[FindersFee5]

Any advice regarding "likeability" for someone who is just introverted and...bland? What I mean is that I don't typically start conversations. I don't talk unless talked to. I'm horrible at kissing ass. I can be polite and professional but simply I don't talk much because I typically don't know what to talk about. I don't have any interesting hobbies, I don't follow mainstream sports, I don't watch many mainstream TV/shows, I've never used IG or similar social media, and so on.

I'm only a first year but I see this as a point of weakness and I want to work on this before getting into clinicals because it seems like likeability is a huge factor. I've seen some of my classmates strike up conversations, sweet talk, and are seemingly effortlessly charismatic.

So likeability is a really interesting thing. I do believe there are people who are just naturally more magnetic, drawing others into their orbit. My wife is like this - people enjoy being near her and open up to her. I've seen multiple people, within 30 minutes of meeting her, confess incredible vulnerabilities, things like drug addictions, abortions, childhood abuse... topics that would never come up in a normal conversation with me. And people love her for listening to them. I don't think I could learn that no matter how hard I tried.

Being likeable is different from being charismatic though. It mostly boils down to being polite and kind, having decent conversational skills, and being interested (NOT necessarily interesting). You already noted that you were polite, which is a huge first step. As @Matthew9Thirtyfive said, conversational skills is the thing requires practice. A simple first step is starting conversations when you would normally be looking at your phone, like waiting in line at the grocery store, between classes, etc. It's totally fine if you fail - the actual consequences of failure are basically zero.

 

[longhaul3]

Any advice regarding "likeability" for someone who is just introverted and...bland? What I mean is that I don't typically start conversations. I don't talk unless talked to. I'm horrible at kissing ass. I can be polite and professional but simply I don't talk much because I typically don't know what to talk about. I don't have any interesting hobbies, I don't follow mainstream sports, I don't watch many mainstream TV/shows, I've never used IG or similar social media, and so on.

I'm only a first year but I see this as a point of weakness and I want to work on this before getting into clinicals because it seems like likeability is a huge factor. I've seen some of my classmates strike up conversations, sweet talk, and are seemingly effortlessly charismatic.

This would make you elite-level likable as far as I'm concerned.

Sweet-talking and charisma are not important qualities in a good med student for me. I want to work with people who are hardworking, professional, punctual, honest, and reliable. Those are the things I really care about, plus fund of knowledge and a modicum of self-confidence which both vary widely even among good students. Med students quickly turn into residents and I that's what I want in a coresident (especially someone junior to me).

There are some truly incompetent med students that are more of a curiosity to me than a bother. The ones that bother me are the overconfident, overly familiar (this is the true cardinal sin of being a med student), sweet talking ones. Your residents have all been med students. We know when you are trying to be likable and sweet talk us. It is not appreciated.

 

[proudofmykids]

Hmmmm are you sure you're competitive? They have some pretty high step 1 filters.

jkjk

The professionalism/likeability>usefulness>clinical knowledge is so true! Your suggestions for appearing professional are also spot on.

Posture and NO PHONE are so important. IMO an attending (or anyone) shouldn't ever see you on your phone in the hospital. Too much room for interpretation.

One other important attribute to add is feigned interest/ attitude. Often most noticeable in rotations that student knows they don’t want. Literally observable in their attitude toward learning.

 

[FindersFee5]

One other important attribute to add is feigned interest/ attitude. Often most noticeable in rotations that student knows they don’t want. Literally observable in their attitude toward learning.

Agreed, I don't think you should ever feign interest. But there are going to be subjects you're less interested in, and in those cases you need to figure out something about that subject that is interesting to you or will be useful to your future specialty and get interested in that.

 

[Matthew9Thirtyfive]

Agreed, I don't think you should ever feign interest. But there are going to be subjects you're less interested in, and in those cases you need to figure out something about that subject that is interesting to you or will be useful to your future specialty and get interested in that.

I think they meant that you should feign interest if you don’t have any. Appearing uninterested is rude and a good way to get a worse eval.

 

[FindersFee5]

I think they meant that you should feign interest if you don’t have any. Appearing uninterested is rude and a good way to get a worse eval.

Ahhhh. In that case, I disagree. Feigning interest is often super obvious to a third party observer. I think there is enough variety in every field of medicine that you should be able to find some part of it that genuinely interests you.

 

[Matthew9Thirtyfive]

Ahhhh. In that case, I disagree. Feigning interest is often super obvious to a third party observer. I think there is enough variety in every field of medicine that you should be able to find some part of it that genuinely interests you.

Lol if you can’t feign interest without looking like you’re totally faking it, then you need to work on your acting skills. Feigning interest doesn’t mean you tell every specialty you want to do them. It just means you pay attention, ask questions at appropriate times, try hard for your patients, etc.