Help! My elective is turning out to be an observership

[Razzamataz]

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Hi there,

I am doing an elective in the US. I'm taking it for credit at my home school. As far as the US university was concerned this was a clinical elective and they made me purchase malpractice insurance and obtain a B1 visa, the full works in order to do this clinical elective and the hospital admin also set me up with log in details for the computer system. However when I started today I realized the doctors believe it is more of an observership. I didn't realize it was exclusively an outpatient setting. I just spent the day shadowing the doctor. I'm a bit concerned now firstly because an observership won't cut if for credit at my home school and secondly I was hoping to get an LOR out of this which won't be possible if I'm just watching a doctor and not saying anything all day. The experience was supposed to be a hands on clinical elective. My friend who is with me is doing a different specialty and getting the full hands on experience so I know thats what we supposed to be doing.
Does any one have any ideas on what I should do and on how to turn an outpatient experience into more hands on clinical experience? I'm not sure what role American medical students play in outpatient clinics. Any help would be very greatly appreciated.

 

[MilkIsGood]

ask if you can see patients and examine them and then present to attending

 

[seminoma]

ask if you can see patients and examine them and then present to attending

And I don't think it's uncommon for med students to spend the first day "shadowing" unless they speak up and ask to actually do something.

 

[Razzamataz]

And I don't think it's uncommon for med students to spend the first day "shadowing" unless they speak up and ask to actually do something.

That gives me hope! Hopefully things will improve tmrw, if not I might show them the forms from my uni so they know what I have to do….🤔

 

[justin1390]

You could do that, but don't be afraid to jump in there, too. At the end of tomorrow, if you haven't started getting at least a little hands on, I would say something in the evening to the effect of:

"Yeah today was great, I appreciate you taking the time to teach me. I'm more than happy to see patients and get hands on, too. My school actually has this list of _____ I have to do too while I am here."

 

[GUH]

I'm not sure what role American medical students play in outpatient clinics. Any help would be very greatly appreciated.

It depends on the specialty and the individual physician whose office you're in.
Some outpatient rotations are largely shadowing. Others will allow you to assist the attending physician with certain procedures.

I don't know what your expectations are or how things are done in other countries, but you should not assume that you will be given the level of autonomy given to an intern.

 

[Psai]

an outpatient rotation should not be shadowing
you should be seeing patients and presenting them every day
i can understand if you're with a spine surgeon and they don't want a medical student mucking around in there but if you're just watching someone interview patients, you're wasting time and money

 

[Kaustikos]

That gives me hope! Hopefully things will improve tmrw, if not I might show them the forms from my uni so they know what I have to do….🤔

Yeah,
Definitely don't do that. Unless you want to be failed.

 

[Cytarabine]

And I don't think it's uncommon for med students to spend the first day "shadowing" unless they speak up and ask to actually do something.

^yes. I prefer spend the first half day to day of a new rotation in somewhat of an observing role. It's a relatively small time investment and pays off big time in terms of quickly seeing what your residents / attendings look for in taking a history / doing a physical. Boring as chit though

 

[hmockingbird]

I think having an honest discussion with your preceptor about what is expected of you is totally appropriate, including providing them with copies of the requirements so they make sure you cover everything you need to. (For example, on some of my rotations, we were required to do certain procedures. One of the rotations was at a site with residents who were very familiar with my school and its requirements, so they already knew to look out for us; the other was not, but I simply sat down with my preceptor at the end of the first day and went over everything with her, and we kept a copy in the office so that we both remembered and she could sign off on things as needed.)

It's also pretty normal to spend the first day or so observing, like others have said.

Maybe this is a cultural difference? In the US, medical students are expected to seek out opportunities for themselves proactively. It's not considered overstepping your boundaries by asking for more opportunities. (Of course, you should do so politely and respectfully.)

You could start by a) asking to see patients by yourself (Grab a chart and ask "Do you mind if I see this next patient by myself first?") and/or present ("Is it OK if I practice presenting this case with you?") and b) asking when your preceptor has a few minutes to go over "expectations for the rotation" with you. When you are able to meet I would simply start off by saying you wanted to make sure you are both on the same page, since you are visiting from another school (another country!) and your school has outlined certain objectives you are supposed to cover during the rotation. I actually think showing your preceptor the forms would be fine, as long as you approach them respectfully and aren't like, shoving the forms in their face and saying "Since you won't let me see patients alone here are the papers to prove I should!!111!" Typically, preceptors want to make sure THEY fulfill all their duties to you so the school isn't bugging them about it later.

 

[notbobtrustme]

not unusual to shadow the first few days.

 

[Jlaw]

Are you with the same doc all month or do you switch off? I've found that when you rotate through a group there is always one or two docs who don't really care about teaching and don't seem to want to let a med student slow them down by doing anything but watching or relaying info. Solve the problem by avoiding shifts with that person and working with the ones who let you take an active role. If thats not possible then ask for more responsibility but be quick to recognize if thats not going to happen because pushy or overeager students usually annoy attendings and get dinged on the eval. Worst case scenario you just have to accept it for what it is and avoid those rotations in the future.