How to do well on rotations?

[HueySmith]

Hi, so form what I've learned and looked into, it seems that all that students have to do in order to do well during rotations are to 1) show up on time, 2) be professional, 3) be nice to everyone, 4) smile, and 5) be knowledgeable but not overconfident. These seem like how you should act anyways in any given situation... Is there something that I am missing?

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[Goro]

Hi, so form what I've learned and looked into, it seems that all that students have to do in order to do well during rotations are to 1) show up on time, 2) be professional, 3) be nice to everyone, 4) smile, and 5) be knowledgeable but not overconfident. These seem like how you should act anyways in any given situation... Is there something that I am missing?

Especially the bolded.

In dead seriousness, a lot of schools (MD and DO) are seeing rotating students simply fail to understand the concept of a job. Being on rotations is a job.

 

[meliora27]

Background: Current PGY-3 resident at a large, academic, university program. I've worked with many medical students, and here's some advice.

1. Be nice - As a med student, you are lowest on the totem pole, people will give you attitude, be dismissive, or may even ignore you. Keep your eye on the prize, becoming the best physician possible. Any amount of time you spend focussing on the BS, is time taken away for reading/learning/doing.

2. Show up on time - Actually, show up early, be prepared when rounds start to present your patients. When you show up, be ready to work. Don't show up, and then disappear to the hospital coffee shop, talk to friends on other services, or catch up on Instagram, come ready to work. Look the part, dress professionally, and know your role. If the attending, senior residents, and junior residents are all wearing white coats on rounds, as the MS3, you don't want to be the one person not wearing a white coat.

3. Know your patients. As a med student, you are carrying less patients than the interns, an probably the AI as well, so really know them. If your patient comes in with an AKI and the sCr is 2, what is their baseline? Do they have CKD? Look back in the EMR at old admissions if there are any, and if not, ask the patient who their PCP is, and call their office, asking for their last clinic note and labs to be sent to you at the hospital.

4. If you're on an outpatient rotation, take a look at the schedule for the following day, see what patients are coming in, read their previous note, and have an idea of what's going on before you even meet the patient. The last thing most patients want to do is have to tell their whole story all over again, so if you can walk into the clinic room, already having some grasp of what's going on, you will appear much more competent/confident, will likely gain the trust of the patient, and have a much more positive experience.

5. You can always learn - Even if you're dead set on doing internal medicine, and you're on a surgery rotation, you can still learn about things that will be important in your future career, eg: learn about the perioperative management of aspirin, anticoagulants, what is the literature on perioperative beta blockers? Who gets pre-operative ekg's? What are the ACC/AHA guidelines for surgery when you're on DAPT for a drug eluting stent? There are a lot of things an internists and surgeons can learn from each other.

 

[Chibucks15]

Background: Current PGY-3 resident at a large, academic, university program. I've worked with many medical students, and here's some advice.

1. Be nice - As a med student, you are lowest on the totem pole, people will give you attitude, be dismissive, or may even ignore you. Keep your eye on the prize, becoming the best physician possible. Any amount of time you spend focussing on the BS, is time taken away for reading/learning/doing.

2. Show up on time - Actually, show up early, be prepared when rounds start to present your patients. When you show up, be ready to work. Don't show up, and then disappear to the hospital coffee shop, talk to friends on other services, or catch up on Instagram, come ready to work. Look the part, dress professionally, and know your role. If the attending, senior residents, and junior residents are all wearing white coats on rounds, as the MS3, you don't want to be the one person not wearing a white coat.

3. Know your patients. As a med student, you are carrying less patients than the interns, an probably the AI as well, so really know them. If your patient comes in with an AKI and the sCr is 2, what is their baseline? Do they have CKD? Look back in the EMR at old admissions if there are any, and if not, ask the patient who their PCP is, and call their office, asking for their last clinic note and labs to be sent to you at the hospital.

4. If you're on an outpatient rotation, take a look at the schedule for the following day, see what patients are coming in, read their previous note, and have an idea of what's going on before you even meet the patient. The last thing most patients want to do is have to tell their whole story all over again, so if you can walk into the clinic room, already having some grasp of what's going on, you will appear much more competent/confident, will likely gain the trust of the patient, and have a much more positive experience.

5. You can always learn - Even if you're dead set on doing internal medicine, and you're on a surgery rotation, you can still learn about things that will be important in your future career, eg: learn about the perioperative management of aspirin, anticoagulants, what is the literature on perioperative beta blockers? Who gets pre-operative ekg's? What are the ACC/AHA guidelines for surgery when you're on DAPT for a drug eluting stent? There are a lot of things an internists and surgeons can learn from each other.

This should be pinned or something

 

[PedsAttending]

Just speaking as a preceptor...those students who teach me more than I teach them are the ones who get Honors. Look up EVERYTHING about your cases that you present. 61% of colds are caused by rhinovirus? There's a new thing I learned. Another student got Honors.

 

[AlbinoHawk DO]

Just speaking as a preceptor...those students who teach me more than I teach them are the ones who get Honors. Look up EVERYTHING about your cases that you present. 61% of colds are caused by rhinovirus? There's a new thing I learned. Another student got Honors.

I mean this with all respect, but if you have students teach you more than you teach them, you need to step up your game. There's nothing worse as a student than to feel you aren't learning anything in a rotation and a book can do a better job.

 

[uhmocksuhsillen]

Be a bro with every guy attending. Be super polite and gracious to your female attendings and older male attendings. Figure out things they like, their political leanings, hobbies, etc. and talk highly of them/act interested in them. When someone tells you you've asked a good question, or they take the time to explain something to you in depth...ask that same question to like 3 other attendings...odds are they'll pimp you on the same stuff making you look really smart - this tip is particularly key. Make yourself seen. If you know where a particular attending works, just go walk around his area a few times during the day. I'd make a few rounds on the wards acting like I was following up on something and always looking busy. Then I'd go back to chilling/studying in the library.

Seriously, that's 90% of it. Honors on every rotation and it's literally because I can make people like me, not because I'm a genius M3. Although, I do study my ass off so I would say my knowledge base is greater than most. But really, it just comes down to making the person who is grading you think you're a decent person and perhaps even like you. That's third year in a nutshell.

 

[PedsAttending]

I mean this with all respect, but if you have students teach you more than you teach them, you need to step up your game. There's nothing worse as a student than to feel you aren't learning anything in a rotation and a book can do a better job.

I think my students would have a different review of the situation. I can teach them things about the practice of medicine that they do not know.

But a good teacher should be prepared to learn from students. I'm consistently ranked the most popular clinical attending at my institution, so I think I'm doing something right...and I also will continue to work to improve.

 

[AlbinoHawk DO]

I think my students would have a different review of the situation. I can teach them things about the practice of medicine that they do not know.

But a good teacher should be prepared to learn from students. I'm consistently ranked the most popular clinical attending at my institution, so I think I'm doing something right...and I also will continue to work to improve.

Nobody says a good teacher shouldn't learn from their students. The way you portrayed it is that a good student should be teaching you, which makes it sound like you have deficits in your knowledge base.

Trust me, I've liked a lot of attendings as people and as a rotation, but when it comes to learning, the assessment is different.

 

[PedsAttending]

I think you might find that once you have to evaluate students, your criteria might change. It's hard to fail my rotation. Only one student ever has and that's because she literally didn't show up.

But when a student teaches you that the glucocorticoid receptor dimerizes prior to entering the nucleus, that's a student who did her reading. The fact is that medical teaching should be a two-way street.

 

[JustPlainBill]

Background: Current PGY-3 resident at a large, academic, university program. I've worked with many medical students, and here's some advice.

1. Be nice - As a med student, you are lowest on the totem pole, people will give you attitude, be dismissive, or may even ignore you. Keep your eye on the prize, becoming the best physician possible. Any amount of time you spend focussing on the BS, is time taken away for reading/learning/doing.

2. Show up on time - Actually, show up early, be prepared when rounds start to present your patients. When you show up, be ready to work. Don't show up, and then disappear to the hospital coffee shop, talk to friends on other services, or catch up on Instagram, come ready to work. Look the part, dress professionally, and know your role. If the attending, senior residents, and junior residents are all wearing white coats on rounds, as the MS3, you don't want to be the one person not wearing a white coat.

3. Know your patients. As a med student, you are carrying less patients than the interns, an probably the AI as well, so really know them. If your patient comes in with an AKI and the sCr is 2, what is their baseline? Do they have CKD? Look back in the EMR at old admissions if there are any, and if not, ask the patient who their PCP is, and call their office, asking for their last clinic note and labs to be sent to you at the hospital.

4. If you're on an outpatient rotation, take a look at the schedule for the following day, see what patients are coming in, read their previous note, and have an idea of what's going on before you even meet the patient. The last thing most patients want to do is have to tell their whole story all over again, so if you can walk into the clinic room, already having some grasp of what's going on, you will appear much more competent/confident, will likely gain the trust of the patient, and have a much more positive experience.

5. You can always learn - Even if you're dead set on doing internal medicine, and you're on a surgery rotation, you can still learn about things that will be important in your future career, eg: learn about the perioperative management of aspirin, anticoagulants, what is the literature on perioperative beta blockers? Who gets pre-operative ekg's? What are the ACC/AHA guidelines for surgery when you're on DAPT for a drug eluting stent? There are a lot of things an internists and surgeons can learn from each other.

To this I would add:

6) Bathe regularly and use deodorant -- you laugh, but some cultures do not bathe daily, nor use deodorant -- as a PGY3 I have had preceptors comment on previous residents' hygiene issues and that patients actually complained.

7) Leave the drama at home and don't whine while anywhere near your rotation site --- there's an old military saying which goes "Keep your indiscretions 50 miles from the flag pole" meaning don't get stupid near where you work. I actually had, while an MS3, another set of students from my school walk up to me and whine while the attending, resident and interns were literally 3 feet away at the end of the counter planning the rest of the day. I earned the residents respect when he turned to me and asked if I wanted to leave like those other students who had just walked off. My response? "Sir, I'm part of Red Team. I'm staying here until Red Team goes home. We either all go home or none of us goes home is the way I feel about it.".....later, he actually offered to talk to the PD for me regarding coming into the residency. Word got back to the attending and I got a really good LOR out of it.

8) If you've never held a job where you have to dress professionally, go down to Men's Wearhouse (or Jos. A Bank) if you're a guy (ladies, you're on your own) and tell them that you're a med student going on rounds and need to dress professionally. Fork over the cash to get one set of professional dress. Then walk yourself over to Dillard's/Macy's/JCP and buy a weeks worth of similar items. We had a dingus who thought he knew what professional dress was --- skintight powder blue pants, a canary yellow shirt, baby blue tie with huge Windsor knot which caused the tie to hang down to the bottom of the sternum, 1ct CZ stud earrings bilaterally, pencil line beard/mustache combination and all of this topped off with thick soled Doc Martens -- not kidding one iota.....Medicine is still a conservative profession in terms of dress and comportment -- if you want to succeed, play the game.

9) Do NOT lie -- if you don't know or didn't do something, fess up early.

10) Get a contact number and call/text if you're going to be late -- things happen, traffic is uncontrollable, but at least have the common courtesy to let people know. Don't make a habit of it.

Notice I didn't say anything else about medical knowledge, patient care, etc. -- most MS's have enough trouble with the above -- if you get that down, you're ahead of the game....my attending surgeon loved me because I was early, honest, and worked my butt off trying to anticipate his next move and be part of the team -- when I didn't know the anatomy, I said so, he showed me, I went home and studied it so that when he pimped me a few days later, I knew the anatomy backwards and forwards ----

 

[PedsAttending]

T
8) If you've never held a job where you have to dress professionally, go down to Men's Wearhouse (or Jos. A Bank) if you're a guy (ladies, you're on your own) and tell them that you're a med student going on rounds and need to dress professionally. Fork over the cash to get one set of professional dress. Then walk yourself over to Dillard's/Macy's/JCP and buy a weeks worth of similar items. We had a dingus who thought he knew what professional dress was --- skintight powder blue pants, a canary yellow shirt, baby blue tie with huge Windsor knot which caused the tie to hang down to the bottom of the sternum, 1ct CZ stud earrings bilaterally, pencil line beard/mustache combination and all of this topped off with thick soled Doc Martens -- not kidding one iota.....Medicine is still a conservative profession in terms of dress and comportment -- if you want to succeed, play the game.

I agree with you completely. Let me expand on this a bit: Your personal appearance while in a professional setting should be inoffensive. Be mindful of how much metal you have in and around various bodily orifices. Have your hair in a natural color and unremarkable style. I discourage any facial hair but keep it neat and conservative in style if you must wear it. This is about the patients, it's not about you.

You can show off your own personal style when you aren't at work.

 

[JustPlainBill]

I agree with you completely. Let me expand on this a bit: Your personal appearance while in a professional setting should be inoffensive. Be mindful of how much metal you have in and around various bodily orifices. Have your hair in a natural color and unremarkable style. I discourage any facial hair but keep it neat and conservative in style if you must wear it. This is about the patients, it's not about you.

You can show off your own personal style when you aren't at work.

Good point -- yes, gauges, multiple piercings (perhaps ear piercings are ok but let's not get excessive (i.e. more than 3)), etc. are probably not the best idea to be shown off in the hospital. I get that it's freedom of expression, etc. and you can gripe about it until the cows come home but the facts are that we deal with an aging population and you have to deal with cultural norms --- for example -- from my era, the only people who wore tattoos were Marines, sailors and loose women -- I was actually taught that only slaves and cattle are marked, we're not either one of those, so no tattoos in our family, period. Not right, not wrong, just the way it is ---

And a salient point, if you rotate with a community attending, you will be seeing their patients and directly impacting their business -- "freedom of expression" is a sure way to negatively impact that in some form -- whether it be politics/religion or dress/mannerisms doesn't matter -- if you negatively impact their practice, it will likely be reflected in your review.....

 

[Drrrrrr. Celty]

Learn how to read your attending and do as appropriate.

 

[BIGphysician]

As an attending, this isnt what I personally expect, but from experience being a resident and student, it seems like the people that always get the best grade at the end of the rotation are those that kissed the most a _ _. If you've struggled with this skill in the past, might not be a horrible idea to brush up on the art. Your knowledge in any one area has significantly less impact on your grade than you might imagine. You can be top 50% of your class by the skin of your teeth after the first two years of medical school, then be the valedictorian at graduation if you are a supreme master of the arts and everyone loves you on your rotations and gives you honors all the way through. This actually happened. Just swallow your pride and make your life easier.

 

[MedicineZ0Z]

Especially the bolded.

In dead seriousness, a lot of schools (MD and DO) are seeing rotating students simply fail to understand the concept of a job. Being on rotations is a job.

A job that you pay for (which should provide far more leverage than we admit)... and sometimes have nothing to do (unlike real jobs) and could be 10000x more productive elsewhere studying.

When the rotation does provide good education quality, then yes I definitely agree with you 100%. Shouldn't skip clinical activities that are productive. If time is being wasted though, then I definitely give credit to the students for doing the right thing.

 

[Goro]

A job that you pay for (which should provide far more leverage than we admit)... and sometimes have nothing to do (unlike real jobs) and could be 10000x more productive elsewhere studying.

When the rotation does provide good education quality, then yes I definitely agree with you 100%. Shouldn't skip clinical activities that are productive. If time is being wasted though, then I definitely give credit to the students for doing the right thing.

It's still a job, and students who fail to get this do so at their own peril.

EDIT: all rotations have some slack time. It's on you to make the most of it.

 

[group_theory]

1. Be nice

2. Show up on time

3. Know your patients

4. If you're on an outpatient rotation, take a look at the schedule for the following day, see what patients are coming in, read their previous note, and have an idea of what's going on before you even meet the patient. The last thing most patients want to do is have to tell their whole story all over again, so if you can walk into the clinic room, already having some grasp of what's going on, you will appear much more competent/confident, will likely gain the trust of the patient, and have a much more positive experience.

5. You can always learn - Even if you're dead set on doing internal medicine, and you're on a surgery rotation, you can still learn about things that will be important in your future career, eg: learn about the perioperative management of aspirin, anticoagulants, what is the literature on perioperative beta blockers? Who gets pre-operative ekg's? What are the ACC/AHA guidelines for surgery when you're on DAPT for a drug eluting stent? There are a lot of things an internists and surgeons can learn from each other.

7) Leave the drama at home and don't whine while anywhere near your rotation site

8) dress professionally

9) Do NOT lie -- if you don't know or didn't do something, fess up early.

10) Get a contact number and call/text if you're going to be late -- things happen, traffic is uncontrollable, but at least have the common courtesy to let people know. Don't make a habit of it.

I would add that the above are the minimum expectations of students on rotations. However doing the above do not automatically get you honors. Honors is not a participation trophy - you have to earn it. Honors implies that among the medical students that I've encountered, you are among the best (ie school's definition of honors). It's the student that have a strong fundamental base of knowledge YET able to demonstrate practical application of that knowledge (ie from bookside learning to bedside learning). It's knowing the patient, what's going on, and more importantly, how to present. Basically are you above where you should be at your stage of education (ie beginning 3rd year, end of 3rd year, subI/AI rotation, etc). It is the student that can get along with the intern, resident, fellow, other services, bedside nurses, bedside PCA/CNA, unit clerk, etc.

You are there to learn medicine. You can't learn bedside care from a textbook, a board prep book, from multiple choice questions, etc. If you think your time is better spent in a library reading/digesting texts and doing questions, instead of seeing patients (and the variety of presentations) and how their diseases interact with other organs (and other medical issues - patient don't just have one problem) ... then you're still a MS2 student pretending to be a MS3/MS4.

For some, it's their first time outside the academic environment and it's a hard transition. For others, it's an easy transition. For some, they have prior healthcare background that makes the transition easy

 

[JustPlainBill]

I would add that the above are the minimum expectations of students on rotations. However doing the above do not automatically get you honors. Honors is not a participation trophy - you have to earn it. Honors implies that among the medical students that I've encountered, you are among the best (ie school's definition of honors). It's the student that have a strong fundamental base of knowledge YET able to demonstrate practical application of that knowledge (ie from bookside learning to bedside learning). It's knowing the patient, what's going on, and more importantly, how to present. Basically are you above where you should be at your stage of education (ie beginning 3rd year, end of 3rd year, subI/AI rotation, etc). It is the student that can get along with the intern, resident, fellow, other services, bedside nurses, bedside PCA/CNA, unit clerk, etc.

You are there to learn medicine. You can't learn bedside care from a textbook, a board prep book, from multiple choice questions, etc. If you think your time is better spent in a library reading/digesting texts and doing questions, instead of seeing patients (and the variety of presentations) and how their diseases interact with other organs (and other medical issues - patient don't just have one problem) ... then you're still a MS2 student pretending to be a MS3/MS4.

For some, it's their first time outside the academic environment and it's a hard transition. For others, it's an easy transition. For some, they have prior healthcare background that makes the transition easy

Agree. But on the flip side, it’s incumbent on the attending to ensure that true bedside teaching takes place. Unfortunately in some institutions, the attending “teach” by pimping rather than realizing everyone learns differently and making an honest effort to present/expound upon cases in various ways to ensure true learning takes place. If you’re not prepared/able to do that, you shouldn’t be in academics. This was the case at UNTHSC-TCOM when I was there. Students were regularly ridiculed/mocked for having questions or not understanding.

 

[MedicineZ0Z]

It's still a job, and students who fail to get this do so at their own peril.

EDIT: all rotations have some slack time. It's on you to make the most of it.

I would add that the above are the minimum expectations of students on rotations. However doing the above do not automatically get you honors. Honors is not a participation trophy - you have to earn it. Honors implies that among the medical students that I've encountered, you are among the best (ie school's definition of honors). It's the student that have a strong fundamental base of knowledge YET able to demonstrate practical application of that knowledge (ie from bookside learning to bedside learning). It's knowing the patient, what's going on, and more importantly, how to present. Basically are you above where you should be at your stage of education (ie beginning 3rd year, end of 3rd year, subI/AI rotation, etc). It is the student that can get along with the intern, resident, fellow, other services, bedside nurses, bedside PCA/CNA, unit clerk, etc.

You are there to learn medicine. You can't learn bedside care from a textbook, a board prep book, from multiple choice questions, etc. If you think your time is better spent in a library reading/digesting texts and doing questions, instead of seeing patients (and the variety of presentations) and how their diseases interact with other organs (and other medical issues - patient don't just have one problem) ... then you're still a MS2 student pretending to be a MS3/MS4.

For some, it's their first time outside the academic environment and it's a hard transition. For others, it's an easy transition. For some, they have prior healthcare background that makes the transition easy

Issue is that many rotations are somewhat poor in terms of teaching. It's the preceptor's job to also teach students step by step what his/her expectations are from day 1 and then proceed to expect those things. The burden should never be on the students to get taught.


Expecting students to hang around doing scut work or help the nurses out or stay late for the sake of it etc. is very silly. Paying >50k/year should absolutely gain students leverage to guide their own learning within the framework set out by the preceptors/school. And schools should enforce grading to actually reflect clinical performance.