What do you actually do during rotations?

[DeadCactus]

Are you just following a resident around? Do you actually take care of patients? Obviously, you're not just given free reign to place orders at whim.

I guess the question is, is it more just following physicians around and asking/being asked questions? Or is it more "Go check-out this patient, come-back and tell me what you found and what you want to do next, I'll double check your work and make any alterations to your plan, rinse and repeat."

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[bergwood]

Or is it more "Go check-out this patient, come-back and tell me what you found and what you want to do next, I'll double check your work and make any alterations to your plan, rinse and repeat."

This.

Though realistically the resident probably knows almost everything important about the patient before he/she sends you to see them because the ER resident or whoever did the referral probably already told them all about the patient over the phone. Makes you feel kinda worthless, but it's part of the learning process.

 

[ShyRem]

The point is to make you learn how to gather the important information in a timely fashion, put it together in a cohesive coherent presentation, and do some thinking about what might be wrong. This takes practice. LOTS of practice. And someone to present to to guide you through the learning process.

That is what your clinical years are for. As a resident, you become masters of scanning vast amounts of information in the computer and learning the important things quickly.

There really is a purpose. Doesn't feel like it many days, and you'll feel like it's all scut work and "I'm not learning anything", but you are. You are.

 

[1nycdoc8]

guiac.

 

[mq123]

guiac.

👍 Just did two in the ED within a few hours of each other. My lucky day.

In general, though, I feel like you do as much you're willing to do (and wanting to learn). Like the above poster said, residents probably do know almost everything about that patient, so sending you to see the patient 1) lets them work on other, more important stuff while they're uninterrupted by you hovering over their shoulders and 2) maybe gets them some extra info that only med students can get from patients. Oh, and you also learn something in the process, hopefully -- the more you're willing to do (going beyond the HnP and wanting to work on an assessment and plan, asking *thoughtful* questions, checking up on the patient to keep them updated, following up on labs and tests, etc), the more you'll get used to being the healthcare provider role.

 

[thanecyan]

The point is to make you learn how to gather the important information in a timely fashion, put it together in a cohesive coherent presentation, and do some thinking about what might be wrong. This takes practice. LOTS of practice. And someone to present to to guide you through the learning process.

That is what your clinical years are for. As a resident, you become masters of scanning vast amounts of information in the computer and learning the important things quickly.

There really is a purpose. Doesn't feel like it many days, and you'll feel like it's all scut work and "I'm not learning anything", but you are. You are.

Best thing I've ever read/heard for motivation to push on :O

 

[MedicineMan99]

Yes residents often do know what they are asking you to find out... however I've found that my best rotation experiences have been when I've been a true member of the team, i.e. when the resident or even attending uses me as a right hand man rather than as a student.,, When the resident/attending asks me to go to the ER and get the scoop on the new patient we are admitting to speed things along or when they ask me for my opinion becasue I know the patient best and they respect my opinion- not because they are pimping. Sure they need to provide their input but I've gotten the most out of rotations when I've been a respected and trusted member of the team, not just a H&P/rectal exam monkey.

 

[SGuttenberg]

What I've learned now that 3rd year is half over is that you CAN learn if you would like but you don't have to. (I want to do path or rads so I don't care about clinical medicine.)

You basically just do pointless scut work and observe residents and attendings (which is quite boring). Also you annoy patients by being the 4th person to poke and prod at him and ask him the same questions. Luckily most patients are stupid enough to not care and/or realize they should avoid teaching hospitals. Sometimes you may be asked to see a patient who hasn't been evaluated, but someone else will also evaluate him eventually.

Occasionally lazy residents/attendings will have you see patients and just use your HPI and the super lazy ones will use your physical exam (surgeons).

Nobody gives a crap what med students present or write in their notes, you really have to ask for feedback if you care to get it.

 

[MrBigLips]

This.

Though realistically the resident probably knows almost everything important about the patient before he/she sends you to see them because the ER resident or whoever did the referral probably already told them all about the patient over the phone. Makes you feel kinda worthless, but it's part of the learning process.

If you somehow manage to pick up something the resident didn't know that is actually relevant... make sure you let him/her know of it.

The point is to make you learn how to gather the important information in a timely fashion, put it together in a cohesive coherent presentation, and do some thinking about what might be wrong. This takes practice. LOTS of practice. And someone to present to to guide you through the learning process.

That is what your clinical years are for. As a resident, you become masters of scanning vast amounts of information in the computer and learning the important things quickly.

There really is a purpose. Doesn't feel like it many days, and you'll feel like it's all scut work and "I'm not learning anything", but you are. You are.

Wow, I wish somebody gave me that advice in med school. Great stuff and absolutely true.

 

[McGillGrad]

What I've learned now that 3rd year is half over is that you CAN learn if you would like but you don't have to. (I want to do path or rads so I don't care about clinical medicine.)

I would wager to guess the attending radiologists and pathologists that review patients every day would disagree with you. In fact, they have to know clinical medicine as well, if not better, than the residents in order to question and tease out pertinent details from the history and physical.

Believe it or not, the world of radiology/pathology is as grey as "clinical medicine." You still need the H&P to confirm most results.

 

[Law2Doc]

Are you just following a resident around? Do you actually take care of patients? Obviously, you're not just given free reign to place orders at whim.

I guess the question is, is it more just following physicians around and asking/being asked questions? Or is it more "Go check-out this patient, come-back and tell me what you found and what you want to do next, I'll double check your work and make any alterations to your plan, rinse and repeat."

The goal is to have you be a useful part of the team by the end, a second set of eyes/ears for the residents, and to give you practice learning how to be a resident in terms of examining patients, presenting patients to attendings, etc. In most rotations, you may be expected to "pre-round", meaning you go see and examine the patient, see if there's anything new in the chart, and check the labs, talk to the overnight nurse to see if there were any events, before the residents get there. The residents will also pre-round after you, but since they tend to cover more patients than the med students, to the extent a med student can bring things to their attention (ie "this guy's potassium is way low"), that tends to be appreciated. Med students should help out on the paperwork. They should learn to write notes, even though at most hospitals these notes won't get put into the charts for legal reasons. And most importantly, they should learn to take ownership of patients, and present them to attendings. The goal is not to have them become scut monkeys who keep coming back to the resident and say "what should I do next", although truthfully there will be a lot of that. The goal is for them to take ownership, know everything that is going on with "their" patient, and basically be an integral part in the daily care and plan for that patient. On top of that, they may be involved in daily bandage changes and wound inspections, and if there's any easy procedures they can help out on, (putting in NG tubes, Foleys, pulling lines, performing LPs, performing I&Ds, with the appropriate supervision, etc) and if they have "proven" themselves useful and competent, hopefully will get a shot.

 

[psipsina]

Alot of how much autonomy you get has to do with what you put into your rotations. If you act like you own your patients, even though you know that ur resident is coming behind you double checking, they will notice it. On multiple occasions major decisions have been made based on my findings or something I brought up on rounds. I have also gotten to do some amazingly cool procedures for a medstud - chest tube placement, ureter and vascular anastomoses, multiple first assists, even a minor operation skin to skin. Some of this is of course school/attending dependent, but having done away rotations I have seen that clinical rotations are very much what you make of them regardless of where you are in school.

 

[nlax30]

Alot of how much autonomy you get has to do with what you put into your rotations. If you act like you own your patients, even though you know that ur resident is coming behind you double checking, they will notice it. On multiple occasions major decisions have been made based on my findings or something I brought up on rounds. I have also gotten to do some amazingly cool procedures for a medstud - chest tube placement, ureter and vascular anastomoses, multiple first assists, even a minor operation skin to skin. Some of this is of course school/attending dependent, but having done away rotations I have seen that clinical rotations are very much what you make of them regardless of where you are in school.

Definitely agree with this. From my experience attendings and residents are much more likely to let you get involved (whether via decision making or procedures) if you show genuine interest and take some sort of initiative. And usually all it takes is simply asking "hey, can I scrub in with you" or "can I try this line?".

Also applies to clinical medicine. My most rewarding months on wards has been when I was treated more like an intern/resident than a student there to do scut work. That requires you to show up early, know everything about your patients, read/research on their diagnosis and be able to discuss the next management step and other small details such as simply calling the lab for a result that's not back yet or to find out that the send out lab your team wants needs to be drawn by 10am it's not going to be sent are things that can really help your team and make you an actual valuable part of the team.

 

[ShyRem]

Y'all should be aware that vasca is NOT A US MEDICAL RESIDENT and vasca's opinions are not generally representative of hospitals, residents, and student life in the United States.

Now if you are talking about medical students, residents, hospitals, and attendings where vasca is, by all means pay very close attention to what vasca says.

 

[KeyzerSoze]

Y'all should be aware that vasca is NOT A US MEDICAL RESIDENT and vasca's opinions are not generally representative of hospitals, residents, and student life in the United States.

Now if you are talking about medical students, residents, hospitals, and attendings where vasca is, by all means pay very close attention to what vasca says.

Aww... are you saying that US students don't get to do a weekly dog-breed H&P?

 

[McGillGrad]

Aww... are you saying that US students don't get to do a weekly dog-breed H&P?

I am pretty sure I did a do breed H&P. ShyRem might be a bit off on this one.

 

[ShyRem]

I never had to know what breed each dog in the patient's house was. Nor breed of cat, mouse, rat, chinchilla, hamster, turtle, or lizard. I did ask about breed of snake and spider.

 

[nlax30]

I have asked specifics about birds in the house once, and about possible scorpion "encounter". And both were actually helpful pieces of information

 

[Deferoxamine]

You get what you put in.

If you're the type that needs coaching and coddling, you won't be doing very much and you'll get pretty bored. If you're independent and Type A and motivated, you'll be plenty busy and actually learning a ton, and also saving the resident some tangible amounts of work.

 

[Zoom-Zoom]

Hey, that is not fair. I am also a medical student in mexico and I agree with vasca. For one, dogs are a popular side item and many doctors have other businesses related to breeding, fighting, skinning, and training (only the best will train). Second, most of my hospitals are quite boring too. Occasionally there are patients, and then I write long notes for them. It really depends on how much shift deliveries you have, though. I did 30 one time. Then there's rounding (with or without the patients) and some learning, and lab testing, and reading, with more writing, generally at least 20 pages (I can now write cursive in ten languages). Beware when you rotate on the shift deployment council for surgery it will be stressful because they only care about cats, not dogs, and most of them will be mixed breeds which makes the dosing schedule impossible. Ferrel cats are the worst by the way. Especially the rabid ones. Sometimes the residents critique us based on our handwriting also x quite stressful for the med students, but the doctors like this because it gives them more time for EKG's and X-rays and they can finish before the day's consult assignment has passed to the next server. Code word this: Naproxen. Keep your ear to the grindstone. You're suspect. I hope that helps. Good luck.

 

[Zoom-Zoom]

Hey, that is not fair. I am also a medical student in mexico and I agree with vasca. For one, dogs are a popular side item and many doctors have other businesses related to breeding, fighting, skinning, and training (only the best will train). Second, most of my hospitals are quite boring too. Occasionally there are patients, and then I write long notes for them. It really depends on how much shift deliveries you have, though. I did 30 one time. Then there's rounding (we round with or without the patients) and some learning, and lab testing, and reading, with more writing, generally at least 20 pages (I can now write cursive in ten languages). Beware when you rotate on the shift deployment council for surgery it will be stressful because they only care about cats, not dogs, and most of them will be mixed breeds which makes the dosing schedule impossible. Ferrel cats are the worst by the way. Especially the rabid ones. Sometimes the residents critique us based on our handwriting also x quite stressful for the med students, but the doctors like this because it gives them more time for EKG's and X-rays and they can finish before the day's consult assignment has passed to the next server.

 

[VoiceofReason]

waste an inordinate amount of time