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“You can do anything for four weeks”: Advice for clerkships

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In two weeks, I'll be starting clinical rotations - yea! I finally get to start doing what doctors do. But I've been terrified, which I think everyone is when they start. The jump to clerkships is one of the biggest transitions we go through as students - where we transition from individual learners to part of a medical team.

The medical school's Office of Student Wellness recently hosted a panel of students who are finishing their third year and preparing to apply for residency. They gave us warm, encouraging advice about clerkships, and I’m now a little less terrified. I thought I’d share some of what I learned.

General

  • Be enthusiastic and interested in learning.
  • Ask members of your team for feedback early and...
  • If at all possible, get in touch with the students that most recently rotated in that department, at that location. Ask for their advice.
  • Remember the names of nurses and scrub techs. Be respectful and nice to them.
  • Remember to be flexible and adaptable.
  • Choose to act like the kind of person other people want to work with all day.

Internal medicine

  • Review how to interpret chest X-rays and EKGs before going on rotation.
  • Get there early and start preliminary assessment and plan. If the intern has time, ask if you can bounce ideas off of them. They might help you improve your assessment and plan before you have to present it at rounds. That’s great!
  • Look up relevant primary research articles and bring them in for the team.
  • Offer to help with tasks for the interns or residents in the afternoons, when you likely have less to do than them. And don’t just offer to help – offer to do something specific. Offer to call a consult or go to radiology. The first time you might need their help learning to do it, but then you’ll know how to do it and be able to be useful the next day.
  • Check in on your patient and their nurse periodically throughout the day. But let your resident know first so they don’t think you’re taking a break. Ask your resident if they need you to do something before you go check on the patient.
  • If you don’t know the answer to a question, respond with: “I don’t know, but I’ll look that up and get back to you.” And then do look it up and get back to them within a day or two.

Surgery: Many people are intimidated by the surgery rotation, but as one of the clinical students said: She's sure she's going into pediatrics, and she still had a phenomenal time on surgery. For some medical students, their surgery rotation will be the only time they get to be in the operating room. For others it will be when they cement their interest in surgery, the beginning of an intense, rewarding career.

  • Be enthusiastic and willing to learn. Apparently this line is worth repeating. Do it.
  • Be the first one in and the last one out.
  • Remember operating room etiquette:
    • Introduce yourself to the scrub tech.
    • Get your own gloves (once you’ve learned how to do this without contaminating them). Bonus points if you remember your team’s glove size and offer to get their gloves.
    • Write your name and status as a medical student on the white board.
  • Keep this in mind when it comes to questions:
    • Being ignored is the worst thing in the OR. So if someone is asking you questions, consider that they're taking an interest in your education. They'll ask questions that you can’t answer and that’s fine.
    • If you have a question you want to ask, that’s great. Consider first if it is the kind of question you can look up online and if so, considering not asking those questions. But if it's about the technique of the surgery, that’s fine.
  • Review cases before a day in the OR. You should know the patient’s history so that if the surgeon asks why the patient chose this surgery over another one, you can pipe up.
  • Brush up on relevant anatomy before a case if possible.
  • If things are quiet in the OR, ask to go see a specialty surgery.
  • When the team isn't operating and you have nothing to do, offer to go walk the patients.
  • Carry granola bars in your pocket.
  • Be a team player.

Personal life

  • Preserve the things that make you happy.
  • Identify your support networks inside and outside of medicine.
  • Set expectations with your loved ones. An example was going for a walk with a best friend on “off days” and establishing before a rotation how frequent those days might be.
  • Adjust personal goals. This was talked about in the context of weight lifting: One of the students started keeping their exercise clothes in the car and chose to have an erratic workout schedule rather than no workouts.
  • Remember: "You can do anything for four weeks.”

Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

Natalia Birgisson is a third-year medical student at Stanford University. She recently completed a year off writing her first novel, described on her site. For more medical school tips, follow her on Twitter: @BirgissonRx

Photo by Norbert von der Groeben

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