Practical advice for Rotations

[doctorstrangerthingz]

Hi everyone,

So we just started our clinical rotations (my school has condensed curriculum) and I’m finding it hard to be proactive. Here as some examples:


My classmate and I are on a hospital service and take on patients, but beside presenting in the morning, the residents do all the work (they do the talking with the patient, they talk them over with the doctor, they get paged and updated on them and new admissions but we don’t, they write all the notes since our notes can’t be used) it just seems like there’s not a room for us to be involved. I understand the limitations of what I can do as a med student but when the expectations are for us is to be team players, it doesn’t feel this way and I don’t like to force myself on them or get on their way but I feel like I have to in order to actually do anything.

I read a lot about being the first to come and first to leave but they usually tell us to just go home since there is nothing for us to do and I always get the sense that they’ll be better off finishing up their work with us out of their hair.

I want to take initiatives by putting in orders or making calls but I wonder if they actually prefer to be the ones to do it or not trust me enough to do that?

They are aware it’s my second week on clerkships and I’m still learning how a team functions/how things are done while also trying to catch up the relatively big gap in my medical knowledge, which is probably why they don’t find us very useful and I don’t blame them at all.

I’m a hard working person, and I’m making a genuine effort to read up a lot and be proactive. I’m just trying to figure out how to do that in a way that is actually helpful, without getting in someone’s way or coming across as a suck up.

I’m working on my oral presentation skills, but beside that, does anyone have a practical suggestions for what things I can do?
Thank you!


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[FindersFee5]

In the morning when you're doing rounds, take note of all the things that the attending asks the residents/interns to do (literally make checkboxes of them like the intern does). Then, make note of any of those things that you think you'd be able to do - getting outside records, calling consults (if it's a patient you're comfortable discussing), patient education, simple manual tasks, etc. Then during/after rounds, ask the interns for these patients if it's alright if you did one of those things. If you choose a simple task, they're usually pretty grateful.

Some will tell you not to bother. Don't worry about that. In general, once somebody has refused my help three times I won't ask them if I can help with anything else, but other than that just keep asking.

Once you've shown that you're trustworthy, that you actually can do those simple things, the residents will actually start to think of you when those tasks come up. It's a really good sign when they get a task within your skillset and remember right away to ask you to do it. Once you've accomplished this, you're actually starting to be integrated into the team and the workflow.

 

[NonTrad16]

1) Ask previous students/your residents what the expectations are. This can guide a lot of your goals, and balance your expectations with theirs.

2) Rotations vary a LOT. Some services will be more agreeable to notes (and more!), others won’t. Same with different residents. Same with different hospitals. So every rotation you will likely be asking yourself how you can be useful. So repeat #1 with new teams/services/hospitals.

3) You not providing a service isn’t necessarily a fault of you, and wont necessarily be held against you with grades.

4) That said, as pointed out above, if something is brought up on rounds/elsewhere that seems more grunt level, offer to do it. Calling for records, making appointments, calling consults (maybe) could all happen. If you say “anything I can help you with?” they may not remember.... if you offer to make that call to the pharmacy, get imaging from radiology, check in on the patient, etc they’re a lot more likely to agree.

5) You want to place orders? I would 100% not do that, but that’s me (a mid year 3rd year). I’d be blown away if you could within your EMR, but... whatever. Point of this: unless it’s a benign thing, ask permission from your resident before doing anything new (for you, or that they haven’t seen you do) that’s beyond the normal M1-2 stuff or relatively harmless activities - h&p, record release/requests, calling for collateral (psych). I know orders would have to get approved, but just write it in your plan or something.

6) Leave when your resident offers. Yes, they will get stuff done earlier without you hovering. Also, sometimes they just forget you’re around and you don’t need that... They were also students, and likely remember sitting with nothing to do. Sometimes there isn’t anything for you. When you’re done helping (in whatever way you can), leave to study or otherwise enjoy life. Be engaged, not overbearing.

 

[OnePunchBiopsy]

Here are 5 non-medical (people skill) tips:

1.) Never ask questions you already know the answer to. It can be picked up on sometimes and is annoying.
2.) Medicine (like many things) is all about who you know. Put yourself out there and stand on the shoulders of giants.
3.) Perception is reality. Also, your perception often doesn't matter if you are perceived of doing something offensive. Apologize, almost always admit fault, learn from it, and move on.
4.) Don't be afraid to ask attendings/residents about their life outside medicine. Letting people talk about themselves (especially surgeons) is a great way to show you are a good listener and can make them feel like they resonate with you (even if you never get a word in).
5.) Never be afraid to stroke egos, especially if it is a big wig in the department. Walk the fine line though, don't do it excessively in public or people will see you as a brown noser.

 

[Medic741]

Just go with the flow, and pay attention to what the attendance one from you often times they do not want you to work hard or be a gunner.

Like seriously don’t try hard and just make the attending happy. This could mean **** Chat, this could’ve been writing notes, or it could be just staying out of their way.

Once I realized this was the secret to third year I am at least High passed every rotation. Literally by working less hard I am getting better grades, And in talking to classmates this is a consistent experience

 

[jurassicpark]

First off - Find out how your Attending wants things done. Every Attending will be different in how they want things to flow. Adapt
Second - Find out what your senior resident wants and how they want it done. Adapt
Third - Find out how your Intern wants you to do things, throw it in their face and stick with the resident. Odds are they'll be the ones doing your eval anyways. Just kidding, don't throw anything at your intern, they're stressed enough as it is.
Fourth - You don't have a license. Do NOT put any orders in. In fact, do not do ANYTHING without permission. It's your Attending's license on the line. Back during my med schools days we had one or two med students who thought they were doctors, did not end pleasantly at all.
Fifth- Did I mention adapt? Med school is all about learning how to be the fish out of water that turns into Rambo.
Sixth - The clue is to be helpful. Making sure you have labs, radiology reports, path reports, consultant rec's etc all on hand and organized ready to go especially during rounds. Pre-round on your patients before your resident does their morning glory and slide your notes underneath their bathroom door. Always be on the look out for patient updates. Anything asked of you do better. If they say jump, don't say how high. Ask them whose legs you want to cut off to use as pogo sticks. That kind of thing.