General Advice for 3rd Year Clerkships

Below is some advice you should take to heart and try to incorporate as you venture out into the scary new world of clinical medicine:

  • Being enthusiastic and interested will go a long way. Even if you aren’t interested in the specialty there is something to be learned in every experience you have.
  • Ask a lot of questions, but not too many. You want to strike a balance between being that guy and being so quiet your team forgets you’re in the room.
  • Have a thick skin. When you are being pimped, it is not to be mean (majority of the time), it is to see how much you know and where the attending needs to fill the gaps in your knowledge base.
  • What sets a new 3rd year apart from the rest is the ability to be a master presenter of a history and physical. Be organized and keep everything in its proper section.
  • Be on time. Be present. Be available. Ask if you can help.
  • Actively learn three things and teach one person every day. They can be small things, e.g. normal range of potassium. Educating your patient or a peer is very simple and can make a big impact. 
  • The key to being a good physician is knowing what you don’t know. Look things up! Don’t be afraid of asking questions (but try to find the answer first). If you don’t understand the plan, speak up. If you have an idea that wasn’t mentioned, speak up.
  • Some attendings use the RIME (Reporter, Interpreter, Manager, Educator) learning model. You should move from a Reporter to an Interpreter by the end of third year.
  • Never, never make up information or say you did something you didn’t. Do a complete PE! Students are not at the point where they can skip parts of the PE. Integrity is the foundation of our profession and of your reputation. People talk and you don’t want something like this hanging over your head.
  • “I don’t know” is always a good response. However, “I don’t know” repeatedly, especially on the same topic, is not ok.

 

Just a few more words of wisdom for really how to survive the year:

  1. Be nice to yourself. You aren’t going to know the answer especially questions that you feel you should. Let it go. Look it up. It’s ok. You’re going to feel like an idiot a lot. It’s a part of the process. Don’t let it get to you. Take a deep breath. Let it go. Move on.
  2. People aren’t always going to be nice to you. That doesn’t mean that you shouldn’t be nice to everyone. Don’t take people’s moods personally. Take a deep breath and let it go. There is another encounter coming your way every couple minutes and you can’t let that bad mojo bleed over.
  3. Seek out your own learning opportunities. 3rd and 4th year are VERY different in that regard. No one is going to hold your hand through this process. You need to be proactive. Ask to do things. If you never ask you’ll never have an opportunity to do it. The worst they say is no.
  4. Know your patient better than anyone on your team. As a student you have the luxury of time that the rest of the team doesn’t have. So spend that time sifting through their records and previous admissions or clinic appointments. You should be a walking encyclopedia of Mr Jones. That is how you are helpful and beneficial to the team.
  5. Focus on ONE topic a day. There are going to be a million things that come up during the day that you don’t know. You’re never going to be able to look them all up. So pick one thing, preferably that is relevant to a patient that you are following, and know that topic inside and out. If someone asks you to look something up look at the following at the very least: epidemiology, risk factors, clinical presentation, workup/diagnosis, differential, management.
  6. Always be present. This is a professionalism thing as well as an active learner thing. During rounds listen to the presentations. Pay attention to what needs to be done. Help be a team player and make sure things don’t slip through the cracks. Learn from your peers and the residents on how to present and what is indicated for a disease process. Not paying attention is easily translated to not caring and apathy which doesn’t reflect well in your eval.
  7. Ask for letters of rec early and often. Even if it’s your first rotation ever and you spend only 2 weeks with the attending, if you feel you did a good job and the attending got to know you and your ability as a team player and how you take constructive criticism.
  8. Your goal is NOT to wow them with your knowledge. Your goal is to wow them with your attitude, your care to detail, your reaction to feedback. Don’t get caught up in what you don’t know. Just keep plugging along.
  9. Try to perfect your patient presentation for H&Ps and Progress Notes as quickly as possible. You will always be working on getting better at this, but this skill is what attendings and residents are going to judge you on, not your medical knowledge. If you can’t formulate an Assessment and Plan, that is ok. At least be able to present the facts in a logical and fluid manner.
  10. Don’t be afraid to ask for help. A lot of things happen in 3rd year. You’re in a whole new setting. It’s ok if you’re overwhelmed with the new setting, the new schedule, or the encounters that you have with your patients. Make sure to have a few supportive people around you. As nice as it is to have supportive family and friends, it is REALLY nice to have someone who is in medicine that you can talk to because they will understand what you’re talking about. What we do on a regular basis is NOT normal from the average person’s perspective and often times it’s overwhelming for them, which doesn’t help your situation. So try and find a mentor or a classmate to commiserate with every once and a while.
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