Transitioning to Clerkship Year
One of the most frequently asked questions is, “How can I do well on rotations?” The transition between pre-clinical and clinical rotations can be challenging as many students have never been part of a clinical team before. In addition, as a medical student, you do not have clearly defined roles. Thus, it takes a bit of initiative from the student to become a helpful member of the team. Here are some tips that will help you succeed in your rotation.
In general, the responsibilities you can take on as a student are:
Pre-rounding the patients: you can always check with your residents to see if they would prefer that you pre-round with them, or if they would like you to see the patients on your own. Basic questions to ask patients are: 1) Diet - are they tolerating food? If so, what kind of food (clears, liquids, solids, etc). 2) Bowel movements/urination - any issues going to the bathroom?. 3) Pain - are they comfortable? Are their pain medications working for them?. 4) Ambulation - have they been able to move around? If you have never pre-rounded before, you can ask to accompany the resident for the first few times to get the hang of what you should ask. Generally, these are quick visits before the full team rounds in the morning.
Preparing the list: the exact way to prepare the list can differ depending on what service you are on. On the first few days, you can see how the list is prepared - when you feel ready, you can become the designated person to prepare the list for the team. This is very helpful for the residents, particularly when there are many tasks to do in the morning.
Grabbing supplies: this responsibility will also differ depending on the service. Particularly on surgical rotations, floor patients will require dressing changes that may be done during morning rounds. Some students opt to stuff their white coat with supplies, some rock a fanny, or you can also grab a bin from the supply closet. Having supplies ready will make rounds very efficient for the team and is a very appreciated role in the team.
Drafting notes: after morning rounds, you can start on the note for the patients that you saw. Plans can change throughout the day, but starting a draft in the morning helps the team finish the notes for all the patients. As you progress through your rotations and feel more comfortable taking on more responsibility, you can discuss with your residents what would be a good number of patients to follow.
Checking in on patients: was there a patient during morning rounds that had many unanswered questions or wanted to engage in long conversations? Feel free to volunteer to chat with the patient and check in on how they are doing throughout the day!
Overall, one of the best advice I got as a student was to ask residents “Yes” or “No” questions. For example, rather than saying, “Is there anything I can do?” you should instead consider, “I noticed patient X had questions about their medication. Do you want me to go talk to them?” In doing so, you are reducing the mental energy of the resident in needing to assign you a specific task.
Also, feel free to ask questions! It is easy to fall into a pattern of following the plan set by the team, but you should understand why certain labs or procedures are being done. It also makes studying for shelf exams a lot easier when you see an example in “real life” rather than just through a textbook. Just be mindful of the timing of your questions - when the team is very busy or there is a critical situation, it is probably not the best time. If you are unsure, you can always ask something like, “I had a question about the plan for patient X. Whenever you are free today, would you be able to explain why we are doing the imaging study for them?”
If you have difficulties during the clerkship year, remember that many people consider it the most challenging part of medical school! Use opportunities to ask for feedback at the middle and end of your rotations. If you feel that you are weak in certain areas, you can always ask your residents or attendings to comment on how to improve. Clerkship year can seem daunting, but it will definitely get easier as the year progresses.
