How to Thrive During Clinical Rotations & Make the Most of Your Time in the Clinic
Published on Aug 28, 2020. Updated on Sep 15, 2020.
The clinical rotations or clerkships phase of your clinical education sets the stage for the rest of your career. This year, thousands of medical students are entering their clinical rotations in the unprecedented circumstances of the COVID-19 pandemic. To help you survive and thrive in this new environment, the Osmosis team has created a two-part guide to clinical rotations (you can find the complementary article on remote clerkships at the bottom of this article!)
Third year of medicine is a time for clinical rotations, also known as clerkships. This year is considered by many to be one of the most challenging years in medical training. As you begin to shift your academic study toward clinical practice, taking that leap can be difficult and initially overwhelming. Fortunately, your friendly neighbors at Osmosis are here to help you stay organized and focused so you can thrive in your clinical rotations!
We have created a list of clinical rotations you will likely encounter, in addition to a general list of strategies that you can use to not only survive, but to thrive in this new clinical setting.
Rotations you may encounter are listed here for your reference:
Core clinical rotations
Obstetrics/ Gynecology (OB/GYN)
Elective clinical rotations
Allergy & Immunology
Hematology & Oncology
Intensive Care Unit (ICU)
Physical Medicine & Rehabilitation (PM&R)
In this article, we focus on how to make the most of your limited time in the clinic and hospital during your clerkships. Keep in mind that every step you have made along the way has been progress. Never lose sight of that. With some of these key tips, we know you will become the stellar physician that you envision.
Here are 12 tips to follow to help you excel in any rotation!
Tip 1: Invest in the tools you need for success
Clipboard. Pocket guide. Pen. Pen light. Stethoscope. Reflex hammer. You name it. Whatever you think you’ll need, get it.
Investing in the tools you need to assist with information acquisition and to conduct the physical exam is critical. Some instruments, like otoscopes or ophthalmoscopes, may be less important to purchase, as they can cost a lot of money and might be used rarely. Some clinics or hospitals even have these tools ready for you to use, so there’s no need to break the bank.
Remember that the instruments you have relied on in your second year will still be useful here. Also, be sure to purchase a pocket guide. For example, a great resource for internal medicine is Pocket Medicine by Marc Sabatine. Just a little bit of research into what you need to aid in the diagnosis and treatment of disease goes a long way.
Tip 2: “Fortune favors the prepared mind” - Louis Pasteur
The first tip leads right into this one: be prepared! Reach out to your peers for guidance, especially those that rotated through the clerkship just before you do.
Peers can tell you what tools and resources to use. They can give you useful advice, like ideas on how to shine in the prospective clerkship, where to go on the first day, who is helpful, what certain attendings may expect, where you can park, where you can find certain information, how to use the medical record, and so on.
It’s also a good idea to ask your peer to identify the top five diseases they encountered on the rotation. This can give you a better idea of which diseases you might need to review before you begin. Don’t spend too much time worrying about this; you already know so much at this point! The review doesn’t need to be comprehensive, but refreshing your memory is useful, and may alleviate some pre-rotational anxiety.
When you finish your rotation, remember to pay it forward, and help orient the next group of students!
Tip 3: Get organized
When you finally make it to the hospital or clinic, you’ll quickly realize how important organization is to achieving success. You already know how to perform a history and physical exam, but now it’s time to organize the information to convey a coherent and thoughtful patient history to other clinicians.
Learn how to take a patient history
Get used to telling the story of your patients in a concise way, relaying the most pertinent information to your attendings or residents when they ask you to recite your findings. Pay close attention to the information that they are looking for, and stay away from delivering information that is superfluous.
When you first start, it may be a good idea to practice at home. Be comfortable with having these conversations. You will likely stumble initially, but keep it up and you will see significant growth. Organize the physical exam from head to toe, or however else you have already learned it. This is the time for you to learn your personal organizational strategies, and develop good habits.
Create a patient checklist
In the hospital, organization is even more essential than in the clinic. Information comes at you from every direction, and if you don’t filter, prioritize, and organize, you can easily get lost. You will need to start carrying a notebook to keep track of significant laboratory findings, imaging, physical exam findings, and so on.
Create your own method. Write down the necessary findings of today, but don’t forget the trends over the past few days. Find out what your patient’s active problems are and follow the relevant data over time. For example, the BUN, creatinine, and fractional excretion of sodium (FENa) may be useful to track over the course of several days in a patient with acute renal failure.
Keeping your notebook updated with the latest information and yesterday’s pertinent trends will also help you stay ahead of the curve.
Make to-do lists a habit
Next, be sure to create a to-do list. Mental checklists are dangerous; you already have so much to keep in your head! Put that information on paper. This is your external reference cheat sheet. Carry it with you wherever you go.
There is no shame in referring to your list. In fact, it’s better to rely on this than to completely forget what you needed to do, don’t you think? You may even have access to an electronic device that you can carry around to keep updated notes.
Regardless of your organizational scheme, stay on top of it!
Tip 4: Hone your clinical skills
As you continue your journey through your clerkships, you will have the opportunity to improve your history taking, physical examination, and procedural skills. Fortunately, you already know how to perform a complete history and physical exam! Now, you need to figure out how to perform these skills in a focused and efficient manner.
Learn which questions to ask, how to redirect patients when they stray from the topic of their illness, and how to gather a complete story that makes sense. Gathering a focused patient history may be time intensive at first, but the key to success is mastering organizational skills before crunching time. Don’t take shortcuts!
For example, if your patient has congestive heart failure, you may need to listen closely to their lung bases to detect rales. But if they have a urinary tract infection, it may be a waste of time to listen to the finer intonations of lung sounds. Remember to keep your examinations focused, but again, don’t skip steps just to finish more quickly.
Practicing your clinical skills will translate to increased competence and decreased time investment. When I first performed a central line, I kid you not, it took me two hours. I definitely felt the pressure, but instead of worrying that the resident overseeing me hated me, I remembered that they might have taken 2 hours their first time performing a central line too. But after working diligently, I could complete a central line in 10 minutes.
Like every skill in life, it takes time, energy, effort, and enthusiasm. With dedication to your career, you will develop your clinical skills.
Tip 5: Time is of the essence
Time management is an enormous part of being a doctor. This goes without saying. When you are bombarded with information, prioritizing and tackling the more time sensitive tasks is a key skill that you will learn over time. Knowing where to devote your energy is not always easy. You may feel overwhelmed at first, but keep working!
Time sensitive issues can be extremely variable, but keep in mind when other departments or outpatient offices might close, and the time crunches you could face in these situations. You also don’t want to keep patients waiting for too long, in either the hospital or the clinic. Acknowledge when you’re running behind, and apologize if patients are upset.
To avoid issues in the hospital, it’s critical to ensure that you’re driving the progress of your patient’s care forward. Are you waiting for a CT scan to be completed, or is it finished and you need to consider the next step in their management? Keeping track of both pending and active tasks is an important aspect of time management. Practicing skillful and quick note-taking will also alleviate some of your time pressures.
Tip 6: Cultivate your curiosity
Take charge of your education, because no one else will do it for you.
Immerse yourself in activities that will help you learn. Study or review the presenting disease, comorbidities, or medications of your patients. Each patient encounter is an opportunity to strengthen your knowledge base. If you don’t know something, learn it. And if you can’t figure it out, ask for help.
Be honest when you don’t know the answer. But as much as people say there are no stupid questions, there are certainly thoughtless questions. Think before you speak. Make your questions thoughtful, and make them count. If you do this, you will shine in the eyes of your teammates.
Additionally, take advantage of feedback from your teammates, particularly your residents and attendings. Invest in obtaining early feedback, so that you have a point to work forward from to demonstrate your effort. Feedback is a critical part of learning in the clinical setting.
You can also consider asking your team if you can discuss various common medical concepts, such as atrial fibrillation, asthma, diabetes, or whatever else you want to review. But don’t give the residents more work: do the review yourself and teach them if there is time! You can even ask them what they want to review.
You would be surprised by how thankful your team members may be to review different disease processes and treatment algorithms. Plus, you just might gain more understanding of the subject, or your residents might share a piece of information that enhances your budding scope of knowledge.
There is so much medical information to know, and teaching helps foster memory recall and retention.
Tip 7: Stay actively involved with your team
In the fast-paced clinical or hospital setting, it’s easy to get left behind. To prevent this, stay involved with your team.
Touch base with your team members regularly, and stay updated on the progress of your patients. Try to present more information about your patients’ hospital courses than your resident even knows. When you bring new and up to date information that your team doesn’t even know, they’re bound to be impressed.
Go the extra mile, and exceed expectations. Ask to perform procedures to strengthen your skills. Challenge yourself. And when you complete your work, don’t just sit and twiddle your thumbs: dive into your textbook, or find a place to hide away from all the turmoil. Complete all of your work, then look for more ways to help. Be a team player.
If your resident or attending tells you to go home, it is okay to do this. But if your team could use your help in some way, offer to stick around. Medicine is a team effort. If your resident is performing a procedure that you don’t have enough experience with, stay to watch. This may lead to two, three, or four more hours of work. Sometimes you don’t gain too much experience or insight from those additional hours. You might feel like you got “stuck” at the hospital when this happens. But keep in mind that you are there to learn and absorb as much as you can.
Other times, those extra hours pay off, and you learn something you never would have learned looking at a textbook. Keep your chin up and take advantage of these opportunities!
Tip 8: Be positive and adaptable
Occasionally, you can become overburdened with work, and have to stay very late.
Picture this scenario: it’s been a long, exhausting week in the hospital. It’s close to the end of the day, and the weekend is right around the corner. You have an anniversary dinner reservation with your significant other tonight in an hour to kick off your weekend. Unfortunately, your relationship has been strained from all the time you’ve spent at the hospital over the past month. You really need tonight. You’ve completed all your work for the day, but your team is still open to receive new patients, and you’re up for the next patient admission. You’re staring at the clock, counting down the minutes to freedom. But two minutes before you are relinquished from your hospital responsibilities, your team receives a call from the Emergency Department about a patient that requires immediate attention.
How do you feel? Are you frustrated? Despondent? That’s completely understandable.
Situations like these can be disheartening, and it’s okay to feel upset. However, it is unprofessional to express just how upset you are to your colleagues. Don’t bring negativity to your team. They’re likely unhappy about the extra work too, and you don’t know the sacrifices they’re making. It’s okay to commiserate, but it is not okay to dwell on those negative feelings.
Learn to go with the flow, and take responsibility for your work. If you can face adversity with a smile on your face and see this as another chance to grow, imagine how much better off you will be. And if you’re lucky, your residents or attendings might even notice how you handled such a difficult situation with exceptional maturity.
“As you think, so shall you become.” – Bruce Lee
Tip 9: Elevate your hospital team to success
Most of the tips we’ve discussed so far focus on how you can succeed in clinical rotations. But here’s a better question for you to ponder: how can you help your team succeed? Don’t try to “outshine” others to make yourself look better. Your superiors will pick up on this. Teamwork is especially important to remember when working with other medical students. Make a pact to work together and help each other excel, and put that plan into practice.
Along with being team-oriented and attempting to elevate your team to success, don’t forget about your extended team: nurses, assistants, technicians, clerks, janitorial staff, and everyone in between. Take time to get to know the hospital staff! They can make your life and experience much more enriching if you develop meaningful relationships. Think of them as your professional family.
Be genuine and thoughtful: a little kindness goes a long way. Sometimes people will treat you dismissively regardless of the effort you put in. But that’s okay! Remember to go in with high hopes and low expectations. You might be surprised by the lasting impressions and relationships you can develop if you put in even the smallest effort.
Tip 10: Practice compassion
Along with being compassionate to the medical staff, practice compassion with your patients.
When performing a patient history and physical, gathering information while remaining engaged with your patient can be tricky, but it is something you must continue to practice throughout your career. Try to know your patients better than any of your team members. Have a conversation with your patient. Take the opportunity to get to know them. Humanize them. Really listen to what they say. A good physician treats the disease, while the great physician treats the patient who has the disease.
In practicing your empathy and refining your understanding of the patient-physician relationship, you will likely reinforce the reasons you went into medicine in the first place. You will develop patient trust, and your relationship will flourish. You may even elucidate pertinent medical information that may not have been disclosed on the initial history and physical examination.
Finally, by getting to know your patients more intimately, the knowledge of their disease process will stick in your mind more clearly for future patient interactions.
Tip 11: Take advantage of downtime
Occasionally, you may experience moments of downtime in the hospital or clinic, when there are no patients scheduled, or you’re waiting for the next admission. As we’ve already mentioned throughout this article, there are many ways to stay invested in your education by helping your team, actively learning, or diving into your textbook. But sometimes, it’s okay to slow down and really treasure the downtime.
Use it to get to know your team. Relax a bit. Find a place where you can go for 10 minutes to unwind in silence. You have so many things to worry about on most days, it’s nice to cherish these moments of respite. It’s also a good time to stop all the thoughts that are spinning through your mind constantly.
During the whirlwind of clerkships, it’s easy to forget that you are, in fact, still human. We all need to take a break to reset from time to time. Practice this as regularly as you can, and you will find the long hours of work more tolerable.
Tip 12: Reflect
When you finally come to the end of your long day at the clinic or hospital, take some time to reflect on your progress. What went well? What could have gone better? What did you learn?
Put this into direct practice: write down two things that you learned. It could be learning how to best angle your needle for a central line placement, or how to manage and recognize the signs, symptoms, and laboratory findings of diabetic ketoacidosis. Take a few moments to review that information to reinforce your knowledge. Then, give yourself a high five for the knowledge and growth you have obtained in that process. Celebration of successes is important!
Next, write down two situations that occurred during your day and didn’t go as smoothly, and identify ways that you could improve. Then, write down two topics you want to learn, and spend at least 30 minutes reviewing each of those topics. You can even write these items down as you encounter them during your day, but limit this to only two things, to avoid overwhelming yourself. And remember, regardless of what happened, you are on the way to become a more proficient clinician as you pursue the opportunity to broaden your depth of knowledge.
Last but not least: take a deep breath at the end of the work day. You made it! Another day, full of success, failure, and growth. Remember not to berate yourself for a day that did not turn out the way you had hoped. This is just an opportunity to grow, and return the next day even stronger from the experience.
About Dr. Mannarino
Dr. Ian Mannarino obtained an MD/MBA dual degree from UC Irvine. He has over five years of clinical practice, with three years practicing anesthesiology. Ian left the clinical realm to focus on education, health, and wellness. While working clinically, he involved himself in the design and implementation of process improvements in both healthcare and education. Most notably, he strengthened his expertise in the realm of education as an instructor and content creator with Khan Academy, reaching millions of viewers curious about various diseases. He now works with Osmosis as a content reviewer and script writer.
Ian's greatest passions are education, medical science, and wellness. These are the sort of opportunities that make him excited to work! Additionally, he takes a novice interest in astronomy and natural science. His greatest hope is to use his passions, collaborative skills, clinical background, and business background to improve empathy, connection, and wellness within the medical system and broadly, to drive forward thought on social intelligence and mental health. He currently maintains a blog, which you can find at www.livelifemd.wordpress.com.
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