The Osmosis Ultimate Guide to Thriving in Clinical Rotations

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Clinical rotations are a pivotal time for medical students because they take their first big step toward becoming full-fledged doctors. Your days are filled with long hours, there’s a lot of pressure to perform, and you have to make sure to study for exams like USMLE Step 1®. It’s also one of the most exciting times in a medical student’s life because it’s when all of the theoretical knowledge you’ve so diligently learned gets applied in hands-on practice. This guide will help prepare you for clinicals so you can immerse yourself in the next steps of your medical education. 

Getting Started with Clinicals

In the span of four years, the average medical student will learn over 30,000 new words or the equivalent of learning three languages. Congratulations on meeting such a huge milestone!

Now it’s time to apply what you’ve learned and step into the world of patient care. This guide will get you through those first days and help you walk into your clinical rotations with confidence! 

It’s important to understand that every medical school, hospital, and clinic has unique expectations. Some rotations will focus on outpatient clinical settings, while some will occur in an inpatient hospital setting. And while most schools will administer an end-of-rotation test for the pre-clerkship rotations, your evaluations during clerkship rotations will likely be based on the subjective input of the physicians and team members you work with. More intensive sub-internships (4th-year rotations) are evaluated solely on subjective input. You’ve likely never had a totally subjective experience with evaluation and grading, and it’s hard to know how to be successful under these circumstances. This guide will cover the general “rules of the road”, with basic guiding principles to get you on the right track. 

Remember, no matter your location, you’re continuously learning how to care for patients, and each day brings its own special set of circumstances and challenges. Give yourself room to learn, grace to make mistakes, and be open to understanding the needs of others (especially your fellow classmates).

In this guide, we’ll be covering everything (and we mean everything) about clinical rotations, including:

  • Preparing for Clinical Rotations
  • Clinical Rotation Basics
  • How to Prepare for Away Rotations
  • Clinical Evaluation and Feedback
  • Challenges and Opportunities During Clinicals
  • Deciding on a Career Path
  • Finding a Mentor
  • DIAAMONNDS

Now, without further ado, let’s get started with the most fundamental question to help you prepare for clinical rotations: How do I prepare for clinical rotations?

Preparing for Clinical Rotations

Expectations and Responsibilities 

Preparation for clinical rotations starts long before your first day. Remember all those basic science classes and problem-based learning cases? It’s time to apply all of that knowledge to real people. You’ve dedicated the time to studying and passing USMLE® Step 1. Maybe even Step 2. For those of you who haven’t, it’s important to plan your exams so that you can focus on patient care and have your scores ready when applying for residency slots. Requesting time away from rotation to study for exams isn’t appropriate since all physicians have to take their board exams and recertifications throughout their careers, emphasizing the importance of time management skills. 

Woman typing on her laptop with her left hand, holding her mobile phone in her right hand.

Managing Communication

Before you start, it’s crucial to regularly read and respond to your emails, as clerkship instructions and other important messages will arrive often. Take the time to check your spam folder to make sure you don’t miss any important information or clerkship instructions. If you haven’t heard from the clerkship coordinator at least three days prior to the start of a rotation, send a polite email asking for clarification.

Before starting rotations, check for messages on where to report for orientation at clinical locations. Orientation days are not repeated, so attendance on the specified day and time is required. If you can’t attend due to unforeseen circumstances, contact the clerkship coordinator immediately. Rotations usually have a non-MD coordinator, and you should always know who that person is before you start a rotation (don’t say we didn’t warn you)! Medical school directories usually list these coordinators, but if you’re unable to find the information, reach out to an upperclassman and ask for it. Or, if you’re at a new medical school, the Dean of Students or Curriculum is a great place to begin.

TIP: Make sure to find out who the clerkship coordinator is as soon as possible and make a note of their contact information. They’ll provide you with vital information for your rotation!

Before Your First Day

Make sure to give yourself plenty of time to get familiar with your surroundings. Before the first day of any rotation, determine how long it will take for you to commute to the site. Find out where to park and how long it will take you to get from your car to the orientation room. Plan to get lost! And, most importantly, embrace the idea that being ten minutes early is considered “on time.” 

The Dress Code

Unless told otherwise, wear your white coat and make sure it’s clean and wrinkle-free. Stash an extra white coat in the car or a locker, for the inevitable coffee (or other substance) spill. Speaking of attire, choose clothing that’s appropriate for the context. There are tons of articles about assumptions that people will make based on what you wear. You may not agree with their take, but the first day of a rotation is not the time to make a fashion statement. Keep it professional.TIP: Buy at least two white coats and keep the second one clean and pressed in your car (or locker, if available).

Dress Code Policies: No tattoos (cover them up), No perfume or cologne, No nail polish or acrylic nails (due to high risk of infection)

Note that hospitals and clinics may not have space for you to securely store valuables. The items you need with you should fit into your white coat pockets or a small bag or backpack. Avoid wearing your most valued jewelry, watches, or accessories, as they may get stolen. The last thing you want is to add to your stress by worrying about where you left something precious. In addition, many clinical settings have rules about covering tattoos, wearing perfume/cologne, nail polish, and acrylic nails (which pose a significant infection risk to the patient). Get familiar with the policies and adhere to them.

Communication Skills

When you start a rotation, it’s normal to feel like you’ve entered unfamiliar territory. You won’t know your way around, the terms people use may be unfamiliar, and you’ll be uncertain about how things work. You’ll interact with a lot of different people, and communication skills are paramount during the initial days of your rotation. Being a good listener and observer will make a good impression.

Always be kind, especially to those who aren’t on your direct team. For example, the housekeeping staff can help you find your way around. The Unit Coordinator will often have insights into the residents’ and nurses’ preferences. 

Most importantly, remember that nurses are a wealth of knowledge! Don’t be afraid to introduce yourself and work closely with your nursing team, not only to learn but also to give the patient effective care. By communicating effectively with nurses, you ensure everyone on the team is informed and aligned, which is crucial. In taking the time to understand how a team works, you’ll benefit from extra support and will likely earn a great evaluation at the end of the rotation.

Medical team consisting of a male medical student, a male faculty member, a woman attending, and a male senior attending.

Understanding Team Hierarchy

Maintaining a balance between demonstrating humility and showcasing your knowledge is often challenging. Get familiar with the hierarchy within the team, starting with the attending physician to the chief resident, senior resident, intern, and sub-intern. 

The attending physician leads rounds and ultimately has the final say on behalf of the patient. In some clinics or rotations, you may work directly with a specific attending. However, in many instances, you may be on a large team with multiple attending physicians (e.g., the emergency room or ICU). The team will have a lot of say in the day-to-day work and the people you’ll work with. 

Residents are the people closest to you in education and can be your best allies. They have key roles in everyday operations and are the people with whom you’ll spend the majority of your time. While residents don’t always directly participate in writing your final evaluation, their input is important to the supervising attending. So, be collegial, respect social boundaries, and be careful about fraternizing while you’re on the rotation. 

Always keep in mind that you won’t make yourself look better by stepping all over your fellow med students or residents. Everyone on the team is working toward the common goal of helping the patient.

TIP: The attending physicians you work with during clinical rotations are good people to ask for a letter of recommendation!

Interacting with Patients

As a medical student, you’ll often have the most time to interact with patients. Patients may have questions about their disease process and treatment. Always be cautious with your responses, and don’t make any promises on behalf of the team. When the patient has concerns and questions you cannot easily answer, tell them that you’ll consult with the team. Provide a timeline for the patient and keep them updated (see example below). Then, be sure to check in periodically. If there’s a delay, be sure to let the patient know so they’re not concerned if there’s a “bad” reason you might not be getting back to them.

TIP: Always be cautious with your responses and be careful not to make any promises on behalf of the team.

Basic Skills

Most medical schools offer a basic skill workshop like “Introduction to Medicine” to learn things like taking a patient’s history and performing a physical exam. There are some procedures that you may learn in a simulation lab, like starting an IV, drawing blood, and placing a nasogastric tube or a Foley catheter. A lot of skills are taught “on the job,” and the residents will often teach you how to do the skill. Always be respectful of the patient and be sure you know the steps prior to entering the room.

Four panels showing an IV in a patient's arm, health care personnel taking blood, a nasogastric tube, and a Foley catheter.

Clinical Rotation Basics

Rotation Types

Many schools are transitioning to integrated clerkships, which involve longer clerkships across various specialties. While the following list encompasses the majority of rotations you’ll encounter, please note it may not include all the requirements of an individual school.

Traditional Core Rotations - Family Medicine, Internal Medicine, Neurology, Obstetrics, Gynecology, Pediatrics, Psychiatry, and Surgery. Some schools also include Emergency Medicine, Intensive Care Unit, and Radiology rotations.

There are also specialty-specific rotations, including Dermatology, Ear, Nose & Throat (ENT), Neurosurgery, Orthopedics, Ophthalmology, and Urology (to name a few).

Getting the Most from Your Clinical Rotations

Embrace your time on each rotation; it may offer you unique experiences caring for specific populations like children or patients with a particular diagnosis. Remember that you’re not expected to be a specialist at this point in your training. Instead, note that the main goals of core rotations are to develop your differential diagnosis skills so you know when to involve a specialist.

If you’re interested in getting experience in a specialty that’s not included in your school’s core curriculum, make sure to ask about opportunities to spend time in that area. This is a great time to ask your career advisor or mentor about what it takes to be competitive in a specialty. The AAMC Careers in Medicine website offers a wealth of information about each specialty’s competitiveness and how to obtain a residency position.TIP: Need more information? Check out our How To Choose Your Medical Specialty article from fourth-year med student and Osmosis Fellow, Elad Eylat.

Group of doctors on rounds. A medical student ponders the answer to a question being posed to her from the team.

No matter which type of rotation, you’ll be expected to present patients. In clinics, you may present solely to your supervising attending, while you may present to a larger group of people for inpatient service. You may even present in front of the patient, as patient-centered rounds are increasingly common. (Don’t worry! You’ve got this!)

Believe it or not, it’s likely that you’ll have the most time and the lightest patient load of anyone on your team. Take the time to draft your daily progress note in SOAP format (Subjective, Objective, Assessment/Plan) prior to your presentation so you’ve had the chance to think through the problem at hand.

In addition, always be prepared with the patient’s basic demographic information. Never make something up about a patient that isn’t factual. If you’re asked about something you haven’t checked, simply say that you didn’t check it. If you don’t know something, don’t make excuses. Just own it. Because, even though you’re working in a “teaching hospital”, the goal is to keep the focus on providing the best possible patient care and knowing when to seek input from specialists. 

Roundsmanship

Once you’ve finished with orientation, you’ll take part in rounds, a common practice in hospitals. Expect to be asked questions, some related to the patient, some related to specific medical knowledge. 

Generally speaking, the most senior team member, like the senior resident or intern, is expected to answer first. If they’re unsure, the question may be passed “down the line” to the team. Take this opportunity to watch the team dynamics and take note of how questions are handled. Some teams will be more open to you knowing the answer above the senior member, and some won’t.

If a question is directed to you and you know the answer, feel free to respond. If you don’t know the answer, consider offering to look up the information and report back to the team. Honesty and a willingness to learn are highly valued qualities during rotations. For example, if you’re asked a specific question about a patient data point, such as the blood pressure at a point in time or a lab value that you don’t know, once again, do NOT make up an answer. Consider saying something like, “I see that knowing the BP trend is important because of concerns that the patient is becoming septic. I didn’t write that down when I saw the patient this morning, and I will be sure to note that in my pre-rounding going forward.”Is it okay to ask questions during rounds? YES! Absolutely. You’re there to learn, so having questions is natural. The key is in knowing the best time and place to ask them. Avoid asking questions during a serious emergency or when your senior attending appears overwhelmed. Many teams designate specific times for answering questions, so make sure to prepare relevant questions in advance.

Left panel - A med student sits with a patient in a hospital room. Right panel - Two patients sit in the waiting room at a clinic or medical office.

Outpatient Versus Inpatient Expectations

Now let’s talk a little bit about expectations for outpatient medicine and how it differs from inpatient medicine. Often, your outpatient experience will include a clinic of some sort. If you can, try to know which provider you are working with before your clinic day, and even try to look up a patient or two to get a gauge on presentations. You can also look at the note templates that the providers use, so you know some of the information they like to ask that is relevant to their clinic. No matter what, always be on time to the clinic – in fact, be early if you can! Do let your supervisors know of any commitments you have that disrupt your time in their clinic. For example, if you have a mandatory medical school lecture to attend, let the supervisor know the date and time. The end of the day is a good time to ask for feedback about how you did during the day and the improvements that you can make the next time you come. Be prepared with specific questions about the patients you have seen that day.

Illustration of progress notes on a clipboard that say subjective, objective, assessment, and plan, or SOAP notes.

On Writing Notes

You’ll also need to write notes in both the inpatient and outpatient settings. Be sure to get these done in a timely manner, as your supervisors have deadlines to turn in the notes for billing purposes or will face ramifications. Know the differences in the specialties. A daily progress note for surgery may be quite different than for internal medicine or a consult service. 

For example, ophthalmology has a very specialized note. Reading charts in advance will help you get familiar with how notes are written for your service. If in doubt, write a note for practice and show your resident before placing it in the chart. You should also be careful about copying and pasting your note. While you may cut and paste vital signs, be sure you have reviewed the trends carefully rather than simply press control+C! 

Finally, you may use another’s assessment and plan to help guide what you put in your note but do not copy and paste the assessment and plan from someone else. The note should be your own work, written in your own words. TIP: Having a tough time with electronic health records (EHR)? Read The Anatomy of a Chart: How to read and interpret an EHR, on our blog.

What to Expect During Your Shift

People get sick twenty-four hours a day, seven days a week, 365 days a year, so expect a demanding schedule. In the US, there’s a strong desire to keep to an 80-hour work week, with uninterrupted sleep and rest. Comparatively, in the UK, resident physicians are limited to no more than forty-eight hours of work weekly, with variations ranging up to 100 hours across the globe.

Each rotation has its own norms. Make sure to arrive early enough to review everything that’s happened overnight to the patients you’re following. Take the time to review the new data and notes left by the nursing team or specialists while you’re away. Then, organize your thoughts into a coherent patient story before rounds and allocate time for research (i.e., consider developing a differential diagnosis) to determine the best plan for your patient.

Be prepared to accompany your patient to studies or gather information about other patients when requested by the team. If the day is coming to an end, it’s okay to ask about finishing up but do your best to ask with enthusiasm for the rotation. For instance, rather than saying, “Are we done yet?” consider saying, “I’ve tucked in my patients for the evening. Is there anything else I can do to help the team?”

Finally, you’ll likely be asked about the specialty you’re considering. This is NOT a trick question. It’s important to be honest about your aspirations. If the team/Attending knows your chosen field, they may be able to direct their comments and teaching to that specialty. For example, if you want to be a surgeon, but struggle with tying surgical knots, it may not be the right specialty for you. However, if you want to be a psychiatrist, simply knowing how to tie basic knots is fine.

Last, but not least, it’s common for good-natured jesting to take place. Humor is a valuable tool for coping with the challenges of a rough day. Feel free to smile and laugh (when appropriate, of course) to foster a positive atmosphere and navigate through tough times.

Illustration of a map of the US with a plane flying from the east coast to the west coast.

How to Prepare for Away Rotations

Once you successfully complete your home core rotations, consider doing “away rotations”, which are essentially extended job and performance interviews. To explore different places for your rotations, take a look at the AAMC’s guide to Visiting Student Learning Opportunities®  (VSLO). 

For most away rotations, you’ll need to show that you’ve passed USMLE® Step 1 and have an updated vaccination record. Many programs also need a letter of recommendation, which should come from a clinician (like your senior attending) who can vouch for your skills and reliability as a medical provider. 

Your personal statement for away rotations should be brief, sharing why you have an interest in that particular facility and why you’re the best choice. You don’t need this statement to be as extensive as your residency application statement, but it should include a letter from a clinician who can attest to your skills and trustworthiness as a healthcare provider. TIP: It’s crucial that you apply for away rotations as soon as they open because competition is very intense for those positions. Keep an eye out on the VSLO platform and apply promptly.

A medical student preparing to travel to their away rotation destination, holding a VSLO guide.

Should you do an away rotation? 

Deciding on whether to take part in an away rotation depends on your specialty. Most schools will limit the number of away rotations so that you have a more complete education by the end of medical school. Residency programs will often ask about your fourth-year schedule and want to know you’re ready to be a well-rounded MD, as they have years to train you as a specialist. 

Some specialties (especially very competitive ones) may expect you to agree to two or three away rotations. However, some medical schools may not have traditional departments or residency programs, making away rotations necessary. If this applies to you, try to do a rotation with a full complement of residents at a “home site” (a group associated with your med school) before venturing to an away rotation.

Illustration of an immunization record.

Before applying through VSLO, make sure your immunizations are up-to-date. Your medical school needs to send an official transcript and confirm that you’re a full-time student that has appropriate insurance coverage (personal healthcare, malpractice, and disability). An affiliation agreement between your school and the away rotation site is necessary. Consult with the registrar of your school for this information. You can also check to see where other students from your school have rotated. 

If you attend a new medical school, make sure it has full accreditation status (not just preliminary/provisional accreditation) from the Liaison Committee on Medical Education (LCME), as some programs won’t accept a student unless the school is fully accredited. (The LCME grants accreditation to medical schools. New schools often have preliminary or provisional accreditation, which isn’t considered full accreditation.)

How many away rotations should you apply for? 

There’s no guarantee that you’ll get the spot or time that you request, so apply for several sites at several time slots. Be sure to accept promptly and then withdraw outstanding applications once you have secured a slot.

Communicate with the coordinator prior to your arrival and make sure you leave yourself time for travel to be there for orientation. Plan for business casual, but always bring an “interview suit” (business formal) in case you have the opportunity to speak with the residency program director during the rotation. Try to schedule this in advance of your arrival, so they’re aware of how interested you are in their program.

Last, but not least, going on away rotations can be expensive; you have to find a place to live as well as arrange regular transport to your clinical site. Be sure to check whether a program offers scholarships to cover the cost of living or if there are alumni from your school in the area willing to host a visiting student. If possible, consider living with family. If costs are prohibitive, consider staying closer to home for residency.

TIP: When it comes to away rotations, make sure to apply for several sites at several time slots to secure a space. If you’re chosen for several rotations, you’ll have the opportunity to consider which one will best suit you.Want to excel in your classes and on exams during clinical rotations? Take a tour of the NEW Osmosis Clinical Sciences library with Dr. Maddison Caterine, Senior Director of Medical Education at Osmosis.

Clinical Evaluation and Feedback

One of the most challenging aspects of starting rotations is adjusting to evaluations shifting from objective to subjective. Up to this point in your medical school journey, test-taking has become your superpower; you’ve survived any number of standardized and subject matter-focused tests that depend on having one right answer. However, working with patients often inspires more questions than it answers, which can result in a variety of possible approaches to a diagnosis and treatment plan.

This is where feedback and evaluation come into play. It’s hard to be evaluated by subjective feedback, and there will be days when it just doesn’t feel good. You did everything you were supposed to do: you’ve read everything relevant, you showed up early, you knew lots and lots about your patient, and then you’re asked the one question during rounds that you can’t answer. Just know, everyone has those days. This is a learning moment; humbly acknowledging that you’ve identified an issue will demonstrate resilience and a commitment to improvement.TIP: When facing challenging situations, acknowledge them as learning opportunities. Embrace feedback, even if you disagree with it.

An attending writing up an evaluation for a resident medical student.

Giving Feedback

When the rotation is complete, you’ll be asked to give feedback on the members of your team. While most evaluations are anonymous, making it tempting to speak your mind, carefully consider what you want to share. Be constructive and thoughtful. Even if it’s tempting, avoid being insulting, since it’s neither kind nor helpful (and you may have to continue working with that person). Focus on feedback that can potentially contribute to growth and positive change.

For example, you might be hurt that someone ignored you on the rotation and didn’t teach you much. So, instead of writing, “Dr. X ignored me”, consider writing, “Dr. X has a lot of knowledge to share. However, they didn’t seem comfortable teaching students, and we missed out on the opportunity to learn from Dr. X”.

Getting Feedback

During rotations, you’ll be evaluated based on how well you interact with the medical team and patients, as well as your ability to learn and grow. To excel, be prepared. If you’re in a surgery rotation, make sure you’re familiar with the relevant anatomy for the procedure and read ahead for your cases.

Medical student receives feedback from their attending.

If you don’t know the answer to a question, try offering a reasonable answer rather than guessing. Follow up and ask residents about the best source for further reading. Look the answer up on your phone, but be careful! Don’t focus so much on your phone that you appear disengaged. Most importantly, be prepared to answer why you’re choosing a diagnosis or suggesting a particular treatment plan. This type of reasoning/questioning will occur on every patient, every day, several times a day, and is the basis of your clinical evaluation.Note that you’ll get feedback both in real-time and at the end of your rotation. Some of the feedback may be vague. Embrace the process, and don’t hesitate to share any concerns early on. For example, perhaps you receive a comment like, “You need to read more.” A good response would be, “What are sources that you like to use?” Stay curious!

A student in clinical rotations looking up a Osmosis decision-making tree on their phone.

When There’s an Issue During Your Rotation

While it feels awkward to be the center of attention, it’s even worse when you feel ignored. If this happens, have a private conversation with the person closest to you in training (the intern or resident). There’s also a clerkship director for all rotations, and they’re usually the final arbiter of any problematic issue. 

Don’t wait until you get a lukewarm evaluation and then speak up, as that can be perceived as “grade grubbing” or trying to get a grade changed rather than being proactive about an issue while it’s happening. Keep in mind it’s okay not to know every answer, and seeking advice and feedback is a sign of dedication and willingness to learn.

TIP: Have an issue during your rotation? Speak with the people closest to you in training for suggestions, or reach out to the clerkship director. Being proactive is a good thing.

There will be days that you don’t feel you’ve been able to meet expectations. Don’t be too hard on yourself. Reach out to an advisor, resident, counselor, or friend to decompress and cope with challenges. Asking for feedback or creating a list of skills you need to improve on can also help your preceptor guide you more effectively.

Be aware that you may not always recognize when you’re being given feedback. This is especially true if the feedback is informal, such as an offhand remark about your presentation skills on rounds. If you feel you’re not getting consistent or enough feedback, share that with your team.

About Medical Student Performance Evaluations (MSPE)

In the US, the comments from the clinical rotations end up in a summary letter from the medical school called the MSPE, or medical student performance evaluation (formerly known as the “Dean’s letter”). Most schools put the letter together in the summer before you apply for residency. The comments are taken verbatim, so make sure to read your evaluation comments promptly, before the letter is crafted, and review them with a trusted senior advisor. Residency program directors like to see specific examples; what made your performance “excellent,” and what are some ways that you stood out while on rotation?

The MSPE starts out with a section on “Noteworthy Characteristics”. Most schools will ask you to write this about yourself. This section is written in the third person as if you were the Dean. Think about what you want the reader to know about you that’s not in your application. In general, you want to focus on topics that make you stand out. For example, mentioning your efficient time management skills because you excelled at medical school while volunteering and working a job is more impressive than getting a top mark on an exam.

The MSPE also has sections that show your clinical grades, with a spread of grades for your class. The free text comments from rotation evaluations are always important. Many med schools have shifted to a pass/fail system, meaning the only objective score on your residency application will be your USMLE or COMLEX Step 2. This means that subjective input will be very important and includes the personal statement you give your Dean, as well as meaningful experiences and clinical comments. This is where you distinguish yourself from others. Be sure you show these parts of your application to your advisors to get feedback, and don’t wait until the last minute to start working on these essays.

Overall, success in rotations relies on adaptability, a commitment to learning, and the ability to handle feedback constructively. Embrace the learning process; it will pave the way for a successful medical career.

Medical student at work, holding a patient's hand while they're in the hospital. Same student biking on a nature trail. Work life balance.

Challenges and Opportunities During Clinicals

In the world of medicine, you need to be prepared for the unexpected. Patients and diseases often defy textbook descriptions, and sometimes it feels like everything you see is a clinical zebra rather than a standard diagnostic horse. Don’t despair, embrace it! This aspect of medicine is part of the adventure and the thrill of discovery. Remember that there are those who’ve walked the path you’re on now, and they’re eager to share their wisdom and experiences with you. Seek them out and learn from them.

Finding Work/Life Balance

Perhaps one of the biggest challenges of medicine is finding work-life balance. Here are some tips to help you find and keep it!

  • Stay organized with a calendar/organizer
  • Get enough quality sleep
  • Exercise regularly
  • Eat a balanced diet whenever possible

It can be hard to maintain a healthy daily practice, but it’s crucial to your ongoing success. Remember, becoming a doctor is a marathon, not a sprint! So, how can you make sure that you get in that session of yoga? Try using fitness apps! What if you have a mandatory event you need to attend that’s not related to your medical duties? Tell your clinical supervisor as soon as possible, before starting a rotation if you can.

Calendar filled with plans for studying, exams, going to the gym, and mom visiting.

How to Recognize and Avoid Burnout

Taking care of patients can be emotionally rewarding and draining at the same time. If you find yourself experiencing feelings of apathy, exhaustion, and low motivation, or if you’re feeling like you’re a failure, experiencing a sense of helplessness, or you get feedback from colleagues and friends that you don’t seem like yourself, you may be facing burnout. So, how can you prevent or cope with burnout

First, take advantage of opportunities related to stress management like yoga classes, sleep health, or mindfulness sessions. Incorporate regular self-care activities into your day, even if they’re just small moments like five minutes on a bench outside or taking a quick walk when you feel overwhelmed.

Medical student backpacking in the woods with their two dogs. Work life balance.

Second, build and maintain a support network with peers, colleagues, friends, and family who uplift and encourage you. Engage with patients. Pursue research projects that align with your interests and goals. Find extracurricular activities that offer flexible scheduling so you can enjoy them when you have the time. While there’s no one-size-fits-all approach, choices like this contribute to your overall well-being and sense of fulfillment, helping to stave off burnout. 

Next, make sure to celebrate your accomplishments and achievements, no matter how small, and give yourself grace as you make your way through your learning journey. Research shows that acknowledging gratitude is one of the best ways to reduce feelings of stress and anxiety.

Illustration of a med student happily sleeping in their bed.

Consider reframing your thoughts. For example, your sleep pattern will likely be disrupted when you’re on-call or have to shift from working days to nights. Think of the schedule shift as a case of jet lag. What works for you when you travel? Would gradually shifting your sleep schedule leading up to the change help make it easier?

Above all, in times of overwhelming stress or when experiencing persistent symptoms of burnout, don’t hesitate to seek professional help. Reach out to counselors, therapists, or mental health services. Prioritizing your well-being throughout medical school and beyond is crucial for long-term success and resilience in your career. After all, if you don’t take care of yourself, how can you take care of others? Taking the time to discover what it takes to stay healthy (both physically and mentally) is critical to being a good physician.

Medical student standing at a crossroads trying to decide if they should work in medicine or in another area of health care.

Deciding on a Career Path

There are a variety of resources you can refer to when it comes to determining your career path. Take some time to learn about your options. The AAMC has a comprehensive resource called Careers in Medicine that takes a four-part approach to career decision-making. It begins with understanding yourself and provides tools to explore career options, choose a specialty, and prepare for residency. It also includes resources to help you determine how competitive a specialty is based on reliable information they’ve collected nationally. 

Finding a Mentor

As you explore various specialties, make sure to seek out people in those fields to get their perspectives and understand their journey. Mentors can be found beyond medical school. For example, attending webinars is a great way to meet experts and get answers to your burning questions. Avoid relying on online forums like Reddit. The best information comes from professionals with experience, who can help you make an informed decision.Once you decide on a specialty, the next step is understanding residency application requirements. Letters of recommendation are crucial, and while program websites may ask for a minimum of three, plan on four, preferably from those who’ve worked with you on clinical rotations (unless you are applying for a research fellowship).

Illustration of a letter of recommendation

Ask for strong letters of recommendation and provide an updated CV and a draft of your personal statement. Remind your letter writers about the time you rotated with them and include any relevant clinical comments from your evaluation. Include a high-quality headshot (if you feel comfortable doing so), as letter writers often have many students and perhaps many letters to write. 

TIP: Some specialties require a letter from the Department Chair, even if you didn’t have a rotation with them. In that case, ask your institution about acquiring this letter and ask well in advance!

For application submissions, ERAS® or the Electronic Residency Application System is most commonly used in the US. However, different specialties may have their application systems:

  • Urology uses the ERAS application but has a different timeline for the Urology Match.
  • Plastic Surgery uses the ERAS application but is also trialing a specific Plastic Surgery Common Application that has different timelines. 
  • Ophthalmology uses the San Francisco Match application.
  • The military branches have a separate application system.

Stay informed and prepared by checking the relevant specialty society websites.

Conclusion

Going through clinical rotations is an unforgettable journey where learning and theory become reality. Clinical rotations expose students to a variety of medical specialties, each with its own unique challenges and objectives. From internal medicine to surgery, pediatrics to psychiatry, rotations go beyond knowledge gathering. It’s about connecting with patients, mastering communication, becoming a quality team member, and learning how to stay resilient under a lot of pressure. 

As you evolve into a compassionate healer, let this guide serve as a guiding start to light the path. And don’t forget to practice…DIAAMONNDS! 

DEDICATION/PROFESSIONALISM  Show respect Recognize people are looking to you for help Authority figure On time is EARLY  INTRODUCTION Always introduce yourself to the patient & family and your clinical team Be aware of body language (eye level, eye contact) You will always be busy, but do not appear rushed or impatient Reset before entering a patient room and be fully present   ATTITUDE It’s never about you, always the patient Kindness, humility, empathy Patience Show appreciation for all calls/consults  ABILITY Always be prepared If you need help, get it and admit you need it Second opinions are welcome Curbside chat with a colleague   MISTAKES Everyone makes them Honesty, transparency, truthfulness in the record Discuss with trusted advisors Get personal help  OPTIONS/TRIAGE ABCs first DO NOT PANIC Patient emergency/Family emergency Set personal and patient care priorities  Be adaptable, flexible Hiccups will occur  NOTORIETY/REPUTATION You’ll have one (a reputation) Everyone will be evaluating you, consciously or subconsciously Respect everyone, Smile and be cheerful Avoid complaining, come with a solution Go the extra mile Pick up the slack for your colleagues Don’t blame Lead by serving Dress for success  NOTES/MEDICAL RECORDS Tell the truth, Never bend the truth or falsify Be careful about what you enter in the chart Organize notes in an efficient manner Prioritize diagnoses Do not mindlessly cut/paste  DIFFICULT SITUATIONS Expect them daily Always show respect Composure in the moment, reset Surprises are normal Asking for help is okay Get help: witness, chaperone, social services, clergy   SURVIVAL: INTEGRATION Everyone has life stressors - it’s ok Fear of failure - we all have it Take care of basic needs Take care of family, relationships  Seek friendship, support, and mentorship Deal with anxiety, depression Give yourself grace

Contributors & Reviewers

Yolanda Becker, MD, FACS, Osmosis Clinical Content Editor, Surgery

Antonella Melani, MD, Osmosis Content Manager, Script Team

Katie Schultz, MD, MEd, FAAP, Osmosis Clinical Content Editor, Pediatric

Stephanie Stevens, Osmosis Brand Marketing LeadMake your study time more efficient and stay a step ahead during clinical rotations with the NEW Osmosis Clinical Sciences library! Try it free today.


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