Growth Mindset: Things to Remember on Your Clinical Rotations

Posted by Viemma on 2/20/19 7:11 PM

Thigns to remember on clinical rotations

It’s finally that time of your medical school career. The moment you’ve been anticipating since you matriculated. Upwards and onwards. The wards. Up until this point, you have been incubating in your safe and familiar classroom building, only dibbling and dabbling at patient care every now and again. Now you’ll be going through a year, the year, of clinical rotations. 

So, what are clinical rotations about? For one, they’re about taking care of patients. They’re also about developing competency as a soon-to-be physician. Still hard to believe, huh? That in a couple of years, “Dr.” will be your title. Ready or not, it’s coming soon and during your clinical rotations you will become competent by learning, feel competent, and demonstrate your competency to others. On the wards, you will feed your passion for medicine with experiences that will remind you of why you chose to venture on this journey in the first place. And finally, on the wards, you will be exposed to many medical specialties that will inform your decision on what you do your residency in. 

There are some very important differences between learning during pre-clinicals and learning on the wards. During pre-clinicals, most attention is on you, the learner. On the wards, most attention is on the patient – and rightfully so. I mean, isn’t this what medicine is all about? During pre-clinicals, learning opportunities are mostly formal. On the wards, learning is more informal than it is formal. During pre-clinicals, the focus is on acquiring a fund of knowledge.  On the wards, the focus is on acquiring clinical skills. That’s great that you know all about the pathophysiology of systemic lupus erythematosus, but do you have the clinical reasoning skills to identify it in a patient who may not present like the textbook says? During pre-clinicals, everything is standardized. Everyone takes the same tests, has the same teachers, has access to the same notes. On the wards, there is variation in the cases one may see and the supervision one may have. Lastly, during pre-clinicals, the stakes are low-ish. On the wards, the stakes are much higher, as these are the evaluations that will hold a lot of weight.

That concludes my mini introduction to clinical rotations. It will probably be one of the most transformative times of your professional life so get excited because it’s going to be great.

Based on personal experience, here are things to remember on your clinical rotations:

1. The little things do matter

Figuring out exactly what your role is as a medical student on the wards will probably throw you for a loop several times over. Fresh out of the classroom, you really don’t have that much clinical experience which means there a lot of things you’re not going to be able to do. The things you’ve read about, the “cool” things.  In addition, you will be joining a team with a pre-existing history – a pre-existing chemistry even – for only a few weeks.  It’s easy to feel like nothing more than guest in these circumstances, a fleeting existence. Always “just visiting”.  You may even begin to feel like you are imposing and that there’s nothing you could possibly do to make a difference. Refrain from thinking this way! Sure, there are going to be a handful of tasks that are off limits for safety purposes. But there are so many things that you can do. You’ll discover them as you immerse yourself into the rotation. These things, as little as they appear to be, really do count for something. And you are an integral member of the team because of this. Whenever you catch yourself thinking otherwise, stop and consider all the big things that wouldn’t be accomplished if your team had to also manage the responsibilities you so generously took on.

2. Be enthusiastic and willing

It’s very easy to get lost in the fact that you are being evaluated during your time in the rotation. You may find yourself frustrated that you had a really good patient interaction, and no one was around to see it. Or that the residents keep switching schedules and no one is going to be able to speak about your progress because you’re with a different resident every day. The wards are fast-paced, and things are constantly moving. All of these things are accounted for and you should not be actively worrying about grades. The truth is, by the time the end of the rotation approaches, your evaluators will have probably forgotten half of the things you were able to accomplish. All the patients you followed, the H&P’s you did, the notes you wrote, the consults you called, the surgeries you scrubbed in on… that’s great and all, but were you excited to do so? Were you eager to help out? To learn? That’s what your evaluators will remember and that’s what holds more weight. When it comes to having your performance assessed, it’s not about what or how much you did, it’s about how you did it. I say this to say the following: Don’t think about the grades. Be the very best version of yourself and trust that everything else will fall into place.

3. Learn from every- and anyone

You have finally entered the clinical learning environment where you will begin to experience the way multiple disciplines work together to care for patients. Students like yourself, residents, fellows, attendings, nurses, aides, nurse practitioners, physician assistants, social workers, physical therapists, occupational therapists, pharmacists, administrators, etc., etc. Second to taking care of patients, filling in the knowledge gaps you have should be a priority of yours. Any of these people can help you achieve this goal. Though it may seem like you’re supposed to be attached to a resident’s hip throughout the entirety of your rotation, this is not the case. There are going to be times when your resident is too busy to teach you and that’s okay. Remember that you are no longer the focus. The patients are. There are also going to be times when you literally cannot be attached to your resident’s hip for reasons beyond your control. Like when patient does not feel comfortable with a student in the room during a sensitive exam. Or when your resident tells you there’s no room in the operating room because two attendings and two residents have scrubbed in, making you fourth assist aka no assist at all. This is okay too. There are so many people you will encounter and have the opportunity to learn from on the wards. Take the opportunity. Whether it’s going to help a labor and delivery nurse push with an expecting mom. Or calling a social work consult and sticking around to follow the case through even though the medicine part is over.

4. Fight the urge to be timid

This one is pretty self-explanatory. The medical training hierarchy can be quite intimidating as a medical student. Everyone knows this. Fight it. It’s easier to tell a person to step back than it is to drag a person forward. One of the worst things you can do as a medical student is be dragged forward. And you probably won’t be told to step back so long as you are not obnoxious. It takes hardcore effort to be obnoxious so don’t worry yourself. The need for a little hand-holding will be expected, especially in your first ever rotation. Don’t hide behind the steep learning curve. Exceed expectations whenever you can.  Ask to scrub in on that case you find interesting. Ask to put that Foley catheter in because you’re only going to get comfortable with practice. Share your assessment and plan even though there’s a high probability that you’re way off. The worst thing you can be told is “maybe another time” or “that’s not quite it”.

5. Spend time with your patients

Patients spend all day waiting for just one visit from the doctor with updates that they can share with their families over the phone afterwards. They spend all day waiting for an encounter that usually doesn’t last longer than 10 minutes. Can you imagine? Being a patient sucks. Waiting can range anywhere from being boring to utterly anxiety-provoking. As a medical student who certainly isn’t responsible for as many things as an attending or resident, you have the opportunity to spend time with these patients. Their families may be unable to be with them 24/7, and some patients may not even have family in the area or family at all, so your presence can really be a great pick-me-up. Using your down time to visit patients and keep them company is probably the most fulfilling thing you can do on the wards. By doing this, you will have the opportunity to engage in some incredible conversations as well discover things about these patients that you wouldn’t have discovered otherwise. You may even find yourself being a patient’s primary advocate, sharing things that could be change a management plan drastically. The freedom medical students have to be able to sit with a patient for hours if they wanted to is highly valued by the medical team as it makes for patient-centered care.

6. Study about your patients

It’s true that the tests don’t end just because you are out of the classroom. You are expected to take the shelf exam after each rotation and how you do on this exam does influence whether or not you get honors in the rotation. With this in the back of your mind, you may be preoccupied with making sure you read an ancient textbook cover to cover. And you can very much read that book cover to cover if you put your mind to it. But please do not forget about reading up on the patients you are following. Remember that the most important goal on the wards is to take care of patients. And you’re doing a disservice to your patients if you aren’t studying about their illness in real-time. By learning the ins and outs of a patient’s condition, you could potentially be acquiring knowledge that will inform how they are cared for. You may even find yourself in a scenario where you are teaching residents and attendings something you studied the night before. After all, they’ve been out of the classroom for years and can’t possibly remember everything.

7. Take initiative

It’s been a few days of being with the team. You’ve watched your residents closely to see how they like things done. You’ve been instructed to do a variety of things and they have eventually formed a pattern that you can recognize. You’ve gotten the hang of things if you do say so yourself. At this point, you have deduced what your role as a medical student will be on this particular team. That’s great. Time to free your residents from all the babysitting they’ve been doing. You should no longer be waiting to be assigned to job. Volunteer yourself. At this point, you should have a good idea of what tasks are student-friendly and what tasks aren’t. And if you don’t know, just ask. Eventually you should get to a place where you’re volunteering yourself without a grand gesture. You’ll simply pick up on the fact that there is something to be done because you are mindful, go to where that something is, do what needs to be done, and let someone know that it has been done when you return. The best thing you can be for your team is self-motivated.

8. Be inquisitive but do so with social awareness

You’re a medical student. Learning is definitely a part of your job description. And chances are that if you made it into medical school, you were probably already a super curious person to begin with. Don’t lose that. On the wards, you’re going to see things you’ve never seen before and you’re going to have questions. Go ahead and ask them! That’s what this experience is all about. Being exposed to new things and figuring these things out by working through them. If you have questions, it’s because you’re paying attention. There are going to be times when getting your questions answered clears things up for people other than just yourself. There’s a good chance that the other students with you had the same question. And your residents are smart people but sometimes they themselves don’t know what on earth their attending is talking about. Inquiring about it can be learning opportunity for them as well. So yes, ask your questions. Say it loud and say it proud. Just be mindful of when, and only do so when the time is right. Read the room. Ask yourself the following: Would this be an appropriate time to ask? Let’s say you’re on your OBGYN rotation, a specialty you probably had all of two lectures on during pre-clinicals. I know it would be great to know what the indication was for inducing labor in that last patient, but this patient needs a crash C-section and all focus must be on getting this baby out in minutes. This is obviously not the time to ask your question. If you’re afraid you’ll forget the question, write it down in your notebook and revisit it later. 

9. Take it one day at a time

Clinical rotations are not a walk in the park. You will now have the responsibilities you had during pre-clinicals plus a billion more. Your schedule will no longer flexible. Your time will no longer be your own. Patients will actually be relying on you now. Not to mention you will still have tests to study for. It will be quite the adjustment, but it will all be so worth it. The days will be long, but the weeks will fly by.  And before you know it, it will be over. So be in each moment as they come. 

Best of luck!

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