Help! Third Year Clerkships! >> How to "Walk" Instead of "Wander" the Wards

Third Year Tips for the Wards

Every rotation is different, for better or worse. This can cause a lot of discomfort (at least it did for me!) because I was busy trying to find out where the bathroom was in addition to all the new clinical aspects of patient care. Some tips for third year:

• Have fun! We know medical students are on the wards. We want you there. I promise. You have the luxury of time -- get to know your assigned patients, do a deep dive into every aspect of their condition (see below section on where to find that information), pore over their chart, and understand their story of who they are. Take advantage of this!

• Ask questions! No one expects you to be mastery of it all, that is what you graduate med school and then do a residency before we let you loose and completely autonomous. Ask where the bathroom is, ask why residents chose that drug, ask why the attending made the decision to do x, y, z

• At the beginning of the rotation, ask about expectations. It is difficult to meet people’s expectations if you do not know what they are. Figuring out a template for how to approach this for yourself will be helpful. It can be simple, such as, “Hi I am X, the third year student on this rotation. What are your expectations of me on this rotation (week, shift, etc)? What can I do without needing to ask in order to be a helpful member of this team?”

• Get curious and look something up every day. It does not need to be boring or from a basic biology textbook. If you see a patient, identify 1 or 2 things you want to explore and that night do a deep dive into why that occurred. Why did they have shortness of breath with congestive heart failure (pathophysiology)? Why did the we use magnesium for 24 hours after delivery for seizure prevention on labor and delivery?

  • You can use uptodate TO START but only use this as a jumping off platform. Uptodate is written based on expert opinion, which is just that. Opinion. Do not use this as fact. You MUST look at the primary resources and decide for yourself based off the data. Do not let anyone else tell you otherwise.

• Question everything (or my NYC-training slogan: trust no one, expect sabotage). Don’t question out loud, or your residents all the time, because as a resident it is difficult to achieve your daily tasks if you are answering questions that could have been answered in the literature. However, think to yourself “why did they choose Lasix over an ACE-inhibitor?” and then look it up. And then, if you can’t find an answer, ask the resident/attending.

• Get credit for the work you do. If you are curious about a topic and then read about it, feel free to summarize it in a one-page document (I used to call it “the Morning Espresso” for your daily shot of knowledge). You can ask to discuss it with the residents the next day to get a better nuanced understanding of the topic

Where to find Clinical Information

You can use your clinical information finding framework.

Every single society has practice bulletins and guidelines.

Every sub-specialty has a society with their own practice bulletins and guidelines.

For infections, use the “Infectious Disease Society of America”

For Ob/GYN, use “American College of Obstetrics and Gynecology”

For cardiac disease, use “The American Heart Association Guidelines”.

If you’re not sure, as the residents where they go for guidelines and standards of care to dictate clinical care.

[Note: uptodate does not make this list]

Specialty Selection

You do not need to have selected a specialty. I promise.

I chose my specialty August prior to my fourth year. Applications were due in September, the next month. It is okay!

Instead focus on what you enjoy about each rotation. Do you like complicated patients? Do you like healthy patients?

Do you like fixing problems and having a concrete easy solution?

Do you like the disease process or would you rather follow the patient with the disease?

We need all types – no judgement!

Each rotation, think about what your “best” day was. What made it so fun?

What about your “worst” day. What made it so bad?

Specialties have stereotypical cultures, but you do not need to fit in that mold. You get to dictate what kind of physician you are, so think about the patients in that specialty and the relationships, day to day findings, and what has motivated others to pursue that field.

Letters of Recommendations

If you work well with an attending and you are considering that specialty, just ask at the end of the rotation. Ask for an individual meeting or during the time you are working with them, just casually mention you love this specialty and you would love to get a letter of recommendation when you are applying. You can be transparent.

TL;DR

1. Have fun

2. Be curious

3. Ask questions

4. Email/contact me for anything

Thanks!

MedEd Hustler