I must confess that I did not enjoy my clinical rotations. Well…..at least not in the very beginning.
You see, I had grown accustomed to the objective grading style and standardized assessments inherent to the first two years of medical school. I knew my role and exactly what to study. It was oddly comforting to know that every question had a correct answer.
Don’t get me wrong, I was stoked for the clinical years. I had amassed a fund of high-yield USMLE knowledge, and I was excited to finally start putting it to use in the real world.
Unfortunately it turns out that what is high-yield on Step 1 rarely even shows up in the real world. And real clinical medicine is messy. Patients often had atypical presentations with competing problems. It became clear that I still had a lot to learn.
To make my discomfort worse, the clinical grading rubrics were full of nebulous criteria that reeked of subjectivity. I felt like I had to play mind games just to get the grade I needed. I didn’t want to play games. I just wanted to learn medicine and learn how to take care of patients.
Fast forward about a month and a half.
I was no longer just the most awkward member of this speed walking white coat entourage. I had a sense of purpose. I felt like I was contributing. I was getting better everyday and didn’t feel like I had to put on a show for anyone. I had learned the most important lesson of clinical rotations:
The grade takes care of itself when you focus on adding value and not on looking good.
How Do Medical Students Add Value?
In my time both as a medical student and as a resident, I have crossed paths with some stellar learners. And it’s important to not forget that learning is your primary purpose as a medical student. But you can actually learn quite a bit while also contributing to the team.
I’ll give you some real life examples of adding value as a medical student, but there are lots of ways to do it. This is by no means an exhaustive list. I just hope that it helps you get started.
- Pick the low-hanging fruit.
- Be a patient advocate.
- Receive feedback gracefully.
- Be teachable.
- Use your unfair advantage.
- Have the best attitude on the team.
Pick the Low Hanging Fruit
As a medical student you want nothing more than to be helpful. But it is hard to figure out what you can do that would actually be helpful.
Two of my favorite medical students during intern year understood the principle of “low hanging fruit”. They were at the end of their third year and were rounding the corner into becoming MS4s. Despite their experience, they were more than happy to help with every aspect of patient care.
I feel like “low hanging fruit” is a better phrase than scut work, but yes, that’s essentially what it is.
And just to be clear, I am not suggesting medical students should be resigned to only doing scut work. I am only suggesting that being willing and even volunteering for it (occasionally) does help the team. The “low hanging fruit” is still important and it must be picked. And it doesn’t require vast medical knowledge, so it is an opportunity to get involved.
Here are some of the examples of things these MS3s did that could be labeled as “scut”, but that honestly were a big help to me and the team.
- Sat with a patient while she was getting dialysis and convinced her to stay in the hospital until we finished working up her chest pain.
- Called a patient’s nursing home to get records and contact numbers for family.
- Volunteered to check toxicities of an uncommon chemotherapy our patient was on and talk with the pharmacy.
- Called patients’ family members to update them about their loved ones.
- Doubled back after rounds to check in with patients frequently.
If you hear the intern groan about something, volunteer to help them out. On my family medicine rotation during MS3, my resident was really nervous to call cardiology about a patient because the consultant had a reputation of being mean. I volunteered to call the consult for her. And yeah, he was super mean, but he wasn’t writing my evaluation. The resident was. And she was impressed.
Be a Patient Advocate
As the student on the team I often felt more aligned with the patients than the rest of the team. I was still pretty new to healthcare so I was observing some of the same quirks that the patients were. When patients complained that they never saw the doctors after rounds, I would set an alarm on my phone for 2 hours and then include in my plan that I would check in with the patient every 2 hours throughout the day. This helped the team and also strengthened the therapeutic relationship. And honestly, I was the best person for that job because I had the time.
Medical students may also be able to get more of the patient’s story by spending more time talking with them or reviewing their chart. Knowing your patient’s history well is one of the most important things you can do. The team will look to you for that information. It also allows you to be able to communicate what the patient values to the rest of the team.
I always made it a point to leave the patient’s room the way we found it on rounds. Often the team would come in, mute the TV, pull the beside table away, examine the patient, and then head out the door. I would stay behind to make sure everything was back within the patient’s reach and that they were settled. One of my attendings noticed on day 4 of working together and waited outside the door and made it a point to thank me for my kindness.
Receive Feedback Gracefully
You are new at this. It’s expected that you will need some coaching along the way. Some people are better at giving that feedback than others. Your job is to accept that feedback, and try to implement it. You are able to add more value by learning more and doing things more efficiently. It is difficult to give people actionable feedback. And if it is poorly received, they likely won’t do it again.
It’s hard to be told that your best efforts are falling short. But welcome to medical training and the next several years of your life. Find a way to appreciate that the person who is giving feedback is invested in your success and that they care enough about you to try and help you improve. Sometimes the feedback is warranted, sometimes it isn’t, but appreciate the thought in the moment, and decide if it is relevant later.
If people aren’t giving you feedback, then you probably should ask for it. I found it best to ask for “coaching” or “tips”. It made the person feel more comfortable by making it less formal. Or I would ask for specific feedback, like “Can you help me with my presentations? I want to make them more succinct but I’m not sure how.”
I had one resident tell me early on that he gives everyone good grades, but that he wasn’t interested in coddling me. He was pretty brutal. But I listened to his advice and did my best. In my evaluation he wrote “he acted on every piece of feedback he was given and in the end he excelled in his role.” And I may or may not have ugly cried when I read that.
One of my mentors used to say “There’s no comfort in the growth zone, and no growth in the comfort zone”.
This is related to the above point, but I wanted to include it separately because it is important. Residents and attendings love to teach. Especially when the teaching is well received.
If you have a good attitude and are excited to learn, then people will keep teaching you.
And sometimes people will teach you things you already know. That’s okay. It doesn’t have to be your mission in life to tell them you already knew that information. One of the students I rotated with had a habit of saying “Oh yeah, I know.” He would say it every time someone tried to give us a teaching point. Every. Single. Time. And he obviously didn’t know that but he didn’t want anyone to think he had a small “fund of knowledge”.
Even if you know you aren’t going into the specialty, try to communicate interest with your body language. Take a few notes. Try to learn something. You may at least have to know it for the shelf or maybe Step 2.
Having learners around can boost moral and help remind everyone why they fell in love with medicine in the first place.
Use Your Unfair Advantage
All medical students have super powers. I’m sure of it.
You have unique interests, unique expertise, and unique talents.
Use your abilities to help your patients and your team.
My first medical student as an intern was a native Spanish speaker. One of our shared patients only spoke Spanish and had a complex medical condition. She went above and beyond by volunteering to double back after rounds to spend time educating the patient about what we discussed on rounds to make sure he understood everything.
She also found YouTube videos in Spanish that explained his medical condition and bookmarked them on his phone. She helped me draft discharge instructions explaining how to take his medicines. All of this was on my “to-do” checklist but she helped me take care of it. And she made it better and faster than I could have done by myself.
Even if you don’t speak a second language, all of you have something to offer patients and your team. Maybe it’s something you studied in undergrad or during a graduate degree. Or a common interest with a patient. Perhaps you have past work experience that you can leverage for your benefit. Find your unfair advantage and use it.
Have the Best Attitude On the Team
I think this is obvious, but it can make all the difference. Clinical rotations are hard. You’re going to have bad days and that’s okay. But try your best to be engaged, interested, and willing to jump in and help.
The biggest factor I considered as part of the admissions committee for my TY program was whether or not I felt like I could work with the applicant on a night shift or in the ICU. I care more that you are enjoyable to be around than if you know everything there is to know about acute kidney injuries.
We spend a lot of time in the hospital together. It is really nice to be around people who are trying to make the best of whatever the situation is.
I’m sure you’ve already noticed that everyone in medicine is super smart. Recognize that in medicine you don’t distinguish yourself by being extraordinarily smart. You distinguish yourself by being kind. More and more I realize that what patients care about is bedside manner. They rave about their doctors who treat them with kindness and will bash the doctor who is brief or abrasive.
You can be taught to write a note or present a patient. It’s much harder to teach someone to play nicely with others.
Welcome to the White Coat Entourage
Just because the service carries on whether or not you show up doesn’t mean you can’t be a contributing member of the team.
Your excitement about learning is infectious and it helps us remember why we went into medicine ourselves.
You distract my attending so they spend more time teaching you and I get to write my notes faster so I can go home sooner.
You definitely have a place on the team and can be a true asset. The transition to clinical rotations can be rough but keep these things in mind when you start to feel superfluous on the wards. Ask any resident. They all remember a medical student that saved their month on the wards.