Fatima Khan
The Internal Medicine clerkship can easily be considered one of the most mentally and physically intense rotations during the third year of medical school. It can get overwhelming with the vast amount of knowledge you might think you need to look impressive, but I’ve got strategies that you can start doing now to stand out and get an excellent evaluation from your attendings.
#1 Prepare quality patient presentations
#2 Be a team player
#3 Know your pharmacology inside-out
#4 Offer to give an educational presentation to the team
#5 Be humble, seek feedback
#6 Study for the shelf exam every day
#7 Ask your upperclassmen about their experiences
#1 Prepare quality patient presentations
If you’re willing to put in a little bit of extra work for massive gains, this tip is the most important. One resident told me that you will be remembered most by your presentations. Put in the effort to give succinct presentations that show you’ve carefully taken a history, attempted to interpret labs and imaging, and created a logical plan that addresses all of the patient’s problems. Watch the residents and see how they present. During downtime, ask the attending and residents for feedback on your presentations and quickly incorporate that into your next presentation.
Did your patient just get a chest x-ray? Stand out on rounds by offering to guide your team through the interpretation of the image! Before your presentation, run down to the radiology department and find a resident to go over exactly how to read that chest x-ray. Your team will be impressed and your attending will notice.
#2 Be a team player
You’ll be spending a lot of your time with the intern, who is most likely busy and tired. Help them out and yourself by offering to do some of their busy work like making the follow-up primary care appointment and calling the microbiology lab for the gram stain results, and presenting your patient to interdisciplinary rounds. If all the interns on the team are carrying 6 patients and you have 2, offer to take on another patient or two if you can handle it. The goal is to take some responsibility in the team and show others that you are dependable.
#3 Know your pharmacology inside-out
Did you assume you would automatically remember all the side effects of metformin because you’re done with Step 1? Nope. The side effect of lactic acidosis actually makes metformin contraindicated in that chronic kidney disease patient you might’ve just helped admit to the floors. Pharmacology is actually one of the most important chunks of knowledge to retain from Step 1 for your future career in medicine. But don’t despair, if you review relevant pharmacology as you go through patient cases you’ll have an easier time memorizing seemingly superfluous facts. At the minimum for this rotation, you’ll need to know the indications and major side effects of commonly used medications, especially for antimicrobials! You’ll look like a star when the attending asks you why the team chose a particular drug for a patient. The lists of medications listed in the back of each First Aid chapter are most important to learn. Don’t fret about learning the latest, brand-new medications until you master the bread and butter medications first.
For a painless way to review your pharmacology, keep up with the Physeo Pharmacology series whenever you need to brush up. Practicing a little bit every day with flashcards is a good way to memorize this information. Seeing and discussing medications during rounds is an especially good way to review as you’ll have more memory recall hooks associated with the drug to help you remember.
#4 Offer to give an educational presentation to the team
Ideally, after the first week of the rotation, when you’ve gotten comfortable working with the team and have a better sense of the schedule, ask your residents if there’s a topic that you could give a quick presentation (5-10 min) to the team. Set a specific date to present when everyone is around. It would be even better if the attending can stay for your quick presentation.
Giving a presentation on a relevant topic related to the patients on your service can help the team answer a pertinent clinical question that can benefit patient care and make you memorable to the attending. Presentations can be casual or more formal depending on what your team’s schedule is like. For instance, if your team doesn’t have time to sit down and watch a PowerPoint presentation, a presentation while standing during rounds might be more sensible. To come up with a question, keep your ears perked for any questions that come up during rounds and ask “why” when someone says anything during rounds. For example, if you’re taking care of a sickle cell disease patient in a pain crisis, you ask why a specific pain medication was chosen and whether there is data to support one drug over another. You can use the “clinical queries” search tool in PubMed for clinical studies and systematic reviews to find answers to your questions.
#5 Be humble and seek feedback
When you’re asked a pimping question by the attending and you know the answer, go ahead and confidently answer it. However, if you don’t know, simply say “I don’t know, but I can look it up and get back to you.” Don’t feel bad because you’re in training and still learning. Even attendings don’t know everything and still have to occasionally look things up. Remember how this is a profession of lifelong learning?
Along with being humble, ask your for feedback frequently and make efforts to incorporate feedback as soon as possible. Try aiming for a quick feedback session each week with the attending if possible. Consistently ask your residents for feedback as they may be more available than the attending and you’ll be with them all day. When asking for clerkship feedback, use the grading rubric from your clerkship to self-assess your performance yourself first, then come up with an actionable list of goals to improve your performance and earn high evaluation scoring. Next, ask your resident and attending to meet with you separately and ask them how you are doing. It can be helpful to specifically show them the rubric and tell them what your goals are. Be sure to ask for feedback early in the rotation so that you have time to incorporate it. Asking for feedback will show your team that you’re motivated and sincere about doing your best, and will help you improve on weak spots of your performance to get a strong evaluation.
#6 Study for the shelf exam every day
Coming home from a long, tiring day at the hospital to study for the shelf exam in the evenings is definitely hard. However, it will pay off to study a little bit each day to avoid the dreadful anxiety of being unprepared for the shelf. Also, if you’re vying for an Honors, schools often have a cut-off score you need to earn to meet Honors criteria. Figure out which study resources you’ll use and divide them up so that you do a little bit from each resource each day and finish them up by the time of the exam.
Study resources tend to vary between the clerkships, but generally, you’ll need something to learn content from like a textbook or video lecture series along with practice questions. Set aside sometime the weekend before the test to do an NBME self-assessment to identify and brush up on any weak spots. Here’s a link to the NBME self-assessments (https://www.nbme.org/taking-assessment/self-assessments). Asking upperclassmen what was helpful for the shelf exam is a good place to start.
#7 Ask your upperclassmen about their experiences
Asking upperclassmen to talk about their specific clerkship experiences can give you an overall idea of the clerkship expectations and site-specific pointers. Upperclassmen can tell you helpful things like which attendings you’re likely to work with, where to park your car, finding study spots in the hospital, helpful study resources etc.
Final Thoughts
The medicine clerkship is demanding for sure, but an excellent performance is definitely within reach for any student. The most important thing is that you walk in excited and with a plan. Medicine is an important foundational rotation for everyone no matter what specialty you end up in. Are you already doing some of the things we discussed in this blog post? What tips do you think you can start incorporating into your clerkship performance?