Richard Zhang
The aspect of medical school that students seem to most universally anticipate are their clinical rotations. When you’ve got your basic biomedical theory down and have practiced one too many cannulations on a plastic model, you know it’s time to see the real patients. However, it’s very possible for the budding excitement you feel at the thought of attending your first clinical placement to be overshadowed by waves of self-doubt and anxiety. Perhaps you now feel you don’t know nearly as much as you thought you did, or maybe you’re terrified of being schooled by a particularly strict doctor. If this sounds like you, don’t worry— we’ve all been there. Fortunately for you, there are a few tips you can follow during each of your rotations to ensure you make the most of your clinical experiences. Keep reading to find out what they are and how you can put them into practice!
Obstetrics & Gynecology
Remember that you’re the most awkward person in the room – so don’t be!
Do the words vaginal discharge, menstrual blood, and mucus plug give you the shivers? If yes, you’re probably in the same boat as most other students just starting out their OBGYN placements. As a new clinical student, talking to real patients about sensitive topics can be tough. Everything about your OBGYN rotation can seem uncomfortable and you might find that you’re completely out of your comfort zone. In such situations, stay calm and try not to be so awkward! This might sound easier said than done, but, in reality, as long as you stay strictly professional and don’t make too big a deal out of anything, consults should not be a problem. One thing I used to do awkwardly was to ask for permission for every small thing. This could get tiring for the patient and, according to my resident, quite frankly annoying at times. Remember to explain whatever it is you’re asking/doing very clearly, but also remember to not make a big fuss about the questions you’re asking or the procedure you’re performing. The more you try to be overly sensitive and tiptoe around these awkward questions/procedures, the more awkward you come off and the more uncomfortable you make it for everyone. Try to practice not doing this by having very personal conversations with friends and absorb the language your supervising doctor uses when speaking to patients.
Review your female anatomy
It goes without saying that obstetrics and gynecology is centered around female anatomy. Unfortunately, this means that if your female anatomy knowledge is rusty, you won’t be able to learn as much from your clinical tutor and might end up leaving a bad impression on the patients you interact with. Your clinical supervisors are likely to be much more committed to teaching you if they perceive you as a motivated and inquisitive student. Essentially this means that the more effort you put into learning, the more effort your tutors will put into teaching you. So if you’re starting off with an OBGYN clinical rotation, pick up that textbook and make sure you know the basics like the back of your hand.
Family Medicine
Learn how your assigned clinic runs
Family medicine clinical placements often involve traveling to a community clinic to get realistic hands-on experience in the field. If you want to make a good impression on your supervising doctor and their patients, learn exactly how your assigned clinic runs. Look into who is a part of the clinic, how they work together, and the role of each member in supporting patients. Observing how multiple players in a clinic, including nurses, receptionists, pathologists, and family medicine physicians, work together will give you an insight into the importance of teamwork in medicine. And, of course, going the extra mile to learn the ins and outs of your assigned clinic to show your tutor that you’re serious about their rotation doesn’t hurt either.
Realize each patient is an individual
Family medicine physicians often have long-lasting relationships with their patients and are able to provide personalized care to each patient that walks through their clinic doors. It can sometimes be difficult to get to know patients on a personal level in large hospitals where old patients are constantly getting discharged and new patients are constantly flowing in. This means your family medicine rotation presents a unique opportunity to get to know each patient that comes in on a personal level. Most regular patients are quite happy to be able to confide in someone and are open about their concerns. By realizing and acknowledging that each patient you meet during this rotation is an individual, you will be able to consolidate your theoretical biomedical knowledge while also brushing up on your communication skills.
Internal Medicine
Perform a thorough medical history
Internal medicine is quite a vast field and, as such, you need to ensure you’re performing very thorough medical histories while on this placement. Although you might think that a patient who has come in with a heart murmur has a clear-cut case of cardiovascular disease, don’t forget to ask how their other body systems are functioning. The more information you squeeze out of a medical history, the more you’ll be able to report back to your supervising doctors. Since time is quite limited during these rotations, try to initially start with open-ended questions and, later, follow patient cues to piece together a provisional diagnosis. There is a lot to learn on internal medicine rotations, so don’t miss out by forgetting to ask the most crucial questions. Also, learn to read ECG’s. In my experience, knowing how to make even fairly basic diagnoses can really impress your resident or attending, because they have such low expectations of medical students.
Learn to recognize red herrings
Since internal medicine is such an expansive field, it’s easy to get distracted by red herrings or incidental findings and stray off the right track. For example, an elderly patient who needs surgery for acute appendicitis might also present with a history of hypertension, kidney disease, and atrial fibrillation. Managing such patients and eliciting succinct and relevant medical histories from them can be challenging because of the risk of going down the route of investigating the wrong symptoms. When you’re taking patient histories on your internal medicine placement, try to see patient symptoms from their point of view and ask the broader questions to visualize the bigger picture before focusing on finer details. Remember that not every medical condition can be relevant to a patient presentation, and weed out the red herrings to extract only the most key findings.
Psychiatry
Don’t fear the unknown
Many medical students struggle with this clinical rotation because they fear the unknown. During your psychiatry placement you’re likely to be confronted head-on with conversations about mental illness, a topic that tends to be shrouded in stigma and uncertainty for most people. It can be difficult to empathize with patients when you have no idea what they have gone through, and it’s easy to be afraid of saying the wrong thing. To excel in your psychiatry placement, however, you need to vanquish this fear of the unknown. Don’t be afraid to educate yourself and correct previous misconceptions. You can do this by focusing on the way that your clinical tutors speak to patients and by having open discussions with patients about their feelings and experiences. Having an open mindset will enable you to demystify and destigmatize mental illness, and will encourage the patients you interact with to confide in you.
Brush up on your communication skills
When most people think of psychiatry, they think of clear communication. So, of course, one of the most obvious ways to excel in your psychiatry rotation is to brush up on your general communication skills. This is easy— have open, meaningful conversations with everyone you meet and actively make an effort to better your communication skills. An important aspect of this means recognizing that communication goes beyond the realms of verbal speech; eye contact, body language, and facial expressions are just as important!
Surgery
Be punctual and present
Punctual attendance at surgical rotations is an unspoken cardinal rule. If you want to make a good impression on the surgeons you’ll be interacting with, be on time— or better yet, come early! Hospitals usually operate on tight schedules and surgeries need to go ahead in a timely manner. So always, always show up early to your surgical rotation. It’s also vital to be present during your surgical rotations. This is because the principles of surgery are difficult to teach during the preclinical years of medical school, making it easy to get confused or misunderstand a surgical maneuver if you are not present at the moment.
Ask questions
Most medical students find their first time observing surgery quite overwhelming. This is due to the fact that surgery is a very practical field that cannot be taught in the classroom, and can only be fully understood through hands-on practice and observation. So if you get confused while on your surgery rotation (which I can guarantee will probably happen at some point), inundate the surgeons on call with all your questions. Asking questions signals that you have been paying attention and that you are eager to learn. Even better, if you review the surgical procedure(s) you have to observe for the day before you come in, you will be able to ask targeted questions to dispel any specific doubts you may have. Your clinical tutors will appreciate your engagement and perceive questions as a sign of your interest in the subject. So don’t be afraid to put your hand up and ask a few questions during your surgery placement— it’s the best way to learn!
Hopefully you now feel more at ease with the idea of attending your first few clinical rotations. Essentially, you need well-developed communication skills, good analysis abilities, and a ready-to-learn attitude to get the most out of your clinical placements. Armed with these specific strategies, you should be able to excel in your clinical years of medical school and consolidate your preclinical biomedical knowledge.