blank'/> A LITTLE BIT OF LACQUER: Transitioning to the Clinical Years

April 21, 2014

Transitioning to the Clinical Years

Happy Monday all! Thanks again so much for all of your post ideas! For today's Med School Monday I thought I'd do a quick post on a situation many of you are facing now - heading to the wards! The transition from the classroom to the clinic/hospital is a big one, but for most of us, it's what we've been waiting for all along! Finally being able to help care for patients, or get into the O.R. and do some surgery, or deliver babies, it's what we signed up for! This post will provide a few simple tips to succeed on the wards. Ask any question you have in the comments section below!


The Basics

  • You are a student. If you knew all of this stuff you wouldn't be there in the first place. Remember that. But you are a smart student, and you can learn quickly. Ask for expectations from the get go because not all "teachers" are the best at telling you, and learn how to meet those expectations quickly. (Ask whoever is your overseer, whether it be the intern, resident or attending, or all of them as they all have different expectations. A good way to find out is simply to ask (hopefully on day one), "what role do medical students usually play on your team?" Or, "how can I best help the team?")
  • Be an anthropologist. I was told this and I always thought it sounded so corny. But it is so true. Those who succeed on rotations are those who are able to observe how the locals act and quickly fit in. The hardest part about third year is that you're on psychiatry one month and as soon as you feel like you actually know what you're doing, BAM!, you're on surgery feeling like an idiot again! And this happens over and over again. So follow the first point, and do your best to be a local! Most interns keep a checklist of all the tasks that need to be completed, start keeping a checklist too and help where you can (communicating with the team, of course). 
  • (Almost) nothing is below you. Although you are a student, and you are paying to be there, nothing is more annoying than someone on a team who acts like they're paying to be there. Help out as best you can, whether that means undressing wounds before early morning surgery rounds, carrying around extra supplies (including a stethoscope - your attending will need to borrow it more than you expect!), calling family, or putting notes in charts. With that said, there may be some things that seem unfair, and you just need to use your better judgement about speaking up - if everyone on your team rotates to pick up coffee and it happens to be your turn - get coffee! If you're missing out on the action because you're always the one asked to get coffee - we've got a problem, and you should find the right person to speak to about it. Sounds basic but you'd be surprised how many people seem to be lacking common sense when it comes to this stuff.
  • Get to know the nurses. Again, this will change as you move from rotation to rotation, but please do yourself a favor and get in good with the nurses. Nothing bothered me more than working with a med student who thought they knew more than the nurses. In the OR, they can make you or break you, and on the wards, they can help with patient information that no one else on the team will know! I love rounds that include the nurses, but not all of them do, so make sure to get info from them daily! I've had nurses get on their knees with me and help change a VAC (a disgusting task you will likely learn if you do a vascular surgery rotation), nurses help me with suturing before anyone showed me how, nurses page me when family comes by so I could catch them and speak with them, and my last team of nurses that threw me a baby shower for Liv!

On Studying

  • Say goodbye to huge textbooks (well, more like see you later). While you're actually on the wards, the best way to study is to learn from your patients and those your team is taking care of. UpToDate is quite possibly the best resource for clinical care and hopefully your institution has access to it (if not, find out what source your residents are using and use that). If you have time to read in advance before seeing a patient, read the article on their presentation. If you don't have time, make sure to read it that night when you get home. If you're on OB and your patient came in with hypertension, read about hypertension in obstetrics and the differential diagnosis and wherever it leads you (likely pre-eclampsia). There are of course plenty of books for the wards people will recommend and I'll do a post later on that, but learning this way really is the best way!
  • Learn from your patients. This definitely means read up on their presentation as mentioned above, but make sure to actually learn from the actual patient you're taking care of. Listen to them. Ask them open-ended questions and don't cut them off. There will of course be times when you're more pressed for time and you can be more succinct then, but remember that everyone else on the team has even less time, so who else is going to really listen? Try your best. 
  • Learn from your team. If you feel comfortable (and if it seems like it's ok to ask), when there's downtime (ie, don't ask in the middle of rounds or when there's a code) ask why the resident chose the antibiotic course they did, or how they came to their diagnosis. Make sure to not come off as asking in a challenging way, but more for your knowledge, (most) residents love to teach when they have the time. If you feel more comfortable talking to the intern or the attending, ask them! 


On Dressing

  • Scrubs are friends. Wearing scrubs doesn't mean you have to look like a scrub though, and staying well-groomed definitely makes you seem more put together and professional. Comfy shoes are a must with scrubs and I highly recommend Danskos or closed Crocs (I lived in this pair third year that are about a third of the price of Danskos). 
  • For clinics or times you're not wearing scrubs, keep it professional. Check out past Work It Wednesdays for some inspiration! (I'll be heading back to the hospital in June so I'll be posting more inspo then)! And keep your white coat clean! A little bit of OxiClean works magic!

At the end of the day, the main goals are to LEARN and HELP. It's a balance, but it can be done. Make sure to smile everyday and not beat yourself up for not knowing something or slipping up on your presentation. Get better everyday and you will be an all-star. 


5 comments:

  1. Thank you, I'll definitely be saving this for when I start my rotations!

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  2. Thank you!!! This was very helpful!! Will definitely be looking forward to your post on which books were helpful on the wards :)

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  3. Hi Laura,
    I have a question for you regarding the MCAT's. I was wondering what method (books, prep courses, etc.) you used to study?? I mean your score must've rocked!
    Thanks for your help in advance!

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  4. Hi Laura,
    I am starting my internship as a Nurse Practitioner in September and appreciate your tips and advice. I am looking forward to working with patients but feel anxious about it too. Your tips should help!
    Like you I am juggling a family and also a home and job. It can be very challenging at times and reading your blog is inspirational and helps keep me motivated.
    Thanks!!

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  5. Hi Laura
    I'm such a fan! I recently started reading your blog and with all honesty, I can say that you've helped me become a better Medical Student. I'm 3rd year now (All the way in South Africa) and did my first rotation on Internal med. It really freaked me out, not knowing how to approach it all. My next rotation will be in Surgery (anxiety building), but after reading this, I truely feel much better.

    So thank you for giving an approach to this crazy, very nervous time of studies. Keep on inspiring so many people :)

    ReplyDelete

I love getting your comments, they make my day! If you have a specific question you want answered, please send me a message by clicking the Contact tab at the top, or even better, contact me on twitter or facebook and I'll get back to you ASAP! Thank you so much for reading!

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