How do you succeed during your third year of medical school? How do you do well in your clinical clerkships? How do you “honor” a rotation (and since when is honor a reverse transitive verb)?
Now, there are entire books dedicated to clerkship success: pages and pages of “pearls,” entire tomes dedicated to helping you earn the gold stars you’ve always wanted. These tend to be painfully repetitive and full of common sense.
Of course, common sense is your most important tool for third year, so don’t discount that out of hand either.
The bare minimum, most essential advice for third year is as follows:
- Be on time
- Don’t be a dick
- Use common sense
- Be flexible
The pains of “pre-rounding”
Pre-rounds are what you as a medical student (or resident) do because you are (sadly) not an attending and therefore must perform an elaborate song-and-dance routine daily to prove you are a “thoughtful clinician.”
It’s your chance to wake patients up early in the morning and pretend to be a doctor in order to gather information that you will need to present later on rounds.
How early you show up depends on when rounds are, how many patients you are “carrying,” and how much time you need per patient. The amount of time you give yourself to pre-round is inversely proportional to how much sleep you get. This relationship will cause you to want to decrease your pre-rounding allotment as much as possible. This is generally inadvisable. Rushing during the morning sucks. Additionally, the majority of the gold stars you will receive from your attending—should (s)he actually listen to your presentation—is predicated on how well-planned and thorough (but succinct!) your presentation is on rounds. So pre-rounds matter. Data gathering, assimilation, and organization are skills you will develop.
Don’t forget to check your patients for lines and tubes. Write down lab values and know their trends. These facts are generally more important (and certainly more reliable) than your physical exam.
When on rounds, be on rounds
Rounds are a prime time to be interested or at least actively feign interest and not play Words with Friends. Keep in mind the other golden rule:
Everyone wants you to like their specialty
Feel out your attendings and tailor your behavior and presentations for their (usually obvious) preferences. Your medicine attending may want exhaustive detail and your surgeon may just want a single sentence, but everyone actually wants whatever they want. Give it to them.
Keep in mind, patients will change their story in front of the team from whatever they’ve told you. Just smile. It happens to everyone.
How often and to what extent they are read will vary, but your notes are supposed to be an integral part of your third-year performance, even if you think they just disappear into the EMR (which they generally do). However, you never know when someone evaluating you is going to actually read one. Writing a good note quickly is a skill you want to master before intern year.
Know that if you say the words “is there anything else I can help you with?” you are generally asking to leave and the resident will know that you are asking to leave. The earlier in the day you say it, the lazier you can look.
You are likely to receive some somewhat intense advice at some point:
- Get expectations on day one of the rotation
- Demand specific feedback frequently (so that you can change and improve)
- Volunteer to give presentations, especially if you are asked a question and don’t know the answer (the “I don’t know, Dr. Pimpsalot, but I’d like to look that up and give a brief talk on it tomorrow” method)
If these sorts of pearls seem toolish and exceptionally awkward, that’s because they are. There is no single right or wrong way to act on a clerkship. While being super intense may work with some attendings and residents, it’s more likely to drive your classmates insane. If the idea of sitting your attending down and demanding feedback gives you the willies, don’t feel compelled to do it. If you think that your attending has zero interest in hearing another medical student talk, it’s definitely a possibility.
Preparing for the Shelf Exams
Most people get pretty good evaluations. So, depending on how grades at your school work, it’s likely that your clerkship grades will actually depend on your shelf scores.
- Start studying on day 1 (it also helps for not looking stupid and unengaged on your rotation)
- Questions are key
- Detailed recommendations: studying for third year NBME shelf exams
- Leave the hospital out of your social networking posts.
- Seriously, just don’t talk about patients, nurses, attendings, residents, or anything else on Facebook. This goes doubly so for posting photos.
- Be careful what you say and around whom you are saying it (both for HIPAA and also to not be obnoxious in general)
- Be part of the team, especially with other medical students. You are in this together, and you will frequently be judged as a group. If your success depends on making another person look bad, you’re doing it wrong. You will often succeed or fail together.
- Don’t complain about how hard you are working to the house staff or attendings. Save it for your friends and family, who also don’t care.
- Don’t sit in special looking chairs
- Act interested even when you can’t be interested
- Don’t lie
Everything here is a gross generalization. Maybe your school is absurdly academic and your attending and residents actually want to hear your blather. Maybe you’re in a less academic place and you’re actually working with (shadowing) a private doc and there are no residents and all you have to do is laugh at their jokes. Your mileage may vary (this is the internet, after all).
To conclude, when at some point during the year you feel tired and unappreciated and just plain sick of playing pretend doctor, take a step back and remember a few important points:
- This is a temporary problem.
- Residency is worse.
- It’s about the patients.
Shelf exams? Step 2? Planning for fourth year? More here.
I love reading your entries, and had a question to which I feel you can give a very informed and valuable answer. I took about 1.5yr off to study for Step 1, this was primarily due to some personal family related/financial issues, however I ended up with a 250+ score on Step 1. Do you know of anyone who may have gone through a similar ordeal, or have any thoughts on this? How badly does this reflect on my residency application? Note I am now in Clinical Clerkships, but just wondering how I can improve my profile before residency time comes in.
Taking a leave of absence isn’t necessarily a huge deal when it comes to applications, especially when the circumstances are understandable. When programs filter ERAS applications, they do so by graduating year, not by entering year, so they’ll read your application, know your story, and judge or not judge you accordingly. I know several people who took LOA for diverse reasons (e.g. being dumped by a girlfriend), and none had particular difficulties matching. A LOA does not equal failure.
Your Step 1 is excellent, so that box is checked. If you have good clinical evaluations and clerkship grades, that’s the second big part of the pie. Those two combined are far and away the most important aspects of your profile, more so than any other gold stars you can get (leadership, research, etc.).
If you have the opportunity to flesh out your interests through research or extracurricular activities, feel free to if you have the time. It’s critical that such things not impact your clerkship performance, however. I’d also take Step 2 early and have it done for application time so programs know you have no loose ends.
Hi Ben, current third year medical student here about to start rotations (I start in two weeks but still don’t know what rotation I’ll be on). Early on in this post you link a book from Amazon. Do you recommend that book for purchase?
Not really. I think that stuff is mostly overkill and often pretty lame.
Hi Dr. White,
I have a very similar situation such as what Matthew wrote five years back. Just came off of a 1.5 LOA-nontraditional student with a toddler who got ill. Tried studying for Step during that stressful time of ER visits and immunology clinic follow up-scored in the low 200s as I bordered on mental burnout. I’m very proud that I passed and returned to school; I do plan to work hard on rotations and do come from working as nurse; any tips for clerkship and studying with a toddler? I do serve on several national leadership committees and will continue working on research projects/write ups as possible. I’m looking forward to taking Step 2.
One of the frustrations of medical school is how it’s designed for people of privilege and no children (as opposed to people without family support, people who need to work, people who need to care for children or relatives, etc). You can have a balanced career one day but clerkships are a period where you’re time isn’t always your own (and your home time will likely be mostly spoken for).
One key will be figuring out how you’re graded and what fraction of your clerkship grades depends on shelf exam performance. Perhaps it’s sad, but in many schools, a student is likely to do better using downtime during the day to prep for shelf exams than to volunteer or take on extra clinical duties. You’re going to want to optimize every moment you’re forced to be at the hospital.
If you haven’t optimized your study habits, now is the time. That means more time with UWorld and Anki and less time taking notes and other things that the data show are generally less effective. You’re going to want to have things to do at the hospital that don’t rely on your phone (playing with your phone, even to do a qbank, looks pretty bad).