Starting clinical rotations can be a nerve-wracking experience. You’ve been in traditional school for your whole life and you’ve become pretty good at it when, suddenly, everything changes. Now you’re expected to see real patients with real diagnoses and be an active part of their care team. As if that’s not overwhelming enough, you're being graded every rotation on things that may feel out of your control by people who really don’t know you at all. If all of this sounds like a lot to you, don’t worry, we have 10 tips here that will help calm your nerves and ensure your success throughout your clinical years.
Show up Early
This is an obvious and maybe cliche tip, but it really leaves an impression and saves you a logistical headache. Maybe your rotation is at a hospital that is new to you or maybe you didn’t get the most reliable reporting instructions; showing up early ensures you have ample time to find your team, put your stuff somewhere out of the way, and get yourself into the right headspace for the day. While it is incredibly important to be early on the first day, being consistently on time will show your preceptor and residents that you are reliable, professional, and serious about your education, which translates well on your evaluations. If you are running late one day, be sure to let your resident or attending know so that they’re not waiting for you to start their day. You know the old adage: early is on time, on time is late, and late is unacceptable.
Be Flexible
Some rotations will be heavily structured, some will be more loose, and others will be a mixed bag. Take each day as it comes and be flexible with your schedule and how your day looks. As medical students, we are classically type A and have a hard time relinquishing control over our already precious time, but being flexible (or at least seemingly so), trying a new procedure, or talking to that extra patient will show your commitment to the team. As much as I would often like to be doing practice questions or watching lectures, I have had fantastic opportunities to observe procedures, participate in patient care, and get to know my preceptors better because I was engaged and willing to be flexible.
Accept Feedback Gracefully but Don’t Take It Personally
This is a hard one. There really isn’t a way to make feedback directed at you not seem personal, but it is vitally important to your mental health to not take all feedback as a personal reflection of who you are. Some preceptors will be great at giving feedback and really structure it in a constructive and professional way so that you can learn and grow from it. Others won’t be so gentle, and your feelings may get hurt. When the feedback you receive isn’t as positive as you may like it to be, remind yourself that you are still learning and that you are constantly growing in this process. Also, keep in mind that your preceptor has a life outside of their work that you are not privy to. It’s not uncommon for outside stressors to affect the mood of your evaluator and, while they hopefully try to be objective and keep things professional, it can trickle into how they speak to and perceive you. In these moments, you need to learn to remind yourself that their personal feelings are not a reflection of who you are. Thank them for their feedback, take some time to calm yourself down, and then try to pick out what you can actually improve on from their feedback.
Don’t Wait for Formal Feedback, Ask for It Yourself
This is an important one! Some preceptors will take time weekly to give formal feedback on your progress, but some won’t give any feedback until the end of the rotation! It’s important for your growth and education to ask for feedback weekly or even more often so that you can continue to improve. I often wait for a quiet moment (be sure to read the room and situation you are in first) with the attending and then just ask “Hey, is there anything you’d like me to be doing differently when _____?” Whether they have feedback on presenting on rounds, writing notes, or seeing patients, attendings will appreciate that you’re taking initiative and will almost always be willing to give you guidance rather than criticism.
Accept that Every Doctor Likes Things Differently
Do this as early as possible! This goes along with being flexible; you will need to learn to adapt to every superior you’re working with. Each rotation is different, you may be working with one attending the entire time, or a new one every few days. Every doctor has a different background and likes things a different way so the sooner you accept that you’re going to have to adapt on the fly, the better you’ll look. I had one doctor cut me off within seconds of a presentation and overly correct everything I had already said even though I was presenting based off of how my last preceptor taught me. Now, if I’m working with a new doctor, I will preface my patient presentations with “I’m not sure how you like your presentations compared to others I’ve worked with, would you mind giving me a brief overview of what you’re looking for”. This has always been well received and my attendings appreciate that I’m looking to impress them. Even better, if you’re working with a resident who knows the attending, ask them how the attending typically likes presentations or what the attending’s expectations typically consist of. Adapting your work based on the attending will show that you’re committed to learning new things and make you look great throughout the rotation.
Accept What You Don’t Know
Remember that we’re students, and while we know a lot, no one expects you to know everything! They’re asking you questions on rounds and pimping you in the OR to see what you know and to see if you’re paying attention and learning. Sure, there are some old school attendings that may dock you for getting things wrong, but most attendings nowadays are asking you questions to gauge where you’re at. In my experience, when I’ve been asked a question I don’t know the answer to, I get more credit from the attending if I try and reason through an answer and make a guess then if I say nothing at all. So try, make a guess, and back it up the best you can. If you truly don’t know, be honest and say you’d love to learn more. Show that you’re engaged and actively learning. Read up on it at home and come back with questions the next day--that shows your commitment to your education and impresses your attendings. Your attending should help guide you in the right direction and will appreciate your effort to make an educated guess.
Confidence Is Key
Approach every day with confidence and prove that you can make clinical decisions. You will naturally not be very confident or comfortable in a lot of situations during your clinical years, however, the more confident you seem, the more seriously you will be taken by the other members of your team. Remember that nothing you are doing or saying actually dictates patient care at the end of the day, so it’s okay to get things wrong. The confidence of making a differential list and coming up with a care plan for your patient on your own will go a long way, regardless of whether it’s right or wrong. Your attending will appreciate that you care enough about your patient to come up with a plan for them and that you want to help take some load off the team. Have confidence in other areas of the day, too; offer to call family members to talk them through their loved ones’ care (after educating yourself of course), ask to explain the care plan to the patient while your attending supervises, do whatever you can to help the team and do it with pride because you are part of the team now.
Don’t Be Afraid to Take Up Space
It’s easy as a medical student to feel out of place. We are the bottom of the hospital hierarchy and it’s difficult to feel like anything you do or say has value. It is okay, and actually expected of you, to take up space. Introduce yourself to anyone you meet and make your place on the team known to all members of the care team: nurses, techs, other physicians, and the patient. Be an active member of the team and contribute wherever and whenever you can. Continue to make yourself known by asking questions (read the room first though and be sure it’s an appropriate time), offering to see patients or help with clerical duties, and come up with care plans. If you hide in the corner all day and speak only when spoken to, it will be incredibly difficult to make a lasting impression and get more than average evaluations. Always be professional and respectful, but don’t be afraid to ask for what you need in order to learn, it will prove that you are ambitious and committed to your education.
Read Read Read (or Whatever You Do to Study)
I feel like this is the #1 comment medical students get on their evaluation forms: “Good student, could read more.” Educating yourself outside of clinical time is one of the most important things you can do for a good evaluation. Not only do we need to be studying for COMATS and Level 2, but educating yourself on what your current patients are going through shows that you understand your role on the team. Nothing will make a topic stick in your head quite like seeing a patient with a certain condition and then studying it right afterwards. This truly will change how you remember everything and how you approach practice questions. “Reading” traditionally meant literally reading a textbook, and some old-school attendings still expect that you’re doing that, but they don’t know what you do once you go home. However you study, whether that’s books, articles, questions, or videos, try and look up at least a few topics each night from what you saw during the day. Here’s the important part: the next day, bring it up! Find a way to mention, “Hey, I was reading last night about ____ and I have some questions” and your attending will be impressed that you’re going above and beyond for your patients. Don’t give them the opportunity to put the stereotypical comment on your evaluation--make your work outside of the hospital known to them!
Learn Something from Every Patient
Every patient, regardless of what they’re going through, has something to teach you. As a student, you have an opportunity to spend the most amount of time with the patient compared to everyone else on your team. Use this time wisely. Take your time and talk to them, examine them, and comfort them in what they’re going through. You’ll learn more from them than any book or video, so really take advantage of the chance to speak to as many patients as you can. Respect what the patient is going through and get comfortable with conversing with patients while you have this time with them. It’s true what they say, the more patients you examine the better your physical exam will be and the more subtleties you’ll pick up on.
I hope these tips help give you confidence as you embark on your clinical years. Every experience is different, and you are more than just your education. Take care of yourself, drink water, get sleep, and continue to show up with the same excitement you had that first day of medical school and you’ll do just fine.
