Based on my clinical experiences, there are ten pieces of advice I would give to any medical student starting their rotations that will maximize productivity and lead to a robust and thriving work environment (your interns will thank you).
1. Do as complete of a workup on your assigned patients as you can. Be thorough with your admission H&P. Think of all the tests, labs and imaging studies you want ordered. Speak with the patient’s nurses about what has happened because they have seen the patient for a longer period than you have.
2. Keep a dry erase marker in your white coat pocket at all times. Most rooms have a whiteboard on the wall facing the patient’s bed. Volunteer to write down the day’s goals for the patient (to walk around the unit, work with PT to increase mobility, etc.).
3. Ask the resident holding the pager if you can hold it and answer any calls that come in. This is another way to be proactive, especially when your intern is juggling a million tasks.
4. Always run your management plan by your resident before rounds. The worst feeling in the world is after giving a stellar presentation on the history and physical exam/lab findings, your management plan is completely different than the one your resident has written down. Your words will confuse the attending, who will then shift his/her attention away from you and towards the resident caring for that patient for needed clarification. This happened to me on my first rotation, and I vowed to myself to always meet with my resident, even for 3-5 minutes, to ensure that we are on the same page.
5. Give coherent presentations; do not be all over the place. Not all of us are public speakers by trade, and you don’t have to be to give presentations that are fluid and logical. Do not put on your differential zebras if the possibility any one of them being the actual diagnosis is less than 5%. Rather, think about what the top five conditions/disorders/diseases are likely to be causing your patient’s symptoms and reasons for each. One key thing that you learn throughout your rotations is how to think critically and analytically. Use evidence (from UpToDate and your patient’s history) to support your arguments as to why a myocardial infarction is the diagnosis over a pulmonary embolism.
6. Write straight-to-the-point progress notes that your team can rely on. When you start on your rotations, it is easy to get carried away with prose and typing more information than what’s needed. Make your notes concise yet complete. The purpose of your note is so that your resident or attending will get an accurate update on the patient after reading it. No med student likes typing notes, but they are crucial to accumulating an accurate day-to-day history of patients.
7. Always read during the day and when you go home. Find an article that relates to your patient, and offer to present a quick summary on it during rounds. Also, always read past notes. You will always gleam important facts that you would otherwise not get from your interviews with the patient. For instance, say Mrs. S comes in for COPD exacerbation. But, in past notes, six years ago she was admitted a few times for acute kidney injury. Knowing as much as you can about the patient’s past medical history will help you steer the patient’s treatment and management plan in the right direction. Not having enough facts can be lethal to the patient.
8. If you are with other med students, do not secretly work extra hours without approval. If you asked your residents if you could pick up another overnight shift or see an extra two patients, they would enthusiastically say yes because that means more hands on deck. However, your peers, when they inevitably find out you have been outworking them, will lose their trust in you and team cohesiveness will fall apart.
9. Do not be that student who finds reasons to leave early. If you have a legitimate reason to head out early, for instance, you have a meeting with the dean, that is fine. Though, if you repeatedly (and even worse, secretly without informing anyone) leave the premises for a variety of reasons (doctor/dentist appointment, saying you are feeling sick when you are not), everyone on the team may question your commitment. At the very worst, you could end the rotation with a bad reputation as “the student who leaves all of the time.” The main reason students want to leave early is that they want more time to study for the rotation shelf exam. Other reasons include increasing fatigue, dislike of the environment, or a combination of both. If you ever have a concern, whether it be about your performance or another team member, you must always approach your attending and talk it out. Clinics can be a very stressful time for students, and it is vital to be self-aware of negative energy and dislikes before they fester into bad outcomes not only for you but for your patients.
10. General advice. If you don’t know something, ask! If you do not know an answer to a pimping question, give it your best shot and say you will look up the answer after rounds. Keep up with all of your patient’s labs and studies. Know how to navigate the EMR. Learn the hospital layout. Ask if students get remote EMR access. If you finish all of your work for the day, ask if you can help out in another way (make phone calls to the lab/to family members, check in with your patient).
If you are a proactive student, a lot of good opportunities will come your way. Ultimately, you will be known as a team player who made a positive impact on the lives of patients.
Ton La, Jr. is a medical student and student editor, The New Physician.
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