Tips for medical students starting their clinical rotations [PODCAST]

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“Each year, medical students across the country prepare to start the long-anticipated core clinical rotations. Suddenly, we’re thrust into a world of constant adaptation and evaluation, with many highs and many lows.

As I finish up the year and new students get ready to start, I’ve been asked time and time again for my advice. I decided to aggregate my key takeaways from the year, and what I wish I had been told.”

Netana Markovitz is a medical student.

She shares her story and discusses her KevinMD article, “13 tips for medical students starting their clinical rotations.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Netana Markovitz. She’s a medical student, and she wrote the KevinMD article “13 tips for medical students starting their clinical rotations.” Netana, welcome to the show.

Netana Markovitz: Thanks so much for having me.

Kevin Pho: So, we’ll get into your article a little bit, but first off, can you share your story and your journey to where you are today?

Netana Markovitz: Absolutely. I’m originally from a small town outside of Boston, Lexington. I attended Columbia University in New York City for college. There I majored in English, and I also fulfilled all the pre-med requirements. I spent the year following graduation working as a research coordinator in a group called the Cancer Outcomes Research and Education Program at Mass General, and that year I also applied to medical school. I was accepted to the University of Michigan, where I’m currently a third-year student.

Just to provide a little bit of context, I think it’ll help explain my article. Michigan does not follow the traditional two-year preclinical curriculum. We actually have a one-year preclinical curriculum followed by our core clinical rotations. So, I actually finished up my clinical rotations in October, then had my dedicated Step 1 period, and then actually took Step 1 a couple of weeks ago. So, I’m really excited to be here. Thanks so much for having me.

Kevin Pho: Fantastic. And just in general, during the pandemic, how have your clinical rotations been, and how has the medical experience been?

Netana Markovitz: Yeah, that’s a great question. For me, the pandemic really came in full force in the middle of my clinical rotations. I was actually in the middle of my pediatrics rotation. After the AAMC issued a statement recommending that medical student rotations be paused, I was actually home from mid-March through June. Then we resumed our clinical rotations in June. Michigan did a really great job of making sure we weren’t too much affected. They shortened the remaining rotations, and we ended up only ending our year a few weeks later than expected. Things are kind of resuming as normal, or as normal as possible.

Kevin Pho: What’s something that you’ve learned during the pandemic that you wish you knew back before everything started?

Netana Markovitz: It really gave me a chance to pause and reflect. Your core clinical rotations are sort of go-go-go. When you’re not in the hospital, you’re home studying. Having a few months in the middle of that year to really take some time to think about wellness and really take time for yourself, I think I went back in June a lot, really refreshed, and really prioritizing my own mental and physical health, in addition to my learning.

Kevin Pho: All right. So that transition between preclinical and clinical is obviously a huge shift for every medical student. And you offer a few tips in your KevinMD article, in fact, 13 of them: “13 tips for medical students starting their clinical rotations.” Now, for those who haven’t read the article, can you just walk my audience through it and maybe share the story of why you decided to write it?

Netana Markovitz: Definitely. I really wanted to write the article because, for myself and talking to many of my friends, it’s a really isolating year. It can be a really wonderful year, but it’s also really tough. You take a lot of really high-achieving, perfectionist students, used to studying for that test and getting that good grade, and put them in an environment of constant evaluation. And as I mentioned, when they’re not being evaluated, they’re at home studying for what feels like an extremely high-pressured exam. It’s a totally new environment. Oftentimes you’re not seeing your friends in the library like you were in your clinical years. I really wanted to normalize some of the thoughts that I had going through the year and really encourage others to do the same. I think that I got a lot from talking to older students, and that institutional knowledge, and I wanted to pass that down.

In my article, I talk about some tips. For example, my first bullet point talks about normalizing the subjectivity of the evaluation system. When you take a group of students and have them being evaluated, humans evaluating other humans, I think it’s self-explanatory that there’s going to be some element of subjectivity. However, seeing those numbers, for example, at my institution, Michigan, we’re evaluated on a zero-to-nine, nine-point scale, and that number can feel like it’s the end of the world, the end-all, be-all.

I sometimes felt like I was performing very similarly and getting drastically different number grades. Just taking a step back and saying, “OK, maybe one person’s nine is another person’s six,” really helped me. I tried to do my best to really learn as much as I could from each evaluation but not let it define my confidence. So that was my first bullet point.

Another thing that was really important to me was the word confidence. I think people toss that around a lot as a clinical student and as a medical student, and just say, “Be more confident. Really work on your confidence.” And I struggled with this, especially initially, because I would just be so nervous for oral presentations, feel my voice shaking, and just berate myself for the rest of the day: Why wasn’t I more confident? Why wasn’t I more confident?

I think for me, it was taking a step back and thinking, well, really there’s no reason that I should be confident at this point in the year. Oftentimes I know the least in the room. I’m presenting in front of a group of residents, of attendings, who all know more than me. And it’s really awesome that we have the opportunity to learn and work on our skills and get the chance to do the oral presentations. However, I would advise students who are either starting their rotations or in the midst of their rotations to just trust the process, know the confidence will come, and not get too hung up if you’re not confident at the beginning or if you feel really, really scared.

Another thing I talk about in the article is really listening to your body and letting yourself off the hook. There were nights when I got home and I was just like, “All I want to do is lie in bed, watch Netflix, and eat.” And I’m sure a lot of people have felt that way. At the beginning of the year, I was like, “No, I have to do X amount of UWorld,” like I said, and oftentimes on those nights, I would just feel like I wouldn’t be productive and I wouldn’t get the rest that my body was craving. So, towards the end of the year, I did a better job: If I came home and was just so exhausted, I would say, “OK, I’m just going to go to sleep early, get a good night’s sleep, and then maybe start again tomorrow.” And I just want to assure everyone that those nights definitely did not make a difference in my scores. So, I think that was a big learning point for me, really listening to what I needed instead of the quote-unquote “shoulds.” I think that was a big thing for me.

Another thing, just getting back to my point on evaluations: In bullet point nine, I talk about how sometimes you’re going to work really, really hard and just feel like your grades don’t match how hard you’re working or how well you feel you’re performing. I think that’s a little bit self-explanatory, but I think the system really makes you start to believe that your grades are everything, and really that they’ll define how good or bad of a doctor you’ll be. So, I just try to remind myself that what we were doing was really, really hard. Grades, of course, are important, but they’re not everything. And just accept the grade, kind of move on, and don’t let them define your sense of self.

And then a bullet point that actually means a lot to me: I talk about how much of a difference residents can make. I experienced this firsthand this year. Residents could really make or break a rotation for me. What I actually started doing was keeping a list of the things that I liked or disliked that residents did or didn’t do. And I fully plan to reference that list in two years when I’m a medical student. I think I learned so much about how to be a good resident to medical students this core clinical year, and I would encourage others to keep this in mind, too. Just think about the things you liked and disliked.

And then lastly, I think one of the big points I make is doing a better job advocating for yourself. Just to give a concrete example, teaching, for those who haven’t done their clinical year yet, is a really big part of rotations. Oftentimes residents or attendings will take an hour or two out of their day to really teach the medical students, which is an awesome opportunity. But, for example, at the beginning of the year, if a resident or attending said to me, “OK, if you guys want to stick around for a few more hours, then we can do teaching at 5:00 p.m., or if you guys would prefer, we can just do it tomorrow,” I would have been worried that if I said I’d prefer to do the teaching the next day, it would have shown less enthusiasm, or that they would like me less. And at the end of the year, I think I realized that those things were a lot less important, and that I could advocate for myself while still showing enthusiasm. I probably would have said, “You know, I’m really excited about the teaching, but I’d love to take the next few hours to study. Would it be all right if we did it the next day?” And I think that realization, that I didn’t have to sacrifice my sense of self in advocating for myself to get good grades and to do a good job, was a big learning point for me.

Kevin Pho: So, you talk about evaluation, and there are some medical schools that simply just have pass/fail for their clinical rotations. Now, what are your thoughts about that approach?

Netana Markovitz: You know, our medical school, Michigan, has pass/fail for our preclinical year, and I thought there was a lot of value in that, because it really encourages that sense of collaboration and really just learning for the sake of learning, which I think is really valuable. I know there’s been a lot of talk in the broader medical community of whether to switch to a pass/fail system. I think, you know, I learned a lot from grades, and I think, for residency purposes, grades are important, but I don’t know. It’s a hard question that I’m not sure I know the answer to.

Kevin Pho: And one of the things that you mentioned was a list of things that you liked about residents and interns that you yourself would follow when you got to that point. What are some characteristics that define a strong resident or intern as it relates to medical students?

Netana Markovitz: There were some things that I really loved, and I was really lucky to work with some really, really incredible residents. I think, first of all, just the simple fact of acknowledging the medical students and remembering them. As crazy as it sounds, residents just get so busy, and it’s easy to just kind of forget about the students. But taking that extra minute to say, “Oh, I’m going to do X, Y, Z. Do you guys want to come with me?” Or, “I’m going to do X, Y, Z. I might not be back for a few hours. Maybe you guys can take that time to study.” And just kind of integrating them into the team, I think, makes a huge difference.

Another thing, and I think a lot of medical students would echo this, is just letting medical students go when there’s nothing left for them to do. I think obviously there’s huge value in being present and being at the hospital, but sometimes there’s just not a lot going on. And I think medical students obviously have this dual responsibility of studying not only for the clinical rotation but also for the shelf. So there’s also a lot of value in being home and just having that time to study.

I think obviously teaching is a huge component of being a good resident, but I think it’s also being mindful, kind of what I was alluding to earlier, of when the best time to teach is. So, for example, one of my residents on internal medicine made sure to do her teaching on days when we already had to stay late, so that we weren’t staying extra to do teaching. That made a really big difference. One of my residents on my psychiatry rotation knew all the residents would be in a class and I would be there by myself, so she thought to tell me a few days in advance, “Hey, on this one day, don’t come in until 11:00.” So I think, getting back to my first bullet point, it’s just being really aware of the medical students and being mindful that they’re studying and doing clinical rotations.

And then I think, lastly, just complimenting your medical students, encouraging them, and noticing when they do a good job. And even if you have constructive feedback, taking the time to sit down with them, deliver that feedback, and tell them what they’ve improved on is really, really helpful.

Kevin Pho: We’re talking to Netana Markovitz. She is a medical student, and she wrote the KevinMD article “13 tips for medical students starting their clinical rotations.” Netana, you wrote about tips medical students should do, but have you seen any red flags or traps that some of your medical student colleagues have fallen into when making that transition to the clinical rotations?

Netana Markovitz: Yeah, you know, I’m really fortunate to be surrounded by really, really wonderful colleagues and students. So, I don’t think I’ve really witnessed anything egregious firsthand. But I think, getting back to the article, just stay true to yourself. Don’t be someone you’re not. People will see through fakeness or competition or being super competitive. So, obviously, if you made it to medical school, you’re probably really wonderful, and just trust that you can be yourself and that that’ll be kind of enough, is what I would say.

Kevin Pho: And my final question: What is your take-home message that you want to leave with the KevinMD audience?

Netana Markovitz: Yeah, great question. So, I would say have fun. It’s a really, really tough year. Acknowledge that, let yourself off the hook, don’t be afraid to advocate for yourselves, and kind of trust the process and know that competency and confidence will come.

Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

Netana Markovitz: Thanks for having me.

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