medical school rotations – Page 2

How my First Rotation Taught me to be a Better Medical Student

I recently finished my ob/gyn core rotation at a family medicine/ob practice. Despite not being a typical ob/gyn office, I was able to see my fair share of cases. So. much. ob! I wish there would have been more gynecology, as I didn’t get a good feel for the gynecology field or felt like I learned it well because of that. But in either case, I loved my 2 weeks in clinic there, my preceptor, her partners, and her staff!

This rotation was also my first EVER rotation as a third year student. My first time actually seeing patients on my own. Taking history, looking up their charts, doing a physical exam, the works. And honestly, I tried to stick to just the history and physical parts. I know a portion of third year is starting to nail down the assessment and plan; but honestly, you can’t get that far if you don’t learn to do a good H&P. For the most part, the physicians I worked with were fine with that. They knew it was my first rotation ever. But boy, did they still push me.

Much nerve-racking. Very nail-bitting. A true manifestation of being thrown into it.

But during my first rotation, I learned a lot about how to be a better medical student. What are my expectations? What are my preceptor’s expectations? How am I going to learn in this new environment? Thankfully, I had a decent idea of how clinic ran from being a scribe. I wish the program they used was the one that I had used previously, but alas, it was not. And we really didn’t have a lot of time to mess around on it either to learn. So hopefully that will come with time.

So what did I learn?

1. A new exhaustion.

You will have completely forgotten what physical exhaustion is like. As the student, you will need to find where you fit into the room and around clinic. You need to be close enough to see what is going on, but out of the way enough to let your physician and their staff (such as nurses and MA’S) do their job while not interrupting their workflow. And a lot of times, that means there is no seat for you. So expect to be on your feet all day for long hours. In your first two years of medical school, you are used to sitting for prolonged periods, but mentally exhausting yourself. This leads to a slew of things like anxiety and depression right? Well in third year, you will literally wear your body out from all the standing and running around that you won’t have time for those invasive thoughts to pop up into your mind at night. As soon as you sit or lay down you will be out.

I promise.

At least as someone who has suffered with anxiety and imposter syndrome, my body did not blink twice as soon as I went to lie down. I was just out cold.

Do yourself a favor and get good comfortable shoes with inserts in them. If that is tennis shoes, make sure they fit your foot type. I replaced my inserts and it did help. I also have a pair of Dansko shoes from my scribing days. I have yet to use those, but I’m sure those would be helpful too.

Eventually you will get used to standing, but you may not get used to the physical exhaustion as quickly. And that’s okay! You’ll sleep like a newborn baby.

2. Put in the effort.

Get up early to look up cases for the day or review how to do a procedure that is on the schedule. Pre-round if your attending likes that. Stay late to learn and see that extra case. You are in the position to mess up as much as you’d like without putting someone in harms way (your attendings will usually watch you like a hawk if you get to do anything). Take advantage of this! A hard worker = more likely to get to do the fun stuff. Plus, your attendings will take you more seriously if you show that you are willing to put in the work.

Just because you’ve made it to third year doesn’t mean you are done. You still need to strive.

Oh… and just because a particular rotation isn’t what you want to do, is not an excuse to not give it your all. You don’t have to lie about not being interested. It’s okay to say your interest lies elsewhere. But you should still be hauling ass.

3. Try to be helpful, but know your place.

Despite medical students being the next generation of physicians and needing to learn, you are still going to slow your attending down. It’s truthfully why a lot of physicians don’t take on medical students. It adds extra work, disrupts their workflow, and they usually have to redo everything the student has done. Particularly in the first little bit of your rotation. A lot of times, the students end up shadowing and don’t see patients on their own. That could simply be to not fall behind on schedule in seeing patients or it could be they don’t trust you yet. Other times if your attending is willing to let you do more, they will need to literally ask all the same questions you just did and redo the exact exam you did. That’s okay.

You wanted to scrub in and learn up close? Great. But to an attending, you may contaminate their field or get in the way, particularly if it is a more urgent matter to take care of or a true emergency. With time and experience, you will get to do more.

A good medical student inserts themselves or asks to be present to learn new things, but isn’t overly assertive. At the end of the day, your attending will decide if you get to be there or not. Know what is going on and ask to be there or to be notified if you aren’t with your provider when the procedure/surgery is happening. Ask if you can be in the room. Make sure to give your number to the clinic staff, the nursing staff, the floor staff, and your providers. Its always okay to ask to be notified if something occurs. If they remember, they will call you. If not, don’t take it to heart.

4. Be kind to the staff.

This is a huge one. Even if you just come in with a friendly smile and say hello. Or ask how their day went. Nurses, MA’s and even front desk staff can be great sources of information. During my first rotation, the nurses were very willing to teach me things that I wouldn’t have gotten to do otherwise. That’s how I learned about something called the ‘vagina in a box’…

Being kind to them will also help when you want in on procedures. It will put you in their favor and they are more likely to remember to contact you after the doctor contacts you (or if the doctor forgets).

However if you walk in their like your shit don’t stink and don’t acknowledge them, they are going to take note. And they will not be very helpful to you. At the end of the day, the staff working with your attending help run the clinic and make sure patients are the provider’s workflow runs smoothly. They help play a vital role in patient care. It is important to know and acknowledge that even as a student.

5. Humble Confidence

You are going to have situations where you are completely thrown in. No prep time, no advanced notice. This happened to me several times in my first rotation. One attending would walk in the room with me, tell me nothing, and then introduce me and leave. Like WHAT?!?

Don’t worry she would come back. But there were definitely times where I didn’t know I would be doing the patient visit.

The same thing goes for procedures. One attending was the ‘see one, do one, teach one’ type. Which meant you got one shot to see it, go home and research it, and then it was your turn to go the next time. Nerve-racking? You bet your bottom dollar!

But you do have to have some confidence in yourself to be able to do those things. You are going to be put in new and uncomfortable positions for you. Not as in uncomfortable for your safety; more like you are going to get pushed out of your comfort zone. If you don’t have some confidence in yourself and your abilities you will crumble.

But at the same time, you SHOULD NOT act like you can do something if you’ve never seen or tried it before. It is perfectly okay to jump at the chance to do something. But if you haven’t done it before, TELL THEM! They will be much more receptive to you saying “I would absolutely love to, but I haven’t seen one yet. Can I watch you do one first?” or “It’s been a while since I’ve done this. How do you do this procedure?”

Obviously if it’s in front of the patient don’t say that. I made that mistake this past rotation and got a very stern talking to about it. No problem; lesson learned! If it’s in front of the patient, say something like “I’ll watch you do the first side and then I’ll do the second”. That will usually tip off your provider to saying you haven’t done one before.

Letting them know this shows them that you are RESPONSIBLE enough to admit when you are out of your league and that you aren’t willing to harm the patient in the process.

6. Supplies…

Depending on your rotation will depend on how you can help with this. For my past rotation, I always had a pen or two and a small pocket sized notebook handy. Mostly, this was for me. But my provider usually needed a pen. It was small, but it was enough to be handy. Or they would need a sticky note or piece of paper to jog notes down. I could easily give them a sheet from my pocket book.

In other rotations, it may be helpful to have bandage shears (if you own them), tape, alcohol swabs, bandaids, tongue depressors, etc ready to go. Obviously, do not steal materials. But it could be helpful to stock up in the morning and be able to easily whip that out for your provider instead of them spending time looking for it, or having to send you to go find it in the middle of an encounter.

And lastly…

7. Go with the Flow!

You never know what is going to pop through that door. Or if your provider is on call, how many times you have to run out of clinic. Sure, you may be “scheduled” to be there from 7-4, but you likely will be there a lot later. Or maybe you have to go in early. My point is, your rigorous study schedule that you are used to sticking to from your first two years will be out the window. You are going to have to figure out if you have enough energy at the end of the day in clinic to study. If not, make sure on your day off or over the weekend to double up so you can stay on top of your material. Bring your study aids with you, so if there is true downtime at the hospital or in clinic you can learn in between.

You won’t have a single day the same as the next. So don’t hold yourself to a super rigid schedule. I promise you won’t be able to stick to it very well.

8. Empathy (This was added on after…)

I have always been an empathetic person. And in my medical school, we were graded (or at least needed to work on) being empathetic in our standardized patient encounters. In that case, it is hard to be empathetic because “it’s not real”. However, if you’ve never practice it or learned how to have an empathetic conversation, it is going to be difficult in your third year.

You are going to see real patients. Real patients with real problems. Real patients with real and raw emotions. Happiness. Sadness. Grief. Anger. Frustration. Apathy. All. Of. It.

My first rotation helped me utilize how to lead these conversations. It made me realize that sometimes I had to do most of the talking because the patient wasn’t sure where to go and needed guidance during a difficult time. Other times it meant I needed to listen more. Sometimes it was reassurance. Or an explanation of why something happened the way it did.

Either way, I wasn’t exactly expecting to have to be a part of any heavy conversations with patients in my first rotation. In fact, I didn’t even think that was an option on my radar, simply because I wasn’t thinking about it. But they will happen. And you need to learn how to approach those topics gently.

Because at the end of the day, your patient will remember how you made them feel after an encounter. Not if you handled the medical side of their encounter.

Let me know in the comments below if you found this helpful or have any other insights to add!

Cheers.

Life As a Medical Student

Hello hello.

Whether you are a premed interested in what your future may look like in medical school or you’ve recently been accepted, finding out what a day in the life of a medical student looks like is often something searched. It is usually difficult to find, and for good reason! Every school, curriculum, and student is different. Making a “day in the life” of student hard to capture.

I am going to be honest here: I was not usually on top of my shit as a student. Despite what the medical school youtubers show you and what the over-achieving instagramers say, most people are not on top of studying or have it together in medical school. It is completely common to be far behind, too tired to finish, or often run out of time in the day to do what you need to do.

Because of this, I spent a lot of time NOT going to class, learning at my own pace, and sleeping. Majority of my classes were not mandatory in person, and they were recorded so we could in essence “re-watch” them later. What that really meant was most students didn’t go to class and just watched them later on their own time.

Year 1:

Year 1 is all about that learning curve. In case you haven’t read a previous post, I went to a school that was known to have a difficult curriculum. They also had block scheduling, and the curriculum taught the “normal” first year and the “abnormal” second year. So that meant first year you would have anatomy, physiology, biochem, immunology, histology, and embryology for each section. The second year was mostly pathology and pharmacology. So you would have GI 1 in first year covering the basics, and GI 2 going over disease and pathology. They would definitely throw in common diseases to be tested on in first year though; they make great test questions. The idea was that you would have the ability to see it twice; as more repetitions = more likely to get into your brain.

Because the school was proud to have a “tough curriculum”, it also meant that you did a lot of self learning. I won’t go too into details, but you would have your lectures/reference books, but a lot of it was not easily put together for you. You did have to hunt to find important information. First year did hand you a bit more, but by the time you got to second year you did a lot more hunting…

It definitely made it frustrating as a student as most of us wanted to spend them time just learning and understanding what we needed to know, but it is what it is.

I wrote a lot of blocks on my classes in first year. But a schedule typically looked like this:

Class from 8 am to noon most days of the week. Occasionally we would have lectures in the afternoon, but most of the time we didn’t.
Lab usually from 1-4 on 2 or 3 of the days in the week. First year would have PCM, OS, and anatomy labs to fit in during the week depending on the block course you were in. OS and anatomy labs were 2 hours, PCM was only 1 hour.
Any additional time spent off was in the lab or studying for your courses.

This meant that you either had to pre-read/review lectures before class and try to learn a chunk of it during class, or do most of your reviewing later in the evening. I am more of an evening person, so most of my studying occurred at night.

For most labs, you did not have to prep. But for some you did. This obviously took up some of your review time to make sure you were prepared. There were a lot of long nights and most of my weekends were spent trying to catch up simply because of this. As time went on, I stopped going to class to sleep in or try to start studying and just went to campus for labs. For anatomy, you spent most of your time trying to dig and find your structures, but you didn’t learn them well until they were cleaned out and you were able to see them and their relationship in the body. If I would have prepped more before going into lab, I probably would have gotten more out of it.

Our school has something called Mediasite, which is where our recorded lectures would be. They would show up as soon as the in person class was finished. We could speed up or slow down the lectures, so you could get through lectures pretty quickly if you wanted. Other schools I know utilize just voiced over powerpoints, which you cannot fast forward through…

And that was how my first year went. A lot of lectures, doing questions, trying to learn the anatomy, etc. There were some classes that I utilized a lot of additional resources besides my notes, and some where I didn’t need to utilize much. Because I had previously had plenty of exposure to the subjects taught, I knew how to study for them and how to approach them. It was just learning how to accept, study, and understand the large amounts of material in a much smaller amount of time.

Overall I would study an average of 10-12 hours a day first year.

No, I didn’t really work out.

Yes, I had a lot of anxiety and there was a lot of stress burrito-ing happening and cuddles with my kitty.

Year 2:

Honestly, more of the same. Except the focus was on pharm and path. I utilized Robbins path and pathoma the most, in order to help me understand and organize the material better. But honestly, you just have to see the material many times in order to understand path.

We didn’t have anatomy second year, so our only labs were OS and PCM. Most of the important skills we actually learned in first year; so a lot of it was review or integrated with some fine tuning. Since we had exposure to how they tested for different scenarios for both courses in first year, it wasn’t as stressful second year.

For our schedule, it was similar:

Classes 8-12 (or less depending on the day)
and lab/simulations about 2-3 days out of the week. We rotated in smaller groups for more things, so the schedule would look more hectic than it was.

Again, I chose to sleep in during the morning and get a later start to classes/studying than go to class. I simply didn’t learn in class. And if I did go, I could only pay attention for about an hour before I needed to switch. Plus, a lot of our path/pharm lectures were flown through simply because there was so much material and not enough time to teach it.

I’d say I utilized more outside resources consistently for second year, such as Truelearn for questions, or sketchy/pathoma for help with path understanding. So instead of multiple books, youtube, paid resources, etc, I just used the same 1-3 sources. First Aid can also be utilized as well to help organize your thoughts for path.

Then towards the end of the year you start gearing up for boards and dedicated. See my other posts for that information.

Overall, I would study maybe 6-8 hours a day consistently for second year. Partly because I was burned out, and partly because I would avoid my duties due to stress. It is what it is.

No, I still didn’t work out. I did hang out with friends more though. We would call it “study group” but only about 1/2 the time was spent studying…

Year 3:

Well, I’m just starting so I don’t have much to offer yet!

But my site is doing what they call the “2+2” method. It is where we are in clinic for 2 weeks and then off for 2 weeks. But when we are on, we are on. In my first rotation this meant I was on straight for 14 days. Anything that was on call that my provider called me for meant I needed to be there. It was a bit exhausting by the end. I didn’t really get a “day off” until my 14 days were done.

I know in the future, my schedule could be any combination of weeks on/off. It just so happened that my first rotation was one off, two on, one off. Because of this program, we have more work to do than our classmates. We all have some online work to do (and by we I mean my class as a whole), but my site has more additional projects that count towards our grade. This includes case presentations, powerpoints, standardized patients, and virtual reality.

On my weeks off, it would usually consist of doing the work assigned for a grade, flash cards, and practice questions.

For my first rotation, my scheduled looked like this:

6am Rounding: As a student I would go before clinic started. I would usually run into my attending as I was finishing up so I could present. Then we would go see the patients from there. If I finished beforehand, I would look up the first few patients in clinic for the day so I had their information handy if I was sent in to see them.
Clinic from 7am-4pm (which always ran late).
I was on call the whole time, so if anything next door on the floor was called in, I would leave clinic to go be with the attending that was dealing with that. Sometimes it was the attending I was with, sometimes it wasn’t. Weirdly, I was usually with the attending in clinic that was on call that day. So it worked out in my favor. So if a baby was about to be born, we would leave clinic and go deliver and come back.
Some days we would have scheduled surgeries mid-day. So usually over lunch?
After clinic, we would visit patients on the floor. Usually started sometime after 5 pm. We would check in with any mom’s that needed to be delivered, or anything that was admitted while we were in clinic.
I would usually leave anywhere around 6-7 pm.
On the weekends I would be there from 6/7am-7pm. I think there was one night where a case went haywire and we were there pretty late.
This was a mix of inpatient and outpatient.

And that was mostly how my first rotation went. I only had enough time to shower, make food, and eat before passing out during the 2 weeks I was on. And since it was my first rotation, I hadn’t learned how to work in studying yet and hadn’t gotten used to the physical exhaustion yet. Hopefully my next rotation I will be better with this!

All I know is my next rotation is peds. I’m off the first two weeks and on the last two. I believe this rotation is just inpatient, so I’m expecting to be doing regularly scheduled 12 hour hospital shifts, but will let you know!

Cheers!