Another year, another reason not to get sick in July. That’s right, it’s the guide to clerkships/rotations/clinics/whatever you wanna call it. (If you’re not there yet, you should be reading Graham’s Guide to Boards .) Probably not worth reading if you’re not a med student.

Let’s begin at the beginning.

1. Get used to feeling stupid. I often forget this fact, but when I remind myself that I’m supposed to feel this way, it’s much less damaging to the ego. Every first week of a new clerkship, you will feel like the biggest dumbass in the world. You will make boneheaded mistakes, be totally overwhelmed and confused, and will often feel very alone, like you are the only person that has experienced this. It is not the case. In the pre-clinical classroom, you learn by memorizing. In the clinical classroom, you learn by experiencing (or at least, I sure do). And you learn much better and faster. I think part of the reason you pick up things so quickly is that there is so much to learn on each rotation that your brain doesn’t have any other choice. Back to my original point–it is okay to feel this way, so don’t let it get to you. You have residents who do this thing night and day, and attendings who’ve done this thing for 30 years, who argue about minutae for fun. You’re not going to be at their level any time soon, don’t sweat it! (Note: most of this is internalized stupidity or ignorance–in no way do I think anyone else should be belittling you or making you feel shitty. I had a jerk surgeon who humiliated me in front of the entire team my very first week, presenting my very first patient ever to an attending, but I felt much better when the entire team told me his behavior was uncalled for.)
2. “You gotta do your job.” I stole this quote from my surgery chief resident. Don’t half-ass your way through clerkships, do at least what is expected of you. If you don’t, you’re just making even more work for your already-overworked team.
3. Be enthusiastic. This goes ridiculously far, especially in your first 6 months of clinics. You may not know anything, but showing interest and trying counts for a lot.
4. Do. Not. Lie. Your attending or resident will ask you a question about a patient–because either you forgot to mention it in your presentation, or they’re curious, or they want to make sure you didn’t miss something, or I guess sometimes to pimp you–and you will be tempted to think “If I just say that there were no carotid bruits, then at least they won’t think I’m stupid for not checking them”–but just don’t. “There is nothing I hate more than liars,” quoth my Surgery clerkship director. “I can teach people that forget things, but I can’t ever trust liars.” Just be honest! Say “I forgot to check that, but I’ll make sure to right after we’re done” and jot it down. Or if you can’t remember what the patient said or what you found on exam, just say so. You’ll gain trust and credibility, because they are expecting you to miss stuff. You’re just beginning your training!
5. Be professional. What does that mean? Professionals put others’ interests (usually patients’) above their own. That means being on time–always–being appropriately dressed, being respectful of colleagues and patients. Figure out the team’s level of fun/sarcasm/joking/crudeness and don’t go past it, I’d say.
6. Ask questions. If you’re confused, or are lost, or need help, ask. It’s not a sign of weakness, it’s a sign that you’re thinking through things on your own. That being said, there is a time and a place for asking questions. “Which one is the superior mesenteric artery” is probably not best asked when your attending is screaming for suction ’cause he’s just hit said vessel.
7. Be aggressive, and ask for responsibility once you think you’re ready. Maybe I’m just a gunner here, but the clerkships I’ve enjoyed the most have been the ones where I’ve actually felt like I’ve contributed to the team. The worst ones have been me shadowing fellows or writing H&Ps that the intern or resident is going to basically write again him or herself. You’re paying a pile of money to work, you might as well get something from it and “help people” finally–isn’t that what you put on your med school application?
8. Clarify stuff up-front. If you don’t know if your attending likes long thorough presentations (medicine) or short’n’sweet ones (surgery), ask. You won’t waste their time, and you’ll need to learn how to present both types, anyway. (Presentation types to master: the one-liner, the consultation request, the 3-minute, and the 10-minute.)
9. It doesn’t matter what you take first. I know surgery residents who took surgery first and matched just fine, just as well as surgery residents who took surgery toward the end of their first year. It will not kill you. The earlier clerkships will expect you to have more pre-clinical knowledge, while the later ones will expect you to have more clinical knowledge. It all balances out.
10. Certainly not least: MAKE TIME FOR YOURSELF! While it’s great to go above and beyond, don’t stress yourself or drive yourself crazy. Clerkships are rough because you’re expected to learn clinical medicine, manage patients, and still be studying once you get home on both your patients’ conditions and the clerkships’ classic diseases, too. Do your best to find a balance. Make time for your significant other, if you’re lucky to still have one by this point (cynical much, Graham?), try to get together with friends once every week or two, go out, live. Appreciate the time you have outside of the hospital–clerkships really make you do this.

The transition to clerkships can be rough, and at times, very lonely. You go from spending every moment with your classmates as a preclinical student to being thrown around different rotations at different hospitals with different schedules. You often lose your support network, because they’re all busy, too. Lean on non-medical friends if you have them. They’ll enjoy hearing your gross stories about doing rectal exams and weird diseases you’ve seen, and you’ll get a chance to catch up with them.

Oh, and I found a nice physical exam review site tonight if you’re interested. Those skills tend to weaken while you’re studying all night and day for Boards.

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