Any advice for students about to start clinicals?

[DocMike37]

I would appreciate any advice from any of you who have done your clinicals. Advice on what to do, what not to do, what is usually expected of you, how to be proactive and learn the most possible without stepping on toes or being annoying, presenting patients, H&P's, what books or study guides were the most helpful, etc. Any advice would be greatly appreciated!!! Thanks

[FLK]

First of all, can you find out what rotation you will be doing?

No matter what rotation I was doing, I always tried to start reading up for the next rotation at least 3 weeks before it started, so that way on day one when the rest of the nerw students couldn't answer anything , I already had a fair amount of background knowledge, and looked good.
Plus, if you don't waste the first half of the rotation learning basics, you can actually learn a lot more during the rotation.

I drilled my history and physical pretty hard before I started 3rd year. I forgot the name of the book for H and P ( everybody uses it ) but I summarized my physical exam, and would run through it frequently.
I also read theough the Washington Manual many times.
I read Case records of the Mass Gen Hospital ( in NEJM )
these are an EXCELLENT learning reference in terms of H and P ( relevant data ) and how to run through a difficult differential diagnosis.
I bought the BIG book for each rotation ( sabiston for surgery, Cecil for Medicine, Nelson for Peds, etc ) but they are too big to read durung a rotation, Use them for reference on your particular patient, or to read about the patients on the floor, or to review on the bigger topics.
I really liked the LANGE textbooks. ( CURRENT OBGYN diagnosis or CURRENT SURGICAL DIAGNOSIS, etc )you could read it cover-cover at least a few times in a short rotation.
The key is to also read about the things that you don't see first hand, so that you know them for the next patient that may show up, and more importatnly for the USMLE

READ EVERY NIGHT. Also start reading the journals

In terms of how to survive during your first few months of 3rd year.....show up on time or preferably early. be very assertive in your education. in your free time before or after rounds ask the residents if there are any patients with interesting physical findings. Ask lots of questions. Ask people to show you things.
Use the ancillary services to ask questions. You can learn a lot about how the system works from RT, RN's PT, etc
DON"T make a big freaking mess for the nurses. To them you are probably just stealing their oxygen supply. You really offer them nothing. you can't write an order for tylenol to make their life easier. you just get in the way.
People may treat you terribly as a student from the nurse asst right up to the chief of staff.
Just take it. Don't make trouble. Kill them with kindness and look forward to the day when the same nurse that either ignored you or treated you badly as a student, will flirt with you once you have the ability to write orders as an MD. It happened to me ! You might think that just because you are a big medical student you know more than the nurses.
FALSE !! You know how a synapse works. You know golgi bodies and other useless **. You know pheochromocytoma, but can't take a blood pressure. Don't have an attitude. You are there to learn the practical aspect of medicine from the GROUND FLOOR. Focus on mastering the basics in terms of a good quality history and physical exam. Drill differential diagnosis in everything. Forget all the useless ** from the first 2 years. What is a tight junction anyway?
The really brilliant docs don't have a chip on their shoulder.
It always amazed me that by and large the smartest doctors, were also teh most respectful to the staff.

make sure you have some sort of text or reference material handy and by all means read up on what condition your patient has BEFORE rounds. also more importantly read up on what the other student's patients have BEFORE rounds because you see, chances are that the other students on the rotation will be unprepared ( surprisingly I have encountered very few students who work really hard ) and when the attending asks them something easy about their patient that they can't answer frequently he'll ask you. I never considered it bad form to answer the question. Being a gunner means YOU ask the student a question about his patient, or YOU blurt out every answer.
Being prepared means that you learn a lot, get resperct of the housestaff ( and they will show you more things ) , get a good eval, and a good LOR.

this is the same approach BTW that is the key for success during residency and beyond.

What you will find, especially after you begin to interract with US students is that they are not as smart as you had imagined. On the island, you imagine everybody in the USA is a genius who is reading some secret manual of medicine.
Not true. you can do everyb bit as well as they do

[Miklos]

I'd like to nominate this post for a sticky on the clinical rotations forum.

Anybody want to second?

[tRmedic21]

Absolutely

[options]

very good post, thank you.

[DocMike37]

Thanks so much for responding. I really apprecitate the advice.

[TXRN]

Thanks for the advice. Great post.