Reflecting One Year Into Clinical Rotations

The last year of clinics have been full of successes and failures. I’ve helped patients and learned a lot, but I’ve also come up short when it mattered most. One year ago, I wrote a summary of my goals as a clinical medical student, and in retrospect, I feel that I’ve mostly achieved what I outlined. Additionally, here are some lessons I never expected to learn:

Good and Not-So-Good Role Models

We all come across two types of people in life – those we wish to emulate, and those who, for whatever reason, we don’t. This notion applies equally to the clinical training environment. I’ve seen my superiors (namely residents and attendings) exhibit an incredible amount of medical/technical knowledge while maintaining an air of humility about their accomplishments.

Unfortunately, some prefer treating their colleagues, coworkers, and even patients in a manner which, to be politically correct, I internally question. As a student, it’s important to see both sides, differentiate good from bad, and align myself with those who promote traits I deem to be advantageous to my career.

Find Yourself In Each Rotation

I can’t even begin to count how many times my classmates and I have griped about our schedules, teams, and even patients. Someone who wants to do primary care will find surgeons obnoxious. Someone who wants to do surgery will find internal medicine too slow. The list of stereotypes and frustration goes on infinitely.

Early on, I adopted a different outlook regarding unfavorable situations – suck it up, be grateful, and find something about the rotation that you do like and can relate to; let that be the beacon upon which you judge the rotation.

Coming to med school, I had no intention of pursuing internal medicine or psychiatry, but both rotations have shown me just how much I enjoy interacting with patients. Driving in each morning, I look forward to what new personality disorder I might come across, how I’ll manage the next patient with withdrawal, how my long-term-care patients are doing and what new life stories in the military I’ll learn about. Maybe it’s fulfilling my “need to be needed”, but I’ve found a great deal of pleasure in actually interacting with patients, regardless of whatever the hours are or clinical tasks may be.

Scut Work

The term “scut work” is routinely thrown around by med students and junior residents to denote unrewarding, tedious, and often times trivial tasks assigned by our superiors. However, this is a very subjective term indeed and an individual’s interpretation of what actually constitutes scut work is directly related to team dynamics.

In general, an efficient team is a happy team… and a team which usually goes home earlier. If you’re the lowest on the totem pole (read: “medical student”) and there’s no learning opportunity at the present moment nor anything that needs to be followed up on patients, you should do whatever you can to facilitate the needs of your team. Make that run to McDonald’s for the team, get those prescriptions from across the hospital, carry those blood samples to the lab to facilitate processing, or if it’s a reasonable hour and your duties are otherwise done, ask if you can be dismissed.

The team and patients always come first – “scut work” is what you make of it.

Your Best Is Not Good Enough

I think I’m prepared for the procedure. I’ve done all the practice questions for the exam. Yet when the moment comes for me to shine, the attending/resident/shelf exam asks the one question I don’t know. I can identify all the surrounding anatomy except what the surgeon is pointing at. I know virtually everything about biliary disease except what the question is asking. Compound this sentiment multiple times through every rotation, and you’ve got a highly motivated student who has little to show for it.

With my USMLE Step 1 scheduled for March 15th, I’ve got less than 80 days to essentially make or break my career. I have to focus on my Family Medicine rotation in January, but after that, I’ll be studying more efficiently and intensely than ever. I’m motivated. I have a vision. There are no more excuses.

And I will succeed.

Thanks to everyone for their thoughtful comments, emails, and Twitter messages over the last year. I hope 2012 will provide me with more opportunities to share my experiences! 🙂

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3 Comments
  1. Andrea says

    I kind of laughed at the stereotypes comments for various specialties – even in our geeky non-clinician world (the electronic medical record software vendor world), the stereotypes abound! We have one specialty that comes to mind where everyone just groans when we know we have to do an installation for it (a specific type of surgery group)…. we have other specialties that are just a joy to work with (OB/GYNs are usually great). We always wonder if certain personalities are drawn to specific specialties, or if the stress of certain specialties causes the physicians to be totally stressed out basketcases. I think the answer is obvious from your post, and the personality chooses the specialty!

  2. james b says

    this post seems like a light at the end of a tunnel to us noobs but it’s reassuring and helpful, thanks as always rishi.

    1. Rishi says

      Thanks for your kind words throughout the year buddy! Best of luck starting on the wards this Tuesday! 🙂