Posted by: medhelpteam | July 5, 2009

Tips on making The most out of Your Observership/Externship/Clinical Rotation During Residency

• Be familiar with and able to apply the core

content of the rotation specialty. Before

your rotation begins, take time to review one or

two relevant textbooks and go over any notes

you may have. Be sure to draw on this body of

knowledge as you demonstrate your diagnostic

and clinical skills.

• Read as much as you can about the illnesses

of the patients you are seeing. Monitor your

patients’ charts daily. Research patient problems

using journals, reference manuals recommended

by your team, and Internet sources, such as

Medline or UpToDate. This will help you prepare

for rounds.

• Be a team player. Get to know your ward team

– who they are, what they do and how your role

interacts with each of them. Having a good working

relationship with the ward team is highly valued in

the clinical setting. True standouts evenly share

responsibility, are well liked, and communicate

effectively with other team members.

• Dress professionally, be on time and be

enthusiastic. Attitude and appearance count.

Take extra care on your rotations to look your

best. On the first day of a rotation, unless you

know that scrubs are acceptable attire, dress

professionally. Make sure your style of dress is

appropriate for the setting. Showing up early or

staying late could also score you points – as long

as you are being productive and learning in the

process (and not just “hanging out”). Finally, in

everything you do, no matter how dull, boring or

insignificant the task, show enthusiasm.

• Establish an informal learning agreement

with your preceptor, resident or attending at

the beginning of each clinical rotation. This

exercise affords you and the supervising physician

a touchstone for you to learn the clinical decision-

making and procedural skills you want from the

rotation. Agreeing on goals and understanding

how information will be taught ensures that your

clinical experience is valuable.

• Keep a journal for each rotation. Record such

things as the number of patients you see every

day, the types of illnesses your patients have,

any of your medical “firsts” (i.e., the first physical

you perform, the first baby you deliver, etc.) and

any expectations you have for the rotation before

you begin. This will help you remember your

experiences and process your feelings. When

it’s time to choose a specialty, your journal will

help you reconcile your experiences with your

expectations and goals.

• Learn to ask enough questions to satisfy your

hunger for knowledge without monopolizing

precious time. Although you don’t want to stifle

an important question, it is necessary to make

the most of limited time with attendings, residents

and interns. Pay attention to other students and

learn from them – if other students are getting on

your nerves because of their constant barrage of

questions, don’t repeat their mistakes.

• Maximize time spent waiting during rotations.

Since you never know when you’ll have extra time,

don’t go anywhere without something to read.

Keeping journal articles or reference materials

with you will afford you the opportunity to study,

read up on a patient, or prepare for your next set

of rounds.

• During down time, resist the urge to engage in

excessive non-rotation tasks, such as personal

e-mail, Web surfing, blogging or personal

phone calls. Your residents and attendings may

interpret this as boredom, distraction or disinterest.

Instead, check out online resources such as Virtual

FMIG, FAMILYDOCTOR.org and the AAFP’s Board

your rotation experience.

• When you are on call (or working a long shift

on rotations), take time to go outside for a

few minutes. Even if you are extremely busy,

you should be able to find at least 30 seconds to

stick your head out the door and take in few quick

gulps of air between patients or hospital errands.

You’ll be amazed at what a breadth of fresh air can

do to your psyche – especially when you’re going

to work in the dark, going home in the dark, and

you’re bathed in the fluorescent light of hospital

bulbs during most of the day.

• To stay awake and alert while you are

on call, find ways to keep physically and

mentally active. Take the stairs, write notes

while standing up, stretch, read stimulating

materials, or talk to other staff members.

According to experts, the normal circadian cycle

involves a 4:00 a.m. to 6:00 a.m. slump. During

this period, remaining awake or maintaining

alertness is most difficult. The key is to keep

physically active.

• In the middle of each rotation, ask your senior

resident or attending for a verbal evaluation.

Don’t wait until your final evaluation to find out how

you’re doing. If you get feedback early in your

rotation, you can use it to improve before you are

formally evaluated.

• If you are not afforded the opportunity to

perform some clinical decision-making and

procedural skills that you wish to perfect

during a rotation, ask your supervising

physician what you can do to gain more

experience. In a busy practice or on the wards,

it may be difficult for the supervising physician

to know which skills you want to enhance. If

your supervising physician indicates that you will

not have an opportunity to perform a particular

procedure, ask what you can do to gain that

experience.

• When you have completed a rotation, take a

moment to assess what you’ve learned. Here

are some key questions to ask yourself: What

did you learn about illnesses and diseases

from your patients? Did you achieve a level

of proficiency in any procedures during this

rotation? Which ones? What procedures do

you need to work on? What procedures would

you like to gain a greater proficiency in? Are

you more comfortable presenting patients?

What areas do you excel in? What areas need

improvement? What did you learn from your

mistakes and those of others? How frequently

did you seek out verbal feedback? How did you

benefit from this feedback? Use your responses

to these questions to help make the most of your

next rotation.

• At the beginning of your ambulatory block

experiences, identify opportunities to gain

skills beyond doing H&Ps, documentation and

procedures. With your preceptor, identify the

clinic’s most pressing needs as they relate to the

care of patients. Examples might include patient

education programming, developing stronger ties

to community-based ancillary health agencies

and participating in the clinic’s quality assurance

process. Also, keep in mind that a preceptor may

be hesitant to assign tasks if he or she thinks you

are uncomfortable. Don’t be afraid to volunteer.

However, be prepared if the preceptor prefers to

do a task alone.

• Avoid asking questions of the preceptor

during the patient encounter. You should

have some time built in at the end of the day or

between patients to ask questions.

• If you find yourself on the receiving end

of harsh criticism, don’t take it personally.

Remember that the attending, intern, resident or

preceptor is not criticizing you as a person – they

are criticizing your actions. No doubt you have

experienced criticism many times by now, and you

will experience even more during residency. Try to

understand that you are human and you will make

mistakes. Distance yourself from the criticism or

situation, deal with it and move forward.

• Do your best to get through emotionally

draining experiences and, when you get a

chance, take a few minutes to process your

thoughts and mentally recuperate. Students

as well as interns and residents can experience

some powerful emotions during rotations and on

call. Because these situations are often stressful

and don’t allow you to get away immediately, find

a quiet place or walk outside for a few minutes

when you can. For really tough situations,

consider discussing your emotional reactions

with a student support group. Many schools offer

such groups to help students get through the

challenges of medical school. Ask your office of

student affairs what resources are available on

your campus.

• As the end of third year approaches and

you start to work more independently,

it’s important to ask your preceptor for

suggestions for improvement. Preceptors are

under pressures and time constraints and may

not be as focused on teaching as you would

like. Because of the hurried environment, your

preceptor may not take the time to give you the

counsel and constructive feedback that you need

to improve. Remind your preceptor that his or her

input is important to you by asking “What skills do

I need to work on?” or “What can I do to become

a better physician?”

• If you are on an away rotation, take steps

before the rotation begins to get oriented to

your new location. Many fourth-year medical

students opt to do an away rotation in the fall.

September seems to be an especially popular

month for medical students to do a rotation at a

particular residency program of interest. These

rotations are sometimes referred to as “audition”

rotations. If you are on an audition rotation or any

away rotation, you will need to become familiar

with your new working environment quickly. Here

are some tips:

1. Study the hospital layout ahead of time.

Before your rotation begins, tour the facility.

Obtain a map, if necessary, and locate the

essential areas, such as the patient floors,

operating rooms, labs, cafeteria, etc. Knowing

your way around will reduce some of the anxiety

associated with being at a new place with new

people.

2. Find out where your ward team will meet

on the first day. Before your rotation begins,

phone your contact or call the department’s

main office at the university or program to

confirm where you will meet the first day and at

what time.

3. If you know individuals who have done this

rotation, ask them for pointers. Find out what

they felt were the greatest challenges and the

most rewarding experiences. Pay particular

attention to their comments about people you

may be working closely with.

4. Have copies of your CV, personal statement

and other application materials. This

information will come in handy if you decide

to request a letter of recommendation from an

attending (to give the attending as supplemental

information about you) or if the program asks to

interview you while you are still on the rotation.

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