• 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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