Tips for success in clerkships

You're going to hear a ton of things, so I'll just talk about the most simple and accurate things for you to keep in mind throughout the whole year.

The 3 A's: Affable, available, able. If you can achieve all 3, you'll do well. It really it this simple, but actually doing these 3 well is hard.

Affable means be nice to EVERYBODY, nurses, patients, everyone on your team like your classmates, don’t steal their shine, don’t jack their opportunities, don’t answer their questions.

Available means always being where you should be and always say yes when something is asked of you, and ideally you're being proactive and asking if you can help do specific things that the patient needs to have done.  For example, if during rounds the plan was to consult the Neuro team, go to the resident and offer to do that for them. This is preferable to just saying "Is there anything I can do to help?)

Able means just know your stuff, so you get a thorough history and physical, know everything relevant about the patient, generate a great differential diagnosis, have a great plan for the patient (don't just regurgitate what the team is doing, see if you can suggest anything yourself, or at least when you present act like the plan is what YOU'D like to do, not what the team wants.)


Along the same lines, always keep yourself in the mindset that there is no one else there to take care of the patient. If there was no one else there for the patient, what information would you need to gather, what would you like to do for the patient? Doing this will have you satisfy a lot of the 3 A's. And if what you want to do differs from what the team wants to do, that is a great opportunity to ask questions, because it shows that you are thinking about the patient.

You may think this is common sense, but when you are on the wards it is super easy to just defer everything to the team because they are more senior than you, and go on autopilot mentally. You end up just gathering information and regurgitating it and not really understanding what is going on. So you need to constantly reorient yourself so you get into a good habit of thinking independently. Doing this can help you kick ass, and you may find yourself coming up with things for the patient that no one else has thought up yet. I remember I was putting myself in this mindset and was wondering why the resident hadn't done a test that was appropriate for the patient. I asked her why, and she realized that she had forgotten to do so. Later, I saw her evaluation of me and she had given me the highest evaluations across the board.

A good way to have a thorough independent evaluation of the patient is to be very systematic, as you are just starting out doing this and you want to be thorough. This is especially true for inpatient rotations. Start by making a list of all the patient's problems, think about what you would do for each of these problems. Also look at what the team is currently doing, and think about if you should add anything, or if you should stop doing some things. It can be as simple as they are getting potassium replacement BID, and their potassium, levels are nearing high normal, so you say you want to reducing the replacement to once daily. 

Another systematic way to think about things is to go through each organ system from head to toe (Neuro, CV, pulm, GI, GU, heme, ID, endo), and think about FEN (fluids, electrolytes, nutrition), prophylaxis, and disposition. This way, you won't miss any smaller things that need to be done for the patient. This is what the residents do for complicated ICU patients and it is helpful because it makes sure you don't miss anything for these complicated patients.


I know I said I'd keep it short, but one last thing:  pay attention to the rubric. As sad as this is, this is clerkship are basically a game, and the grading guidelines are the rules, so know the rules and game them. In an ideal world, you just do your best and everything plays out (and this may be true if you're a star student), but in my experience as well as many other med students especially if you are borderline honors/high pass, you have to game the system. 

And sadly, if your residents/attendings like you, you are more likely to get a better evaluation. They may deny its true, but its a simple psychological bias/truth. One way to look at it is that you are getting graded on good of teammate you are, and you want to work with people you like. Just make sure to not be an obvious suck up, no one likes that. 

The earlier you accept this truth, the more successful you will be and the happier you will be as you now know the rules of the game and aren't in a fantasy land where everyone knows how great of a student you are without you having to show it.