The Little Things I Wish I Knew Before I Was Set Loose on the Wards

When I was asked to write some advice for rising MSIIIs, I had to take a step back; after all, I still have nearly 12 weeks left in my own 3rd year and  feel as though I haven’t truly mastered it. Regardless, while brainstorming for tricks and tidbits to pass a long, I ended up reflecting on some of the major take-home points I’d garnered from each of my rotations. In the end, I realized it was the “little things” that had the biggest impact on my experiences, and thus, my grades.

I began my year in July on internal medicine. It was a great first block for a couple of reasons – I was fresh off of Step 1, so it was easy to recall the basic sciences and pathophysiology that come up frequently in during rounds. It is where I learned how to really “be a medical student.” I learned how to write a good SOAP note, and how to present patients succinctly during teaching rounds. I quickly realized that I needed to buy a pocket pharmacology reference, because the clinical pharmacology my residents talked about was very different from the way I had learned it during second year. I  filled out discharge paperwork and wrote sign-outs. I found that if I was able to know a little about every patient on our service, I could offer help with paperwork or calling consults. These are the types of things the residents really appreciate, and that will get everyone finished a little bit earlier at the end of the day.

After medicine, I went into my pediatrics rotation feeling well-prepared. I could now write detailed notes, and was learning how to “speak doctor.” I quickly found that the detailed, verbose presentations expected of me during my medicine rotation were unappreciated here; instead, I learned to convey the same message using simpler terms, which were much more reassuring to anxious parents. As a side, I ended up on the pulmonology team at the children’s hospital and really got to know my lung sounds.

I have to admit that my 3rd year schedule was an ideal learning curve, because I had already “completed” 2/3 of Family Medicine. While I lacked some OB/GYN experience, I was able to showcase the knowledge I’d accumulated regarding both adult and pediatric medicine. At my community clerkship site, I was given the opportunity to perform multiple procedures. I jumped at the opportunity to perform pelvic exams and was able to participate in labor and delivery. While demonstrating my initiative to the team, I also was getting some extra help in preparation for my next rotation.

OB/GYN is one of the rotations that students notoriously “just want to get through.” The residents work long, stressful hours, and may be difficult for some to interact with. Personally, I’m the type of person who would rather be busy than bored or angry, so  I actively participated and learned. I asked questions. I scrubbed into every C-section I could and brushed up on my surgical skills. Most importantly, I took every available opportunity to deliver babies. I was thrilled when a family wrote me a thank – you note after I helped coach them through a long labor, and it was what the residents remembered when it came time to write my evaluation.

The hallmark of my psychiatry rotation was learning how to obtain good collateral information. I had to forget what I learned in other rotations about being succinct – I spent hours pulling up hospitalization records and tracking down family members to help my team really understand what was going on with each patient. I set aside my stethoscope for the mental status exam and MOCA (Montreal Cognitive Assessment) test. In fact, I still have a stack of MOCA’s  that I carried in my white coat laying on my shelf.

Currently, I’m learning the ins-and-outs of surgery. However, I’ve already found that preparedness goes a long way. Reading about upcoming cases and carrying 4×4’s, steri-strips, and suture removal kits on rounds has proved helpful. I’ve quickly learned to befriend the scrub nurses in the OR – I get out my own gown and gloves, help hook up machines, and get the patient warm blankets. With evaluations still floating amongst the residents, my cursory assessment is that once again, it’s the little things that are most appreciated and end up paying off.

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3 thoughts on “The Little Things I Wish I Knew Before I Was Set Loose on the Wards

  1. Pingback: Tips on Surviving Medical Clerkship | Oras at Medisina

  2. Pingback: The Short List-July 2012 | PracticalPremed

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