The First Two Weeks of Clerkships

I noticed that for the past two years, I’ve have some kind of post that summarizes the first two weeks of the new academic year. When I was an M1, it was The First Two Weeks of Medical School at NSU. When I was an M2, it was The Start of M2 Year. So, as an M3, it’s only fitting that I make another one of these posts and call it The First Two Weeks of Clerkships.

I’ve been on my rotation for 2 weeks now. It’s been crazy.

But at the same time, it’s amazing. What really blows my mind that I can see patients with disease processes that I’ve only read about in books. Up until rotations started I’ve never actually heard an aortic stenosis, or seen a person completely yellow with jaundice, or help dress a massive lesion. I think the craziest thing is that I’m actually somewhat responsible for patients with actual health concerns- I have to go speak with a new patient and ask them pertinent questions so that I can report back to my resident/attending. If I forget a question, I get sent back to do it again. The nurse will ask me about the team’s assessment and plan- when are we switching to PO? Are we planning on switching the antibiotics now that the urine cultures grew different bacteria than we expected?  And the patient and their family ask about the condition. What exactly is a stroke? Why isn’t my dad a candidate for surgery? I mean..I just finished M2 year a couple months ago, and yet the difference between M2 year and M3 year is huge. The change is great. I’m stressed out 90% of the time, but overall it has been a wonderful experience. I’m seeing a lot, and most importantly, I’m learning a lot. Being a good clinician is definitely an art form and that’s clear to me now more than ever.

I thought it would be interesting for the reader if I went back and answered my own pre-clinical questions that I had in my last post. It’s only been about two weeks but I’ve surprisingly gathered enough exposure on my rotation to thoroughly answer these.

Is my attending going to be a jerk?

No. My attending is nice, but he’s very no-nonsense/cut the BS/lets-get-to-the-point kind of doctor. I can tell it annoys the crap out of him when he asks someone a question and they give this super long detailed explanation for something when they literally could have just answered yes or no.

That being said, that doesn’t mean he doesn’t pimp us. We get grilled all the time. You can’t prepare for them, at least not all of them. The good thing is that not knowing the answer is fine. However, we do get told, “How about you look that up and give us a presentation on it tomorrow?” a lot, which I’m assuming is the super nice way of saying, “How the hell do you not know that by now?”. I’ve had to give two presentations so far, which is more than the other students in my group. Awesome.

Will the residents and attending actually take the time to teach me things, or are they going to expect me to know what to do on the first day?

This was pure luck of the draw, but both my resident and attending take the time to teach. There are some things that they definitely expect me to know as an M3, but in the case I don’t know it or don’t remember, then there isn’t any scolding or yelling. That’s a good thing, since I’m not sure my fragile M3 heart could survive getting yelled at by a physician.

Is there going to be an M4 that can show me the ropes?

Also pure luck, but I had an M4 with me for the first couple days who was super helpful. She showed me how to use the EMR system, how to present, what the schedule is like, and gave me some general advice for M3 year. There was also an M3 that started rotations several weeks before me, so he also helped me out a lot.

How exactly do I work the EMR system?

I was having a hard time when I first started using the EMR system we have at my site but having practiced for 2 weeks now, I’ve gotten pretty proficient. Once in a while someone will see me struggling to type a note and will give me a useful tip.

When am I going to eat?

At home. At least, in the beginning it was like that. For the first couple days I didn’t have time to eat lunch or dinner at all. The only meal I had would be some cereal in the morning before I left and then I wouldn’t have another meal for over 12 hours. It kind of scared me because I was afraid I would pass out from exhaustion. Something that has helped is bringing snacks and keeping them in my scrub pockets or white coat pocket. When I actually have a chance to breath I’ll sneak off somewhere where no one can see me and shove a bunch of snack into my mouth. It sounds horrible but it’s gotten better over the last week or so. Nowadays I can usually find a little bit of time to grab some lunch real quick. I usually still bring snacks if I’m on call though.

Will I have time to pee urinate?

Your resident tells you to take a quick 2 minute break. Do you choose to pee, or do you choose to eat? I choose to eat.

Jokes aside, I actually drink less water now so I don’t have to go to the bathroom as frequently. I feel kind of dehydrated at the end of the day but it’s a necessary sacrifice.

What if a patient codes on me?

Yeah, two weeks in and we’ve already had a code blue. Actually we’ve had several. Basically we run into the room and try to help where we can. Being a lowly M3 I usually just stand out of the way and watch as the doctors, nurses, and techs yell at each other. It’s madness.

What if I get ridiculed in front of everyone?

I haven’t gotten ridiculed, but I’ve said and/or done some pretty stupid things that were embarrassing. Only thing to do is to just learn from them and move on.

What if my attending thinks I’m an idiot?

My attending still asks me questions, so that makes me believe that he thinks I’m at least somewhat capable as a medical student. However, if my attending does think I’m a idiot, that also wouldn’t surprise me, so…yeah I have no idea. I’m planning on asking for a mid-rotation evaluation to see how I can improve. Hopefully that will be more insightful.

What if my patients don’t like me?

Unlike some people I’m not an awkward shell of a person with no empathy, so..my patients actually like me

What if I don’t know the proper medical term for something?

The other day one of our interns said, “the patient is peeing okay” and we all cringed. The attending looked annoyed. It’s definitely professional to say the proper medical term when possible. I haven’t had an experience where I don’t know the medical term for something..yet.

What if my coat pockets rip because I have too much crap in them?

I used to carry a ton of things in my pockets. However, after seeing the M4s and other M3s and what they carry, I’ve emptied my pockets quite a bit.

How much professional attire should I buy to minimize doing laundry?

I have enough shoes/pant/shirt combos for about 10 unique outfits. To my surprise, we don’t have to wear professional attire everyday so I’ve actually been able to go through almost 3 weeks of rotations without using up all of my professional attire combos. Just to be clear, I have done laundry multiple times in the past several weeks. I’m not a degenerate.

Should I wear a bullet-proof vest under my professional attire in case another student tries to gun me down?

In case you couldn’t figure it out in my last post, this was one of my non-serious questions. Unfortunately, it turned out that I actually should have worn a bullet-proof vest because gunners gonna gun. Not to go into too much detail, but I can’t believe the lengths some people go to in order to make themselves look good and make you look bad. It’s pathetic and sad. Speaking with some other students both at my rotation site and at others, this doesn’t seem like an uncommon occurrence. The only thing that helps is other people (i.e. students and physicians) also seeing through the BS.

There are a bunch of stories I could talk about, but for the sake of time (which I’m really short on) I won’t go into them. I’m studying for boards while on rotations, and yes, it’s as horrible as it sounds. Rotations has been giving me a good clinical perspective by which to approach some of the questions, but I’m definitely not banking on that to help my score. Anyways, I’ll probably be back in a couple weeks. I have to go study some heme.

-NB

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