5 Tips for Clinical Rotations

Recently, I was asked to give a speech at a white coat ceremony for PAs who were about to enter their clinical year. Preparing for this talk offered an opportunity to reflect on what makes a good student so I could offer tips and keys for success. There are many articles available that discuss the best clinical study guides, flash cards, and test prep websites, but I wanted to take a different approach and discuss strategies that are more big picture. For the purposes of this article, we will narrow it down to 5 key tips for success. 

 

5 tips for success on clinical rotations:

 

  1. Be professional and eager

Often students may feel that they are low on the totem pole. It can be hard to maintain a positive attitude if your preceptor is grouchy or if the nurses have crowned you the bedpan champion. When I did my internal medicine rotation, I completed over 50 prostate exams when the school minimum was 5. Why so many exams? Well, my preceptor had size 12 hands so I was deemed a preferred alternative by patients throughout my time on the rotation. Instead of getting annoyed or frustrated, I tried hard to maintain a positive attitude and focus on my skills discussing uncomfortable topics with patients. I now work in psychiatry and I have conducted zero prostate exams as a professional, but my experience as a student helped grow and develop my bedside manner. As a student, always keep in mind that attitude matters and even the most menial task likely still beats reading about it in a textbook. Valuable lessons may come in unexpected ways during your clinicals and an open mind and an eager spirit will ensure you don’t miss these opportunities. 

 

  1. Don’t be annoying

This may seem like odd advice, but medicine is overrepresented by type A overachievers. Clinical rotations are exciting and at times the amount of information can be overwhelming. But students should be careful that this excitement doesn’t translate into a nonstop onslaught of questions. Preceptors are often very busy with their clinical work and teaching students while they work is quite the task. Students should be mindful that they are guests and their presence is a privilege. Ask appropriate questions, but be sensitive to the preceptor’s time and make sure your questions are intended to bridge gaps in knowledge and not just show off or replace the google function on your phone. One of my preceptors once told me: “never ask a question if you haven’t already tried to find the answer yourself.” I still live by this advice in my professional life. If I am unsure of something, I will make sure I’ve put in the work to find the answer before turning to a colleague or mentor. One of the most important skills in medicine is to know the limits of one’s knowledge, but also to learn how to find information to fill those knowledge gaps. 

 

  1. Maximize down time

“Hurry up and wait.” I first learned of this term when I joined the local Army ROTC program. This term refers to the military’s canny ability to move subordinates with urgency only to then sit and wait for inordinate lengths of time at the objective. As a student on clinical rotations, medicine can have a similar flair. Many times, I was told to show up at 5am to round before morning handoff only to find myself sitting and waiting on my preceptor. I would receive instructions to scrub in on the 10am surgery only to wait two hours in the pre-op suite because the previous case went long. As a student, you will have down time. Research indicates that nearly 50% of a clinicians time is spent doing non-clinical tasks such as charting, phone calls, and other paperwork. Watching your preceptor chart may be interesting in some circumstances, but often this time can be used in other productive ways. Students should prioritize studying whenever they have down time in the clinic. Use the time to prepare for the next patient or pick a topic that is relevant to the rotation and read the basic overviews (Uptodate is a great resource for broad disease state overviews). Similarly, avoid personal tasks at your clinical rotation site. If a preceptor sees a student scrolling their social media accounts, reading the latest romance novel, or watching movies on their phone, this leads to a perception of disinterest and poor motivation. When I was a student, I tried to maintain internal motivation to study during down time by bargaining with myself that the more studying I accomplished in the clinic, the more free time I would have after-hours at home. There were some days where my brain simply needed a break and I was not productive during my clinic down time, but I tried to make a conscious effort to use the downtime wisely in each clinical rotation.

 

  1. Learn from every single patient you see

Case based learning theory is an educational concept that employs scenarios to stimulate applied knowledge, critical thinking, and decision-making. This educational approach is the foundation of clinical education in nearly every medical profession. Every clinical encounter is an opportunity to learn and students should approach each patient as an opportunity to learn something new. In my family medicine rotation, nearly 75% of visits were for upper respiratory complaints. The rotation was early in the winter and the practice was swamped as colds and flu swept through the community. As a student, I did not prepare thoroughly for each patient encounter. After seeing 10 previous upper respiratory patients in the day, I cut corners and stopped reviewing the patient’s chart exhaustively before entering the exam room. This was a disservice to my educational experience that I look back on regretfully. Each clinical encounter offers the opportunity to learn something new. While the chief complaint may have been a routine respiratory infection, I may have learned something different while properly reviewing each patient’s chart. An incidental finding on a previous study may have caught my eye and altered me to a gap in my knowledge regarding something unrelated to the chief complaint. As a student, work hard to fight the occasional monotony and repetition of clinical medicine by approaching each case as an opportunity to learn something new. 

 

  1. Maintain a work/life balance

Medicine can often be like a drug. On my general surgery rotation I used my hand to retract a beating heart during a lung lobectomy. In OB/GYN, I got to deliver 4 babies with “solo-catches.” These types of experiences are incredible and hopefully you will have numerous times on your clinical rotations where you experience the peak levels of passion that motivated you to pursue a career in healthcare. But clinical rotations can also drain you, physically and emotionally. Everyone in healthcare needs to be conscious of their own health and ensure that they are maintaining proper balance. There will be rotations that require you to work long hours along with the expectation of additional time spent after hours studying and preparing for the following day. When so much is asked of you, it is important to ensure you are getting good sleep, exercising regularly, and eating healthy(ish). If you have down time on a rotation, take a small walk outside to exercise and attain a small mental break. If you don’t have time to go to the gym, focus on small things such as taking the stairs or breaking up studying with jumping jacks and planks. Work hard when you need to, but make time to see family and friends. Give yourself self-care breaks regularly to maintain your emotional well-being. If you feel that you are struggling, reach out and talk to someone. Clinical training can be stressful and quite intense, but you shouldn’t lose your humanity in the process. In the past few decades, physician resident work hours have been reduced by law. Research conducted following resident work-hour restrictions demonstrated improved safety outcomes and no observed decline in physician competency. The reductions in resident training hours demonstrates that quantity isn’t always superior to quality. As a student, it is healthier to go to bed early and sleep well than stay up all night studying. You will likely not retain much from all nighters anyways. Clinical rotations can be grueling and if you maintain a disciplined schedule, breaks and self care should always be included.

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