Embarking on clinical rotations is a pivotal part of medical school, offering hands-on experience in various specialties. Here are essential tips for excelling in each clinical rotation block. I also included links to my other blog posts on each rotation.
Prepare and Build Good Relationships
Arrive before the surgeon to assist with anesthesia and support the team.
Know how to scrub in and introduce yourself to everyone in the room.
Be courteous to the scrub techs—they can be invaluable allies. You can make enemies with the scrub tech very quickly by not being friendly or knowing what you’re doing.
Get supplies into the room as soon as you can and locate the best place to keep these.
Ensure you know your glove size and if you need latex-free gloves.
Take Initiative
Ask anyone in the operating room if there is anything you can help with. Know your role in the operating room so you can be confident. I was that shy medical student in the corner who was afraid of touching something I wasn’t supposed to. I wish I started good habits early about taking more initiative during surgery. However, there is a balance to this. Never correct the surgeons, especially during surgery.
Study and Practice
Review anatomy, patient history, and common diagnoses like colorectal cancer, gallbladder pathology, hernias, and hemorrhoids.
Prepare one thoughtful question to ask during surgery to show interest but not be annoying.
Practice suturing at home to build confidence and impress the team. Here is the kit I recommend.
Hygiene and Safety
Clean your stethoscope after every use to avoid spreading germs. Children harbor many nasty germs, and at my medical school and many places, it’s assumed that you have to plan for sick time while on this rotation. It doesn’t have to be that way; be careful, practice good hygiene, and use personal protective equipment (PPE) to reduce the risk of illness.
Key Knowledge Areas
Memorize or have easy access to vaccine schedules. Save it on your camera roll or bookmark it.
Know your rashes and how to differentiate them. Think of not only the difference between rubella and rubeola but also about hives and eczema.
Development and Physical Exam
Familiarize yourself with developmental milestones and age-specific questions, especially in the first four years.
Review the infant physical exam, which includes a few parts that would not be covered in an adult exam, like assessing the fontanelles and checking for hip dysplasia.
Foundational Knowledge
Study routine prenatal care steps, labor and delivery basics, and pregnancy complications before you start the rotation.
Understand common gynecologic cancers and age-related screenings.
Diagnostic and Clinical Knowledge
Review abnormal uterine bleeding differentials and pelvic anatomy.
Understand conditions like gestational hypertension and preeclampsia.
Communication with Preceptors
Discuss your role in deliveries and patient interactions beforehand.
Medication Mastery
Learn psychiatric medications and their side effects. It's important to note both the common side effects and the rarer but severe or life-threatening side effects.
Use an app like Epocrates to make this easy to reference or bookmark UpToDate or a similar site.
Approach to the H&P
Familiarize yourself with the Mental Status Exam, the objective portion of your patient examination.
Know the set of questions that are more relevant to ask during psychiatric evaluations, like a more extensive social history, details about substance use, and a psychiatric review of systems to rule out mania, psychosis, etc.
The Right Mindset
Treat psychiatric patients with the same care and respect as others.
Enter every encounter with an open mind to seek understanding of the person in front of you. You will see psychiatric patients in all specialties, so this is important to understand and practice now even if you know you are not going into psychiatry.
Push back against derogatory terms and advocate for professional standards.
Study Smart
Start Anki early and pair learning with patient cases. Keep up with your cards because IM is broad, and you need to set a strong foundation of medical knowledge to get the most out of the rotation.
Use question banks like TrueLearn. Pairing the theoretical learning to hands-on clinical skills will help solidify both in your brain.
Core Skills
Practice thorough history-taking and focus on associated symptoms to refine your differential diagnosis.
Review management of common conditions like heart failure, chronic obstructive pulmonary disease exacerbations, acute kidney injury, and gastrointestinal bleeds.
Physical Exam Efficiency
Focus on an abbreviated physical exam: chest auscultation, abdominal palpation, pulse checks, and edema assessment.
Know when to expand from the basic physical exam to clarify your differential or monitor for specific pathology based on the patient's medical history.
Chronic Disease Management
Review screening guidelines.
Prepare for chronic disease follow-ups, particularly for diabetes and hypertension.
Start practicing EKG interpretation early to identify arrhythmias and other critical findings confidently.
Read Savarese and begin practice questions early.
Build a strong understanding of techniques before applying them in clinical settings.
By following these tips and preparing effectively, you can make the most of each clinical rotation and set yourself up for success.
Frequently Asked Questions (FAQ)
How should I prepare for clinical rotations in advance?
Start by reviewing foundational knowledge for each specialty, such as anatomy for surgery, vaccine schedules for pediatrics, or psychiatric medications for psychiatry. Additionally, gather any necessary supplies, like a suture kit.
How do I make a good impression on my preceptors and team?
Arrive early, introduce yourself to everyone, and show initiative while respecting boundaries. Always be professional, eager to learn, and open to feedback. Engaging in thoughtful discussions and preparing for cases will demonstrate your dedication.
What resources are most helpful during clinical rotations?
Useful resources include apps like Epocrates, UpToDate, and MDCalc. Question banks and Anki flashcards are great for solidifying medical knowledge. Specialty-specific books like Savarese for osteopathic medicine can also be valuable.
How do I balance studying and clinical duties during rotations?
Time management is key. Dedicate time after clinical duties to review cases and related materials. Use downtime during rotations for quick reviews, such as reading answer explanations for practice questions or doing Anki.