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Advice for Third Year Med Students What NOT to Do on a Clinical Rotation

Midway through their third year, I expect medical students to act like seasoned veterans on each rotation. By now, you should understand the electronic medical record, know how to take a comprehensive history, and understand the basics of giving a thorough, yet concise presentation on rounds. You should also know how to be a good teammate and someone that is enjoyable for your peers, residents, and attending physicians to be around. Yet, time and time again, students seem intent on engaging in behavior that frustrates those around them and ultimately ensures a poor evaluation for the rotation.

As I tell my students on Day One of a rotation — you can be the smartest person in the world, but if you aren’t hardworking and a good team player, you will never live up to your potential. Likewise, hard work and a great attitude can often cover up an average foundation of knowledge. So, I’m here today to teach you how to avoid some of the common behaviors that frustrate residents and attending physicians.

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Don’t Try to Make Others Look Bad

I listed this point first because it is my biggest pet peeve and the most surefire way that a student can earn a poor evaluation. As an intern in the medical ICU, I was part of a team that included two third year medical students — one who was very intelligent and near the top of his class and the other, a student with a slightly below average foundation of knowledge. But while the former was very well read and nearly always knew the right answer to each question, it was the second student who ended up with the higher evaluation for the rotation. But why?

Every day, I watched as the more intelligent student attempted to stand out from his peer but cutting him off to answer questions, interjecting additional information in to his presentations, and pimp him to demonstrate his own superior knowledge base. Moreover, this student would openly question myself and our senior level resident in front of the attending in an attempt to showcase his own knowledge. Needless to say, nobody enjoyed working with this student.

Being intelligent is never bad and is always something that you should be proud of. But, whether you are a student, resident, or attending, you should never attempt to flaunt your own knowledge as a way of putting others down. While on a rotation, try to follow these points to demonstrate your knowledge in a professional way:

    • Don’t answer questions asked to another student
    • Do offer to help teach your fellow classmates in a private setting
    • Don’t interrupt your peers during a presentation
    • Do offer them constructive criticism in an appropriate presentation
    • Don’t reverse pimp your intern and residents
    • Do ask them to explain their reasoning behind management decisions
    • Don’t ask rhetorical questions designed to showcase your own knowledge
    • Don’t round on your co-student’s patients behind his or her back
    • Don’t act uninterested

I get it, not every rotation is going to be your favorite and not every rotation is going to seem applicable to your intended career. However, your grade and evaluation from that rotation will ultimately matter, so don’t act like a douche. The other night, I listened for 30 minutes as my wife’s co-residents complained about a student who was constantly on her phone during rounds, came up with excuses to leave early nearly every day, and attempted to avoid going to the operating room at all costs. At the end of the day, you have to complete each of your rotations — acting uninterested is only going to hurt you and the way that you are perceived by others.

Don’t Lie

You’re a medical student — nobody expects you to be perfect. But what we do expect, is for you to tell the truth. If you forgot to ask a question when interviewing a patient, don’t make an answer up. If you are unsure how to do a certain procedure, don’t claim that you can do it unsupervised. At the end of the day, the truth usually has a way of coming out and telling lies is one of the quickest ways to lose your credibility or any autonomy that you may have. Even worse —telling a lie can have horrible impacts on patient care. It’s okay to say, “I don’t know.”

Don’t Act Entitled

You’re a student and as residents, it’s our job to teach you. However, there are certain times where your involvement in a particular situation or procedure will not be appropriate. When I was an intern in obstetrics & gynecology, I tried to involve my students as much as possible. Still, there were many times that I was unable to have them participate in a pelvic exam or delivery due to the preference of the attending or a need to obtain numbers for myself. So while I understand that these situations can be very frustrating for a student, you should understand that sulking or complaining about them is not in your best interest. Ask your resident to be involved as much as possible and trust that they are doing everything in their power to help your education.

Don’t Make Excuses

Whether you showed up late, forgot to round on a patient, wrote a bad note, or failed to do an assigned reading — just own it. Making excuses will never impress anyone and quickly irritates the rest of your team. Admit to your mistake, apologize for it, and make changes to prevent it from happening again.

Don’t Turn Down Advice

While on a wards rotation, one of my third year medical students was really struggling with her daily presentations. They were convoluted, lacked important details, and never addressed an appropriate treatment plan for the day. After having an attending complain to me about this in private, I made it my mission to help this student improve her skills. In addition to providing her with constructive feedback on how to better organize her presentations, I also agreed to meet with her before rounds each day to ensure that she would be presenting the appropriate treatment plan for each of her patients. Did this help improve her performance? No — because she never listened. Rather than taking my advice, she continued to stick to her presentation strategy and would present her own treatment recommendations despite the feedback I had given her.

As residents, our time is very valuable, so when someone takes the time to teach you or offers to help improve your performance, the least you can do is listen. Making your residents feel like you are wasting their time or disrespecting their efforts is a surefire way to get ignored or end up with a bad evaluation.

Don’t Speak Out of Turn

My final piece of advice is to remember your role on the team and to act accordingly. There are certain discussions that students should not be having with a patient, unless it has been explicitly assigned for you to do. Things like cancer diagnoses, miscarriages, or HIV results should likely be communicated by a resident or an attending. Additionally, don’t bring up mistakes or question the chosen management plan in front of the patient or their family — that is not your place. At the end of the day, act with good judgment in terms of what you do and do not say when interacting with patients, families, and other healthcare professionals.

I hope this advice was helpful and can shed some light on to how you can achieve a great evaluation on each rotation. Avoiding these common pitfalls is a great start to a successful 3rd and 4th year.

 

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