Day in the Life of a Medical Student: Clinicals
- Aug 11, 2022
Congratulations on making it to clinicals! It’s been a challenging road thus far. You’ve endured hours of lectures, anatomy labs, and the colossal hurdle of Step 1. Now, you have the opportunity to take everything you’ve learned over the past two years and apply it to “the real world,” so to speak.
I remember the majority of my classmates feeling excited about starting clinical rotations. Though I understood the appeal, I dreaded losing my freedom and having a set schedule. As a medical student embarking on the clinical journey, you finally get a taste of what you’re training for: connecting with patients, treating illnesses, working as part of a medical team, and being involved in the medical decision-making process. Essentially, you get to see how the sausage is made and contribute in a meaningful way. Clinicals also present a unique opportunity to experience multiple specialties and ultimately discover the best fit for your eventual residency choice.
With that said, clinical rotations also have real stakes: you’re just as capable of doing good as you are of doing harm, even as a medical student. Moreover, your performance during clinical rotations can shape the trajectory of your career by closing some doors and opening others.
My Experience as a Medical Student: Clinical Years
It’s hard to capture a singular, universal clinical experience because every rotation is unique. However, there are some commonalities I’ve found from my own experience.
You’ll work hard and have significantly less free time compared to preclinicals. Usually, I worked 8-15 hour days, about 5-6 days per week.
You’ll have shelf exams to study for in addition to your clinical duties during your core rotations. It’s fast-paced: once you get the hang of things for your current rotation, it will be time for a new rotation!
During your rotations, you’ll find yourself in awkward, difficult, and sometimes surreal situations. You’ll also learn how to take feedback. Spoiler alert: unless you’re a rockstar, it won’t always be glowing, and that’s okay.
Keep in mind that every institution is different and that the rotation experience even within the same specialty can vary wildly between students. However, I hope my experience can give you some insight into what to expect on your clinical rotations. Here is a day in my life during one of the most important clinical rotations of medical school: internal medicine.
I wake up bleary-eyed at 5:45 a.m. It’s still dark out, and I roll out of bed in order to try to make it to the hospital by 6:30 a.m. I hop on the 6:07 a.m. bus after hastily washing up and getting dressed. The interns are already there by 6:00 a.m. to receive sign-out from the night team, but the upper level has mercy, allowing us a later arrival.
Our inpatient team consists of two students, two first-year residents (aka interns), and an upper level (a PGY-2 or PGY-3). Sometimes there will be a sub-internship student with us. Each student follows anywhere from three to five patients from our team list, usually assigned by the upper level.
Every morning, we enter the small team room and receive overnight updates from the intern. First, I log into the computer, print my list, chart review my patients, and prepare my progress notes. I try to keep chart review to under 20 minutes so that I have time to pre-round on my patients prior to the morning report, which starts at 7:30 a.m. Then, I run upstairs to pre-round on my patients and debrief with the resident after.
By the time the morning report comes along, I’m starving. Luckily, there are free bagels, in addition to the learning case presented by one of the inpatient residents. The morning report is our version of House, MD. Everyone follows along with an interesting case and attempts to make a correct diagnosis based on the initial presentation and lab/imaging data. Afterward, we return to our respective team rooms and wait for our attending physician to start rounding.
Rounds start at 9:00 a.m. and usually last two to three hours, depending on patient volume and complexity, as well as attending preference. As we walk room to room, the residents efficiently present their patients, and afterward, we gather around the patient to answer questions, perform a physical exam, and discuss the plan for that day.
When we get to “my” patient who has cirrhosis, I timidly start to present. Staying on script and communicating only the essentials in a SOAP format is definitely a work in progress, especially as a green medical student!
The attending interrupts to ask me questions about the causes of liver failure and the recommendations regarding the treatment of spontaneous bacterial peritonitis. Luckily for me, the intern and I discussed the medicine regarding my patient. I answer, and, satisfied with my reply, the attending gives me a pat on the back and we move on.
If I didn’t know the answer, that usually means I’ve scored myself a 10-15 minute presentation on the topic in question to be delivered to the team later in the week. As we round, the superhuman interns run around arranging discharges, calling consultants, answering pages, and generally being in multiple places at the same time. I’m suddenly grateful I have the chance to learn without having to bear that much responsibility.
Today is Friday, so we aim to finish by noon for protected lecture time. (Plus, more free food if we’re lucky! Free food is the lifeblood of a medical student.) Sometimes we have patients left to see, and we make plans to meet after didactic hour. This can complicate the schedule because most days our team is responsible for some form of admissions or another.
During my training, we followed an 8-day cycle of admissions, alternating between long call, midday call, and short call. Today, we are on long call, which means that after 12 p.m. we start taking admissions until 6 p.m., up to six new patients with a potential seventh ICU transfer. The students usually take on one to two new admissions each. These are one of the best learning opportunities, as we have the chance to get to know the patient from admission to discharge, and we’re able to come up with our own care plan. New admissions are difficult and take a significant portion of time, so be prepared.
Before new pages come, I try to complete my progress notes on our existing patients. Students can’t sign notes, but we can pend them for the residents to review with our EMR system. If it’s a slow day, our residents sometimes ask for help with various tasks, such as following up with the social worker, updating the list, or going to ask the patient or family additional questions.
Sometimes the upper level or attending will give a 15-minute chalk talk teaching session on a topic of our choice. Then there are days when the afternoon is spent having difficult conversations with the patient and the patient’s family, often regarding goals of care or a sobering update on prognosis. These days were often the hardest.
On admissions days, the residents accept the admissions and assign a patient to me. From there, I look through the vitals, labs, ER notes, and notes from previous admissions. I prefer to systematically organize my thoughts before presenting the new patient to the team, so I use a guided H&P form. The resident and I go down to the ER to observe me performing a history and physical exam. As I go through my H&P with the patient, the resident steps in occasionally to ask follow-up questions, or to get their own exam findings.
After the encounter, we discuss our thoughts on the patient and what the plan should be. When we’re happy with what we have, I present the patient to the attending, and we finalize our plan as the resident places admission orders in the EMR. This is another good opportunity for teaching, and oftentimes the attending includes some clinical pearls pertinent to the patient’s diagnosis.
The residents continue taking admissions while the students work on our admission notes. I’m still working on improving my efficiency, so the note can definitely take me a while. If the resident is not too busy, they will review the note and provide helpful feedback. If it gets to be too late and close to sign-out, the residents make plans to review the note with us on a further date. The students are usually free to go by 6 p.m. on an admissions day, and earlier on a non-admissions day (closer to 4:30 p.m. or 5 p.m.).
I take the bus home and reflect on the day. Clinical rotations are definitely harder than my pre-clinical days, and there’s definitely more to the balancing act than before. I know that even at home, I have more preparation to do for the next day, as well as studying for my eventual internal medicine shelf exam. There are thousands of practice questions in order to prepare for the internal medicine shelf, and many things I still don’t know. For dinner, I’ll usually cook a quick meal or order take-out, hunkering down to study more or work on my upcoming presentation.
I make a goal for myself of finishing at least 50 practice questions per day, but it doesn’t always happen, especially on busy clinical days. Weekends and days off are my heavy-duty study days. I aim to sleep early because I know I have another early wake-up call tomorrow. Luckily, tomorrow won’t be an admissions day, and I’m looking forward to more teaching in the afternoon and getting to connect more with my team. Tomorrow is another chance to learn and grow, just another step further toward realizing my dream to be a doctor.
About the Author
Mike is a driven tutor and supportive advisor. He received his MD from Baylor College of Medicine and then stayed for residency. He has recently taken a faculty position at Baylor because of his love for teaching. Mike’s philosophy is to elevate his students to their full potential with excellent exam scores, and successful interviews at top-tier programs. He holds the belief that you learn best from those close to you in training. Dr. Ren is passionate about his role as a mentor and has taught for much of his life – as an SAT tutor in high school, then as an MCAT instructor for the Princeton Review. At Baylor, he has held review courses for the FM shelf and board exams as Chief Resident. For years, Dr. Ren has worked closely with the office of student affairs and has experience as an admissions advisor. He has mentored numerous students entering medical and residency and keeps in touch with many of them today as they embark on their road to aspiring physicians. His supportiveness and approachability put his students at ease and provide a safe learning environment where questions and conversation flow. For exam prep, Mike will help you develop critical reasoning skills and as an advisor he will hone your interview skills with insider knowledge to commonly asked admissions questions.