If you’ve made it to an outpatient clinic or elective rotation, that means you’ve probably completed a significant chunk of your inpatient core rotations. Congrats! Outpatient medicine and inpatient medicine can be a night and day difference. Generally, outpatient clinic and non-inpatient elective rotations have fewer hours when compared to inpatient rotations. However, they can come with their own host of caveats. There doesn’t seem to be a consensus on which schedule is better, and is largely a matter of personal preference.

Common outpatient clinic rotations that you will encounter during your core rotations include pediatric, family medicine, or neurology clinic. Elective rotations that only take place in the outpatient clinic are actually somewhat rare and may contain some component of procedural or even OR time (such as dermatology, ENT, and ophthalmology). Internal medicine subspecialties seem to be more primarily outpatient (such as endocrinology, rheumatology, allergy/immunology).

Of course, some attendings also take on a consulting role in many hospitals. In my experience, the rotations often reflect this component. Because I was interested in a physical medicine and rehabilitation residency, all of my electives were in this field. Though there are inpatient rotations in this specialty, the rotations taking place in a clinic setting were all 100% outpatient!

My Experience as a Medical Student: Elective Rotation

A major benefit of the clinic setting is the attending is generally more available to teach, but again this can vary based on how busy the clinic is. At least as a student, you can focus on one case at a time more than you can in the inpatient setting, where there may be many small fires at any moment that captures the team’s attention.

Most clinic rotations have a simple structure. As a student, you interview and examine the patient independently, present to the attending or resident, review pertinent clinical information with the attending and resident, see the patient with your team, and write a student note. Here is an average day in my life as an elective student. 

Mornings

I am always grateful for the later wake-up time when I’m on an outpatient rotation. 7:20 a.m. versus 5:30 a.m. is a blessing. Having been through the latter, I know how good I have it on this rotation! I usually aim to make it to the clinic by 8 a.m., which is when the first patient is scheduled. I can usually review the reason why they are here and previous notes (if applicable), pertinent labs/images/consults within 10 minutes.

Patient Interviews

Usually, I like to have a note template ready to guide my line of questioning. I knock on the door of the first patient’s exam room, introduce myself as the medical student, and ask if they’re OK with talking to me first. You’d be surprised because sometimes the patients will say no! 

The patients in this particular clinic are often here for a musculoskeletal complaint or back pain complaint. As a medical student, all of the exams and questioning can seem a little overwhelming, but as an elective student, I’m not expected to be an expert in the field. This rotation is an opportunity for me to learn the pertinent questions to ask these patients, familiarize myself with the physical exam, and gain exposure to some interesting pathology I might not otherwise see on my core rotations (for example, De Quervain’s Tenosynovitis, or Neurogenic Thoracic Outlet Syndrome). The elective rotation is also an opportunity for me to work on organizing my presentation, and starting to flesh out a differential diagnosis for a musculoskeletal complaint.

Presentation and Review

So after I see my first patient, interview them and examine them, I will think about what pathologies can possibly apply to their situation, and come up with a few possibilities of what it could be, as well as what I suspect the most and potential management possibilities. I don’t always get it right, but the attending or resident gives me helpful feedback and other factors to consider. Once we finish talking about the case outside of the patient room, ideally the entire team including the attending physician, the resident, and I go back into the patient room together to reconcile the history and physical, and discuss a plan. This is one of the most valuable learning situations, as it serves as direct feedback for the data I gathered from the encounter. 

Oftentimes, you won’t be expected to see every single patient on the clinic schedule, and the attending may enter the room to see another patient as you’re finishing up with your first one. Clinic schedules can be quite packed, and having multiple members of the care team see the patient definitely extends the visit.

Student Note

I work on my student note during any idle time and try to delineate the clinical reasoning the attending explained to me as clearly as possible. The attending still writes their own note or has the resident write the note, but if my documentation can improve their efficiency, then all the better! After I finish my note, I see the next available patient. Patient rapport is important in the clinic setting, as doctors tend to form closer relationships with their patients from seeing them on a longitudinal basis, and the banter and life updates are always a treat to see.

I’ll usually see 3-4 patients before the lunch hour. Clinic sometimes runs over into lunch, but many attendings are very nice about allowing me to go at 12 p.m. and return at 1 p.m. Having a full hour for lunch is a treat, and isn’t always possible beyond medical school when responsibilities increase.

Afternoons

I return in the afternoon, which can be more of the same as what we did in the mornings. On some afternoons, my PM&R attending has more procedural patients mixed in with his clinical patients. Sometimes, we set up the patient in the fluoroscopy suite for Fluoroscopically-guided intra-articular hip steroid injections. Once in a while, we see a patient for whom we perform Platelet-Rich-Plasma injections to the knee or hip or shoulder. For other patients, I’ll observe the attending perform an ultrasound-guided joint injection.

The last patient is usually around 3:30 p.m. or 4:00 p.m. and depending on late patients or no-shows, I can depart by 5 p.m. or 5:30 p.m. The attending does often stay behind to deal with all of his additional responsibilities, such as replying to messages, finishing documentation, and filling out paperwork. This is all after he spends a good amount of time providing clinical pearls and answering questions about the patients we saw that day! 

Evenings

Going home, I usually find I have plenty of time to study. One of the perks of being on an elective is that usually there are no shelf exams. However, I’m hoping to enter this field and would like to impress my attending enough for a potential recommendation letter. Thus, it is important that I read up on patient cases, and exhibit interest as well as growing knowledge while going through the rotation. It is a different kind of motivation than shelf exams, and can often come with learning that is more satisfying. 

I definitely appreciated the improved work-life balance that the rotation allowed me. By getting home before 6 p.m., I find that I have more time to cook and run errands. I don’t have to work any weekend days or holidays either, and can use the extra time to study or work on extracurriculars or research, or just slow down and enjoy my last 1-2 years of medical school. The day-to-day isn’t everything in selecting a medical specialty, but it can definitely play a role in figuring out which specialty fits the best.

Further Reading

• Day in the Life of a Medical Student: Clinicals
• Surviving Intern Year and Clinical Rotations: Must-Haves & Essential Tips
• How to Choose the Right Electives During Your Clinical Years