How to NOT Shine on Rounds: Part 2

  • /Reviewed by: Amy Rontal, MD
  • (Missed Part One? Click here.)

    Gather round, brethren, for a story about rounding. 

    Keep your ears open at the hospital and you’ll keep hearing phrases like this: It’s time to round. What time are rounds? We’ll do that after we round. Can’t, gotta round Saturday morning. How does she conduct rounds?

    So much of our time inside the hospital revolves around rounds. During medical school, these important hours are often the only times that we get to rub elbow with our attendings, residents, and colleagues, so it’s incredibly important to take them seriously and approach them in a way that allows you to grow, learn, and shine.

    Guidelines for behavior on rounds aren’t too much different than the guidelines for being a good person outside the hospital. You show up on time, do your work to the best of your ability, and maintain a courteous, professional demeanor all the while. It’s not too much to ask. We went over some ways to be atrocious in our **(link)last article, and now we will cover 5 more. Here are the ways NOT to shine on rounds.

    1. Overpromise, underdeliver

    So much of what we do in medicine revolves around teamwork. We depend on so much other staff (nurses, respiratory therapists, environmental services, nutrition, etc.) to help us achieve certain goals for our patients. There is also a dependence on our lateral colleagues (fellow medical students and residents) in order to make sure all of the work gets done. When you depend on others, they depend on you. Nothing can destroy others’ trust in you like not doing what you were assigned to do.

    Being an active member of a patient’s care team takes real responsibility. If you take ownership of getting the outside hospital medical records faxed over, deliver on this promise. Follow-up on the lab results and imaging studies that you told your peers you’d follow up on. It sounds painfully obvious, but if you say you are going to do something, do it.

     2. Be a gunner/jerk

    I’ve developed a lot of distaste for the word “gunner,” as its definition has morphed over the years. Labelling the medical student who goes above and beyond to learn, educate their peers, take fantastic care of patients, and then study hard after-hours as “a gunner” is simply a sham. It’s a way for those who don’t want to work as hard to feel better about their indolence. There is nothing wrong with working really hard; in fact, it should be the norm.

    Now, the student who is ripping pages out of textbooks at the library so others cannot read them (I’ve only heard this as a dated urban legend), is deliberately misinforming colleagues so that they do worse on exams, and going out of their way to make fellow students look bad on rounds…this person is a jerk. While they might feel crafty and sly in their approach to boost their own self-image, the wiser among us can often tell that this person is a jerk. Don’t be a jerk. Help everyone around you excel altogether. There’s enough room at the top for all of you.

     3. Repeatedly ask if you can go home yet

    Want to get labeled as annoying? Ask over-and-over again if you can go home. Follow it up with “Anything else I can help with?” a few times for good measure. EVERYONE wants to get all the work done and go home. No one wants to waste time. We all have the common goal of getting all of our patients as healthy as possible in the most efficient manner.

    As a student, you must be creative, ambitious, and proactive. Think two steps ahead, and find ways to help your resident without badgering them about whether you can leave or not. The subtlety between your desire to help and your desire to get out of Dodge is all about how you present yourself. Don’t repeatedly ask if you can be helpful – find a way to do so. 

     4. Use shelf studying/reading as an excuse to get out of doing work

    Ah, the much-dreaded, much-loved shelf exam. Dreaded because its a mutli-hour standardized test that can make or break your clerkship grade. Loved because it provides the most convenient and hard-to-argue-with excuse for cutting your clinical hours. Some important things to remember on this front…your residents want you to do great on your shelf. They also want you to get great clinical experiences by actually seeing patients. The recall that you develop from answering questions pales in comparison to the recall that you develop from actually treating a patient. Looking up diagnosis and treatment of SIADH in First Aid cannot hold a candle to managing a patient with this diagnosis. Your best bet is to learn as much as possible from every patient encounter. The more effort you put in on that front, the less effort you need to put into traditional shelf studying.

    Yes, it is difficult to work a 10-hour day at the hospital and then crack open a textbook after dinner to further your knowledge. But that is requirement if you want to be excellent. Let patients teach you the first 75%, and patch up your knowledge by reading.

     5. Correct everyone and anyone at any opportunity

    Remember rule 2? Don’t be a jerk? Showing everyone how smart you are by correcting them and touting your own knowledge is being a jerk. Again, the subtlety is in the way you present information. If you interrupt another student’s or resident’s presentation with a snide “Um, actually, he spiked a fever at 11pm, not at 10,” you are helping no one. “The breakdown product is morphine-6-glucoronide, not morphine-6-glucoronidate!” Foolishness. If someone does make an egregious error, like ordering a medication in a patient who is anaphylactic to said medication, by all means interrupt and correct. But let the small stuff go.

    Have you spotted this not-so-elusive beast (a jerk) on rounds? Tell us what they did so we can all know what to avoid.