Med school rotations can be tough—there are a lot of unspoken rules and subtle cues you have to learn, all while putting in some serious study time! On top of that, you’ll be interacting with patients in a way you never have before. It’s a lot to handle, even for the most dedicated and talented students!
That said, rotations are the most impactful part of your medical school career. While you’ll be challenged for sure, they can also be incredibly rewarding! And if you go into them prepared, there’s a lot you can get out of them.
So, the obvious question is, how do you best prepare for your rotations? Based on my own experience, there are so many things I wish I knew going into them! While the typical advice of time management and staying consistent with studying and doing questions rings true, other things are less obvious. There’s an art to balancing everything that often goes unexplained!
In this guide, we’ll go over a few main takeaways to help you handle each rotation with grace. Let’s get started!
7 Tips to Help You Rock Your Med School Rotations
1. Ask what you can do to make your residents’ lives easier.
At the beginning of rotations (after orientation and introductions), you’ll be given a rough guide of what’s expected of you. This is a great time to ask something about how you can be helpful! It can be something as simple as, “What have past medical students done that you’ve found helpful?” or, “What are ways that I as a medical student can help the team day to day?”
Questions like these will go a long way, as not only do they show effort and thoughtfulness, the answers to them will give you a sense of how to maximize your efforts.
2. Figure out how you can be of assistance.
In addition to asking how you can be of assistance, you should always look for ways to help out on your own. Your residents won’t tell you everything explicitly, so stay alert and figure out ways you can be helpful without being asked.
Here are some examples of how I did this on different rotations:
Surgery
On my surgery rotation, I’d perform “afternoon rounds” by myself (or with another med student) on the patients I was following. They may have gotten a procedure or imaging done, so checking in on how they were doing in the afternoon was helpful since the residents were usually busy at that time.
When checking in with your patients, encourage them to use the incentive spirometer to prevent postoperative complications.
Internal Medicine
On internal medicine, sometimes during rounds the attending may ask something about a patient that you’re not following like, “Have they ever been on a blood thinner?” which your resident may not know the answer to.
After rounds would be a great time to look through the patient’s chart or go to their room and ask them if they’ve ever been on certain blood thinning medications. Simple things like this go a long way, as it shows your engagement on rounds for all patients, not just the ones that are yours.
Also, when you’re on internal medicine, offer to write hospital courses for your patients. This helps a lot during discharges for the residents, and while they might not use every part of yours, they’ll use it as a rough draft and your effort will be noticed.
Neurology
During this rotation, try to perform neuro exams in the afternoons on stroke patients to see if there have been any changes. Most patients are on “q4 neuro checks,” but nursing staff is often overworked and getting more practice doing a good neuro exam will only add to your skill set!
Psychiatry
While I was on my psychiatry rotation, I offered to call my patient’s listed contacts to get more information on their diagnosis/previous admissions if I was unable to see it in their chart.
I’d call a family member and ask what medications they had previously been on and if they worked well, if they’d ever been hospitalized before for this diagnosis, and other questions just to give more context since often psychiatric patients are unable to provide this information on their own.
OB/GYN
On OBGYN rotations, I used to grab ice chips (if they’re not NPO) or blankets for patients in labor when they asked for them.
Other ideas for offering assistance:
On most rotations, I’d offer to provide family updates for the patients I was following. Obviously, make sure you feel comfortable presenting the medical plan to the family and always know when to say “I don’t know but I will ask my resident and get back to you.” You never want to tell a patient or family something incorrect.
If your resident prints out a work note for a patient the day of discharge, offer to drop it off at the patient’s room.
If the official radiology report comes back for one of your patients (that wasn’t available during rounds) let your residents know what it showed when the time is right.
Always have spare supplies with you. This can be suture removal kits on surgery (or gloves/masks for patients on infection precautions), your neuro kit of reflex hammer and tuning fork, etc. Small things like this can come in handy for your residents and attendings.
Once you get a lay of the land, help the team by guiding on rounds. If the flow is normally 1st floor patients then 2nd then 3rd, when you start at room 105, check to see which patient would be next and help guide them in that direction. Saying something like, “Our next patient is 109 here on the right,” helps take some of the mental load off your team.
If there’s a niche topic that’s new and emerging that has everyone in the medical team confused, offer to look into it and give a small 2-5 minute presentation on it!
Use your best judgment to figure out what the day normally looks like for residents on that rotation. If there are small things you can do to be helpful and kind, do them! Teamwork makes the dream work, and rotations are when you’ll see first-hand what people mean when they say medicine is a team sport.
3. Know EVERYTHING about your patients. This means doing a thorough history and a full exam!
Every day on rotation, you should be showing up early! This is so you can chart check your patients, perform a subjective interview, and an objective physical exam in a thorough manner. As a medical student, it’s your job to know as much about your patients as possible.
If the electronic medical record (EMR) allows it, I would look into medical history including recent hospitalizations or outpatient visits to get more details. Small examples of this include knowing what chemo regimen a patient is on for their cancer and how many cycles they’ve completed. These are things you can write down that may not necessarily be brought up in your presentation, but could come in handy.
For example, if a patient reports a pins and needles sensation in their feet that’s new or unrelated to their reason of admission, you could be the one to share that this symptom of peripheral neuropathy could be a side effect of their chemo regimen of vincristine.
Do a quick review of your patient’s symptoms daily, as this will let you get comfortable asking these questions and help the medical team catch any potential new symptoms or concerns. Take a complete physical exam, even if you only share pertinent things in your presentation. Being thorough will take time, but you’ll get more efficient as time goes on!
4. Tailor your presentations to each rotation, and stay flexible!
Different med school rotations have different expectations of medical students, and that’s completely understandable. Use your first couple days to figure out the format, and stay observant and adaptable.
Odds are on your internal medicine, family medicine, and pediatrics rotations, you’re going to want a full “SOAP” format:
Subjective: How the patient feels today and overnight, noting any symptoms or new complaints.
Objective: Starting with vital signs, your pertinent physical exam findings, pertinent labs, microbiology, imaging results, and any other objective details.
Assessment / Plan: As for your assessment and plan, they’re usually problem based.
Be sure to think of differential diagnoses if something is still vague or being worked up. For a problem such as “dyspnea” or “lower extremity swelling,” differentials could be CHF exacerbation, DVT and PE, pneumonia, COPD exacerbation, myocardial infarction, amongst other things.
You need to show your thought process, even if it’s wrong! Something like, “Higher on my differential includes CHF exacerbation as supported by the patient’s missed doses of diuretics, history of similar presentation, BNP of 2,000, pulmonary vascular congestion on CXR, etc.”
Attendings and residents want to know your thought process as to why a patient has an acute kidney injury or new GI bleeding. That shows your “assessment.”
Lastly, try to succinctly review your plan with your resident if time allows before rounds. Having your own draft plan will help you make clinical decisions, and again, it’s okay to be wrong!
Presentations for Specific Med School Rotations
Surgery
On your surgery rotation, keeping things focused and brief is more important during morning rounds. Focus on the p’s: poop, protein, pain. Report on if the patient’s been able to have a bowel movement, tolerate diet, and how their pain is. Here, physical exams need to be geared towards the actual surgical area.
Psychiatry and Neurology
On your psychiatry and neurology rotations, keep your presentations specific to the field itself.
A complete psychiatric exam focuses on speech, behavior, mood, thought processes, hallucinations, and delusions, among other things.
A complete neurologic exam should also be reported for your neuro rotations. It may seem obvious, but focusing on what matters most to psychiatrists and neurologists will keep your presentation focused.
OB/GYN
On your OBGYN rotation, presentations will vary based on your service. Ask your residents what the normal flow looks like for a labor and delivery day (where you might not give direct presentations) versus a maternal fetal medicine (MFM) day (where you give more of a SOAP- style presentation).
Outpatient
Outpatient presentations in the clinic should also follow a SOAP format as much as possible, but again tailor them to the specialty you’re in. Your skills will continue to develop as you progress in rotations, so have grace with yourself if you’re not sure how to proceed at first!
5. Know how to use your downtime/free time while on your med school rotations.
You should always have something you can review or look over to maximize your day and minimize the amount of studying you need to do when you get home. You might have 40 minutes between OR cases where you can knock out some questions or review the procedure for the next case. You may also have to wait a couple of hours for an admission on a long day in pediatrics or internal medicine, so your laptop should be charged and ready for flashcards or textbook review.
If studying feels too difficult with all the distractions on rotations, edit the case report you’ve been putting off or finalize your grocery list for when you leave the hospital. Having something you can always go to is crucial to prevent yourself from feeling like your time on rotations is being wasted. Understand that not every minute of rotations will be exciting or action-packed, there’s actually a lot of down time.
Don’t forget to take care of your basic needs: making sure you’ve eaten and used the bathroom should be priorities. Your residents and attendings will understand if it’s 2 p.m. and you ask, “Do you mind if I take a quick 15 minutes to eat lunch?” Again, use your best judgement and take advantage of any downtime.
6. Attitude matters. Be present and helpful.
On rotations, it’s easy to feel overwhelmed and frustrated by your lack of a clear schedule, defined responsibilities, or the stress of balancing studying and research while deciding on a specialty. It’s completely understandable if you get a little stressed out.
However, your attitude on rotations is something that can make everything seem more manageable. Furthermore, residents and attendings can pick up on a medical student’s attitude. If you know you don’t want to do surgery, still try your best to have a good attitude going into the OR and asking where you can help. Eagerness to learn and make the most of a situation will only be rewarded. As this will be the first and last time you’ll be experiencing certain fields of medicine, soak it up!
Attitude also matters when it comes to your day-to-day schedule and flow. Unfortunately in the world of medicine, your hours are never going to be well-defined. This is also unlikely to change in residency, so get used to it while you can. Some days may surprisingly end early by 2 p.m. and you’ll have the entire afternoon to study! Other days will end at 6 or 7 p.m., and you’ll have spent more of your day at the hospital than at home. Understanding there will be variety that’s beyond your control will make things more tolerable.
Your attitude will also undoubtedly be affected by your life outside of medicine. Take the time to invest back into yourself. Making sure you’re getting enough sleep, eating healthy, and exercising from time to time is crucial. It may seem obvious, but these are easy things to misprioritize in the midst of rotations.
Also, don’t forget to help out your fellow medical students or other members of the healthcare team. Small things like helping a nurse by grabbing water for a patient or holding the door for the transport folks are acts of kindness that help the healthcare system run.
7. Ask for feedback on how you’re doing!
It’s important to ask your residents and attendings for feedback, usually after the first or second week on a rotation. Asking earlier on can give you more time to act on their feedback in the upcoming week. Some schools have forced mid-rotation feedback, and this is enough to do the trick.
If you don’t have a required time to go over feedback, take initiative to ask in the afternoon when there’s some downtime. It’s impossible to read anyone’s mind, so asking is truly the best way to hear what their thoughts are on your performance. It can definitely be daunting and scary to ask, but keeping it casual and setting a deadline for yourself to have asked for feedback are good ways to keep yourself accountable.
Final Thoughts
Don’t forget the residents and attendings that are giving you evaluations were once in your shoes. Think of ways you can make their lives better and easier, as one day that’s what you’ll want from your medical students.
It’s normal to feel a bit stressed out over your med school rotations, but at the same time, there’s no need to be overly anxious or overthink everything. If your residents ask you if you want to leave early, take advantage of the opportunity. It’s not a trick question. Stay engaged and attentive during each rotation, and fake it till you make it for the rotations you find less exciting. Work hard by constantly asking yourself how you can improve your presentations or speed up your time to see a clinic patient. Striving for improvement personally will win you points professionally.
Most importantly, have fun and soak up the once-in-a-lifetime opportunities that come with rotations! Getting to deliver a baby, help perform a leg amputation, drill an intraosteal line, and learning how to read an EKG and CXR more confidently are all unique experiences that you probably won’t get to use later down the road. Plus, you never know when having those skills could come in handy!
Your medical school rotations will have a huge impact on you and play an important role in the physician you become. Having a grateful and positive attitude during them will pay off for you in the long run. Follow these tips and I think you’ll get more out of them than you could have ever imagined!
