I didn’t create this document for the blog, but wanted to send it out into the world so . . .why not 🙂 It was written for the 4th year medical students that rotate through our division* (I’m in charge of coordinating them). I hope it is useful for other medical students as well – feel free to share! Feedback welcome.
1) Come excited to learn. It’s okay if you don’t know all that much in our field – this is the time to gain that knowledge. No shame. Embrace the deficits – we’ll have more to teach you. Topics like “growth” can sound deceptively simple but the deeper you go, the more nuanced things will get. Have an open mind about what you might learn on this rotation. Even if you’re not interested in going into peds endo (though . . .you should consider it – ha!)
2) Don’t necessarily, however, expect that we can teach it all to you verbally. Take advantage of reading materials – books + PDF collection of articles. Strategize by hitting one topic/night and I guarantee you will get a lot out of this rotation.
3) Use EPIC** and plan ahead! Look at the next day’s patients for the attending you will be working with. See who looks interesting, and if there are specific topics that pertain – example, if there is a Graves Disease patient, read about Graves Disease in advance. You can use the “Media” tab in EPIC to scroll back and look at labs and scanned documents for new patients, too. There is so much to be learned from the medical record and looking at prior notes. Plus, half of learning ‘medicine’ is learning to speak the language.
4) Volunteer for good learning opportunities. Our best students look ahead, see who would be interesting, and plan on seeing them first and generating a note. Fully immersing in one good “new” case is much more valuable than just tagging along to multiple returns.
5) Don’t be afraid to examine. With the exception of leaving puberty exams for when we are all together, I recommend doing thorough exams on the patients you are seeing. This is important practice you need. The more “normals” you look at, the more you’ll pick up future abnormals.
6) Don’t hover. Sorry, but it’s not helpful for you and it’s not helpful for us. If I’m just making 29348 patient calls and catching up on notes (which has to happen!), that’s a great time for you to be working on a note, reading about a topic, or prepping for a future patient.
7) That said, make sure we do SOME kind of focused learning every day. This can be focused on the topics of our patients or we can plan ahead to talk about other topics. Refer to topic list for inspiration!
8) Practice writing notes, and ask for feedback. No, we don’t “need” you to write notes. But as an MS4, you need the practice doing them, because in less than a year you’ll be an intern that needs to be able to chart efficiently and accurately! We’ll never stop you if you volunteer to put a note in the chart on an in- or outpatient. It won’t “count” for the daily note but is still excellent practice for you and a chance to get valuable feedback.
9) TALK to the patients! Go in first, and get the story. Yes, review EPIC, but charts are not a substitute for actual face time and hearing things first hand. Screens are not a substitute for actual patient face time. It’s nice sometimes to get a list of questions that can be addressed when the attendings come in with you.
10) Let us know how you’re feeling! If there are topics not being addressed, please feel free to ask, or if you feel you are not getting the right balance of inpatient/outpatient care. Want to spend the day with our educators or attend a pump class? Play with a glucometer? Let us know. We welcome your feedback in making this a useful experience for everyone.
BONUS #1 – work/life balance and time management is a passion of mine and I’m happy to discuss these things with you. Bring me questions about careers, making things work with a family, etc – it’s all fair game. Some of the most valuable things I learned from attendings weren’t necessarily medical. Just wait until I’m caught up on charts or taking a break . . . please.
BONUS#2 – when you’re crafting your presentation, try to think about what you could teach US. You can give an overview, but then go narrow and look to primary literature (NOT Wikipedia/uptodate). Let us know if you want us to look it over before you give it! And cases make the topics come alive.
* Where I work, we do not have our own medical school but we provide clinical rotations for a number of local institutions as well as some visitors from other states
** The electronic medical records system (for the non-medical, EPIC is one of the most commonly used systems so even most visiting medical students are used to it!)