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How to do well on clerkship?

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OnlineMedEd is a good high-yield way to prep for a specific specialty.

More important than knowledge is likeability. Sometimes pure knowledge will win, but for the most part being likeable trumps. I often feel bellow average with respect to my knowledge, but I get consistently high(er) evals, and offers for reference letters, and I'm convinced it's because I like to connect on a personal level with my team. Will that carry you through an orthopedic rotation with an antisocial preceptor who pimps you on subspecialty material even though he knows you have no interest in surgery (personal experience? Haha)? No. But as long as you're punctual and happy to put in the hours, it works more often then not.

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Students often worry about their level of knowledge prior to clerkship and are eager to try and read as much as possible in order to "succeed." Clerkship in my experience is a lot more about developing your diagnostic thinking, approach to common presentations, and ability to formulate appropriate management plans. A significant portion of it also comes down to doing your preceptors' work: ex. writing referral letters, admission orders, discharge summaries, dictations, etc. and doing it correctly.

It really comes down to showing up on time, trying your best, and being respectful towards everyone you encounter. It can be very anxiety-provoking as you are often trying to adjust to different preceptor expectations, figure out different wards, etc. but as long as you do the aforementioned things, you'll be good and just need to trust in yourself and the process. Clerkship is one of those things where you "just have to go through the fire" so to speak, but it really isn't that bad. There are many times where it sucks @ss, but you will survive it.

Definitely do your best to remain connected to activities that promote your personal well-being, and to spend time with family/friends, especially people outside of medicine.

--

1. How did you review/ study?

Read inbetween cases when possible. Do some reading at night time/energy permitting. Case files is really helpful. 

2. How to perform well in clerkship?

See above.

3. How to be a good clerk?

See above.

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1. Read around my cases and made sure I met the learning goals of the particular rotation. Didn’t really study much more than that. 

2. Watch out for yourself and your fellow clerks. Ensure you’re sleeping, eating, and resting when you can. Find a task organization system that works for you and stick to it so that you’re staying on top of the things you should be doing. Get to know allied health professionals and don’t be afraid to ask them questions.

3. Be polite. Be honest - ESPECIALLY if you screw up/forgot to do something. Show up on time. Help out where you can. Respect your allied health care staff. Basically, be professional and don’t be a jerk. 

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7 hours ago, Peds123 said:

I will be starting clerkship in Feb and I wanted to know:

1. How did you review/ study?

2. How to perform well in clerkship?

3. How to be a good clerk?

Thank you 

I agree with the previous answers: it's important to take time to protect yourself and connect with friends/family. However, for my answers below, I'm going to answer you assuming you want a competitive specialty and that you are on a rotation where you want to work extra hard because you want a strong LOR. Please don't stress out if you just want to be able to pass the rotation or if you want a specialty with low competitiveness since being a reasonable person can often get you a pass by itself.

1) With studying there should be 2 goals. The first is understanding the clinical knowledge well enough to function well while on service/in clinic (e.g. having a good DDx & approach for common presenting complaints, learning about how the diseases you typically encounter are treated). The second goal is gaining the knowledge to be able to answer pimp questions and pass the rotation exam (usually some clinical knowledge but more often pathophysiology of disease, common associated condition, complications of treatment, random 'fun' facts.). 

On my IM rotation, during the day I would read up on patients and their conditions if time permitted--usually this totaled to less than 1 hour on average since the service was busy. In terms of clinical resources, I found DynaMed the most helpful, with occasional references to UpToDate when I needed further clarification. After work I would study 1-3 hours using an assortment of resources, i.e. OnlineMedEd lectures, Boards & Beyond lectures, CaseFiles/UWorld Step 2 CK question bank, and clinical resources (DynaMed/Medscape/UpToDate) as needed. With clinical resources, keep in mind that there's a ton of knowledge beyond the scope needed to impress as a medical student--you will have to be the judge of what you need to know, what you should know, and what you don't need to know.

If I felt my clinical knowledge was weaker, I would focus on reading up via clinical resources, as well as going through OnlineMedEd lectures and CaseFiles.

If I felt my general/science knowledge was weaker, I would focus on Boards & Beyond lectures and UWorld.

Occasionally I had to sit down and draw out flowcharts or take notes, but 95%+ of my learning was just listening to lectures on 1.5-2x, going through cases/questions, and reading the occasional Medscape or DynaMed page.

For Peds I would focus on using pedscases.com as your primary clinical lecture base. For Surgery I would probably pick up whatever textbook is recommended by your upper years.

Many preceptors and residents commented on my strong knowledge and my evaluations reflected that.

2) & 3) 80% soft skills & social awareness, 20% medical knowledge. Intrepid86 and freewheeler put it best.

Quote

Do as you're told.

Don't lie about anything.

Don't get in the way. 

A significant portion of it also comes down to doing your preceptors' work: ex. writing referral letters, admission orders, discharge summaries, dictations, etc. and doing it correctly.

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How good do you have to be with your physical exam skills when you start clerkship?

To my understanding, they'll ask you to examine a patient on your first day/week. I wouldn't even be able to pick up a murmur (unless it was really obvious) on a cardiac exam for example

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22 minutes ago, brady23 said:

How good do you have to be with your physical exam skills when you start clerkship?

To my understanding, they'll ask you to examine a patient on your first day/week. I wouldn't even be able to pick up a murmur (unless it was really obvious) on a cardiac exam for example

No one expects you to pick up murmurs. Just know how to do a basic exam in each discipline.

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44 minutes ago, brady23 said:

How good do you have to be with your physical exam skills when you start clerkship?

To my understanding, they'll ask you to examine a patient on your first day/week. I wouldn't even be able to pick up a murmur (unless it was really obvious) on a cardiac exam for example

If a med student can pick up a murmur, it’s either not there or very obvious.

Quite honestly, lots of staff docs aren’t great at picking them up either. I’m by no means an expert at auscultation but I’ve caught several that staff missed just because I take time with listening. 

Youre there to learn. If you were already good at clinical things, you wouldn’t need clerkship. 

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1 hour ago, brady23 said:

How good do you have to be with your physical exam skills when you start clerkship?

To my understanding, they'll ask you to examine a patient on your first day/week. I wouldn't even be able to pick up a murmur (unless it was really obvious) on a cardiac exam for example

95%+ of preceptors are understanding and realize that if you're just starting clerkship, you probably barely know how to do a physical exam, and almost certainly not one with any real value. There is some expectation of knowledge (that you know the steps to an exam, and can correlate basic findings with disease), but it's pretty minimal.

If you're unlucky, you'll get someone who has forgotten what it's like to be a medical student; certain specialties have a higher concentration of these personalities. Nothing you can do about that except bite the bullet and try to learn from it.

1 hour ago, brady23 said:

Is there a "hidden expectation" that you should show up 15-30 minutes early (especially because lateness is really frowned upon)?

It's the same as any 'real job'. It's important to not be late, but no one is going to expect or even want you to come in early unless you have assigned work or a reason for doing so.

The only rotation where I showed up early for was Surgery, and that was because there was a bunch of equipment/charts to set up, plus the expectation that we could present new patients during team rounds. Other than that, I typically aimed to arrive on time or just early enough to print lists.

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Try to align with evaluators that like you. It helps if you're attractive.

 

If nobody likes you don't take it personally. Medicine has a lot of meanies. Just put in the required hours and study for step 2 ck at any opportunity.

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On 10/20/2018 at 11:56 PM, Birdy said:

1. Read around my cases and made sure I met the learning goals of the particular rotation. Didn’t really study much more than that. 

2. Watch out for yourself and your fellow clerks. Ensure you’re sleeping, eating, and resting when you can. Find a task organization system that works for you and stick to it so that you’re staying on top of the things you should be doing. Get to know allied health professionals and don’t be afraid to ask them questions.

3. Be polite. Be honest - ESPECIALLY if you screw up/forgot to do something. Show up on time. Help out where you can. Respect your allied health care staff. Basically, be professional and don’t be a jerk. 

Thank you for emphasizing the importance of respecting your allied health care staff.  I can’t tell you how many residents (not clerks, residents) I’ve worked with who think they know more about nutrition than a master’s-trained registered dietitian. They don’t. Guess what? Allied health have a “say” in your final evaluation, so treat us, and our expertise, with the respect it deserves!

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On 10/22/2018 at 5:50 PM, JohnGrisham said:

No one expects you to pick up murmurs. Just know how to do a basic exam in each discipline.

I'm staff and I'm lucky to hear the lub and the dub parts of the heart beat. 

 

/kidding.......I actually don't own a stethoscope. 

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On 10/23/2018 at 9:29 AM, GrouchoMarx said:

 

If nobody likes you don't take it personally. Medicine has a lot of meanies.

This x 1000.

Medicine, especially an academic center, is full of self important, self serving, blow hards with terrible social skills.

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6 minutes ago, NLengr said:

I'm staff and I'm lucky to hear the lub and the dub parts of the heart beat. 

 

/kidding.......I actually don't own a stethoscope. 

 

3 minutes ago, NLengr said:

This x 1000.

Medicine, especially an academic center, is full of self important, self serving, blow hards with terrible social skills.

The social skills is the one that continually baffles me - many situations where i think...really, is this the most appropriate way to behave amongst students in a professional setting? Yes, guess so!  

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1 hour ago, NLengr said:

This x 1000.

Medicine, especially an academic center, is full of self important, self serving, blow hards with terrible social skills.

ha yes it does :) Pretty often they don't even mean to mean. They just are in their own little head space. 

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