Struggling in clerkship

[carbook]

Hi everyone:

I am U of C student and I started clerckship in Jan. Recently, I finished an elective in the specialty that I am interested in at my home school and my preceptors thought that I was hard working, motivated, diligent, and showed a lot of improvement over the two weeks.... but they did not think i was good at what I was doing. They gave me satisfactory overall. 

I feel that I struggle in clerkship because I don’t know how to do histories that are relevant and it takes me a while to learn how to do things. 
I also agree with my preceptors, I think I am hard working but I am not naturally smart. I was wondering if there is hope for me to match to competitive specialty with these comments or should I just try for something else. It was my first elective in this specialty!

I think my strength is patient interaction and pts always like me but I struggle with some of my clinical skills.

[frenchpress]

1 hour ago, carbook said:

Hi everyone:

I am U of C student and I started clerckship in Jan. Recently, I finished an elective in the specialty that I am interested in at my home school and my preceptors thought that I was hard working, motivated, diligent, and showed a lot of improvement over the two weeks.... but they did not think i was good at what I was doing. They gave me satisfactory overall. 

I feel that I struggle in clerkship because I don’t know how to do histories that are relevant and it takes me a while to learn how to do things. 
I also agree with my preceptors, I think I am hard working but I am not naturally smart. I was wondering if there is hope for me to match to competitive specialty with these comments or should I just try for something else. It was my first elective in this specialty!

I think my strength is patient interaction and pts always like me but I struggle with some of my clinical skills.

The whole point of clerkship is to learn clinical skills. You can’t learn how to do this stuff in preclerkship, and I don’t think there’s really an expectation that clerks should be able to show up already good at clinical skills. I know that Calgary has a condensed schedule, but still, it’s only been 2 months. Don’t be too hard on yourself. Your attitude and teachability and ability to work with patients / staff I think matter more than sheer aptitude. If you’re putting in the time and you’re improving, and if preceptors are picking up on that, you’re probably on the right track. Don’t count yourself out of a specialty so soon.

I’m just finishing my clerkship year, and I found things didn’t really start to click for me until about 6 months in. 

[Artier]

You'll improve exponentially as you progress, even if you don't notice it right away. Keep working hard and asking for feedback, you'll do great. Also, although knowledge is one component of making a good impression on elective, don't discount comments you get regarding being hard work, diligence, and working well with others. Often it's those things that are much more important. It sounds like you're doing great. 

[_gettingthere_]

Is this true for specialties like peds too? I had all my electives right at the start of clerkship and got similar comments, but I feel like they cared WAY more about knowledge because they all said I'm good now but I'll be better later, and I didn't get a reference letter from one of my electives for this reason. The others I got letters but I dont think they'll be strong, also for this reason.

[Arztin]

To be honest, you will eventually realize: it's extremely hard to ''impress'' at the beginning of clerkship.

Keep it up with the great attitude. I find it's the most important thing for a med student, especially for a first year clerk.

Everyone likes a med student who is motivated, who asks questions, who follows tips given by residents and staff, who do things as told.

In contrast, everyone dislikes the student who argues constantly, who thinks they outsmart others, who just gives the tourist vibe.

At the end of the day, you are learning for yourself. Evals are important, but don't focus all that much on evaluations!

Study hard. Enjoy the journey. Focus on learning and becoming a better clinician!

 

At your stage, it's normal to not know what's important and not when you take a history. I fully expect a third month clerk to go take a history, and take 50% of the useful information, and 500% of the useless information and then be overwhelmed with the information. It's a stage pretty much everyone goes through. It's with time, and repeating the same chest pain history 500 times that you will know what's important and what's not. History taking is not an easy task. There is always polishing to be done.  

Off note, I'm still figuring out chest pain by the way. A weird chief complaint.

 

Some actual tips to improve:

Learn to find information. A good med student knows how to quickly find the useful PMH, whether it's imaging reports, old consults, discharge summaries, etc...

Read around your cases daily. Doesn't need to be extensive. Learn some key concepts around your cases. 

Ask why your supervisor thought about something, but your didn't. You'll kind of pick up their ''brain''.  Don't be actively shy to ask for feedback.

Also tease differences. E.g. For this patient who presented with abdominal pain, what if it was rather a female patient who was 75? What would you do differently? That way, you kind of learn about 2 cases in 1.

Case Files series are generally fairly good for med students. 

Read articles too. Look up guidelines (don't read 100 page guidelines. Most have key points). 

Ask your staff or resident what they recommend reading.

Good luck!

[excelspreadsheet]

43 minutes ago, Arztin said:

To be honest, you will eventually realize: it's extremely hard to ''impress'' at the beginning of clerkship.

Keep it up with the great attitude. I find it's the most important thing for a med student, especially for a first year clerk.

Everyone likes a med student who is motivated, who asks questions, who follows tips given by residents and staff, who do things as told.

In contrast, everyone dislikes the student who argues constantly, who thinks they outsmart others, who just gives the tourist vibe.

At the end of the day, you are learning for yourself. Evals are important, but don't focus all that much on evaluations!

Study hard. Enjoy the journey. Focus on learning and becoming a better clinician!

 

At your stage, it's normal to not know what's important and not when you take a history. I fully expect a third month clerk to go take a history, and take 50% of the useful information, and 500% of the useless information and then be overwhelmed with the information. It's a stage pretty much everyone goes through. It's with time, and repeating the same chest pain history 500 times that you will know what's important and what's not. History taking is not an easy task. There is always polishing to be done.  

Off note, I'm still figuring out chest pain by the way. A weird chief complaint.

 

Some actual tips to improve:

Learn to find information. A good med student knows how to quickly find the useful PMH, whether it's imaging reports, old consults, discharge summaries, etc...

Read around your cases daily. Doesn't need to be extensive. Learn some key concepts around your cases. 

Ask why your supervisor thought about something, but your didn't. You'll kind of pick up their ''brain''.  Don't be actively shy to ask for feedback.

Also tease differences. E.g. For this patient who presented with abdominal pain, what if it was rather a female patient who was 75? What would you do differently? That way, you kind of learn about 2 cases in 1.

Case Files series are generally fairly good for med students. 

Read articles too. Look up guidelines (don't read 100 page guidelines. Most have key points). 

Ask your staff or resident what they recommend reading.

Good luck!

What's the tourist vibe? Too standoffish? Shadowing instead of hands on?

[Arztin]

2 hours ago, excelspreadsheet said:

What's the tourist vibe? Too standoffish? Shadowing instead of hands on?

To be the student that make people think ''who the hell is this person and why is this person even here?''

Basically absent or minimal presence, wants to leave as early as possible,  doesn't want to calls, doesn't want to work, not interested, doesn't read about topics you suggest, doesn't take your feedback, and doesn't seem fit to be in the environment.

[m_jacob_45]

For history taking, I find it very helpful to organize questions by what are the things I really want to rule out rather than just getting the most detailed OPQRST possible. This mindset helps you cover all your bases and not get too bogged down in the details. I.e. for chest pain that could be ACS, PE, pneumothorax, pericarditis, muscular, pneumonia. Obviously the order of the differential will change based on accompanying symptoms and the overall patient context as well as rotation context. Hope this helps!

[Arztin]

15 hours ago, m_jacob_45 said:

For history taking, I find it very helpful to organize questions by what are the things I really want to rule out rather than just getting the most detailed OPQRST possible. This mindset helps you cover all your bases and not get too bogged down in the details. I.e. for chest pain that could be ACS, PE, pneumothorax, pericarditis, muscular, pneumonia. Obviously the order of the differential will change based on accompanying symptoms and the overall patient context as well as rotation context. Hope this helps!

Yes this is very important indeed!

Most people staff off just fishing for symptoms. At some point, when someone has a chief complaint, you should take your OPQRST, and then be disease specific according to your DDx. For the person reviewing with you afterwards, it's much easier to follow you also. It also probably means that you have a higher level of clinical skills than the one just fishing for symptoms left and right.