How much free time do you really have?

[lostintime]

During clerkship, how much free time do you really have? I've heard a lot of rumors, etc. but I'm just curious.

 

Is it a case of you being too tired to really have any sort of social life or do any extracurricular activity and you just want to sleep once you get home....?

[flying kumquat]

I found I had plenty of free time overall. Clerkship was nothing like the grueling experience I'd read some people go through (especially when reading about US-based medical education).

 

There are definitely worse rotations than others. The major culprits that come to mind are general medicine IMU/CTU, gen surg, ortho, and ob/gyn. This can totally vary by school, rotation, and preceptor. Even then, it was really only gen surg's early mornings and OB call shifts that made me a bit zombie-like.

 

Being involved in regular extracurricular activities can be difficult, but some in my class were able to pull some less intensive things off. This is mostly due to being on call and having an endpoint to your day that is more or less at the whim of your superiors. People still have time to get out socially, it can just be a little more difficult with call/away rotations/electives/early, early mornings.

[Satsuma]

As has already been mentionned....it depends on your rotation and even your school to some extent. (some Quebec schools only have their students do call until midnight...no overnight call!)

 

You will survive though...everyone does.

 

Some rotations are light in terms of call...ambulatory (no call, he he), family medicine, and psych for me were decent in terms of call.

 

Worse rotations for call for me were: 1) surgery - during the week we only did call until midnight (which really means til 1-2 am it seemed). But because it was not overnight call was still expected to be in hospitals for rounds starting at 6am and work the whole day. I found I would rather have overnight call and at least be done at noon the next day. Also, we did whole weekend calls...so you would start your weekend call Friday 4pm and finish Monday 8am (and still work the whole day Monday). So for that whole rotation I never got any post-call days. And being at the hospital for 6am is not easy for me...I am not a morning person.

2) Internal medicine: Calls were busy so little sleep, it was my last rotation so was just plain tired from the whole year, call only has to "average" to 1 in 4. So they would always make it so your entire weekend was lost (so you would be on call say Fri and then Sun for example - so that there would always be someone who knew the pt issues on). I had to work both long weekends in that rotation...and while residents get a lieu day for working those holidays, students do not!

 

It is still possible to have a life though. It becomes harder to coordinate with friends since you might not have the same time off that they have.

Scheduling things regularly is tricky. Though I managed to keep up my horseback riding for the most part - my coach was a bit flexible if I had a crazy week, and wasn't as hard on me on my post-call days....oh and absolutely no jumping on a postcall day, cause I like to stay in one piece.

 

I think you just kind of get used to being tired and eventually just don't notice it. But there will be little indicators now and then to remind you that you are tired. Like when you try and put the cereal away in the fridge and can't figure out why it doesn't fit, or when you scrape you car on the side of your garage cause your reflexes are just a little slow.

 

You'll be amazed though, that for the most part, you will probably feel like call isn't as bad as you thought it might be!

[abcwxyz]

Just curious...

 

what kind of things do you even do on call?

 

As a clerk, I'm going to guess that you have very little autonomy.

 

Are you just on call with a resident/attending, following them/doing things under their supervision? This is what I understand the regular day to be like. Or are you on call alone?

[Satsuma]

It depends on the rotation. You are not ever on call by yourself...meaning either a resident or a staff is around for you to ask questions. But you do not "follow them around".

 

So...for most rotations at Ottawa the clerk is first call. Meaning if there are any floor issues, you go up and assess and come up with a plan. If you are able to complete said plan by yourself you do it (for example in internal you can order CXR, ECGs, basic bloodwork etc). So, if someone is complaining of nausea you can write the order for gravol etc. In instances where you cannot manage the situation, you call your resident/staff (if no resident is on with you) - usually at least with some kind of plan cause they will ask you what you want to do. The other thing that you do while on call....is admissions. In this case the ER will have already called your resident/staff who would have been given some kind of hx on the pt (they may or may not have gone to see the pt) and agreed to admit the pt to their service. As the clerk...you will then need to go get the complete hx, do the physical exam, review whatever tests have already been done, and write the admission orders. After you are done all these things you call your resident to review with you. At any time, if you feel your pt is unstable you call your resident/staff!

 

Obviously some things are rotation dependent...so on surgical rotations you are also assisting in the OR when needed, with obs you are delivering babies and assiting with c-sections etc.

[xylem29]

Would you happen to know if the American clerkship experience is similar to this?

 

It seems to me that as a clerk - you get to do A LOT

 

+1 for the cereal comment, I've had quite a few of those during undergrad..lol.

[A-Stark]

I could be completely wrong about this, but my *impression* is that clerks in the US are given fewer responsibilities.

[Icebox]

I could be completely wrong about this, but my *impression* is that clerks in the US are given fewer responsibilities.

 

Depends on the State and school since it varies quite a bit in the U.S. I've heard and seen the opposite. I did some shadowing in the States and from my brief experience - and from what family members in health care have explained - clerks do far, far, far more than here. I've heard about them doing next to nothing as well though.

[blinknoodle]

It can really depend on the rotation and the school.

 

As a third year clerk at UWO, during my team medicine rotation, I was doing 1:3 call, covering the floor and ER for my team. Brutal.

 

As a third year clerk at Toronto doing team medicine, you do 1:4 call, but in actuality, you get one consult from the ER before midnight, then you go home and come back for morning rounds. As a fourth year, you actually stay overnight and cover the ER. Still don't cover the floors.

 

It can be tough, but at other times, it can be great. I found clerkship much more stressful than residency so far. As a clerk, I would prepare for the daily teaching, read around my patients, but also had a worse call schedule than residents (medicine, mainly) - remember clerks don't have a union. There was limited vacation time and it could be stressful deciding what you wanted to do for residency. Plus, I found short 2-week rotations more stressful as you were constantly being shunted to different services, etc.

 

Search around, there was a thread with actual hours. I was on medicine when I posted my hours - it was disgusting, especially without any lieu days for working that long weekend, either.

[JCTulip]

life can be tough as clerks

 

remember on top of clinical duties and calls, there are usually end of rotation exams and oral osces - which clerks have to prepare in the free time.

 

usually that involves a lot of reading, especially if your school uses the american nbme exams that really cover a broad knowledge base.

 

on top of all that you have the pressure to impress residents and attendings to get reference letters

 

without all of those hurdles, I have found my life to be a lot better in my pgy-1 year than clerkship

[xylem29]

Depends on the State and school since it varies quite a bit in the U.S. I've heard and seen the opposite. I did some shadowing in the States and from my brief experience - and from what family members in health care have explained - clerks do far, far, far more than here. I've heard about them doing next to nothing as well though.

 

Icebox - care to share the US schools that give their clerks comparable responsibilties and experiences as Canadian schools? Or the ones where they do more?