Tips for a junior clerk

[Karma]

I just started clerkship and was wondering if members who are senior clerks or residents already have some tips to share about surviving clerkship!

 

Any info will be greatly appreciated:)

[Renin]

Five Do's!

1. Come ON TIME.
   
2. Turn ON your pager.
   
3. Come prepared. Steth. Reflex hammer. Penlight. Pen.
   
4. An extra pen. Excellent for lending out. Or if yours runs out of ink.
   
5. Have a fiver in your pocket. Good for buying coffee on an unexpected break.
   

 

Five Don'ts!

1. Ignore your pages. Obvious.
   
2. Try to show up your residents/fellow clerks. Will only make them hate you.
   
3. Brown nose to your residents/attendings.
   
4. Insult the nurses.
   
5. Ignore the patient's families.
   

 

Five Other Random Things

1. Wash your hands.
   
2. Wipe down your stethoscope.
   
3. Be nice to the nurses, but don't be a pushover.
   
4. Stand up for what you believe in ... to a point.
   
5. Don't bring goodies for the team, unless it's your last day or a special day (birthday, etc). Otherwise it's just weird.
   

 

Oh. And try to sound happy on the phone, even if you're paged at 3 am. It's hard, but makes everyone's life easier. Also, using please and thank you

 

Five Things You Should NEVER Do

1. Making up stuff about your patients or their care or their results.
   
2. Tell another medical student/nurse/attending/resident/anyone that they are stupid/worthless/etc.
   
3. Leave the hospital when they tell you you're not allowed to; especially on call.
   
4. Take money/gifts from patients ... check your hospital/school policies.
   
5. Anything that makes you feel unsafe, uncomfortable, or unsure if unsupervised.
   

[thebouque]

It really depends on the rotation but now it must be tough for you guys because of the strike. Again it depends on the rotation.

 

My piece of advice: read on your cases within 48h of seeing the case (for eg: you see a case of hyponatremia, make sure that you review it on the same day or the day right after).

[Karma]

Thanks alot Renin and Thebouque!

 

Yes, I find it tough with the strike and all. But on the other hand, I understand why they are on strike, it's not fair that there is such a big difference in pay for Quebec residents and residents in other provinces, after all, they do the same work.

[Lactic Folly]

Good points above. I'll add a few random points:

 

- maintain enthusiasm. if asked whether you want to do something (medicine related), the answer is yes. if told to go home, I'll make sure they are serious about the offer before accepting. if there is nothing to do and you want to go, ask them if there is anything else you can help with.

 

- you may feel very junior, but to patients and their families, you are a member of the healthcare team. keep this in mind when chatting in the hallways, cafeteria, etc. you are also in a unique position to spend time with patients, explain medical jargon, etc. and even if you can't do much else, at the very least can always make them feel cared for.

 

- bringing goodies can be done without weirdness if passed off as "stress baking" - I have seen this

 

- everyone has input into your evaluation. be proactive. accept/solicit feedback without defensiveness. if something is clearly malicious/inaccurate though, don't take it to heart.

 

- if you don't know, say so. but then look it up or find out. don't let lack of experience stop you from taking initiative to do things and learn. in order not to be unsafe, ask first / verbalize what you plan to do.

 

- somewhere between cocky/obnoxious and passive/retiring is where you want to be. you don't want to show others up, but at the same time you want to be perceived as a capable, confident future physician

 

- basically, work hard, be a good person, play nice with others, and do the best for your patients. Have fun and learn lots!

[Renin]

And dont' tell people you're on your period. It's just weird.

[Renin]

if asked whether you want to do something (medicine related), the answer is yes.

 

But don't lie. At this time of the year, if people ask you what you want to do, don't say things like, "I'm really not sure." Because all your electives are in, and you're setting up your CaRMS things - you probably do know and are lying, and people don't like that.

 

At the same time, when I tell people I want something non-their-area; they either try really hard to convince me that I want their area, or that they don't want to have anything to do with me. LOL. So ... be genuine and you won't find yourself in hot water.

[Lactic Folly]

And dont' tell people you're on your period. It's just weird.

Except for entertainment purposes during long and boring rounds.

[Lactic Folly]

But don't lie. At this time of the year, if people ask you what you want to do, don't say things like, "I'm really not sure."

 

Agree with this. I was actually not referring to being asked about career prospects, but rather things like - do you want to come see this procedure?

[lostintime]

If you're not prepared for a procedure (i.e. have no clue what to do but want practice) and people ask if you want to do it, what should you say? Would it be rude to say "I would like to do it, but I haven't done it before and if you can walk me through, I would appreciate it"?

Or just say, I'll watch this one and do the next?

[Lactic Folly]

If you're not prepared for a procedure (i.e. have no clue what to do but want practice) and people ask if you want to do it, what should you say? Would it be rude to say "I would like to do it, but I haven't done it before and if you can walk me through, I would appreciate it"?

Or just say, I'll watch this one and do the next?

 

Usually a junior trainee will be asked if they have seen or done any before, and it will be up to the preceptor to offer their student the chance to participate as they think appropriate. The more enthusiasm/gratitude/base capability you demonstrate, the more likely it is that you will be offered more to do.

 

If for some reason they do not ask if you have any experience, I think the wording you have suggested is excellent. If (for your own reasons) you don't wish to get hands on this time, you could just ask to watch.

[Renin]

If you're not prepared for a procedure (i.e. have no clue what to do but want practice) and people ask if you want to do it, what should you say? Would it be rude to say "I would like to do it, but I haven't done it before and if you can walk me through, I would appreciate it"?

Or just say, I'll watch this one and do the next?

 

Yep, that's what I usually say!

 

"I've never done this procedure before, only read a bit about it - would it be okay if I watch you do this one?" (Sure.) "Great! Maybe you could walk me through the next one?"

[Renin]

Agree with this. I was actually not referring to being asked about career prospects, but rather things like - do you want to come see this procedure?

 

Oh; okay, yeah, if people ask if you want to go to the OR, it's not really a choice. Unless there's clinic and it's going to be busy, etc...

 

"If you don't mind, I'd rather help out in the clinic today, as Dr. Smith's clinic is usually really busy - maybe I could come to the OR on a non-clinic day?"

[thebouque]

Also, if you have some free time when on call, ask to perform nursing procedures (under the supervision of nurses) such as putting NG tubes, PVs etc.

 

Nowadays hospitals are fully staffed day and night with ancillary staff and physicians tend to lose these basic skills. I think it's always good to know how to put an NG tube even if you're not a surgeon because if the nursing fails to install it, they'll ask the doctor for help (even with PVs even though they're 100X better than us at performing them).

[Karma]

That's a great tip Thebouque, thank you!

 

But you think the nurses don't mind showing those procedures, I mean in general?

[lostintime]

Really depends on the nurse. More safer to get a nice resident to help you.

[Lactic Folly]

As with any other teaching moment, you've got to read the person and the situation. Most people will not mind letting you watch. Tell them that you want to get more hands-on practice, and see if they offer to let you do it. If you're going to be around for a bit, it helps them as well since you'll be able to do these procedures independently after an initial investment of teaching.

[NLengr]

My rules for a good med. student:

 

1. Work Hard.

 

2. Work Hard.

 

3. Work Hard.

 

4. Seem interested, even if you aren't. Even if you are a psych wanna be, there is something valuable that can be learned on a surgical rotation. Delirium management for instance.

 

5. Show up on time. Don't ask to leave early (without valid reason). Don't pretend you have teaching etc. and then goof off. Don't ask to take a nap at 3 in the afternoon.

 

6. Know your role. Don't get lippy with other students, residents, patients or hospital staff. You are the bottom of the ladder. Get used to it for a few years.

 

7. Don't take yourself to seriously.

 

8. Don't be a complete moron. If you are deficient in basic knowledge (i.e. don't know how to treat bread and butter problems of the rotation), read.

 

8. Did I mention work hard?

[thebouque]

Really depends on the nurse. More safer to get a nice resident to help you.

 

I actually had really good experiences with the nurses, and since you'll be performing a procedure that you wrote in the orders, it's kind of normal to do it with the nurses and not with the resident.

However, it's true that it depends on the nurse, but this applies to residents as well. Some of them are very unhelpful but quite a few nurses will be glad to show you.

[lostintime]

I guess technically the nurses don't have any obligation to provide a teaching role for you. Of course, anytime people offer help or seem to want to help if you ask, grab the opportunity. By definition, residents are supposed to teach you, so they kind of have an obligation. Of course, whether they actually do or not really depends on the resident lol.

[ploughboy]

Also, if you have some free time when on call, ask to perform nursing procedures (under the supervision of nurses) such as putting NG tubes, PVs etc.

 

 

Another tip for IVs. If you are doing an anaesthesia rotation at some point, ask to spend a day/morning in the surgical prep area (if your institution has one) starting IVs. Or, if your institution has one, ask to spend a day with the IV nurse or the phelebotomy team.

[Renin]

I find that as a psych-wanna-be, you have a valuable role on the team, even on surgery. A lot of the people who don't like psych or don't feel comfortable with psych will give you these patients - double bonus: you can work on your psych skills and have helped out the team.

[Renin]

I actually had really good experiences with the nurses, and since you'll be performing a procedure that you wrote in the orders, it's kind of normal to do it with the nurses and not with the resident.

However, it's true that it depends on the nurse, but this applies to residents as well. Some of them are very unhelpful but quite a few nurses will be glad to show you.

 

If they throw a fit, don't take it as a personal attack.

 

For example, I politely asked a nurse if I could try to insert an NG tube in a patient. Or if she didn't feel comfortable with that, I could watch her.

 

"NO! Don't you know how to do SIMPLE PROCEDURES without supervision?! YOU HAVE NO IDEA WHAT IS GOING ON!"

 

LOL. The NG tube nurse. I totally avoided her for the rest of the rotation.

[A-Stark]

Oh; okay, yeah, if people ask if you want to go to the OR, it's not really a choice. Unless there's clinic and it's going to be busy, etc...

 

"If you don't mind, I'd rather help out in the clinic today, as Dr. Smith's clinic is usually really busy - maybe I could come to the OR on a non-clinic day?"

 

Usually my schedule has been set in advance with little to no flexibility - the exception was sometimes on neurosurg, where as the rotation went on I had an increasing amount of choice in what to do. Once I did ask the staff surgeon if I could scrub out during a spine case since I wasn't doing anything. I don't think they care in general if they know you're doing nothing more than watch.

 

Also, if you have some free time when on call, ask to perform nursing procedures (under the supervision of nurses) such as putting NG tubes, PVs etc.

 

Nowadays hospitals are fully staffed day and night with ancillary staff and physicians tend to lose these basic skills. I think it's always good to know how to put an NG tube even if you're not a surgeon because if the nursing fails to install it, they'll ask the doctor for help (even with PVs even though they're 100X better than us at performing them).

 

It's actually really, really hard to practice skills like IVs for this very reason. I managed to get a little bit of practice on emerg and (even less) on ICU. The OR is great for them if you get there in time, though, and I even had an arrangement while on gen surg that they'd specifically call me to do foleys. The OR nurses were great about getting me practice.

 

I haven't found call to be a good time for practice, though. As the saying goes, eat when you can, sleep when you can... you'll be busy enough as it is.

[Renin]

Eat when you can.

Sit when you can.

And don't **** with the pancreas.