Medical Student Cheater: Tips on Excelling on Rotations

I know that my performance on clinical rotations is important for how I will be assessed. How can I distinguish myself?

Response from Sheila M. Bigelow, DO

Resident Physician -- Pediatrics, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio

Clinical rotations can be very challenging. For the first time, you're expected to follow patients, present on rounds, show your medical knowledge, and work well in a team environment with people who are new to you, knowing that you'll be moving on before long. Not only are you expected to meet the basic requirements, you are expected to do well enough to earn an honors grade or a strong letter of recommendation from the attending.

Fortunately, there are some "must know" tricks that can help you distinguish yourself and help get the grade or letter that you want.

1. Be on time or, better yet, early. I know -- this is a really basic rule that everyone should have mastered by the third year of medical school, and yet it still is a problem for some people. I have heard interns, residents, and attendings comment about a student who is consistently late -- and it's one of the easiest things to get right! Of course, we all know that "life happens," and you may occasionally have good reason to be late. In that case, give the appropriate person a call. On the first day of each rotation, be sure to ask who to call if you're sick or late, so that everyone knows you are holding yourself accountable.

2. Put the phone away. You may find it difficult to get through a whole day without checking your cell phone, and most residents won't mind if you do so occasionally, inconspicuously. However, don't check your phone during lectures, grand rounds, patient rounds, any teaching time, or basically any time when you should be focused on listening to your supervising resident. Ensure that the ringer is off, especially in an auditorium setting. You don't want to be "that medical student" whose phone interrupts the famous grand rounds lecturer.

3. Know your patients. As a medical student, you will be carrying fewer patients than your intern, resident, or attending. Therefore, you should have more time to really dig into the patient's chart and know his or her history, why they're being seen, and what sentinel medical events have occurred. Don't make the mistake of thinking that this is someone else's responsibility. Besides, you'll learn more when you really know the patient.

4. Be proactive regarding your patients' care and your own education. If you have access to the lab system, follow up on your patients' lab values. Ask the intern or resident how to check labs if you're not sure. Do not ask them if the lab report came back or what it said. Do some research on interpreting labs yourself. No one will expect you to know everything, especially about challenging conditions, but they do want to see that you put some thought into it before just coming to them for the answers. If you don't understand why the attending ordered a certain test or treatment, feel free to ask. As a third- or fourth-year medical student, your number-one job is to learn, so take the opportunity to ask questions and learn everything you can.

5. Be a team player. This encompasses many aspects. Be available: If an interesting case comes in and you're nowhere to be found, no one is going to hunt you down to come listen to the murmur or look at the rash. Be friendly: Offer to help residents when they're busy and look overwhelmed. Be open to constructive criticism and ask for feedback often. Find out what the team expects from medical students by asking early in the rotation. Don't be a "gunner." No one wants to work with someone -- no matter how smart they are -- if they try to show up colleagues. Remember, medicine is a team sport, and we all have the same goal: good patient care.

If you master these 5 areas, you are almost certain to distinguish yourself on rotations. You will also learn more. In the end, no matter how many honors or letters of recommendations you receive, the real achievement is becoming the best physician you can be.