Monthly Archives: December 2015

7 Rules to Surviving as a Clinical Medical Student

If you are reading this and are currently a medical student, you will understand these rules perfectly. If you are going to be a medical student, print these rules out and memorize them before clinic time starts. If you are never going to be a medical student….then…well, I guess you’re welcome here also.

The Rules:

  1. Figure out what you need to know. There are three kinds of learning, and its your job to figure out which category this lesson/fact falls under.
    1. Things you MUST know: for example, this could include maintenance IV fluid rates, first line treatments for common diseases, basic workups, etc. You need to know these things because you are going to be a doctor (probably). These are equivalent to the “High Yield” facts to know for boards and exams and you should learn them.
    2. Things you need to know FOR THE TEST: these pieces of information are usually a little more abstract. Your residents will either not know anything about it or say something like “I used to know that when I took my boards”. This is often a completely separate set of information. I did horrible on my OB-GYN shelf because I assumed the information that I was learning in clinic and the OR was also the information that would be stressed on the test, and oh boy was I wrong about that! This is why you need to spend your precious time off reading through Case Files, Lange, or Pre-Test.
    3. Things you need to know to get through your day. On bad days, this gets down to a really primal level. For example, on some days I just needed to find a bathroom. Any bathroom. Otherwise you are more focused on learning the workflow of the team, where to be for rounds, conferences, surgeries, consults, etc. An easy way to do this by default is to stay with your resident at all times, but that can get annoying, and I try to minimize the annoyance that my presence often causes.
  2. Never miss a chance to eat.
    1. If you see a donut, you eat the donut. If you have five extra minutes somewhere between 10:30am and 2:30pm, you just got lunch. If you then go to a lecture and some rep or something has lunch, you smile and also eat that lunch. This is especially true on surgery. This rule has some broader applications as well. For example, if you see a place available to sit down, do it. (Disclaimer: by “available” I mean you are literally the only person in the room standing, there is an empty place to sit, and you have been expressly instructed to sit. Don’t go taking chairs from residents and attendings. That’s a beating if you do.)
  3. Never miss a chance to go to the bathroom.
    1. Similar to the rule above, use the bathroom all the time. The reasons for this are many. First of all, you never want to be stuck somewhere and think “I need a toilet right now”. And honestly, you’ve made it this far managing your bowel habits, so I don’t need to help you there. I’m talking about the hidden benefits of going to the bathroom. First of all, you get time away from all of the craziness going on. No one is ever mad at you for going to the bathroom. What are they going to do….force you to not ever urinate? It’s like a nice short break: no one knows where you are, it’s perfectly legit, and you can use these breaks to help you through your day.
    2. Pro tip…scope out the really nice bathrooms in your facility. The best one at my hospital is on the 11th floor and always has a window cracked for fresh air, with a decent view of the city if the weather is clear. Don’t go using the dingy one in the basement, and don’t use the one that all the patients and families use in the main lobby or by the cafeteria.
  4. Your resident (and sometimes attending) is always right.
    1. This one has some nuances to it. Your resident is almost always right for the simple reason that they can make your life hell very easily. They are always busy, have an unlimited supply of scut work, and can often be short tempered or grouchy. These are often the people that will send you home at the end of the day (see rule #6). They may also be the ones writing your evals. Do NOT cross your resident. The only acceptable circumstance that your resident can be wrong is if they are actually wrong and the attending is calling them out on it. If this happens, the best thing you can do is discreetly insinuate that the resident was correct, it was you, the naive medical student, who actually wrong. Your resident was helping further your education, that’s all. I’ve done this before, and it works great. Your resident will like you, the attending might yell at you for a little, but hey, I cry myself to sleep at night already, so no big deal, and ultimately the whole ordeal ends up going away. Tl;dr Your resident is right most of the time.
  5. Carry all of the things with you all of the time.
    1. This is the reason you wear the short white coat. My coat actually weighs around 10lbs when it’s fully stocked. You need to have survival basics to start. This includes your stethoscope, 3+ pens, your name tag, a granola bar for a snack, an emergency granola bar if things get real, your phone charger, emergency contact information (I’m only kidding a little bit), a Maxwell’s, your patient lists, and maybe an iPad mini because they fit really well in your pocket. After your basics are loaded in, get your service specific items next. On surgery, it’s great to have trauma shears, suture removal kits, surgical site marking pens, lots of gauze, alcohol prep pads, all of the kinds of tape, maybe some Dermabond or Mastasol, and while you’re at a Foley tray (just kidding). For neuro/psych, you’re looking at reflex hammers, tuning forks, and probably the printouts for evals and consults depending on your institution. I’m 90% sure I got honors on a short surgery rotation because I had a suture removal kit in my coat for a patient on rounds (the other medical student didn’t, and she got a pass), so this matters.
  6. Be Early
    1. Being early is the start to a good day. If conference is at 6:30am, you better be in the med student section (that’s a thing, by the way. If there is a scheduled conference or grand rounds, I guarantee that the med students sit in an assigned area, so you need to find that out beforehand) with your coffee at least 10 minutes early. If handoff is at 5am, you are there at 4:45 to print off patient lists for your residents. You want to beat the residents there, otherwise you will be perceived as late, and if you are actually late that reflects really poorly on you and your grade. So be early always, because on the day that you actually do get stuck in traffic/can’t start the car/get lost in a new hospital you will have extra time that might make all of the difference.
    2. Part 2 to this rule is my most important rule: when the resident/attending tells you to go home, you go home. This isn’t some sadistic contest to see who can stay at the hospital longest without eating, this is real life. I usually ask briefly if there is anything else I can help with to show that I am an eager and enthusiastic medical student who wants to be a team player (at least I hope that’s what they put on my eval), but then I gather my stuff and leave promptly after.
  7. Never touch the pancreas. It is weird and I’m not really sure what it does, so I never touch the pancreas.

Everything is Terrible on No One Knows Anything

Just kidding. When I thought about one sentence to sum up my third year of medicine so far, this is the first thought that came to my mind.

I haven’t written a single post in 6+ months. I’ve been pretty busy, but also extra lazy, and that combination doesn’t usually produce any meaningful posts. In my defense, there are at least 3 half finished drafts from those months that are mostly coherent, so I was making an effort to get stuff posted.

So while I intend to publish my “Survival Guide for the Clinical Years” very soon, I need to write a quick update of what I have done so far with my life as a clinical student.

OB-GYN:

I started out energetic, bright-eyed and bushy tailed on the OB-GYN service. Specifically, Labor and Delivery. We split our shifts between nights and days, working 12-14 hours per shift depending on how crazy the hospital was. I finished with rotations through Gynecologic Surgery and Gynecologic Oncology. I also pulled a rotation through the Emergency Room, but that’s a whole different story.

When I started medical school, the only thing I knew for sure was that I would not be a gynecologist. Much to my surprise (and disgust) I ended up liking this rotation quite a bit. I did completely horrible on the shelf exam because I broke Rule #1 of Being A Medical Student (more on that later as well), but I ended the rotation relatively happy.

Spoiler alert: I didn’t actually like Obstetrics or Gynecology. I liked being out of the classroom, I liked working with patients, and ultimately I liked the surgery that I was exposed to during my Oncology and Gyn Surg rotations. I just hadn’t figured that out yet.

Thankfully, my OB experience was pretty good. Because the hospital I worked in served a portion of the population I refer to as “Hoosiers” (not the basketball team….this is more like People of Walmart), I came away with a lot of great stories and met a lot of really cool people during the rotation.

Pediatrics:

This rotation is split into two halves. First, I spent a month on outpatient pediatrics. This was a total vacation since I had just come across town from 14 hour OB shifts and it was mid-summer, so outpatient visits were not exactly popular with kids on summer break. I often had the afternoon off to “study” and “read”, which I sometimes did. My second month was inpatient PEDS, working with the floor teams in our incredible, top notch children’s hospital. This was a great two weeks. My hours were reasonable (60 hrs a week, cover one day per weekend and one call night per week), and I had a lot of time to study. I have never had any intention of being a pediatrician, but kids are great and the vast majority of the pediatric doctors are incredible people, so this rotation was awesome. It helps that our pediatric hospital has an incredible cafeteria and nice facilities.

Surgery:

Disclaimer: surgery was easily the worst rotation I’ve experienced, and I think I will probably be a surgeon. This will take some explaining in a future post, but the main problem with surgery is that the actual surgery is awesome, but being a medical student in a surgery department is horrible. Surgeons have spent years cultivating bitterness and hate, combined with huge egos and fueled with long hours and crushing call schedules, and medical students (with our bumbling incompetence) are ideal targets for their scorn. Even if we aren’t abused directly, it tends to roll downhill from the attendings, the residents, the nurses, the janitor, or really anyone can then turn and yell at the medical student. Since we exist at the absolute bottom of the totem pole, there’s not much we can do about it, besides the usual crying yourself to sleep every night, but that’s par for the course. (just kidding…..a little)

My surgical experience was widespread. I did my first two weeks with this insane surgical oncologist who averaged about 6 words and maybe 3 emotions per week while operating 40+ hours each week. He managed this by doing 16 hour cases back to back on Thursday and Friday, then biking all day Saturday while we took call. The surgeries were “fascinating” and “interesting” (read that also as “exhausting” and “mind numbing”). Next up I did Orthopedics, which I loved and was literally the best possible rotation for medical students (all operating, no notes, no scut work), but that will get its own post down the road as well.

Next up was my trauma rotation. Important context is that our hospital is a Level 1 Trauma center serving an urban city center and about a gazillion square miles of rural farm country, so we see absolutely everything. Our trauma service is nationally recognized for being top notch and absolutely insane. We use a fun internal grading system on trauma to describe the severity of a trauma. On this scale, a 4 is something like scraping your knee. I’m not even sure what a 1 is. The only guy that got a 1 was shot 8 times and died before he made it to ER. We had a guy drive up to the doors and walk in the lobby with a 10 inch knife sticking out of his chest and he got a 2. We had another guy shoot himself in the face twice, bleeding out of every cranial orifice, and he also got a 2. Trust me when I tell you that this place is absolutely insane.

I learned a ton on trauma because I was the only medical student helping a service of 50+ patients with just one intern and one chief resident. I was able to act as a pseudo-resident and do all kinds of fun things (medical students don’t get to “do” a whole lot, sadly). I don’t know if I ever worked as hard as I did those two weeks, but I got an amazing review and recommendations from my team and realized how rewarding trauma can be. I also realized how exhausting it can be, and how difficult it will be to manage trauma responsibilities with family and having a social life as an attending someday in the future.

I finished with two weeks in Urology, which I liked quite a bit. I liked it so much that I did an additional three week elective in Pediatric Urology, as I thought I could be a good urologist someday, but I ended up deciding against it. This week I will finish up the final week of an elective and head to a nice break for Christmas, with Psychiatry and Neurology on board after the first of the year to get me started. I have a lot of other posts I need to write, most of which will include pictures and be a little more detailed. It continues to amaze me that people still read this every day even when I don’t post for months at a time.

As always, I’d be interested to hear from you at sortadrwordpress@gmail.com