One medical student's simple approach to becoming a doctor
My Clerkship Pearl: Care

My Clerkship Pearl: Care

One year ago, as I prepared for clerkship, I collected advice from many mentors. I published the thoughtful tips in a post “Be nice, be humble, be interested: advice received for clerkship“. I still refer to these and you should too. Around the same time that others were offering me advice, I published the article “My Preclerkship Pearl: Show Up” as a suggestion for those just starting medical school. Now, with one year of clerkship under my belt, I feel ready to offer some near-peer clerkship mentorship advice of my own for those about to embark on what continuously proves to be an amazing, trying and wondrous experience. What is my clerkship pearl?

CARE

It seems so simple, and it is. Each and every day as you walk to the hospital care about what you are doing. First and foremost care about your patients, the rest will follow. Care, not about getting the right answer, but trying to get the right answer. Care about your responsibilities. Care about your notes. Even when you are tired, care. Care about what you are learning. Care about your colleagues. Care about your workspace. Care about contributing in the limited ways you can. Care about yourself.

But caring ABOUT is not enough. You must be active in your caring. You must care FOR.

Care for what you are doing. Care for your patients. This includes simple acts like finding her a warm blanket or glass of water. It also includes harder acts like vociferously advocating for him at team rounds when you think it is an important issue. Take care of the tasks you say you will. Care for your notes by making them legible, comprehensive and useful for the next person who might need to read them. Care for what you are learning by reading around cases. Care for your colleagues by pitching in, recognizing when they are struggling and celebrating their victories. Care for your workspace by cleaning up the mess you’ve made and others you find. Find caring ways to contribute in the limited ways you can. Care for yourself.

Some days all this caring will leave you feeling on top of the world. Some days you will care all you can and you will feel as though you were hit by a truck. Caring will leave you feeling everything in between. Either way, the next day, keep caring. If you notice that you are caring less, find someone to talk to. Seek out a classmate or  a mentor; they will care about and for you.

Caring “about” and caring “for” will hold you in good stead. When you approach every interaction and each task from a place of caring, you will be doing your best. It will provide you with resilience when things go wrong (trust me, inappropriately dwelling is different from caring) and it will promote happiness and satisfaction in your day-to-day life. Caring is my clerkship pearl.

Fortunately, courtesy of the Queen’s Medicine Class of 2015, I have many more practical clerkship pearls for you. My classmates generously offer their advice below:

  • However much food you were planning on bringing for medicine call, you will need more. Anticipation is key! (this is the real message, applies also to non-edibles)
  • Don’t forget your phone charger!!!
  • Be nice to your patients. Say hello and have a nice day to everyone. They will appreciate it and so will your preceptor.
  • Be ready to admit when you don’t know something or aren’t comfortable carrying our a procedure or task. Admitting your limitations shows maturity.
  • When it’s time to go home, go home.
  • Ask lots of questions – 99% of the time your preceptor is happy to answer/teach you about anything that you’re not sure of, and at this stage we’re really there to learn – no one expects you to know everything, so don’t be shy to ask.
  • Make a management plan! Even if you are 100% wrong, this is the time to make mistakes and learn, because you are not technically responsible and your work will be checked, but that’s not the case next year!
  • Smile! When you don’t know what to say, at least look happy to be there.
  • Introduce yourself (#hellomynameis) to the allied health care professionals (social workers, OTs, PTs), and especially the nurses. Get to know their names. This is one simple, concrete way to show that you are invested in the health care team. (PS. If you keep the nurses happy, they’ll help you out: they’ll keep you from looking silly in the OR, call you for deliveries, teach you how to place IVs, etc.)
  • Always always come up with a diagnosis (or at least some top contenders) and a plan. This kind of active learning is far more effective than passively waiting for someone to tell you what to do, even if you’re wrong. Plus, your resident / attending will interpret your effort as a sign that you’re engaged and taking initiative. So even on your first rotation, when you’re presenting to your senior, don’t just stop after S and O! You DO know things, and probably more than you think.
  • Never, ever feel guilty for staying and talking with a patient. Make time to chat, clarify, sympathize, etc as you feel it’s needed; that extra few minutes of delay won’t be the end of the world, and the trust you build may end up being invaluable to both of you.
  • Commit to your plan and write out your orders, fill out requisitions, etc, before you present it.
  • Stop to look up a differential diagnosis / plan when seeing a consult. It’s not cheating if your differential diagnosis is made up of your work + looking it up on uptodate/diagnosaurus/pocket medicine/whatever other source you use.  Don’t feel you need to rush too much. This especially applies to when on call for internal medicine. You’ll be a few minutes slower, but will look much more prepared when you do present, and you’ll learn more with each case.
  • Don’t feel pressure to say you are interested in whatever rotation you are on. Often times, staff and residents will tailor which patients you see or what questions they ask you to your interests. Saying, “I am not sure yet and am keeping my doors open” is also not a bad thing – if it’s true. I use every chance I get to ask preceptors why they those their specialty and what they like about it, because it helps me to think about and question my own interests.
  • Write something about patients who really touch you. These will become the long entries in your logbook and will count as being reflective, if you’re into that sort of thing.
  • Even though things can get complicated and overwhelming, and even though you may feel pressured to cut corners, don’t forget your basics. What you learned in pre-clerkship will serve you well.
  • And don’t let your patients get constipated.
  • But don’t get too worried if they get constipated. Soon you will fix that by loading them up with enough stool softeners that they will no longer be constipated, but rather have incredibly loose stools. But don’t worry about that, because some Loperamide will plug them back up. But don’t worry about that, because……
  • The patient is always the most important person in the room. Yes, it is important to try to appear engaged and interested, but your preceptor comes to the hospital every morning to manage and treat patients, not to pimp you. With that in mind, think more about what you’re doing for your patients, and less about how you think your preceptor sees you; strive to be helpful and pleasant no matter your audience.
Finally, I will once again share the graph that says it all. It’s a model for “what makes a good clerk” proposed by Michelle Gibson last year at around this time.
4 types of clerks 
 
Thanks to Heather Johnson for reviewing this post and thanks to members of the Class of 2015 (Zahra, Pepi, Paul, Soniya, Michael, Rebecca, Meghan, Marie, Lindsay, Kalie, Alexis, Jules, Michelle, Heather, Jeff and Joe) for their pro tips! What tips do you have for those just starting clerkship? Share your thoughts below. 
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A fourth year medical student with interest in all things medicine but especially emergency medicine, rural medicine, medical education and social media in health care. While not clerking it out, she is usually running, playing guitar or planning an outdoor adventure.

7 Responses to My Clerkship Pearl: Care

  1. Ken says:

    You are a super star Eve! Such a great post. We all need to remember to care, clearly you care deeply.

  2. Great post! Fascinating that everything except “don’t forget your phone charger” was 100% relevant when I was a clerk in 1998/99. *Especially* the bit about constipation (shameless geriatrics plug). Looking things up involved these ancient beasts called books, which we carried in our lab coat pockets, but we did it nonetheless.

    Nice to see the grid up there (and thanks to the urology resident who proposed a slightly darker version many years ago). Really – all clerks are smart, but they don’t all work/act smart, so that’s the difference.

    And caring is IT. It is also what makes doing what we do worthwhile. It is also what keeps us awake at 3:00 a.m. sometimes, but so long as that isn’t every night (or most of them), it’s totally worth it.

    So- thanks for the post and for the #QMed15 folks who contributed.

    • Eve Purdy says:

      Dr. Gibson

      Thanks for reading. Books? In your pockets? I guess that is what the white coats were for? Fair enough about the working smart. Motivated might be a better word but that crosses into the domain of nice. I think of the grid often and make every effort to sit in the RUQ. I often miss vertically though and end up in the RLQ which seems to have worked out okay!

      Eve

  3. Thanks so much for this post. I’m not imminently facing clerkship but I’m on a summer elective up North and it seems like so much of this applies. Especially about not shying away from the A & P in SOAP. It’s effectively doubled my learning. I’m so thoroughly enjoying and taking full advantage of the hospital’s access to uptodate.com- definitely subscribing next year.

    Hope you’re having more days that make you feel on top of the world than hit by a truck and thanks again for taking away some of the mystery from clerkship.

    • Eve Purdy says:

      Hey Danielle, thanks for reading.

      Interesting that you mention uptodate. I’m not sure that it’s be all, end all resource. Definitely not necessary pre clerkship (or in clerkship for that matter). I’m actually thinking about not renewing my subscription this year because I feel that it limited my efforts to search for material from other sources and think about the differential diagnosis and plan on my own. Much of the time the information was far too detailed and not always applicable/feasible in Kingston and definitely not in rural centres.

      The ratio of on top of the world days to hit by a truck days is certainly quite high. You’ll love clerkship and second year is great too! Look forward to seeing you back in Kingston.

      Eve

  4. […] not about the apps. It’s not even about how you use them. It’s about how you care for your patients. If the apps are helping you care, then go ahead. If they are impeding your […]

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