The Unwritten Curriculum: 7 Simple Rules to Live By On Your Clinical Rotations

The Unwritten Curriculum: 7 Simple Rules to Live By On Your Clinical Rotations

Cover Photo Credit: Rex Features- Charlton Heston in The Ten Commandments

Before Starting

1. Research the best spot to do your specific rotation

Many med schools have multiple hospitals associated, and as much as they wish it were the case, the experiences just aren't the same. Some sites will be easier, some will be harder, some will have specific patient populations, and some will have a wide variety. Especially if you're not interested in going into a certain field, find an easy site that will give you flexibility to study.

2. Before starting the rotation, review how you will be graded

Don't wait until the last week of the rotation to find out that 80% of your grade comes from your clinical evaluation and only 5% is associated with the test. Spend your time according to where the most points are in the grading rubric. I'm sure most of you do this already.

3. Select what books, if any, you should have for studying

Use SDN or ask me directly or comment below if there is a specific subject that you have coming up and you aren't sure what to study. In general, Uworld is your best friend for 3rd year, but there are many variations on the theme.

If your rotation doesn't have a test, then you don't have to study! You can focus on doing things to impress your attending! See #7 below for suggestions.


While On Rotation

4. Don't be late- ever... Also, don't be annoying

Residents and attendings have very little information to pull from when assigning you a grade. If you do your job, they will be scratching their heads wondering what grade to give you and 65% of you will end up with a "excellent" level grade. If you stay late and study really often, you can make an impression but avoid being annoying.

It is hard to say exactly how to not be annoying. The way the system is set up guarantees that you will be a slight nuisance to your residents. They have split obligations- patient care and your education. Obviously, patient care comes first. The best residents blend the two together, but you'll come across MANY who are just horrible teachers. It is unfortunate. Remember those experiences for when in a few short years you will be the resident with a pesky little med student following you around.

For specifics, I'll say that if you residents are working really hard to get their work done so they can leave and it is getting late, consider saving your question for tomorrow. The morning and rounds is a GREAT time to ask questions, just be sure that you have your question formulated very well, and if it is a simple question, consider looking up the answer yourself using UpToDate or Dynamed. If it is an interesting question, consider presenting your findings to your group. See #7 below for suggestions on how to do that.

5. Get to know your resident/attending; get to know ancillary staff

Be yourself- be slightly goofy; if you're genuinely funny, then be funny. Treat your residents and attendings like fellow human beings. No one likes the groveling medical student. Well, let me take that back- there are a few residents and attendings who like the groveling medical student. They look like this ->

 "Bob Kelso" via Scrubs Wiki

"Bob Kelso" via Scrubs Wiki

6. Don't lie about what you are interested in

People have various opinions on this. I'll give you mine and it's simple- be honest. Lying to get ahead doesn't seem like a quality that should be associated with a medical student, resident, or doctor. Invariably, people will make assumptions about you based on your respective field of interest. That's their problem, not yours. You have worked really hard these past, at least, six years if you are about to start rotations. No one would argue with the fact that you have earned the right to pursue whatever you want. So if you want to go into ortho, plastic surgery, dermatology, or family medicine, be proud of it!

Tell people what you actually want to do, especially your attendings and residents, because it will give them something to discuss with you. For example, during my internal medicine rotation, I did a pre-op evaluation on a patient because my attending and resident knew that I was interested in anesthesia. Having those experiences will only make me a better anesthesiologist someday, and I might have missed out on it if I hadn't said what I really wanted to do.

7. Start studying EARLY

I didn't have this problem, but for some, it is a struggle to get studying for your SHELF exams, especially after you just spent at least a month studying for USMLE Step 1. The SHELF exams are not particularly easy- so don't delay. Biting off a little bit everyday- doing 15-30 Uworld questions each day, is a great way to study without having to cram at the end of the rotation. This is also rotation-dependent, as some rotations have SHELF exams, some have written exams, and some don't have exams at all- that is determined by your medical school.

A similar problem would be that some people get so engrossed in their rotation, that they want to read all the journals and primary literature related to their patients rather than studying the basics, like Uworld. This is the opposite ditch to fall into. If you can't pass your SHELF exam, your school will probably either have you retake the test or retake the course. 4, 6, or 8 weeks is too long to have to repeat!

So do it right and do it once:

1. Start studying early using Uworld and whatever other text books you'd like

2. Study at least a little bit each day, taking 1 day off a week for self care

3. Get through at least all of the Uworld questions that pertain to your given rotation, and go back through your "incorrect" questions if you have time

4. If you can, use PubMed or Google Scholar to find 1-2 articles per week that pertain to your patients. Review the article and highlight or take a few notes on a few things you can practically take away from it. Print off a few extra copies for your attending and residents and bring up the article at the end of your oral presentation of your patient. Pass out the article and state 2-3 BRIEF things you learned from it. This will make you look like a stinking GENIOUS! Seriously, if you want an easy way to boost your clinical grades- this is it! I recently started doing this, and all of my graders mentioned it specifically as a strength of mine.


Now that I am a 4th year student, those are 7 simple things that will take you from good to GREAT on your 3rd year rotations. Let me know what you think! What are are the simple rules you live by on your rotations?

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