Before I start, I feel obliged to write a disclaimer that all of the following is 100% based on my personal experience, and may be totally non-applicable to many other students. As with everything else in the med school multi-verse, use what you can and discard the rest.
As a third year medical student, you spend months either looking forward to or dreading your medicine rotation. For me, I didn’t have to wait very long, as it was my very first rotation of third year. I was of the former camp, but that was likely because I had just spent the better part of four straight weeks cooped up inside of my small SF studio studying for Step 1. When the first day of medicine arrived, I was so excited to finally see a patient (or anyone, really).
Generally, the most important part of your medicine rotation is to be present. I mean this both literally and figuratively. Medicine is a team sport. Even as a third-year medical student, you are an integral part of the team, and you are expected to play a significant role in caring for your patients. As a rule of thumb for third year, don’t be late. If you are a habitually late person, you should start setting your watch 15 minutes later just to give yourself a head start. (I totally did this.) When you are on with your team, pay attention to everything. Keep your ears sharp so that you can grab a chart, call a nurse, etc. when your team needs it. Listen to everyone’s presentations on morning rounds. If your intern is out tomorrow afternoon for clinic, then you can help care for his/her patients in your intern’s absence, but only if you know what is going on with them. Yes, rounding always takes a long time, and yes, you will have a strong urge to tune out... But don’t! As the most junior person on the team, you stand to learn the most from what is being discussed. This brings me to a related point, which is to say that it is okay to have questions, but it may not always be a good time to ask them. Invest in a notebook, and jot them down for a less busy time during which to discuss with your team. This one carried me through my third year. (It’s also a great place to write down all of the things that you are learning throughout your rotation.) Also, your feet will ache, so you should also invest in some comfortable shoes.
Be Confident, Clear, and Concise
The next most important aspect of your medicine rotation performance is preparation. Make sure to give yourself enough time in the morning to pre-round. Get all the numbers and prepare your presentation sheets. I liked to fold a blank piece of paper lengthwise and add a new sheet each day, so that each of my patients had a packet. When collecting numbers for your patients, make sure that if there is an abnormal value, you write down what it had been most recently, so you can let your team know what the trend had been. Once you have your numbers, you should come up with your own assessment and plan, and then check in with your intern before rounds. That way, your intern can remind you of the things you missed or suggest a better plan. We are, after all, still learning. If you are not confident in your presentation, you should go over it a few times with your intern before rounds. For presentations, you want to make sure that you are confident, clear, and concise. In my experience as a third-year on medicine, it was fine when I presented a plan that my attending didn’t agree with, as long as I was clear in my reasoning for why that was my plan. Finally, as we are all well-acquainted with how long rounds can run, never be the medical student that holds up your team. Timing is difficult at first, but if you are listening closely to your interns and seniors present every day, you will get the rhythm down in no time.
Be Receptive to Feedback
Another key component of your medicine evaluations will be feedback. As a student, you should always ask for feedback. Medicine residents and faculty love to give you feedback, and making the changes they suggest is an easy way to show that you are improving. What I loved about my medicine rotation was that there was such a strong emphasis on learning. Medicine people love to teach students, and I remember that my learning was truly explosive during those eight weeks. Where I rotated, we generally worked with every resident for a month and every attending for two weeks. Take the time every Friday to check in with your team members and ask how they think you could improve. As a general rule, you should always ask for both midpoint feedback and final feedback from every resident/faculty member with whom you work.
Finally, medical knowledge can seem like a subjective, abstract category on which to judge students, but at the end of the day it makes up a non-trivial component of your final grade. Luckily, I feel that it is less dependent on your actual knowledge and more dependent on your preparation. So, let’s talk resources. Before you even start the rotation, you should download the UpToDate app on your phone. This was my “go-to” resource on the wards, and it comes with really helpful charts and diagrams that help to consolidate your learning. Some other resources that others have found helpful are “Step Up to Medicine”, “Pocket Medicine”, and “AgileMD”. I didn’t use the first two that much, but “AgileMD” was great for a super concise summary of how to manage basic medical conditions. I believe there is an institutional login subscription, so reach out to your medicine clerkship coordinators at the beginning of your clerkship so that you can get access. Because teaching is so central to the medicine curriculum, it is really important that you learn everything that you can about your patients’ chief complaints. Take a little time each week to teach your team about what you have learned, whether it is with a handout or just on the fly. No one knows everything, so you may very well be teaching or reminding your team about something really interesting! For the shelf, the best preparation is doing UWorld questions. Try to do all of them before your shelf, but spread them out so that you aren’t doing them all on your last week of medicine. The Clinical Mastery Series provided by NBME is also an excellent resource for more questions.
At the end of the day, like with pretty much everything else in life, your enthusiasm and being a nice person will get you the farthest. Everything else is secondary to that. Yes, your medicine rotation will be exhausting and stressful, but at the end of the day, you’ll find that it was all worth it. After years of iterative science classes and applications, you are finally doing what you were meant to do. You will be taking care of patients, and that will make all those early morning wake-ups just a little bit less painful.
Norah Liang is a third-year medical student at UCSF and tutor for USMLE Pro.