How do I fit into the care team?

Summary:

You’re going to start out at the bottom of the totem pole – this is just the reality that you’ll have to accept. Be humble and realize that it’s not about you anymore. The patients are the number one priority. You need to accept this reality so you can make the most of the learning opportunities in this new environment. If you want to be successful during your clerkships, you need to be a keen observer and have situational awareness. Observe and figure out where you fit into the flow. Talk with your residents, nurses, and other staff about how you might be useful. Approach every interaction in the hospital as an opportunity to learn – that’s why you’re there! Get to know your patients. They can offer valuable insights and it’s good for you to learn to translate your medical speak into layman’s terms. One of the fundamental challenges of rotations is adjusting to the different care teams for each rotation. One thing you can do to always make yourself stand out is be reliable and humble.

“It’s not about you” (anymore)

Unfortunately, your first experience working in a care team as a medical student places you firmly at the BOTTOM of the totem pole… This is something you will have to accept and become comfortable with. But don’t worry too much, because there are plenty of opportunities to shine! With time, the trust you gain from your coworkers will give you a sense of comfort and will provide you with experiences that will help you gain valuable skills as a future physician.

However, before all of that happens, you must be humble enough to know where you stand in the hierarchy of responsibility. You are learning how medicine is practiced in the hospital and in outpatient clinics, with REAL patients, being taught by real physicians. At the end of the day they have numerous responsibilities, only one of which is teaching you, and the most important of which is taking care of patients… Once you understand this reality, you can observe what is needed, help the care team, and make the most of the learning opportunities in this new environment.

 

“Be a keen observer”

Situational awareness is the key to a successful clerkship experience. But what exactly does this mean? Situational awareness means that you must be able to “read the room,” whether you are with residents, fellows, or attendings, and respond accordingly. If things are busy and you feel helpless, find small tasks that you can accomplish (i.e. grab lists off of the printer, prep notes if you have time, follow up on labs, write down brief action plans for each patient on service, etc.) so that you can help residents follow up on things that need to get done throughout the day. You can even offer to grab a quick snack or coffee or something for everyone if there is nothing else for you to do.

On the first day, observe how things work and write down the workflow so that you can figure out what small tasks YOU can do to be helpful. Find an open computer and start reading about patients on the service. Ask your senior resident ahead of time how to get access to the list so you can be prepared/have something to do on the first day. Being a keen observer will allow you to better understand your surroundings and be prepared to act when the time comes, without getting in people’s way.

 

“The ball is in your court to engage others”

To restate an earlier point, things are not all about you when you are on your rotations. Sure, interns and residents may often feel an obligation to take care of medical students, but they have a job to do and a finite amount of time in which to do it. The best way to start things off is by talking with the residents about how to be useful, and how to get involved in the daily work.

Don’t forget to be friendly! You will be working with these people for a few weeks… Every day will feel like a struggle if you don’t have a great rapport with your coworkers. However, there is such a thing as being too friendly, so be sure to keep things friendly, but professional.

Make sure you interact with the nurses, OR staff, MA’s, etc. to get to know them and offer to help them out as well. These should, and likely will be, the first people you learn from! Early on during your rotation, you should ask them how things are done on that floor or in that specific clinic so that you can build a relationship with the whole team.

Chat with the other med students on the rotation on the first day about goals for service (e.g. things you all would like to work on) so that you can look out for each other and push/challenge each other. Whether it is asking about professional or personal things, it’s always helpful to find even one connection between you and another person. One connection that you automatically have with your fellow med students is that you’re all there to learn…

 

“Learning is infectious”

You should approach every interaction with patients, physicians, and hospital staff as an opportunity to learn. This is why you are in the hospital in the first place! Having this mindset is important not only for your own resilience, but also because others around you will take notice. If you’re too focused on what is relevant for your shelf exams, you may miss out on key interactions that will help you become a better, more comprehensive physician.

You should take the time to get to know your patients whether or not you plan to go into the specialty in which you’re rotating. Patients are often receptive to talking with med students, and you can learn from their experience. This is also a wonderful opportunity to train yourself in translating the language of medicine for your patients into layman’s terms. Try to approach every opportunity you can to learn, but in a humble, non-overeager way. For example, if a difficult conversation is happening with one of your patients, a procedure is going on, etc., ask if it would be alright if you joined so you could see how the procedure is done. Oh, and don’t take it personally if they say “no”! You need to listen and do what they say as well as do what YOU say you’re going to do!

 

“Do what you say you will do”

Adjusting to the care team with each rotation is one of the fundamental challenges of your clinical rotations, but one thing must be constant: you have to be reliable. Follow up on tasks and be honest about what you are comfortable doing. It is easy to lose the trust of your teachers/mentors if you are not reliable… Don’t let this happen to you! Stay true to your commitments and it will be easier to fit in wherever you are.

Resources:

Previous Pain Point (from Phase 2): How do I continue to develop professionally?

Next Pain Point: How do I stand out in my clerkships?