All across the country this week medical students are coming back from their Step I vacations, dusting off the collared shirts and neckties from the back of the closet, and putting on pristine white coats as they head onto the wards as new third years. I want to congratulate all of you M3’s on getting this far. If you’re like me, you’re probably totally lost at this point as far as what your responsibilities are on your clerkships. I’m creating a new series called The Life Raft where I will move step-by-step through each rotation to tell you about your responsibilities, etiquette, what books are useful, and some general tips that will make you shine.
Before accepting anyone’s advice you should look at his qualifications. So, I feel that a bit of self disclaimer is necessary. I went through eight clerkships this year and earned honors on several of them, including getting the highest grade in the class on one rotation. Out of the 30 or so evaluations that were filled out by residents and attendings, all but one of them were for honors. Consistently my biggest struggle has been with the Shelf exams. I won’t be giving out any advice on how best to prepare for the tests. Instead, my goal is to make you a star on the wards.
There are some rules you should observe regarding your interactions with your teammates and teachers. First, realize that you and the rest of the medical students make up a team. You are partners. And unless there are any glaring differences, you will all generally be looked upon with either the same high regard or disgust. Therefore, you should do whatever is necessary to make your teammates look really good. You should alert your teammates to any changes with their patients. An example is if you have to stay till eight o’clock because of a late surgery and discover that someone else’s patient suffered a code at seven, you should call your teammate to let him know what happened. He’ll need to be prepared when he pre-rounds next morning. He certainly doesn’t need to get caught off guard with any surprising information when he arrives to the hospital at 5:00 a.m. the next morning.
Second, give teammates credit when delivering presentations. Whenever an attending posed a question to the group and told us to look it up, I would present the information the next day and state that my partners and I all played a role in researching the topic. My teammates ended up paying back the favor and cited me to make me look good on rounds. What the attending sees is not a group of students who individually hunt for data; he’ll see a cohesive team where members teach each other and work well together. The end result is that everyone gets high marks. If you’ve ever heard of the prisoner’s dilemma, the same situation applies here.
In short, the prisoner’s dilemma states that the best result can be obtained by forgoing a large reward and helping yourself and your partners obtain smaller rewards. The reasoning behind this action is that if everyone is searching for the largest reward—e.g., “I want to get honors and no one else should”—teammates will begin stepping all over each other, will make each other look bad, and then no one gets a reward of any kind. I’ve had several attendings tell me at the end of the rotation, “Your team is so great. I’m going to give you all excellent evaluations. You’re much better than many of the other students I have seen around here.” In reality, I don’t consider us that much better at all. I think that we showed up on time, knew about our patients, and did our work for the day. The only difference is that my teammates felt the same way I did. I will say that I’ve been lucky in that regard. I’ve heard horror stories from my friends about lazy partners who make the whole team looked bad. Nothing is worse during third year than a dysfunctional team. I’m lucky enough to have been shielded from much of that.
The final piece of etiquette is that you should never say anything bad about other students, residents, or attendings. Even if you have the world’s dumbest intern—and your attending openly calls him that on rounds—you should never say the same thing. Remember what I said earlier about making your team look good? The same rule applies in a way that you treat the house staff.
You should also go so far as to never make fun of other specialties. While I admit to making a lot of disparaging remarks about different specialties on this website, you should realize that this is just an anonymous place for me to vent. I would never call a psychiatrist a fake doctor while I’m in the hospital. You just never know who you’re talking to. While you’re ragging on shrinks in front of your surgery attending, he might feel a little insulted if his wife happens to be a psychiatrist.
With that said, this concludes my introduction to The Life Raft. Hop on over to the downloads section and pick up a patient tracking sheet that you can use on rounds. Welcome to third year. You are now a Half M.D.