Thomas Jefferson UniversitySidney Kimmel Medical College

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How to Do Well

There is no golden formula for getting great grades in medical College, particularly during the clinical years. Each rotation will have different expectations and responsibilities. These will vary depending on the field, the individual attending physician, and, perhaps most importantly, the residents with whom you work. In general, there are several tenets that will hold true, regardless of the rotation.

Be a Team Player

Actively involve yourself in the tasks that the team must complete. Try to write your notes early in the morning before residents or the attending physician see the patient. Continuously ask yourself about the needs of your patient. For example, if you see your patient in the morning and notice she had a fever overnight, you may want to suggest ordering some labs for her, like a CBC and/or cultures. Document the changes overnight in your progress note and write an order for your labs. Don't hesitate to present your patients during morning rounds and discuss your recommendations. The residents must co-sign all notes and orders, so the worst that could happen is that they cross out your order if they disagree with your management. However, you will have shown initiative and your team will be appreciative of your efforts. It also does not hurt to politely remind residents to co-sign your orders and notes should they overlook to do so, since they are held responsible for doing so at most places. The more aggressive and involved you are with the assessment and management of your patient, the more you will shine and the more you will learn. The worst that can happen is someone will disagree with you.

A good team player also doesn't mind helping out with some of the "busy work" throughout the day. For example, help out by looking up current labs and following up on imaging studies. Your efforts aid in creating good team dynamics (and could mean leaving earlier for the day).

Be Courteous to Everyone

This is a broad category; courtesy should be demonstrated to the house staff, your patients, the residents, clerical staff and nursing staff, as well as to your fellow medical students. Health care requires a team approach. There is nothing more annoying than a medical student acting as if he or she knows more than a floor nurse who has been at the hospital for 20 years. Understand that the nurses, techs and other ancillary staff can be your best friends - helping you find items out on the floor and explaining how things are done - or your worst enemies. Impoliteness could make for a miserable experience for all involved. Just use your good judgment and you should be fine.

Certainly, courtesy must be shown to all patients. Remember that there is a Code of Professional Conduct for students, house staff and faculty alike. Keep in mind the patient's rights and privacy. For example, avoid interviewing a patient while in the hallway or the bathroom. Respect patient confidentiality by not discussing patients by name in public places. Always try to explain to the patient what you are doing and why, especially with embarrassing procedures such as pelvic or rectal exams. If your patient asks you a question and you don't know the answer, simply tell him or her "I don't know, but I'll find out" and come back later with an answer or with someone who does know. Making up an explanation breaks down your trust with the patient.

There is another unwritten but important rule: wait your turn when giving out answers to questions posed by attendings or chief residents. It does nothing but look bad for you when you choose to cut off your fellow medical student with an answer in an attempt to look good. Most residents and attending physicians do not appreciate students demonstrating their knowledge at the expense of others.

Know Your Patients

Be on top of things. Know the latest lab values and studies and their impact on patient care. Read, read, read. Learn about your patients’ diseases and the treatments for their conditions. It is much easier to retain information when you read and put the knowledge together with a face. It will also be helpful when reviewing for the USMLE Step 2. Track down results from all of your patients for the day; it will save time for the residents and will help you understand indications for certain tests. Try to see as many procedures as possible.  Go with your patients for their bronchoscopies, cardiac catheterizations, lumbar punctures, etc. Take advantage of your time as a student to learn about different procedures.

Ask Questions

You will find that the residents will be more enthusiastic about teaching if you express a genuine interest. Ask relevant questions at appropriate times. Offer to present a topic or research some articles for discussion throughout the clerkship. Choose a subject that would be beneficial to you as well as the other students and residents. Such experiences, you will find, can be the best learning opportunities.

Exhibit Ethical Behavior at All Times, No Matter What

It is important to act professionally at all times. Do not lie, cheat, or make your fellow students look inferior. Be honest. You are not expected to know everything, so don't feel the need to act that way. You may call on residents or faculty in the future for recommendations so don't burn any bridges. There are no back exams for some rotations. Taking copies of the test or copying questions and answers to share with friends is still cheating and breaks the Jefferson Honor Code.