Now and then: a letter to my former self, on existence in clerkship

Sean Duke (class of 2021) shares some tips for navigating clerkship

A third-year Medical Student Intern (MSI3) is a brand-new clinical clerk, emerged from the chrysalis of classroom-based education, delicate wings poised, eager to explore the healthcare system at last.

I was recently reminded of how confusing this role can be when two lovely – albeit somewhat disoriented – new clerks, who were assigned to co-follow my patients, began to follow me towards the washroom, unsure if they were expected to trail without a cue or gesture. I recognized their uncertainty, their unfamiliarity with the new territory.

After sharing a few high-yield points with these MSI3s, I felt compelled was to write a letter on clerkship, to my former MSI3 self. It is my hope that prospective, new, and former MSI3s, and those that work with them, will read this letter and get in touch with their inner MSI3. This letter reflects my opinion only; it is not intended to be a “how-to” guide on clerkship.

Why do I feel like an imposter?
Imposter syndrome is real. You will inherit trust, rather than earn it, because you wear scrubs, an ID badge, and a stethoscope. Always introduce yourself as a student to patients and staff; this will help manage expectations. One day we will grow out of this feeling… so I’m told.

How do I survive clerkship?
1)“Eat when you can eat, sit when you can sit, and sleep when you can sleep” – my General Surgery preceptor.
a. You will have hunger pangs with a relapsing-remitting prognosis. Do not pass up opportunities to eat – you never know when your next snack will be. The pain of regret can worsen hunger pangs. Luckily, some iteration of arrowroot cookies can be found in most hospitals.
b. You will have long days on your feet, followed by long nights on your feet – give them a rest when possible, and wear comfortable shoes.
c. More sleep is better than less sleep, even if it’s a 10-minute nap that gets ruined by your pager.

What is “pager”?
This ancient piece of equipment may sometimes be perceived as your greatest nemesis, particularly in the wee hours. Although it can elicit a startle reflex during your REM sleep, to answer its beckon call is your great privilege. It represents your duty to serve – your belonging to the system. It’s what makes you a true clerk.

How do I succeed in clerkship?
1) Be on time: This crucial message goes without saying.
2) Be pleasant: Without having years of clinical experience on offer, the least you can bring to the table is a positive attitude. If you find that others aren’t necessarily pleasant to work with, chalk it up to bad circumstances rather than character. We all have bad days.
3) Learn names: Get to know the fantastic people you have the privilege of working with. These are important folks, on whom you will rely much more than they will rely on you. People’s pets are typically a solid conversation topic.
4) Work hard: Although you are designated as a learner, you have the responsibility to perform actual work (e.g. writing notes, seeing new consults, helping to discharge patients, retracting body parts etc.). No task occurring in the hospital is below your paygrade; offer to help others with tasks that are in your scope. For example, offer to start an IV, or help settle a fussy baby.
5) Know your patients: You will be assigned to care for only a few patients each day – get to know these patients well and be accountable for their management.

What if important people ask me questions that I cannot answer intelligently?
Try to respond with some sort of approach. Important people LOVE approaches, and thought processes count for part-marks. If you are completely stuck, or seem to run out of steam, try looking at your junior resident, who may be mouthing or acting out some sort of phrase to help you along, hopefully undetected by the important person with all the question-asking. Although you hope to excel in your rotations, at this level, there is no shame in being wrong.

What is “Rounds”?
“Rounds” is a diverse term used to describe many inner workings of the hospital, itemized below:
1) Pre-rounds: Pre-rounding is the process by which learners visit patients and gather information. Pre-rounding typically occurs in the early morning, when many patients do not wish to be disturbed. Rightfully so, many patients may find your presence annoying, particularly if you disturb their sleep to ask them the same questions you always ask them and to poke and prod them with your clammy hands and cold stethoscope.
2) Bedside rounds: These are more formal rounds whereby trainees present their patients to the medical team. These presentations transpire in the hallways of the wards, outside of the patients’ rooms. Before they begin, you will be expected to rapidly gather the charts, stack them on a cart, and wheel them along. It is normal to feel nervous while presenting to a group that knows infinitely more than you do.
3) Sit-down rounds: These more informal rounds are similar to bedside rounds; however, they occur while sitting down in a single setting.
4) Running the list: These are brief sit-down rounds where updates are reviewed.
5) Coffee rounds: These are very exciting occasions whereby the team goes for coffee/tea.
6) Grand rounds: These are academic presentations that have little to do with the above rounds. Take advantage of this opportunity to eat non-crunchy foods.

Navigating the role of MSI3 is challenging. You awkwardly begin a rotation, then battle your way to feeling somewhat competent, only to move on to the next rotation where the cycle begins again. The transient nature of the role – the constant adjusting to new environments, new faces and new areas of medicine – can be a constant source of trepidation; however, the expectations of the MSI3 are much the same across all settings. With that being said, this will be one of the most fulfilling year of your medical education. You will work with amazing patients, interdisciplinary staff, and trainees alike, and you will grow immensely in knowledge, experience, and character