Talk about the opportunity to showcase yourself. Most schools give you two or three elective rotations where you are able to spend four weeks on a service of YOUR choice. We have three pieces of [seemingly OBVIOUS] advice:
First – do your elective in a specialty that you are interested in pursuing for RESIDENCY (i.e. if you are interested in cardiology, do all of your electives in INTERNAL MEDICINE, NOT cardiology, which is a fellowship, NOT a residency). This way, you can not only hone your knowledge and clinical acumen, but also become proficient in the more technical aspects of working on the floors. This latter point is critical because you will learn soon enough that there are so many more dimensions to being a STELLAR resident than a broad fund of knowledge. A solid JUNIOR resident (which is the position you are vying for as a 4th year medical student) is able to:
ANTICIPATE daily plans for patients on the team’s service without having to be instructed by the senior resident:
If a patient’s antibiotics were supposed to be on for a total duration of 5 days, you should know what day antibiotics he/she is on and be ready to state this during morning rounds, discontinue then if a therapeutic course has been completed.
If you have called a consulting service, follow-up on and implement the recommendations on morning/afternoon rounds.
Have the discharge paperwork ready to go with prescriptions written the day PRIOR to the anticipated discharge date so there is no hold-up in the patient’s course. This will make nurses and patients HAPPY – both these parties have a voice in your evaluation so it’s in your interest to keep them content.
COMMUNICATE with other members of healthcare team and with patients:
Nurses are really at the forefront of patient care. They execute your orders, they interact the most with patients, and they are the first to alert you if anything looks/seems suspicious. So it makes patient care that much more effective and safe if you convey to them the patient’s heath-status and plans of care.
Being sick really, really sucks. Not only does it put a halt on one’s daily activities, but it can profoundly impact their future life plans and understandably so, be a major source of anxiety. That’s why it’s a major responsibility of the primary team to keep patients [and their families] in the loop with regards to changes in health status, treatment plans, prognosis ad long-term outlook, post-discharge expectations and precautions, etc. This role is most often assumed by the junior resident, who is in most frequent communication with patients and their families.
There is undoubtedly a hierarchy in medicine. You have probably heard the saying (or should I say truism), “Sh*# rolls down hill.” Well, there is a similar saying “information climbs uphill.” As a junior resident, you deliver information about patients to senior residents who in term report to the Attending physicians. Therefore, it is critical that you are on TOP of things – from whether treatment plans were executed, suggestions and actions by consultations, changes in patient’s health status, essentially EVERYTHING. Because if the senior resident looks good, you look good. Word spreads quickly in medicine. Acclaim of your performance will surely reach the faculty and program director. Not to mention, your being on top of things will translate to better patient outcomes.
As a 4th year medical student doing your elective on a service, you are the Junior resident’s RIGHT-HAND MAN. They’ll appreciate your help in conquering the day’s tasks and you’ll have the advantage of learning some of the aforementioned traits from an early stage in the game. This will make your transition to residency that much more pleasant and your success that much more guaranteed.
Second – We STRONGLY encourage your FIRST elective rotation be done at your “home-base” hospital as opposed to another institution. Understanding the flow of a service takes some time. As a 4th year medical student, and new member of the team, you need to learn how to be helpful on the service without coming off as pushy, annoying, a know-it-all, or a brownnoser. Just like a newborn adjusting to the outside environment, this takes some time. By doing your first rotation at your home-institution, you’re in a more comfortable learning environment and that too, in one with a bit more leniency since you’re a native. So take this opportunity to not only learn the basics, but become a proficient 4th year/acting-intern (i.e. for those aspiring to do surgery, get really good at closing skin. So scrub in on AS MANY cases so you have the opportunity to close skin at the end of the case).
Third – Lastly, spend your remaining electives at an institution other than your “home-base”. Ideally, you’re going to want to spend it somewhere that you have a good shot at becoming a resident; where getting to know the faculty and program director/chairman will help you land a spot and a good letter. Away rotations really are your golden ticket. Hopefully everything you learned during your elective at your home institution will give you an edge you during your “away” rotations. It’s all about having a running start.
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