Freaking Out About Starting My Hospital Rotations

by Jason

I'm actually very nervous about beginning my hospital rotation. The past two years have been purely in the classroom with standardized patients for history and physicals or in medical jargon H&Ps.

But things are about to get real fast.

I have one week of hospital orientation from 8am to 7pm and then the show begins. My first rotation will be Emergency Medicine. Personally, this is a tough rotation because anything and everything can come through the door and you have to be ready for it. Plus, the volume of knowledge you have to know.

So I'll admit, I don't like looking like an idiot but Emergency Medicine poses its unique set of hurdles to overcome as a medical student. During my preclinical years our modules were all organ based so it was all peds, cardiology, renal, etc. and you knew to study that material cold and life would be all good. Unfortunately this even meant when taking exams you could elminate some answer choices because it wasn't based on the current module we were studying.

Well, with Emergency Medicine (EM) things are tricky because your focus is NOT limited to an organ system or a certain patient demographic. Everything is fair game.

Now I don't have a problem with this because I fully understand medicine is about treating the entire patient, it will just be unnerving having so much knowledge to grasph for my first clinical rotation.

If you know me and have been following my trajectory throughout medical school you'll realize I have no fear of blood, guts or trauma that stuff doesn't phase me in the least bit. Now knowing exactly what I should be doing and when freaks me out.

Mentors Words of Wisdom
So I got some advice from one of the doctors I have shadowed in the past when I mentioned and asked for tips about starting in the hospital. The doctor said if you have questions and don't know what to do ask a resident or 4th year medical student before asking an attending because you don't want to look stupid or distract the attending. She was referring to things about when to arrive, expectations on the service, etc.

These are all things that can annoy your attending so don't do that to them.

Also I was advised don't be the annoying medical student who doesn't know when to shutup or simply asks way too many questions. The doctor said she wasn't concerned that I would fall into this category but you'd be surprised at some of the impressions your classmates will make on the attendings and it won't be positive impressions.

You don't want to brown nose but you have to show a level of enthusiasm. This means if you come across an interesting case go print out an article on the topic and bring it in to discuss while on rounds. Those who are superstar medical students will also print out copies for everyone too.

My friends who are in residency in various specialties had advice to give too.

Be enthusiastic always. Show up on time. Which really means getting there early. Be sure to learn a lot.

Oh, one of the physicians gave us advice which makes a lot of sense. Do NOT study while at the hospital. He said you are embarking on your clinical years and this is the time to learn how to be a physician and take H&Ps, save the board studying for later. You only have one chance to build clinical skills and acumen so do it now because afterwards you are going to be out on your own and people will expect that you know how to do the basics.

I guess it goes without saying that nurses are your friends. Be nice and be kind to them. Apparently, they can make or break your life.

So following in the advice of the doctor I shadow I went ahead and asked a 4th year some questions in regards to preparing for Emergency Medicine. My school is great because this student is going to be on our rotation as well doing and audition rotation because she wants to go into EM.

And there's one more student from my class who has the same rotation schedule as me.

This morning we were both on Facebook discussing things about getting ready for the hospital, such as attire and also thought hey we better exchange numbers since we will be seeing a lot of each other.

4th Year Med Student Guidance
Here's what the 4th year had to say in response to my email and nervousness about starting my EM rotation:

Don't have to worry about note writing in the ED, you won't be doing it. There is one doctor that makes students write notes as a teaching exercise, but I don't see his name on the schedule this month.

When you arrive to the ED on every shift, you will be with a different preceptor for the most part. You will just let them know, "I'm a 3rd year, this is my absolute first rotation," everyone is understanding and will only expect you to be courteous, on time and TRY to answer questions.

In the ED, you will learn how to take good focused histories and practice your physical exam skills. You will get to do some procedures (suturing, IV lines, NG tubes...exciting!) I know it seems daunting as your first rotation because of trauma and heart attacks, etc, but seriously you are there to learn and everyone knows that and everyone is on board with that.

I laugh as I write this because I remember during the year when our rotation assignments came out my best friend from medical school said, "Spears you have EM if you don't know how to read an ECG you're going to kill someone who is having a MI (heart attack)!" Haha, we joke around a lot but there is much truth to her words.

I won't bore you with what we are supposed to wear and all the other nitty gritty details the 4th year conveyed about what materials to have on us for EM but will say attire is scrubs and white coat.

In the medical community it is generally accepted that the length of your white coat signifies your level of training like med students have short coats while doctors have long white coats. One of the doctors in the preclinical department is headstrong about things and would constantly instill in us that, "when you get to the hospital and wear that white coat to everyone you encounter you're a doctor so carry yourself like one." Basically to the general public you're a doctor.

Here's an interesting story from a pediatric intern.

This doctor stated whenever you're in the hospital introduce yourself as a doctor and NOT a medical student. She said some patients will refuse to let you work on them if they know you're a medical student so to avoid this issue just call yourself a doctor.

I respect the hierarchy of medicine so would not call myself what I am not especially if a doctor would overhear me and then chew me out. Although, at my medical school we don't refer to ourselves as medical students you're either Student Doctor or Student Physician.

Medical Specialties
I have no clue what specialty I want to enter. I'm walking into things open minded and will decide based on what I'm good at and what I enjoy. Although many doctors say you are either procedure based or people based. I honestly can't answer that question and think I will like something that is a good mix of everything.

Let's see when choosing a specialty you can either rule things in or rule them out.

This may shock a lot of people but Orthopedics hasn't grabbed my attention this is despite working as a sports medicine aide, shadowing orthopods, etc. It's probably due to my lack of ability to think in 3D.

Another specialty I can rule out is Dermatology. That's just not for me. I know you can make some great clinical findings in this specialty but the concern with appearance and talking about moisturizers and creams does not excite me in the least bit.

Honestly, I think I'm going to shock myself in what specialty I will enter.

I'm keeping a very open mind about EM and who knows after two weeks or so I will know where it belongs on my list of specialties. But first things first get ready for my first shift of Emergency Medicine.