What to expect when you’re expecting…to begin clinical rotations !

Finally, the post I have been meaning to write for a very long time. I get questions about clinical rotations very frequently, so below is Nandini’s guide to medical school clinical rotations, in FAQ format..

1) What is a clinical rotation?

It’s a period of time that you spend at a given hospital (or clinic, doctor’s office, etc.), gaining hands-on clinical experience from seeing patients and learning from patients, nurses, residents, attendings, and anyone else who chooses to teach you.

2) How many clinical rotations do I have to complete?

Well, this varies slightly from school to school, but most students must complete required “core” rotations, and “elective” rotations. Core rotations include:

Pediatrics: 6 weeks
Obstetrics/Gynecology: 6 weeks
Internal Medicine: 12 weeks
Surgery: 12 weeks
Family Medicine (considered an elective by some schools): 6 weeks

“Elective” rotations are just that. They are voluntary. You can usually choose which elective rotations to do, but most schools require a certain number of “medicine” or “surgery” sub-specialty electives. My College  requires a total of 30 weeks of electives.

3) How do I schedule rotations?

The answer to this question really depends on your school.  You apply for core rotations through the clinical department. You can request roations at any of the affiliated hospitals, and they will try to schedule you for them. Keep in mind, however, that they can only schedule you for availalbe slots. So, what you get will depend upon your schedule, and availability. For elective rotations, you can can request them through your college  clinical departemnt, or you can contact the hospital directly.

4) How do I know which rotations are best?

My best advice? Ask around. Word of mouth seems to be the best way to find the best rotations. I don’t think ValueMD has much merit. And see question numbers 13 and 14, for more information related to this.

5) What do med students actually DO during clinical rotations?

EVERYTHING!

Okay, let me be more specific. Here are some common things you will do:

- Perform, write-up, and present H&Ps (histories and physicals)
- Write SOAP notes on patients (progress notes)
- Follow up on things related to your patients. This includes (but is not limited to!) following up on lab results, radiological reports, consults, etc. The more you know about your patient, the better you can help them, and the more your residents and attendings will love you.
- Perform “procedures.” Examples include drawing blood, placing lines, placing NG tubes, suturing, putting in foley catheters, and anything else you can imagine. As far as what you are allowed/expected to do, this really varies from hospital to hospital. But at minimum you should be prepared to draw blood, place lines, and hold retractors (for long periods of time!). As far as training for the procedures is concerned, this also varies from hospital to hospital. But remember the golden rule: NEVER perform a procedure if you have no idea how to do it!
- Round on patients.
- Attend all lectures, presentations, etc.
- Present information on various clinical topics.

6) What are “rounds?”

Some attendings prefer sitting rounds, some prefer walking rounds, and some do a combination of both. Rounding on patients simply means going through the list of patients and presenting information on each one of them. If they are a new patient, you are expected to present the entire case. If they are not, you may just need to provide an update. You then generally go from room to room as the attendings and residents talk to and examine the patients. Expect to be asked many questions during rounds. And this is a great opportunity for you to ask questions as well!

7) What is the “hierarchy” in the hospital?

Med students are the lowest on the totem pole, then residents, then fellows, then attendings. Sometimes you will work only with the residents, and sometimes with the attendings, and sometimes all of the above.

8 ) Will I receive traditional (didactic) lectures during my clinical years?

Again, this really varies highly from hospital to hospital and rotation to rotation. I’ve received lectures in almost every one of my rotations (all the cores), but the amount of time I spent in lectures versus other activities varied widely. You will “learn” clinical medicine via many routes. This includes didactic lectures, “teaching” rounds, and of course, at the patient’s bedside.

9) What is “pimping” and should I be scared?

“Pimping” simply refers to a higher-up (usually an attending, but can also be a resident) asking questions (sometimes in a machine-gun style) about anything and everything. No, you should not be scared. But yes, you probably will be anyway. It’s scary to be put on the spot. And you will never know the answer to all of the questions. But you should remember that you’re not expected to know all of the answers. Keep that in mind, and you will be less stressed out by the situation.

10) What is the schedule like for clinical rotations?

Again, this varies WIDELY based on the hospital and the rotation. Expect to spend longer hours during your core rotations versus electives. Almost all core rotations also involve “on call” hours, which involves staying late or during the night. An average day at the hospital during a core might go something like this:

6:00 – Report to hospital for morning sitting rounds
7:00 – See your patients, write SOAP notes
10:00 – Walking rounds
1:00 – Lunch
3:30 – Follow up on patients
4:30 – Lectures
6:00 – Walking or sitting rounds again
8:00 – Go home

Again, this is just a  my schedule . Night calls vary from a few hours, to 12-hour or 24-hour shifts. Most rotations give you “post-call” days. This means that if you have a call shift, you are allowed to go home afterwards and have the rest of the day off before you come in again the next day.

11) Are there written exams?

Again, this varies, but most of the core rotations will have quizzes and exams. Of course, you will also need to take your board exams (USMLE, etc.) and Shelf exams, if your school requires them.

12) How are you evaluated?

This varies. But for most rotations, your grade is ultimately based on your exam scores and your “clinical performance,” which is based on your clinical skills, clinical knowledge, professionalism, and other areas of performance.

13) What’s the most important piece of advice you can give about clinical rotations?

That you get out what you put in!

Yes, the hospital matters. Yes, the attendings and residents matter. Everything matters. But the most important piece of the puzzle, and the one that YOU have ultimate control over? Yourself. If you show up early, volunteer to stay late, ask questions, and are a very motivated leaner, you will succeed and learn how to be an amazing doctor. It’s as easy as that.

That’s all I can think of for now! I hope this helps some of you out there.I will add them to the list!

Sealed with kiss by Nandini ! 

Things I Love "NOT" to Love the Most !!

Religious Protesters.  Seriously people, if you disagree with my beliefs then so be it... chances are I disagree with yours too but I will never take time out of my  life to picket your place of worship.  As I watch you yelling and screaming all red faced and manic, I can only imagine the examples you are to you children as they watch you berate someone for the way they choose to worship.
 Fat people who blame everything but the Ho Ho's they are eating for the reason they are overweight.  You aren't fooling anyone.  It isn't glandular... it's psychological and it's about self control and what you eat and the fact that you don't exercise.
Peas and broccoli .  Argh, the thought of them makes my stomach turn.  I think I must have regurgitated them way too many times as a child and legend continue. 
Men who constantly grab themselves.  What is with this all about?  Can't you work this problem out in private?  I know this guy who does more ball handling than Kobe Bryant.  I know you may get a pinch or an itch occasionally.. women do to but you don't see us fondling ourselves at the grocery store do you? 

Anyone who acts differently around others to make believe they are a certain type of person than they truly are.  If you like Nascar, then like it.  If you can belch on command, brag about it.  Don't pretend that you are someone else because you think it is more socially acceptable.  Grow a "set" and be who you are and love it. On the other hand, if you are a total social idiot who has no class or tact... don't necessarily flaunt it for the world to see either.  Take a class or read a book or something and learn some social skills.
Hair that grows out of people's noses and ears .  Please manicure your nasty orifices... I know as we age, we get hair in our ears and noses... 1 minute a day can alleviate the need for me to be forced to stare at your 4 inch nose hairs.
One uppers.  I have mentioned this  before.  When I am having a conversation with you... listen.  Don't just sit there pretending to pay attention while you think of a better story to trump mine with.  It's rude and you look like a dumbass.
Liars and Careless.  I don't need to say much more than that.  Out of all these things listed above this is definitely the thing I truly do hate the most.

That was a bit therapeutic I must say....

Sealed with a kiss by Nandini !!

Stuff that won't make sense to you..

Sometimes you feel a million things.

So many, that its mind boggling.

So many, that you do not realise you're feeling it.

Sometimes you feel like laughing and crying at the same time.

Sometimes everything is just there but still is a long, long wait.

Sometimes, all it takes is a hug.

Sometimes, you just sit and stare  for hours.

Sometimes the present itself is a nostalgia.

Sometimes you're insecure of nothing tangible.

Sometimes, everything is like the sea... coming & going.

Sometimes you just don't make sense when you're trying to pen down everything.

Sealed with kiss by Nandini 

I wana Hold your HAND :)

A couples of  weeks ago, I had an experience that has really stuck in my head. The resident and I were performing a painful procedure on a patient, and I could tell that he was really enduring a lot of pain by the grimace on his face. As I’ve done in the past, I instinctively reached out my hand and held his hand in mine. I allowed him to grip my fingers, and told him to squeeze my hand as hard as he needed to.

He started squeezing my fingers, and suddenly his face turned from a grimace to a smile. The change was rather startling, and so I jokingly told him that I’d never seen a patient with such a huge grin on their face while undergoing such a painful procedure. He smiled even more and said that it was because he was so happy to hold such a “pretty girl’s”? hand. I smiled back, and soon the procedure was over.

I think it probably makes common sense that hand holding might bring some relief from pain. We all reflexively hold a child’s hand when they’re in pain. And I believe that even the most callous people might agree that there is something powerful about the human touch. Hugs are an even better example. I don’t know when the hug was invented, but I’m sure that it’s been around for quite some time. People of all races, ethnicities, and cultures seem to use the hug as a means of displaying affection. And while certain cultures might value human touch to varying degrees, I think we all agree on its significance.

One of the most well known studies on the power of touch and the importance of physical and social interaction is that of Harry Harlow. In his famous experiments, he allowed rhesus monkeys to choose either a cloth or wire “?surrogate mother,”? both with and without a bottle of milk attached. Regardless of which mother had the bottle, the monkeys continued to choose the softer, cloth mothers. He also performed other controversial experiments, including ones where he deprived the monkeys of all physical or social interaction. The lack of physical touch produced monkeys with severe psychological pathologies, and in a few cases led to their deaths from self-induced starvation.

A study recently published in the journal Science also found some interesting results with regard to “warm hands and a warm heart.”? The researchers found that if people were given something warm to hold, they subsequently described other people as having “warmer”? personality traits, such as being more generous, more social, happier, and better natured. They also discovered that people who held something warm were more likely to behave in a friendly and generous way.

I’ve only begun to scratch the surface of the importance of the human touch, but you can see that the subject is much more than simply skin deep (pun intended). I tried to find some research that supports my anecdotal notion that holding someone’s hand who is in pain can serve to decrease their perception of the pain, but I was unable to find much research on this topic. Perhaps it’s a topic that will be further explored in the future.

But for the time being, I will continue to hold my patients’ hands. Whether they are in pain, or just very sad, or just very lonely, or even just very happy, I will continue to offer my hands to them. And hopefully when I need a hand to hold, someone will do the same for me :)

Sealed with a kiss by Nandini !!

Family Medicine Rocks :))

I really can’t say enough how happy I am right now. I had perhaps the best day in med school thus far. I drove  to a health clinic a few miles away. I was set up with a resident and met four patients. The resident was so awesome! :) He let me do everything. I did the H&Ps, wrote the SOAP notes, and even wrote the orders for all the patients. I did good! My resident and attending both complimented me on my skills.:)

One of my patients presented with a simple complaint, but when I pressed further, she admitted to me that she’s been under a ton of stress lately. She ended up bursting into tears, and I ended up giving her a hug and consoling her. Is it okay to hug patients? Well maybe not in all cases. But I believe that I did the right thing. I think I’ll write more about that later. But she thanked me. She told me that I was a great doctor. I felt like I did something really, really good.:)

I am just enjoying family medicine so much. I also really liked out-patient experience. Up to this point in med school,  I’ve only dealt with patients in hospitals. It was so good to have some actual clinic experience.

I even diagnosed a dermatological condition that my resident had never heard of! Talk about impressed! :))) Both my resident and attending gave me "mad props" for that one.!!!

The weather was nice. I even went for a walk . I’m getting ready to eat some veggie Sub from Subway . Life is good. Very, very good!

well expect some little things here and there :|

Sealed with kiss by Nandini ! 

HAPPY BIRTHDAY ANJALI !!!!!

 hello :) 

Today is yet ANTHER   very spacial day for me 

Today is Birthday of ANJALI  my BESTEST FRIEND  in the whole wide world ..

so please  be part of my happiness and wish  her The happiest Birthday ever!!!!

Anjali .. this is something i wrote for you ..

HOPE U'LL LIKE IT :)

I know there much more to you,
than what you think i see.
i know because you seem,
exactly just like me.
it feels like your heart,
will never fully mend.
you don't like being alone,
and you hate losing a friend.
only a few good people,
know how to make you smile.
and having them in your life,
makes it all seem worthwhile.

here's a little inspiration,
from a person kind of like you.
the following information,
is the honest  truth:
i hope your rainy nights,
turn into sunny days.
and i hope you know i'm always here,
to make you feel okay.
i know sometimes you feel,
like your falling from the sky.
just remember people look up to you,
so flap your wings and fly.
i know this all because,
we have similar lives.
and in case you didn't know this yet,
you're an angel in disguise.

I  love so much anjali and Thank you for ALWAYS being there for me :)

 HAPPY BIRTHDAY SWEETHEART  !!!

Sealed with a kiss by Nandini !

I do not know what to write here :|

I am a bit odd in the head. You know, there are times when i am just normal. And then there are times when random things cross my mind and i start acting a bit crazed up. Like in the last two days I read two three books go yadda yadda yadda .(okay, uhm, i din't intend to sound the way you think i sound.) so ya, and then last night, i couldn't sleep. I had my family Medicine  exam in exactly 6 hours and there i was, wondering if i can still write or not...why? cause my alter ego reminded me that i hadn't updated my blog for the past 2-3 days and there IS a possiblity that i might have developed the oh-i-can-nomore-write syndrome in 3 days. 48-72 hours. Oh don't look at me. It was my alter ego. Anyway, the first thing i do after i come home, jab the keyboard furiously. Think. Type. Erase. Get Angry. Furious. Type some more. Erase some more more. Get angry some more more more. Shut eyes. THINK. TYPE. ERASE. And then, get tired. Yawn. Stretch. Calmly get up n go to the kitchen. Break open a packet of oreo cookies and munch on cookies  after cookies . Who cares man if i can write or not! When the brain wants to think, type and hit the post button, it will. Its like saying 'Don't teach daddy how to fuck' ?? opppsssssss :O

Moral of the post: BingoBoomBaamDhoomDhamDhishum! i CAN write. So ya, you still have a lot of rubbish coming you'r way, my child, before I retire *coughs like an old lady* (CLAP. the speech is over =/)

*goes away dancing. tapori dance.*

Sealed with a kiss by Nandini !