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When the Stride Becomes a Stumble

Thomasrobey72x721Thomas Robey -- My school's internal medicine clerkship is twelve weeks long. In contrast to shorter rotations, this format makes it possible to hit a stride as a productive member of the wards team. With two months on the floor under your belt, you know how to write admit orders, you can pre-round on three patients in under an hour, and you have the experience that comes from giving a hundred oral presentations. You even know the ins and outs of the electronic medical record. The last two weeks is your time to shine. And rightfully so: you've got a lot of information in that cavernous shell on your shoulders, and a lot of it's actually useful (the hospital cafeteria's night-owl hours, for example.) The tenth week is when you can legitimately take ownership of managing your patients. And at my school, management equals an honors grade.

With that in mind, consider this scenario... My team was on call the first night of our new attending's service; I picked up two patients and helped with a third. Usually that would afford a few hours of sleep before morning rounds, but in a portent of things to come, my admission H&Ps came together a little more slowly. Therefore, I wasn't able to catch my 4 AM beauty nap. No biggie: It's not like I had much beauty to start with, anyway.

In preparation for rounds, I had jotted important notes from the patient's presentation on a notecard; the admission note was tucked inisde my labcoat pocket like a security blanket; and, I'd recited my 4-minute oral presentation in front of numerous mirrors around the county hospital. I was enacting what students in medical centers around the country repeat every four nights: 18 hours of hard work boiled down to a rhetorical device that is partly polished statement of fact and partly persuasive discourse. I was ready.

What followed that morning was the most rambling, incoherent jumble of words I've ever heard emerge from my mouth. Which says a lot -- the oral presentation is what I've struggled with most over my third year's tenure. But I was improving, was gaining confidence, and even was comfortable working within this format to share medical information. You can imagine the frustration I felt when I suddenly transformed into a green third-year clerk in front of a new attending, just as I was supposed to be "hitting my stride." I went home later that afternoon crushed. It hardly mattered that my second presentation was okay and that one of the patients had turned the corner due to a treatment I suggested overnight. That "first impression" was lost. Instead of hitting my stride, I found myself in an uphill trudge.

But all was not lost. I'm probably not alone among medical students in admitting I have a fixer personality. When I see something wrong, I have to get in and wrestle with it; at the very least, I tinker. I woke up the next day resolved to fix this thing. After all, I LIKE clinical medicine! I would not allow my little stumble to precede a precipitous fall. Some of the strategies I came up with that morning could apply to any difficulty encountered in medical school, or (if you have one) in real life. They included:

1. Forget about it, move on, wow the team next time.

2. Acknowledge your mistake; ask the attending for pointers.

3. Practice, practice, practice. Practice again.

4. Consult with a third party adviser about the situation.

5. Take a long run.

Initially, I decided on #1. But I quickly grew impatient with this. (Recall that I'm a fixer.) When the attending offered pointers before I could request them, that took care of #2. #3's a given. And #5 offered a painful reminder of just how much an inpatient service messes with one's conditioning. In the end, it was tactic #4 -- emailing the hospital's clerkship director -- that helped me the most, and may have initiated the most important realization during my three-month medicine clerkship.

Continued Tomorrow...

April 24, 2008 in Thomas Robey | Permalink


I can identify - there are few things worse than feeling like a complete wally after a ward round! Even when you've stayed up extra late to prepare for the post-call round, the consultant always manages to ask a question that makes you wish your shoes would swallow you...

Posted by: Linda | Apr 30, 2008 1:07:04 PM

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