How to Have a “Better” Clinical Rotation Experience
Kendra Campbell -- I just finished reading the book, Better, by one of my favorite authors, Atul Gawande. In the afterword, Gawande gives his list of “Suggestions for Becoming a Positive Deviant.” I absolutely agreed with all of his suggestions, and it inspired me to write my own list for making your clinical rotation experiences “better.” Here are some tips that have worked well for me thus far:
1. Don’t be afraid to complain. Today, at the end of a lecture, a surgeon asked us how our rotation was going. Everyone pretty much replied “okay.” Then (knowing that we were all holding back our negative remarks), he asked us to be honest and speak up about the things that we didn’t like. In true med student form, everyone remained silent. I broke the ice and offered up a piece of constructive criticism. Eventually, everyone else chimed in with their own complaints. He reminded us that we need to be vocal about giving feedback. I actually agree with Gawande, that sitting around with colleagues and complaining all the time is a horrible idea. However, providing constructive criticism to the powers that be shows that you care, and shows that you’re not afraid to take a stand.
2. Introduce yourself to everyone. Of course, in med school we are taught to always introduce ourselves to the patient. This is obviously important. But how often do we take the time to introduce ourselves to the nurses? How often do we just walk up to someone and ask them for something, without introducing ourselves first? I’ve learned that an introduction can go a long way. And as Gawande mentioned in his book, getting to know someone by asking them a more personal question is also a fabulous way of making friends, not to mention making the hospital more of a fun place to be.
3. Stand out. As Ben Bryner pointed out in his recent entry, standing out can come in handy in many ways. Even without my pink hair, I tend to stand out in a crowd of med students. It’s not even always an intentional thing for me. But when it comes to making good impressions on attendings, residents, and patients, standing out can be a great asset. Not to mention when it comes to getting letters of recommendation down the road. Know what is unique about yourself, and use that to your advantage.
4. Smile. Smile. Smile. A smile can be worth a million words. I always try to smile at people as I pass by. When I walk past a patient’s room, even if I don’t know them, I give them a friendly smile. Obviously, there are times when a smile is inappropriate. But for the most part, a friendly smile can brighten someone’s day, make them feel more relaxed, and show them that you care. Even if you’re tired and have had a hard day, try to spread some joy with a nice contagious smile.
5. Get your money’s worth. You’re paying a lot of money to be trained and learn from your clinical rotation. Even though you’re expected to do a lot of work, you’re paying for the experience! Learn as much as you can, and remember that the point of the rotation is not to be tortured or to just “make it through.” You are there to learn, and you’re paying money for that privilege! You’ll never have this kind of experience again, so make the best of it!
6. Make friends with your fellow students. This tip seems pretty obvious to me, but some people seem to ignore it. Get to know your fellow students. Not only can this make the rotation more enjoyable, but it can also come in immensely handy. When an attending asks you a question and you blank, how awesome is it to have a good friend whisper the answer in your ear?!
That’s all I can think of for now. To all you fellow students out there doing your clinical rotations: good luck and try to make your experience even better!
I Need My Patients as Much as They Need Me
Kendra Campbell -- Before I start, I want to take a moment to thank everyone for all their comments on my last post. I enjoyed reading all of them (even the negative ones!) and I appreciate everyone taking the time to leave me helpful advice and thoughtful words. To provide a very quick update, my surgery rotation has been going so much better! It turns out that my first week was just a horrible combination of a heavy patient load, not knowing the hospital, being new to rotations, and a bunch of other things. Since then, things have been going much more smoothly. (Although I still have a lot to say about medical training, which I’ll share in the future.)
Today I had an encounter with a patient who spoke very little English. Her doctor had explained to her that she needed an above the knee amputation, but hadn’t done the best job of explaining it to her in a way she could understand. In addition to that, I don’t think the doctor realized how much of their conversation had been lost in translation. When I came in to examine her, I could tell that she was very upset. I had to contact a few people and find a way to explain to her what was going on. After I helped, she thanked me profusely for taking the time to help her understand her options.
Afterwards, I felt so glad that I had paused in my busy day to help ease her anxiety. The time I spent running around trying to figure things out turned out to be much more appreciated than my cleaning and dressing of her wounds. It made me feel like more of a doctor than auscultating her heart or percussing her abdomen.
The past two weeks of my surgery rotation have been so empowering for me. I’ve finally had the opportunity to spend lots of time with my patients. I’ve been able to really get to know them. I’ve even had the opportunity to participate in their care and operate on them. I’ve seen their progression from the emergency room, to being admitted, to being prepped for surgery, to their actual operation, and then to their experiences post-operatively. No longer are they just a series of lab values or vital signs. I know their stories. I’ve aided in their care.
This is what makes me get up at 5:00 in the morning. This is what makes me be able to work for 12+ hours. This is what makes me want to get up in the morning and do it all over again.
Many times I have thought about doctors who choose fields like research and healthcare policy, where there is less patient contact. Honestly, I don’t know how they do it. I sometimes say that I am selfish because I don’t think I could do it. Yes, they might be able to help more people in the end, but I guess I need that instant gratification. I need to see that smile on my patient’s face. I need to hear their words of relief. I need to touch them and ease their suffering when possible.
I’ve received so many kind thanks from patients over the years. But I want all of them to know that I’ve received so much from them. They keep me going. They are more of a gift to me than I think I’ve ever been to them. And that’s something to be thankful for.
Does Med School Have To Be Torture?
Kendra Campbell -- I just finished my first week of my third-year surgery rotation. I have no better words to describe it other than pure hell. I was unfortunately assigned to night call for my first week. For four nights I endured 16 to 18 hour shifts with no sleep, no food, only small sips of water, and no time to sit down. In addition to the grueling hours, I was subjected to the fierceness of our residents.
On my very first night call, the residents began rounding on the patients at around 6:30 a.m. I hadn’t slept or eaten in almost 24 hours. I was empty in both body and spirit. When the resident asked me about the ins and outs of one of my patients, I had to admit that I simply didn’t know. Not only had I not realized that I was supposed to be monitoring them, but I couldn’t even figure out how to answer his questions because I didn’t know how to use the electronic medical records system (we had received no training). He knew it was my first night of surgery night call. I admitted to him that I had not been trained on using the system, and that I was completely new to the hospital. But it made no difference to him. He laid into me so hard, that I felt like I was being physically ripped apart. I held back my tears and quietly told him that it wouldn’t happen again.
I’ve only experienced one other clinical rotation before surgery, and it was entirely different. In my psych rotation, I knew what the expectations were, and I was able to surpass them all. The hours were reasonable, and the residents and attendings were kind and understandable.
My first week of surgery has been the polar opposite. I’m starting to understand what sleep deprivation can do to my body and mind. I’ve realized that I simply lose the ability to think without sleep, food, or water for 24 hours. Every part of me begins to break down, and my defenses are lost. Welcome to medicine?
From what I can ascertain from my first week, med school rotations (and especially surgery) are very much like boot camp. You’re expected to challenge yourself physically and mentally in every way. You’re looked down upon if you complain. Failure is not acceptable.
A year ago, our very own Medscape editor, Christine Wiebe wrote an article on med student hazing, and I was very much interested in reading it at the time. However, now that I have walked a mile in the shoes of a lowly med student being yelled at by a so-called “teacher,” I understand all too well the devastating consequences of med student abuse.
At the end of only my first week of surgery, I feel like a shell of a person. I don’t have the energy to give 100% to my patients. I’ve lost all hope, and the first night I seriously considered running out of the hospital. I felt all my compassion exiting my body like the sweat rolling down my temples. I simply didn’t care.
I understand that medicine is a challenging field. I realize that the “weaklings” might not succeed. I understand that doctors are responsible for making life and death decisions, and hence should be held to the highest standard. But I can’t say that I agree with torture as a means of “weeding out” the weak ones. And I now realize why I’ve met so many less than compassionate physicians. I guess I just want to believe that there’s a better way.
Medical Education for Real Life
Kendra Campbell -- Yesterday was an uncharacteristically eventful morning. I awoke to the sounds of my doggies whining and I immediately knew that the only way to shut them up was to take them for a walk. I woke up my partner, Micah, and we hooked their leashes to their collars and headed down the stairwell of our apartment building. Halfway down, we saw a young man sitting beside a slumped over female on one of the stairs. While he looked distressed, it seemed like he had everything under control, so we just continued walking.
After taking the dogs to the park to do their business, we returned to our apartment building. Before we even got inside, the young man from the stairwell rushed out of the front door with a frantic look on his face. “Please, can you help me?!” he screamed anxiously. “Yes, what is it?” I replied. “My friend, I can’t get her up...please help!”
As soon as I heard those words, I spontaneously switched gears from doggy walking to emergency mode. When I opened the door to the apartment building and saw the young girl sprawled on the floor in front of the stairs, I immediately began creating a differential diagnosis. Could she have fallen and fractured her skull? What if she had become severely hypoglycemic and had a syncopal episode? Could she have just experienced a tonic clonic seizure? Perhaps she had a myocardial infarction secondary to a cocaine overdose? And of course, the most immediate possibility that came to my mind was that she was simply very drunk.
I was suddenly acutely aware of the details surrounding me. I noticed that the young man had a fairly heavy smell of alcohol on his breath and that his clothes were stained with paint and dirt. I surveyed the area and checked for any sharp or otherwise dangerous objects and saw none. I observed the position of her body and deduced that she most likely had not fallen down the stairs.
I leaned down to her and asked her loudly if she was okay. “No, he won’t leave me alone!” she replied. I asked her if she’d been drinking and/or done any other drugs and she admitted to drinking but denied using anything else. She was obviously agitated and as I leaned towards her I could detect alcohol on her breath. We went back and forth for a few minutes and she became increasingly belligerent and verbally abusive. She started screaming profanities at me and the young man, who I discovered was her boyfriend.
To make a long story short, I eventually realized that she was just very drunk and upset with her boyfriend. He was trying to get her to the car, and she kept physically attacking him and screaming. She made threats to attack me and called me some very unpleasant names. By this point, I had switched gears yet again into more of a psychiatric emergency mode. I tried using some techniques to calm her down and diffuse the situation. Luckily, having been called every name in the book already, her comments failed to offend or upset me.
After over an hour of failed attempts, I realized that I had no other choice but to call the police. So I dialed 911 and waited for the cops to arrive. They showed up just a few minutes later and I gave them a full report, including my information in case they needed to question me again. The police also failed to reason with the girl, so they eventually handcuffed her and hauled her off in a van to the police station for booking.
For the rest of the morning, I thought about the sequence of events surrounding the girl. I wondered if I would have responded to the situation the same way before going to med school. I guess most of it was really just common sense. But on the other hand, things could have turned out differently. She could have had no pulse, or been in the middle of having a seizure, and things would have been more serious. I don’t know if I would have responded as calmly or even remembered what to do. At the very least, I guess I gained some practice that I can use with actual patients in the future.
The Scalpel is Always Shinier on the Other Side of the Operating Table
Kendra Campbell -- I’m currently sitting in a new chair at a new table in my new apartment in Brooklyn, New York. I’ve had the past two and a half weeks off from school and I will be starting my surgery rotation at a nearby hospital in just a few short days. It’s been quite an adventure relocating all of my belongings to a new city and a new state yet again. This will be my fourth move in less than two years, and it’s definitely becoming a little taxing.
It’s taken me almost my whole break to find an apartment, move all my belongings, unpack my stuff and get completely situated. However, now I am completely finished and I no longer have anything to do. Yes, I am only a fifteen minute subway ride away from Manhattan, and yes there are approximately eight billion things to do and see in NYC, but strangely enough I am still bored. I think I am just one of those people who always needs something to do, and it’s difficult for me to switch from “unpacking mode” to “fun and relaxation mode.”
When I begin my surgery rotation, I know that I’ll be working an insane amount of hours every week. I’ve been told by other students that this rotation is especially difficult, and that I won’t have a lot of time for sleep or relaxation. And interestingly, I am awaiting this with eager anticipation.
During my first two years of med school, there were times when I was incredibly busy. I went without sleep and fun for many days in the name of studying. At the time, all I wanted was a few extra hours to run errands and enjoy myself. All I could think about was my next break, and how much fun I’d have.
Now, here I am with all the time in the world, in one of the coolest cities on earth, and I’m absolutely bored out of my mind! I’m starting to think that maybe I’m just a chronic complainer at times. However, on the other hand, I definitely do know how to appreciate many things.
So, it seems that whatever I’m doing, the grass is always greener on the other side of the fence, or if you will, the scalpel is always shinier on the other side of the operating table. When I have no free time, it’s all I can think about. When I have too much free time, I long for a busy schedule.
Actually, I think what it comes down to is the amount of time involved. I do need breaks, and I can enjoy myself. But if I have too much free time, I tend to go a little whacky. Perhaps two weeks would have been enough time in this case, but I got three.
Okay, I’ll stop complaining now and try to enjoy my last few days before I join the ranks of all the other sleep deprived med students on my surgical rotation. Perhaps I will go take that fifteen minute subway ride to Manhattan. Hopefully my next post will not involve me complaining about my busy schedule!
No Sleep 'til Brooklyn
Kendra Campbell -- My mind is currently filled with an amalgamation of excitement, fear and a feeling of accomplishment. A few days ago I found out that I passed the USMLE Step 1 (yay!). That once seemingly huge and insurmountable obstacle is now nothing more than a blip on the radar screen behind me. For a few days, I basked in the satisfaction of having a profound sense of achievement.
Today, I took the final exam for my psych rotation. I can proudly say that I finished my first rotation in the States, and judging by the marks on my evaluation, I did an outstanding job. So, that is behind me now as well.
Just when I felt like I could let out a huge sigh of relief and sit back and relax, I had a bomb dropped on me. I’m currently living in Baltimore, Maryland, and had hoped to do all or most of my clinical rotations here. My school has affiliations with many different hospitals all over the country, and around five of them are in the Baltimore area. When I received the paperwork with my rotation schedule for the next nine months, all of the relief and relaxation made a furious exodus from my body, and was immediately replaced with fear and anxiety.
I found out that I was scheduled to begin a surgery rotation in Brooklyn, NYC in three weeks, and that I’d be spending almost a year finishing my rotations in Brooklyn and two other cities in NYC. There was a point in my life where this information would have made me immensely happy, but I’m not currently at that point. You see, my partner and I just recently moved into an apartment in Baltimore. All of my earthly belongings are here. And that’s not the bad part. My partner is starting a graduate art program at a local university just a few blocks away. His program begins in September, and lasts for two years. So, what this means is that he won’t be able to come with me to NYC. Not only that, but practically speaking, I won’t be able to bring either of my dogs to the city. In just a few weeks I’ll have to leave my partner, my dogs, my apartment, all of my friends and family, and most of my belongings behind.
I’m still in the midst of working with my advisor to get some of my rotations scheduled in this area, but I’m not sure if it’s going to work out. If it doesn’t, I will be spending anywhere from nine to seventeen months away from everything familiar to me.
There is a part of me that is very excited about this upcoming adventure, but another part of me is scared to death to leave my life behind. One of the reasons that I chose the school I’m attending is because I knew that it would involve a lot of travel. I got to live in a foreign country for almost two years, and I knew that my clinical rotations could be scheduled at many hospitals throughout the country. But I think I forgot to take into account the effect of having to be separated from my loved ones (partner and doggies!). I’m questioning whether the adventure of travel is worth the sacrifice of leaving my loved ones behind.
But, I know that I’m up to this, and that I have overcome many larger obstacles in the past. So, I will just keep telling myself that, as I pack a small portion of my belongings into my two pink suitcases and hop on the bus to Brooklyn to discover what lies ahead.
I Have a Dream
Kendra Campbell -- Going to a medical school in the Caribbean has some drawbacks, but it definitely has its benefits. Rather than launching into a laundry list of positives and negatives, I’m going to focus on something that I recently noticed: My school has an incredibly diverse student population. Since I was immersed in the environment on an isolated island, I never fully appreciated just how diverse it was. U.S. schools also have students from diverse backgrounds, experiences, education levels, and ages. But the profound difference at my school was the variety of ethnicities I saw on campus.
I’m currently nearing the end of my first clinical rotation in the States, and I made quite an interesting observation a few days ago. During a lecture, I finally got to meet medical students from other medical schools. Several local universities send students to the hospital where I’m rotating. I was surprised to find out that they were quite similar to the students from my own university. However, there was one profound difference: they were all white.
Of course I know that these students represented only a small sample of med students from U.S. universities, but the difference was nonetheless quite fascinating. At the table sat students from both Caribbean and U.S. medical schools, and the Caribbean students were quite a bit more diverse.
I’m not the first person to make this observation. I won’t go into the statistics, but I know that U.S. medical schools have a much smaller percentage of minority students than do Caribbean schools. The Association of American Medical Colleges (AAMC) has been aware of the less-than-optimal percentage of minority medical students for years. In fact, they have a program devoted to trying to increase the numbers of minorities in medicine.
There are many reasons why Caribbean medical schools attract and accept more minority students, but one of the obvious reasons is that they have different acceptance standards. Caribbean schools are more likely to accept a student with a lower MCAT score or GPA. Because of many reasons that I won’t go into here, certain minority groups don’t have access to the same educational resources as do other students, and sometimes this means that their scores might be lower. This issue is obviously very touchy and much more complicated than I can elucidate in a short blog entry, but the difference does in fact exist. The numbers don’t lie.
I’ve written before about the need to create a diverse physician workforce. It’s something that I adamantly believe in. I just can’t accept that certain barriers exist, which prevent the enrichment of the field of medicine with a more heterogeneous group of folks.
Please excuse me for using this tawdry metaphor, but I have a dream that some day I will be sitting again at a table with my fellow colleagues, and I’ll enjoy the presence of a more diverse group of individuals: diverse in body, spirit, and mind.
Med Student "Personality Disorders"
Kendra Campbell -- As part of my psych rotation, we have lectures once a week on various psychiatric disorders. The most recent lecture was on personality disorders. In the beginning of the lecture, the psychiatrist warned us that we’d find certain characteristics of the disorders to be ones that we actually possess. However, she reminded us that this doesn’t necessarily mean that we have the disorder, because we don’t have the traits to the point of pathology. Of course, even with that disclaimer, I noted traits that I display, and it caused me to pause! I also realized that many of the traits are ones that are particularly applicable to medical students. So, I’ll list the disorders, and note the specific relevance to med students.
Paranoid Personality Disorder – Reluctant to confide in others due to unwarranted fears that the information will be used against him/her.
Med Student Disorder – Sometimes, we hide things from others because we fear that people will think we are incapable!
Schizoid Personality Disorder – Shows emotional coldness, detachment or flattened affectivity.
Med Student Disorder – While we’re supposed to display compassion, aren’t we frequently supposed to hide our true emotions to patients?
Schizotypal Personality Disorder – Displays odd thinking and speech.
Med Student Disorder – The relevance here is profound! With all of our medical jargon, and the way we have to think about the world, who out there can’t admit to having this one?!
Borderline Personality Disorder – Has an unstable sense of self.
Med Student Disorder – We endure all the trials and tribulations of med school and continue having to live up to ever-changing expectations.
Narcissistic Personality Disorder – Has a grandiose sense of self-importance, believes that he or she is special and unique, and can only be understood by, or associate with, other special people or institutions.
Med Student Disorder – I don’t even think this one needs an explanation.
Histrionic Personality Disorder – Displays rapidly shifting and shallow expressions of emotion.
Med Student Disorder – Isn’t this necessary in order to see twenty different patients with serious illnesses in a short period of time?
Antisocial Personality Disorder – Irritability and failure to plan ahead.
Med Student Disorder – Hopefully, this one only applies during times of stress.
Avoidant Personality Disorder – Avoids activities that involve significant interpersonal contact.
Med Student Disorder – Ummm, hello?! Have you ever spent three days with only your books and loads of caffeine?!
Dependent Personality Disorder – Has difficulty making decisions without an excessive amount of advice and reassurance from others.
Med Student Disorder – How much do we look to our residents and attendings for direction and advice?
Obsessive-Compulsive Personality Disorder – Has a preoccupation with details, rules, and lists, and is devoted to perfectionism and work, to the exclusion of leisure activities and friendships.
Med Student Disorder - Another one that doesn’t need an explanation! I must admit, that I might be the queen of lists.
So, there you are! Which personality disorder fits YOU?
Disclaimer: I am not implying that med students actually have all these traits, or the disorders! Rather, I'm attempting (perhaps poorly) to point out the humorous parallels between our lives, and the disorders' traits.
The Dog Days of Med School
Kendra Campbell -- I just returned from taking my two dogs to the veterinarian. These dogs were once puppies that I adopted while living in Dominica and taking my pre-clinical coursework. Over a year ago I wrote about an intensely emotional experience involving the death of another one of my puppies. Interestingly, the stress of med school had never brought me to my knees at that point, but the death of an animal, combined with other stressors really sent me on an emotional roller coaster.
As a child, I grew up on a dairy goat farm, and we had many other types of animals as well, including chickens, pigs, and many dogs and cats. I guess you could say that I grew up in a very animal-intense environment.
Okay, so now you’re thinking, “this is a blog about med school, not vet school, what does all this rambling have to do with human medicine?” Well, I actually happen to think it has a lot to do with it.
I’m going to go out on a limb here and say that being surrounded by animals all my life has definitely shaped my personality. I’ll even go as far as to say that it may have served to foster my compassion and ability to care for all living beings, humans included.
The two puppies that I adopted in Dominica turned out to be immensely valuable to me in medical school. I have fond memories of taking short breaks from studying to pet and cuddle my pups. Cuddling with them never failed to rejuvenate me when studying had sucked all the energy and life from my body and mind. And when I was stressed out about an upcoming exam, taking my pups for a walk on the beach or rubbing their bellies was always guaranteed to provide me with much needed stress relief.
You could assert that all this psycho babble about having dogs, or any pets for that matter, is a bunch of holistic mumbo jumbo. But the existing research actually supports my anecdotal evidence. Studies have shown that owning a pet can nurture both their owners’ physical and psychological well-being. Some of the medical benefits include lowering blood pressure and cholesterol levels, improving survival rates after surgery, and decreasing the number of visits to the doctor. As for psychological health, pets can help people cope with stress, reduce rates of depression, and even reduce loneliness.
So, I guess what I'm trying to say is that while there are some disadvantages (cost, allergies, responsibilities, poop-scooping) to owning a pet, the benefits shouldn’t be underestimated. My now almost two-year-old doggies are proof enough to me that owning pets can have a myriad of wonderful rewards. And that’s exactly what I told myself when I signed the $900 credit card charge at the vet’s office tonight!
The Gift of Psych
Kendra Campbell -- Oh my goodness, I’m quite tuckered out. I started my psych rotation last week, and I just had a full day packed with all kinds of psych goodies. I promised to share my feelings about my first clinical rotation, so here goes. To sum up everything that I’ve seen in six days on the psych ward: I am soooo in love with psych!
As I’ve mentioned before, while just out of college I worked for three years at a state psychiatric hospital. My undergrad degree was in psychology and neurobiology, so I do have some decent experiences in psych. But since leaving the field years ago, I’ve really considered going into a different specialty. I’ve recently been leaning towards emergency medicine for various reasons. However, being a “green” third year medical student, I realize that I simply don’t have enough experience to make a definite specialty decision. And I have one of those personalities where I tend to enjoy just about anything I do, so I am always suspicious when I fall in love with anything.
All that being said, man I really do love psych. The hospital that I’m rotating at is in Washington, DC, and it’s a district (DC is not a state) facility. What this means is that the patient population consists of clients with very serious mental illnesses. The facility is not a place for persons with simple psychological problems. Everyone who finds their way into the halls is extremely ill.
This patient population is exactly where my experience lies. Having worked at a state hospital, I’m very familiar with schizophrenic patients who are refractory to treatment. I’ve worked with homeless folks, and while I’m no expert, I do have experience helping those who are less fortunate.
I know I still have many rotations to complete, and I’m sure that I’ll probably change my mind a few more times. But right now, psych is certainly starting to look like a very tempting field.
The population of very ill patients really grabs my attention. Those who end up in state facilities tend to have a lot in common. They are the poor, the neglected, and the ones that have very little hope left. Often times, their friends and family have abandoned them. In the past, society has overlooked many of these unfortunate souls.
I guess what I’m trying to say is that to be able to share with these folks, to be able to help them in any way, to be able to make even the smallest impact in their life -- in my opinion, that’s one of the greatest gifts I can imagine.