Clinical rotations represent the transition from classroom learning to hands-on patient care. Success requires not just medical knowledge, but also clinical skills, professional behaviors, and interpersonal abilities that distinguish exceptional medical students.
Preparing Before Your Rotation
The first days of each rotation are crucial for making good impressions. Before starting, review the rotation's required reading list, familiarize yourself with common presentations in that specialty, learn basic procedures relevant to the rotation (suturing for surgery, mental status exams for psychiatry), and review previous students' evaluations to understand what the team values. Research your residents and attendings—knowing their specialties and interests facilitates connections and conversations.
Excelling on Morning Rounds
Morning rounds are your primary visibility opportunity. Arrive 60-90 minutes before rounds to pre-round on your patients—check overnight events, vitals, labs, imaging, and examine patients. Present concisely and confidently, using organized SOAP format (Subjective, Objective, Assessment, Plan). Highlight important overnight changes or new developments. Anticipate attending questions by reviewing differential diagnoses and treatment alternatives. Strong presenters stand out immediately and earn more responsibility and teaching.
Taking Ownership of Patient Care
Teams notice students who demonstrate initiative and ownership. Write daily notes on your patients, follow up on pending studies and consults, communicate with nurses about care plans, and stay until your patients' issues are resolved (within reason). Anticipate needs—offer to call consults, arrange follow-up, or complete discharge paperwork. Residents appreciate students who lighten their workload. However, recognize your limitations and always verify plans with supervising residents or attendings before implementation.
Mastering Clinical Presentations
Strong clinical presentations balance thoroughness with brevity. Lead with one-line summaries: 'Ms. Jones is a 58-year-old woman with hypertension and diabetes here with 3 days of progressive dyspnea.' Highlight pertinent positives and negatives rather than reciting every detail. End with clear assessments and evidence-based plans. Practice presentations regularly—with roommates, in your car, or before mirrors. Smooth, confident delivery impresses teams more than comprehensive but disorganized rambling.
Asking Intelligent Questions
Questions demonstrate engagement and facilitate learning, but timing and quality matter. Ask mechanistic 'why' and 'how' questions during teaching moments, not during busy clinical work. Research independently before asking—'I read that X, but I'm confused about Y' shows initiative. Ask for feedback regularly: 'What can I improve in my presentations?' or 'How can I be more helpful on rounds?' Genuine curiosity and receptiveness to feedback distinguish exceptional students.
Building Relationships with Your Team
Strong relationships with residents and attendings enhance learning and evaluations. Show genuine interest in their careers and experiences. Offer to help with tasks, even menial ones. Be reliable, punctual, and pleasant—attitude matters as much as knowledge. Remember details about team members' lives and follow up on previous conversations. Bring coffee or snacks occasionally. These small gestures build goodwill and create advocates for strong evaluations and letters of recommendation.
Developing Clinical Reasoning
Clerkships develop clinical reasoning beyond textbook knowledge. For each patient, develop differential diagnoses considering probability, can't-miss diagnoses, and underlying pathophysiology. Compare your initial assessment to the final diagnosis to calibrate clinical intuition. Read about every patient you encounter—even common conditions teach something new in each presentation. Use resources like UpToDate, DynaMed, or specialty-specific texts to learn evidence-based approaches to clinical problems.
Procedural Skills and Hands-On Learning
Seek opportunities for hands-on procedures: Place IVs, suture lacerations, perform lumbar punctures, intubate patients (in appropriate settings), assist in surgery, deliver babies. The first attempts feel awkward—persist through discomfort and request feedback. Video yourself performing physical exams to identify areas for improvement. Students who actively seek procedural learning develop skills faster and stand out to evaluators.
Managing Time and Wellness
Clinical rotations are exhausting. Surgery and OB-GYN often require 80-100 hour weeks. Prioritize sleep when possible—even 15-minute naps between cases help. Maintain basic nutrition despite busy schedules—pack portable snacks and eat meals when available. Exercise when you can, even if just 20-minute walks. Connect with co-students going through similar experiences. Recognize that struggle is universal—nearly everyone finds clerkships challenging and exhausting initially.
Preparing for Shelf Exams
NBME shelf exams significantly impact clerkship grades and require dedicated study beyond clinical work. Use question banks extensively—UWorld for all rotations, AMBOSS for additional practice. Study 1-2 hours daily throughout rotations rather than cramming at the end. Focus on high-yield topics tested on exams. Take practice NBME exams 1-2 weeks before shelf exams to identify weak areas. Correlate shelf studying with clinical experiences—linking book learning to real patients enhances retention.
Receiving and Implementing Feedback
Request feedback regularly rather than waiting for formal evaluations. After presentations, ask 'How could I improve?' After patient encounters, ask residents to observe and provide suggestions. Implement feedback immediately and let evaluators know you've incorporated their suggestions—this demonstrates coachability and commitment to improvement. If you receive critical feedback, respond professionally: thank the person, ask for specific improvement strategies, and show change in subsequent encounters.
Success in clinical rotations requires medical knowledge, clinical skills, professionalism, and genuine enthusiasm for patient care. Students who demonstrate initiative, show interest in learning, contribute meaningfully to patient care, and maintain positive attitudes despite challenges earn outstanding evaluations and develop into excellent physicians. Embrace the steep learning curve, seek feedback actively, and remember that every attending and resident was once a medical student learning these same skills.