From the classroom to the hospital unit: Putting my skills to the test in clinical rotations

As I get out of my car at 7 a.m. at the start of my first clinical rotation, I take a moment to look at myself. I smooth out my scrubs, put my nametag on and swing my stethoscope around my neck. I look at the hospital in front of me, my new place of learning for the next two years.

No longer will I be working in hypotheticals. My stethoscope will not be listening to prerecorded sounds; I will use it to hear real humans with real issues. My words, previously rehearsed for a camera and a professor to grade, now will impact a patient’s health outcomes. Gone are the days of spending hours in a lecture hall, then poring over numerous slideshows and trying to cram information for the next quiz or test.

Now is the time to take the knowledge I soaked up in the first two years of medical school and apply it to real-life events.

The dynamic shift to clinical rotations is exciting. It helped me get back in touch with why I wanted to be a doctor in the first place. I am seeing people live the dream that I am working toward and getting to experience it myself under a physician’s supervision.

Clinical rotations made the long and stressful nights of the first two years—when I sometimes felt like there was no way I would make it through—worth it for me. But with that excitement, several new feelings have surfaced: a new sense of stress, determination to do right by my attending physician and, at times, disappointment. These feelings can make the transition from didactics to clinicals a bit difficult.

To help other students, I wanted to share some details about my experience as a fourth-year student who has done rotations in both inpatient and outpatient settings, as well as reflect on some principles I have learned this past year.

Making the transition

When you have spent all of your medical training working with simulations and patients who are actors, there is a comfort in knowing that what you are experiencing is not real; no matter what these actors are saying, the outcome is already predetermined, and your only job is to get the right answer and be kind.

When I began to meet patients in the hospital, I saw that the diagnosis and the treatment was not so clear-cut—I heard doctors saying they were not sure why a patient’s status had changed and why their condition deteriorated to the point of hospitalization. Other times, a patient recovered and was able to go home when the doctors saw no signs of improvement.

I learned here that medicine is often much more of an open-ended question rather than a multiple-choice one. I think it is important for us students to understand that sometimes, even health care professionals don’t know why things happen.

The human body is very complex, and people respond and react differently to changes in their stability. Being comfortable with being wrong or not being sure is an important skill to have in medicine, because it makes us research more, think harder and work diligently through talking to the patient, understanding their history and thinking about how different parts of the body can affect one another.

In our first two years, when we do standardized patient encounters, we are so worried about getting the correct diagnosis that we often treat the patient as just a case and are afraid to be wrong. Once I reached the clinic, I was told I could spend more time with patients. If someone was there for abdominal pain, I talked to them not only about any dietary or travel history, but also any events going on in their life, including any emotional or life changes and how they could contribute.

I realized that I could ask a patient about more than just their focal complaint because I had more time, and I was talking to a real person and had to consider their life beyond this one complaint.

Navigating challenging experiences

The other area that is difficult to teach during didactics is how to experience loss, how to have family meetings about progression of care and how to navigate those feelings as a physician. I remember having two patients whose conditions were deteriorating very quickly and to the point of no return. As a student, I was only on that rotation for a month, and I began after these patients had been in the hospital for several weeks.

I did not have a role in their care like the physicians or the nurses did, and I did not have a strong connection to these patients. Sitting in the family meetings where the preceptor was discussing end-of-life care and watching everyone cry, I felt their sorrow deeply. I was surprised by how calm my preceptor was and how effortless it seemed for him to deliver bad news to one family and then go straight to another to deliver more bad news.

I wondered how I was supposed to do this—how I was supposed to put on protective armor so that each time this happened it would not chip away at me. I wanted to stay empathetic and not be robotic, but I did not want to suffer emotional burnout.

One year later, I still wonder if I can do this efficiently. During my psychiatry rotation, I saw many people who were burned out by life, people who were struggling with issues that were not in their control and defeated caretakers. My preceptor would often tell the patient and their family that they did not choose this disease, and their behaviors connected to the disease were not their fault.

I saw how the patients clung to those words, using them as rungs on a ladder to pull themselves up to face the world. This is what helped me learn to navigate the emotional burden of medicine. I thought about how I could use my words to help decrease my patients’ and their families’ pain.

Support and resources

It is important for students to be mentally prepared to see death and understand that it will affect all of us, even if we do not have a distinct connection with the patient. We learn through observation and asking those who are more experienced than us. There are also resources available at the hospital and at your COM to help you learn how to get through experiencing a patient’s death.

In the hospital I currently rotate in, the HR department is always available to hear out students or faculty and direct them toward support groups, hospital social workers and clergy. There are also prayer circles for all religions in the shared religious space. You can also speak with the behavioral health professionals that are available through your medical school.

As your preceptors will also tell you, it is not possible to save every patient. Also, there is only so much we can predict about the human body. Our job is to provide the best care possible and not do harm, and to learn how to talk to families who are never ready to hear difficult news.

Coming into third year and not knowing what to expect can be daunting. Remembering that every day is a learning experience that you will surely use in the future can reignite or strengthen that passion and drive that we all have to help people and provide great care.

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