Personal Preparation for the Clerkship Year
Fund of Knowledge: Prior to each rotation, identify gaps in knowledge and determine how best to meet these deficits. This will require an honest self-assessment and the discipline to schedule study time when not in the hospital or clinic. A frequent review of the learning objectives may prove very helpful.
Interpersonal Communication: One key to a successful clinical year is the ability to get along with preceptors and the other employees at the site. Mastering “people skills” is a valuable and necessary part of the learning experience. Be respectful and courteous to all staff and patients. Sometimes tone of voice and body language may give an impression that a student has an attitude, even when s/he is unaware of this unintended signal.
Personal Preparation: Some rotations require taking call, meaning staying at the site late into the evening or overnight. Others may require early morning or late-evening hours. Every site is different. Anticipate the need for baby-sitters, dog-walkers or the care for others who rely on you. It is NOT ACCEPTABLE to arrive late or leave before the rest of the team.
Transportation: Expect that some rotations will be far from home. Anticipate the time needed to reach each site and allow plenty of time. It is wise to make a dry run before the first day to see how long it will take. Some rotations begin as early as 6:00 AM and preceptors will expect you to have seen patients before rounds.
Site Assignments: Site assignments are NOT NEGOTIABLE. Students may inquire about Elective choices for Clinical Clerkships. The Clinical team reserves the right to change Elective Clinical Clerkships during the Clinical year.
Oral Presentations: Oral presentations are required for every rotation, which consists of the student presenting the medical course of a patient to preceptors, fellow students, and physicians. Practice oral presentation at home, in front of a mirror or friends. Preparation for oral presentations beforehand helps the student appear confident and well informed.
Feeling Inadequate: Many students feel inadequate as they become aware of the responsibilities associated with the PA profession. Acknowledging this feeling without being crippled by it is the best strategy. Students are not expected to know everything, and most preceptors and staff will be sympathetic to nervousness. Most importantly, ask questions, listen, and learn. Confidence will grow with time. The ability to realistically self-appraise and to seek help in overcoming knowledge deficits will boost confidence.
Getting Help: The Clinical Coordinators, Clinical Site Manager and program staff can be relied on for support. Call as problems arise, rather than wait until a situation spirals out of control. Should issues concerning lack of supervision or any type of discrimination arise, a Clinical Coordinator or the Program Director should be contacted immediately.
Involvement in Clinical Setting: Clinical rotations provide access to experiences that may never be available again. Therefore, expending the greatest effort will maximize the benefit and enjoyment of each clerkship experience. Spend as much time as possible at each site. Read about each medical condition seen each day. Volunteer for presentations. Staying late, after the team has left, may afford additional opportunities that would otherwise not be available.
Personal Goals and Objectives: Familiarization with the goals and objectives for each rotation is extremely important. Discuss these goals with the preceptor and ask for ongoing feedback. In addition, develop an Individual Education Plan (IEP) for personal goals. Identify areas of weakness, lack in number of experiences or procedures, or skills needed for long-term career plans and determine how a given rotation can help meet these goals. Assess the IEP midway, see how many goals were met, and create a new plan to reflect the assessment.
First impressions count: Preceptors form opinions of students early in the rotation. It is important that you not only pay attention to punctuality and appearance, but also to showing initiative and a desire to learn by asking questions. Demonstrate responsibility by following through on assignments, volunteering for extra activities, etc. Staying quiet can unintentionally give the impression that a student does not know the material. A preceptor can judge only what is seen. Speaking up will demonstrate your knowledge base and critical thinking skills.
Ambassador for the PA Profession: During clinical clerkships, students may encounter a wide range of opinions among medical personnel regarding physician assistants. Some believe that there is no place for physician assistants within the practice of medicine. Others have embraced our profession and recognize our contributions to health care. Be prepared to discuss the PA profession, our history and our role within the health care system. Patients will also be curious, skeptical and, in some cases, hostile to the idea of being cared for by a physician assistant student. Anticipate these responses and develop a way to reassure them. Continue to carry out your tasks without becoming personally offended. Also remember patients have the right to request a different provider if they choose.
Seek out teachers: In addition to the preceptor, other staff (e.g., patient care technicians, nurses, social workers, radiologists, etc.) may be willing to teach. Seek them out. Learn whatever you can from whoever is willing to teach.
Be assertive: Many sites will have other students (medical, other physician assistants, and nurse practitioners) and/or residents competing for attention, wanting to present cases on rounds, read EKG’s or X-rays, and to do procedures. Without assertion, students may miss important learning opportunities. Fight the temptation to sit back and merely observe.
Learn through every interaction: Keep notes on each patient seen. Later on, review the chart to determine if the findings are consistent with the first impression of the disorder. Ask the preceptor to explain the rationale for the diagnosis or intervention. Note questions as they occur for later exploration. Become familiar with the principles of evidence-based medicine and develop skills to enhance lifetime learning (see Sackett, D.L., Straus, S.E. Richardson, W.S. Rosenberg, W & Haynes, Rob. (2011) Evidence-based medicine: how to practice and teach EBM (4th edition). New York: Churchill Livingstone).
Expect Frustrations: There are many situations that frustrate students during the clinical year. An example is when a patient changes the history when re-interviewed or re-examined by the preceptor. This may be due to a number of factors such as a jog in memory during a second interview, better patient rapport or better interviewing skills of the second provider. Do not be upset by this and don’t reproach the patient for it. The preceptor may provide clues as to why the patient responded differently. Seek out ways to resolve and potentially avoid frustrating situation.
Read: Continuous reading during the clinical year is the chief way to prepare for patient rounds or daily discussions with preceptors. Many sites afford the ability of accessing textbooks and articles on-line. Whether to review basic concepts or learn about rare or complex disease states, it is important to read each evening.
Cellphones: It is very tempting to refer to the Medical Apps on the cell phones during rounds, DO NOT use your cell phone during rounds. Attendings do not know what you are doing with the cell phone and it might be misinterpreted as texting, being on social media, etc.