So you’ve taken and passed your Step 1 boards. Now what? Not only do you get to start studying for Step 2, say goodbye to your flexible, structured schedule of years past. Put your big-boy (or -girl) pants on because it’s time for clinical rotations. However nervous or excited you may be to begin rotations, here is an overview of what you can expect and how you can nail each of them.
The first thing you can expect to start your morning off with is pre-rounds. During pre-rounds, you won’t be seeing any patients, but you will be getting objective information. The goal is to get the vitals, labs, and necessary information from the previous day, so you can use this information to establish the three D’s on rotations:
1. Dying
If you see something really wrong, drop what you’re doing, go get a resident and save someone’s life!
2. Discharge
Ask the question, “are they ready to go home?” If so, see them first so their discharge papers can be started. See: Urgent vs Important, Turkeys and Windows in the intern bootcamp.
3. Diagnosis
If the diagnosis is still to be decided then you’re going to want to go in and see that person and get the paperwork started as soon as possible. As a student, you can also directly help with billing – work with your interns and attending to get that moving!
From pre-rounds you’ll probably go to a morning report, where you will report your findings (pretty self-explanatory). After your morning report, you’ll go straight into work rounds. This is when you will actually go in and see the patients, complete physical exams, patient histories, and card flip. Card flipping is when you express what you’ve found to your resident. The resident won’t always agree with you but even if you think you’re right, it’s probably a good idea to agree with your resident since he/she is the leader of the team.
Your morning will most likely end with attending rounds. The most important thing to remember is that you’re being evaluated during the attending rounds. Yes, attendings need the information your team has come up with, but they can easily look it up—and likely have done so—and they want to see if you know what you’re talking about. You can use the mnemonic R.I.M.E.: Reporting what you find, Interpreting it, Managing it, and then Educating others on it, to help you through this part. You should end your attending rounds with a bigger to-do list than you started with.
After you finish attending rounds, your day can vary on rotations. You might have didactics, you might do some procedures, or you might even get to leave early! In this case, take full advantage. Go home and start studying for your shelf and/or Step 2. You also need to spend time doing scut work to help your team’s ship run smoothly. Go get the data for the day, fill out handoff sheets, and make calls to nursing homes! These are all examples of things that can help you understand the process of care while also helping out other members of your team. Get started with us today!
