It is Friday afternoon at 4 pm. I’m headed to see a consult while simultaneously attempting to shove a granola bar in my mouth and respond to several pages. My intern is somewhere frantically discharging people and post-oping the day’s OR cases. My medical student lists along several feet behind me, dragging his feet and clearly hating life. The consult turns out to be operative, so I call my staff, book the OR, activate the emergency surgery pathway, consent the patient, talk to the family and write the note in rapid succession while my medical student hovers beside me. As I hit “sign” on my note, I hear the sharp intake of breath that heralds the coming question.
“Do you need me for anything else?”
“Well, we are taking this patient to the operating room. It should be a relatively quick, but interesting case. Would you like to join us?”
“I see. Well, you don’t have to. You can go.”
“Ok. Sounds good. Oh, and I was wondering, is it ok if I take this weekend off? My friend from college is getting married tomorrow and his bachelor party is tonight, so…”
“We usually have you guys round at least one day each weekend.”
“Oh, ok. It’s just that he’s, you know, my best friend, and I’m the best man, and I kinda have to stay out with him, so…”
“Fine. Have fun,” I respond, in a flat tone and turn back to my computer.
This exact scenario has never happened to me, but variations on this theme are very common experiences for me and my fellow residents. I have talked with other residents and attendings at different programs, who report that they also have students who turn up on rotations and show an obvious indifference to the specialty being practiced. I’m not entirely innocent of this myself. There were definitely medical school rotations that I did not enjoy. I did not love Psych. I hated how Internal Medicine spent the entire day rounding only to round some more. On Emergency, it tore me up to watch the Trauma team roll a patient to the OR, while I went to see the next person requesting a refill on their anti-hypertensives. I will even tell you a secret: I do not love all of the subspecialties that fall under the general surgery heading. We all have things that we love and hate about different specialties. But that doesn’t mean that we have nothing to learn from the specialties/rotations where we don’t experience pure bliss. Below are a few suggestions for incoming third and fourth year medical students on how to delude yourself (and your preceptors) into believing you truly want to be there. If people think you want to be there and learn, they are more likely to teach you, and you may find that you end up liking a rotation more than you thought possible.
You’ve surely heard the phrase “you don’t get a second chance at a first impression.” This is incredibly true on rotations. If you show up late, underdressed, or unprepared on your first day of a rotation, you have already given the impression that you do not care. Unless you are told differently, dress in business casual clothes. Guys, this means a button down and tie under your short coat. Girls, this means a dress, or slacks/skirt and top with the white coat. Do not show up without your white coat unless directed. Shower that day. I really shouldn’t have to say that, but, believe me, I do. Be punctual. Don’t hammer page your resident if they are five minutes late. I was totally guilty of this. Being a DO student, I rotated at many different hospitals, and I was never sure I was in the right place. It wasn’t until I was the resident being hammer paged that I realized just how off-putting it must have been when I did it. Introduce yourself. If you are with a resident when you meet your staff for the first time, give the resident a moment to remember your name and introduce you, but if they don’t, find a break in the conversation to introduce yourself to the staff.
Do not follow your well-timed self-introduction with an immediate request for time off or by asking how weekend rounding works. If you need time off on a rotation, send an email request or find a quiet time to let your resident or attending know you need to be gone. Make it be for a good reason—like a wedding, funeral, or your Mom’s 60th birthday, not because your buddy Dan is throwing a rager 4 hours away and you don’t want to have to drive back for rounds on Sunday morning.
Find something to like about the rotation. You might think the patients are interesting. Maybe your resident has a sense of humor similar to yours. Perhaps you don’t love being in the OR, but you find the disease process interesting—read about it. You might hate rounding on Internal Medicine, but my goodness, you don’t even need to go to the gym with all those steps you are getting. You don’t have to love something major about the rotation, but finding at least one thing will improve the day overall and may make you engage just a little more.
On a similar note, do not complain to the staff, residents, or nurses about the things you do not like about the rotation. This will only get you into trouble and will lower the grade that you eventually get. Don’t complain about the hours, or how busy/slow the service is, or how you have to come in to pre-round. If you must complain to someone about the rotation, commiserate with a friend or a fellow medical student, and be certain you are out of earshot of anyone else.
Remember, if you aren’t going into that specialty, this is your only opportunity to have real exposure to that field, and it generally takes a person being present in order for them to learn. So be present. Even if you find that a specialty is not for you and there isn’t a high enough base salary out there to tempt you to go into it, try. If you aren’t even trying, your residents and preceptors will notice, and they will be much less inclined to teach. It turns into a vicious cycle of cause and effect. You don’t want to spend time on a rotation because you just knew you were going to hate it, your attitude turns off the people who otherwise might have taught you, you hate the rotation because no one teaches you and there wasn’t ever a point in being on it because you aren’t learning anything anyway. And on and on. You would be surprised how many residents and faculty truly love teaching and are only looking for someone interested on which to bestow their knowledge. You could totally be that person. You’re paying for this education. We are here to help you learn. And even if at the end of the month, you still hate the specialty, take comfort in knowing that you tried your hardest and will likely get a good grade for your effort. And maybe, just maybe, you’ll get something out of it that will help a patient one day.