Falling down the clerkship habit hole
So, if it seems that I disappeared down a hole into the dark abyss this last month, it’s only because I have.
I’m just starting my 5th (out of 8) week of my surgical rotation, and my 2nd week of my general surgery rotation, having already actually completed my ortho surgery rotation…and no, even if it was only three weeks I cannot imagine being done a rotation yet. I feel mostly still about clerkship so far is much the same as those first 2 days I posted about, though thankfully I am feeling more secure in a lot of the actual ‘clerk’ things; how to write a progress note, write up a consult, patient orders, OR note, rec forms and all those sort of things that I was learning by trial by fire that first week.
Ortho was a good rotation, over all. I did really like it more than I thought I would; I liked how it was very problem based, how it was a ‘fixing’ type of medicine, and I found the clinics enjoyable and the OR very interesting. I don’t think I liked it enough to pull me away from OB/GYN, but it’s definitely a speciality that I’m going to revisit how I felt about it when I am going through OB/GYN as a comparison.
I…don’t like general surgery. Now, I’m actually having a great gen surgery rotation so far; the first two weeks I had this off service radiology resident and this amazing 4th year clerk with me who genuinely made that time the best. They took so much time to help me; gave me a quick approach to blood work, chest x-rays, CT scans, how to write orders, how to actually think about writing orders, and just took time to teach subjects in general an I could not have been more grateful to them.
But I don’t have any interest in gen surgery – I don’t have any interest in GI, biliary, the appendix, the bowels or any of the other things that gen surgery makes their money on – and honestly I’m glad I’m having a good rotation that I’m just not interested in, because it helps me identify what that actually feels like. Because we are so new to everything, all the things we do for the first time are so ‘shiny’ that we run the risk of not really liking them. Then, there are classmates of mine who have had awful rotations because of staff or residents, and they come out hating a rotation but they aren’t sure if it was because of the bad experience or because they just weren’t into that speciality. I had our first two trauma codes over my Saturday call, and I did find that very interesting, but I would not do gen surgery just for the trauma codes, and honestly, I’d want to see a more life and death code – the 2 I saw were both stable – before I made that decision, because I’m sure that would affect my decision.
Gen surgery has taught me so far that, although I don’t want to be a general surgeon, I do need to go into a speciality where I have OR time. I love the OR. I love suturing, I love the feel of the OR and the atmosphere there. I’ve seen totally routine laparoscopic surgeries, laps that needed to be opened, seen huge ortho incision and bowels pulled out and resected out of the body cavity, and almost saw a patient code mid surgery at 1 am on call in the OR (fastest surgery ever let me tell you) and it was all great. I don’t get nauseous, don’t mind the smell of burning flesh and bone, don’t get squeamish when I get splashed on the face with blood or hit in the shoulder with the butt of a drill that died and came out wide and hit the surgeon and I (whee, rescrubbing). I know that I couldn’t do a speciality that was just clinics, and honestly that knowledge might be what makes the family OBs vs. OB/GYN decision for me.
So, here’s some clerkship wisdom for when you just start your own clerkship (from the wisdom of 5 weeks of it).
- You know nothing. It doesn’t matter what you learned those first 2 years, you know nothing, and if you accept that, your life will be easier.
- Related to that first one, get used to being comfortable to saying “I don’t know,” when you don’t know something. I hate saying “I don’t know,” I always think people will judge me for not knowing, but honestly, unless your attending or resident is a jerk, they won’t. You’re there to learn, your residents and attending are there to teach. Life is too freaking short to worry about that.
- Nurses know everything, treat them with the respect that deserves. You get on the wrong side of a nurse and you’ll never get rid of that reputation. Please and thank you are the best three words.
- Finding crap is going to be most of your job, and it sucks so much time. Charts are never where they should be, forms are in stupid places, and nothing inspires more fear than your resident saying, “can you get me that on instrument or item” because that is absolutely never going to be there.
- Always ask that question you have, no matter how dumb it is. You’re there to learn, after all.
- You have just taken on a 12-24 hour/day job, and are still expected to study. Try to make sure you get sleep, and there will be days when you just cannot study because you are too tired. Just accept it, and study the next day, because you’re already exhausted, you don’t need to make yourself feel like crap on top of it.
- Bring food to call, especially on the weekends. Bring snacks, and learn to keep them in your pockets at all times. You’re not guaranteed a lunch break, or a dinner break and it’s up to you to make sure you eat.
- Keeping pictures of forms – without patient info – on them, like orders, med orders, OR Notes, etc. is a great way to help you write those without having to ask your resident over and over again (and it has the added benefit of making you look good).
- 4th year clerks are your friend, and an amazing resource; make the best use of that as you can.
- The doctors aren’t going to let you do anything that would seriously hurt a patient, and the hospital can run without you. Try things outside your comfort zone, ask to do procedures and to scrub in on surgeries, and just try your best.
- Be on time. You’re never going to be the best clerk, and you don’t have much that you can actually do to offer, but you can always be on time and ready to learn.
Clerkship is tiring, and hard, and so much better than just being in class. Honestly if there was no exam hanging over my head, it would be perfect. Try to have fun, and you’ll really learn stuff – even I can answer questions now that I certainly couldn’t a week ago, and it really does start to feel worth it.
…not sure if I’ve got any tips for surviving the 8 hour surgery I’m going to scrub in for tomorrow though…