Acing a rotation requires more than just showing up, getting along with your team, demonstrating excellent medical knowledge, and taking great care of your patients. This article provides key information about how to really stand out and make a great impression on your outpatient rotations.
1. Impress before you even start.
About a week before you start your rotation, email your attending or the rotation coordinator. Ask if they have a schedule available for your review, if they have any prep work they would like you to complete in advance, or if they recommend any reading before the rotation begins. You may also consider asking if they know with which attendings or residents you may be working. If they do have this information, you may want to look those physicians up to get some understanding about their backgrounds and expertise. Even if the answers to these questions is “no,” or they don’t have a schedule prepared in advance, your organizational skills and proactive approach is likely to be noticed and may even be communicated to those in charge of the rotation.
2. Arrive prepared.
Before each half day of clinic, you should ask for a schedule of the day. Arrive early each day and review the medical records of the patients you and your attending or resident will be seeing. If the office is still using paper charts, ask if it may be possible for you to get advance access to these charts so you can review them. Make sure you thoroughly review the medical records and take notes about any pertinent details, including your thought about a plan of action or even routine health screenings that may be due. Your attending or resident is likely to see the pre-work that you have done, which will make a positive impression. It is also appropriate to say “I reviewed our patient’s chart earlier this morning and see that she is here for follow-up of X condition and is also due for a pneumonia vaccine. I’m interested to meet her.” Letting your preceptor know that you have spent time getting to know the day’s patients will score points and maybe even improve the flow of the clinic and quality of patient care.
3. Determine the desired presentation style.
Every attending has a preferred presentation style, and they often differ significantly from one another. Instead of guessing and hoping that you hit the mark, just ask. Does your attending want an entire inpatient-style thorough history that includes the history of present illness, review of systems, past medical history, past surgical history, family history, social history, medical list, and allergies? Or should you just present the medical issue at hand and any pertinent medical history? Being proactive will get you and your preceptor on the same page right away and avoid any frustrations.
4. Offer to write progress notes.
After you determine your preceptor’s desired presentation style, ask if it would be helpful for you to write progress notes for the patients you will be seeing. It takes time out of a busy schedule for your preceptor to have you in the office doing a rotation. Depending on the setting and local regulations, your preceptor may be able to addend and sign your note, saving some time that can be directed to teaching. Even if your attending can’t use your note for official documentation purposes, learning to write good outpatient chart notes is a skill on which you can be provided valuable feedback. Some preceptors will prefer that you focus instead on seeing more patients to get more clinical experience, and that’s great too.
5. Always offer an assessment and plan.
When presenting a patient to your preceptor, you typically will present the subjective information (the “S” in a SOAP note), followed by the vital signs, examination findings, and any relevant data such as laboratory results (the “O” in a SOAP note). At that point, many medical students stop and wait for the attending to say “so what do you think is going on?” or “so what’s your assessment of this patient?” I highly encourage you to go for it and provide your own assessment and plan unsolicited. You may be incorrect or your preceptor may have differing thoughts, but taking the leap and being willing to be wrong does several important things: 1) it shows your attending that you have thought about the patient and are not simply reporting data; 2) it helps your attending understand your thinking and identify knowledge gaps, both of which allow for more focused teaching regarding the medical issue at hand; and 3) it develops your clinical skills because arriving at a well-reasoned assessment and plan is the key sill that every physician must master.