Blog | Monday, July 22, 2019

Setting expectations for new clinical learners


Monday morning we have new interns and new third year students. During rounds I will set expectations for their first clinical rotation at these levels. (I also have a new 3rd year resident, but he has had all second year to learn how to be a resident).

What should I expect; what should they expect? In setting expectations we should try to remember our own experiences and feelings. They will be very excited and a bit scared. The interns are really doctors now, and feel that responsibility. Many have the impostor syndrome. The third year students really are “newbies”, as the third year of medical school has little in common with the first two years.

The first thing I tell them is that our job (the resident and me) involves helping them grow. We do not expect them to know how to fit their new roles, and it is our job to help them grow. We are not as concerned with their current state of knowledge as their ability to grow and improve consistently.

We will give you immediate feedback. We will teach you how to present so that the listeners know how hard you have worked on the history, physical and understanding the patient. We expect that you will need much feedback to grow.

We will ask many questions to gauge your knowledge. The questions will mostly focus on the basics. This month is all about learning the basics and trying to own them.

Learning internal medicine is difficult. We all try to learn more even at the PGY42 year (like me). Keep a notebook, or a file in your smartphone. Pick two things each day that our patients helped us learn. Spend around #5goodminutes reinforcing the learning from rounds. Refer back to those notes because remembering what you learn is very difficult!

We will support your growth. We expect you to work hard, but also set aside some personal time each day if possible. Take care of your mind and your body. Try to eat well. Exercise regularly. Do some things outside of medicine especially on your off days.

You will be amazed at how much you learn this year. We are here to help you. The system works. It has worked for more years than I can remember. Patients are our best teachers. Learn from them and thank them for the privilege of being part of their medical team.

Learning internal medicine really is a life long journey that never stops amazing me. You will see so much, but remember that the most interesting conversation topics will only be interesting to other 3rd year students, perhaps 4th year students, interns and residents. What you learn and know are difficult to share with non-medical friends and family. I often tell friends that they do not want to hear what I see and know.

Support each other. Internal medicine is a team sport. The best students, interns, residents and attendings make everyone around them better. We will do our best to role model all these expectations.

Congratulations, this is the most exciting, challenging, rewarding, frustrating, tiring year of your education!

db is the nickname for Robert M. Centor, MD, MACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and the former Regional Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds regularly at the Birmingham VA and Huntsville Hospital. His current titles are Professor-Emeritus and Chair-Emeritus of the ACP Board of Regents. This post originally appeared at his blog, db's Medical Rants.