How to Be a Great Clinical Clerk

How to Be a Great Clinical Clerk

I have written a lot about medical school, but mostly about getting in and some of my experience as a “preclerk” – the primarily classroom based learning I did in my first two years of medical school.

Now that I am in my 4th and final year, I have over a year of clinical experience under my belt. Besides two weeks off for winter break, I have spent the last 12 months straight working in hospitals and clinics, rotating through every single service imaginable. One week I would be suturing lacerations in the emergency room, and the next I could be delivering a baby. I am a firm believer that a medical student’s first clinical year presents the steepest learning curve in all of medical training.

However, I didn’t write much about clerkship for a few reasons.

The first is that it was my busiest year ever, and that meant I always found an excuse not to write: too tired, too busy, too stressed, etc. Fortunately, 4th year is full of elective rotations, and my schedule is much improved. I don’t have any excuse for not writing unless I get lazy. Hopefully that doesn’t happen (look, this is the first time I would have blogged two days in a row in forever – when was the last time that happened?).

The second is that I was always worried about what I would be allowed to write from clerkship. Given that I am seeing patients and coworkers day in and day out, I was scared to write something that would identify another person. It doesn’t help that I write openly as myself – anyone who has come into contact with me on service might think I am writing about them. Now that I have completed my core rotations, I have a bit more freedom to write, but of course I will be safe and cognizant of privacy.

The third is that I just wasn’t experienced enough to write about clerkship. It has taken me the full year to really realize the value of clerkship and what it takes to be a great clerk. Chances are, what you think might make a good clerk probably is far from the truth – I know that was true for myself and my peers (hint: if you think the clerk who studies the most impresses the most, think again). It takes experiencing something as intense as clerkship to really realize what is expected of you and what you should really expect of yourself.

Now that I have this experience, I feel ready to freely share my thoughts on what it means to be a great clinical clerk. For those of you who have recently started or will soon be starting clerkship, I hope there are some gems in this article for you. For those of you still not yet in medical school but hope to one day, I hope this gives you a bit of insight into what being a medical student is like and what attitudes and skill would be useful to adopt in your life going forward.

Disclaimer: Before going forward, I just wanted to say that the following are a collection of ideas of what I think make a great clinical clerk. I’m not saying that I personally do all of these things or do any of them well or that I am even a great clinical clerk myself – I know I have much to learn, and that if I followed my own advice more closely, I would be a much better clerk than I am today.
Create value

One of the biggest changes from preclerkship to clerkship is how you are evaluated. In preclerkship, you are mostly evaluated by relatively objective measurements of knowledge and application – i.e. tests, both written and oral.

While you still take tests in clerkship, most of your time is spent outside the classroom, and the evaluations that matter will come from your supervisors and colleagues – i.e. welcome to the real world.

It’s tough rotating through departments as a clinical clerk. It takes you a week or two to settle into your role, and then a month later, you get shipped off to a new location and begin Day 1 all over again. Because of this, you may worry about starting off worrying about being a nuisance to your supervisor and health care team.

Yes, a big purpose of clerkship for you is to learn. Yes, your supervisors are supposed to teach you things, however keep in mind that not all preceptors were born the same. Some preceptors are fantastic; they will be patient with you, really guide you along the way, and praise you for your good work – these are the preceptors that love having students. Then you will come across others who seem like they could care less about you – they might make you feel like you are just in the way.

The truth is that whenever you start a new rotation, you are in the way. In many cases, your presence slows down the efficiency of the health care team, makes the clinic run overtime, etc. Why? It’s not your fault (okay well it is, but not in a bad way). You are a learner – of course it takes you longer to interview and examine a patient than a resident or your supervisor.

However, that doesn’t mean you should just accept this fact and ignore it. Instead, you should try to change that, and find a way to become a valuable member of the team.

Once you are able to create value for your team, every single supervisor and resident (both the nice and mean ones) will love you.

So how do you create value?

Work hard

One of the things you realize in clerkship is that a lot of work of being a doctor is process stuff. There are a lot of notes to write, phone calls to make, and faxes to send. Sometimes, there are way too many patients to see. Simply working hard wins you a lot of fans in the workplace.

Imagine it from a preceptor’s point of view. They are always overwhelmed with work – if you can save them time, by working efficiently and effectively, it means less work for them and they can finish on time and go home sooner. Preceptors love clerks who save them time.

Look at it from another point of view. Your clinical rotations are also in a way an audition for residency. Preceptors want residents who will work hard for them and get stuff done. Work hard and your preceptor will want you as a resident. This will be well reflected in your evaluations and what your preceptor tells his or her colleagues.

The same goes for impressing your residents. On your surgery rotations, you will need to round on many patients in the morning. Getting there early and helping to prepare all the charts makes a huge difference. Residents don’t care if you studied the night before – helping them finish their work faster will make them love you and wish you are a future colleague.

Recently, a 5th year resident told me I was the best clerk she had ever worked with and that she I should apply for her residency program. It was a surgical service and I have no interest in applying for a surgical residency. So you can imagine, there’s no way I knew more information or studied more than clerks before me.

But the reason she liked me so much was that I worked hard and did a good job. I didn’t spend time sucking up or asking questions for the sake of asking questions as she felt previous “keener” clerks had done. I focused on helping my residents and supervisor deliver great patient care.

One of the mindsets that has helped me in clerkship is to focus on creating value and delivering great patient care. I always tell my preceptors and residents, I might not be interested in your specialty, but I want to help and create value to make your lives easier. It’s true, and everyone is really glad to hear it. No matter what service I’m on, I am nice to my patients and treat them well – trust me, people notice.

Copy how your supervisors and residents do things

Mimicking success is one of the most important tools to use when you have no idea what you’re doing.

When your resident or supervisor interviews or examines a patient, observe closely what they do. What are the important questions they asked for that specific medical problem? Which tests do they always order? What language and tone do they use to explain things to patients?

By following this, whenever I encounter a new patient with a similar medical problem, my supervisor sees my work as comprehensive and complete because it’s already been done using their own methods. I have already asked every question they wanted asked, so they don’t need to do it themselves.

It goes even deeper than that. Keep an eye on everything. If your supervisor is more concise and to the point, don’t belabour your patient with additional questions you know your supervisor will say is a waste of time. On the other hand, if your supervisor spends half an hour explaining things to a patient, well, they probably expect you to do the same thing. Your supervisor is your boss – realize that, and adapt your approach to match theirs.

Also, check the way your residents and staff write their notes. They are useful both as templates for writing your own notes in the long run, but also for recognizing what your staff thinks is important.

Be friendly and personable

Personality matters. Now that people are marking you instead of computers, subjectivity is king, and you want to be on his good side. I’m not saying to be fake and someone you’re not – but at the very least, be friendly and easy to get along with.

This also relates to auditioning for residency – your staff is going to be thinking about whether they want to be working with you for the next 5 years. You might be a smart and hard working clerk, but if you annoy or are mean to your staff, residents and other team members, they sure as heck won’t want to work with you.

The way I look at it is to find the parts of your personality that matches your preceptors. In general, I am a pretty laid back and chill guy, and I love to make jokes and laugh. When I am with a preceptor who loves to make jokes, I am happy to have a riot with them and joke all day long.

But if I am with a preceptor who is more serious and doesn’t share my same sense of humour, I am more apt to stay serious as well.

It’s a whole psychology thing, but the basic idea is that people tend to like others who are similar to themselves. Share the side of you that matches your preceptor’s personality, and you will get along well.

Write legible and organized notes

One of my biggest pet peeves are illegible notes in the chart. I remember sometimes coming onto a service for the first time and trying to decipher the notes written by the previous doctor caring for this patient. In particular, I remember one time my supervisor and I simply gave up on the previous doctor’s notes and just hoped we could read her doctor’s orders to see what she did – even that was a struggle.

Other health care providers will read your notes. Keep them organized and concise so that they are actually useful. Believe it or not, sometimes that is the only way different health care providers communicate with each other (it’s a sad truth in health care, but I will leave my rant about this for another day).

Read around your cases

You are going to hear this phrase a lot. Basically it means, learn more about the conditions facing your patients. There are a few reasons for this.

First, if your patient is sick in hospital and you have no idea how to manage it, then you should learn about how it so you can actually treat your patient. That’s just being responsible.

The second reason, and one that I find many people agree with, is that it is much easier to remember the medicine that you actually saw and treated yourself.

You will never forget the patients you treat, and their conditions that you treated. Every time I think about the management for stroke, I just need to think of my first stroke patient and what I learned to do for them.

It’s very hard for medical conditions and informations to stick for problems you have never seen or treated.

While ideally you should be studying everything, whether you have seen it or not, at the very least you should try to read around your cases.

I promise you it will often be hard (how the heck do you study after waking up at 4:30am and coming home at 8pm?), but it’s up to you how badly want to do well.

Conclusion

So there you have it, some of my thoughts on what it takes to be a great clinical clerk.

What do you think – am I missing anything? For current and almost clerks out there, I’d be curious to hear your thoughts.