The third year of medical school is an exciting time. You finally get to move out of the classroom and into the clinic to do what you went to medical school to do: take care of patients. That being said, it can also be one of the most challenging times for that same reason.
Here are 5 tips to help you crush your third-year clerkships.
- Know How You’ll Be Evaluated
- Be Kind to Everyone
- Ask for Feedback
- Take Advantage of Your Downtime
- Focus on Being Instead of Doing
1 | Know How You’ll Be Evaluated
The first step to doing well in your clerkships is to know how you’ll be evaluated. Although many medical schools have moved to pass/fail curriculums for the preclinical years, third-year clerkships are always graded. The four grades that you can achieve are honors, high pass, pass, and fail, or some similar combination.
There are generally two main components to your clerkship grade: your shelf exam score and your evaluations from preceptors.
Shelf exams are subject-based tests designed to assess a medical student’s mastery and practical application of medical knowledge within the clinical setting. They are generally taken after core rotations in various specialties such as internal medicine, general surgery, OB/GYN, neurology, psychiatry, family medicine, and pediatrics.
These exams are licensed by the National Board of Medical Examiners – the same organization responsible for the USMLE Step exams. They are called shelf exams because they are composed of expired USMLE Step 1 and Step 2 CK questions that have been “shelved” by the NBME. Although shelf exams aren’t necessarily a requirement for medical licensure, most schools factor these scores into your clerkship grades.
The evaluations you receive from your supervising resident and attending physicians are the other component of your clerkship grades. You will be assessed on qualities such as professionalism, communication, work ethic, knowledge, and competency.
Depending on the school and the rotation, how these components are weighted with respect to each other will vary. For some schools, 80% of your grade may be based on your shelf score and only 20% on your evaluations. For others, 60% of your grade may come from your evaluations and only 40% from your shelf score. Understanding how you will be graded is key to knowing how you should prioritize your time.
The best place to start is by reading the syllabus. Although it sounds obvious, many students fail to do this. The syllabus will often break down exactly how you are graded, what is expected of you, who to contact in certain situations, and other details specific to that rotation. Although it’s helpful to get advice from upperclassmen and other students who have completed that rotation before you, you shouldn’t rely on that advice alone. It should be taken into account only after you have read through the syllabus and understand the grading rubric.
2 | Be Kind to Everyone
Next, be kind to everyone. During your clerkship, you’ll meet all sorts of people including doctors, nurses, techs, patients, and their families. One of the best ways to build a good rapport with those around you is to be kind to everyone you meet. This includes those who do not offer the same courtesy back.
Medicine is a team sport, and the moment you step into your first clinical rotation, you become a part of that team. As such, it is to your benefit to start honing your ability to work with others early in your training. Something that has helped me be more kind to others is to remember that there is something to learn from everyone.
During my clerkships, I was inspired by physicians with great bedside manner who were able to put patients at ease while remaining professional. Even when patients were less than respectful, seeing the attending or resident act with grace set a positive example and inspired me to incorporate these into my own clinical repertoire.
One of the great things about clinical rotations is that you get to see how many different physicians practice and interact with patients. From these experiences, you can decide for yourself how you want to practice and what kind of doctor you want to be.
But if that isn’t reason enough, medicine is also an incredibly tight-knit community. You never know who’s watching or who that person might know. Being rude to a tech, receptionist, or janitor can easily make it into your evaluation and negatively impact your grade.
Never make enemies while on your clinical rotations.
This may sound obvious to many of you, but you’d be surprised at how many people forget the “golden rule” from Kindergarten: treat others the way you want to be treated.
3 | Ask for Feedback During Your Rotation
Next, most students don’t take advantage of asking for feedback from their preceptors. By asking how you’re doing and how you can improve during your rotation, you have time to make adjustments and improve on your weaknesses before grades are set in stone. If you wait until the rotation is over to find out how you’re doing, it’s already too late.
It is important to note that this is not the time to become defensive or argue for a better grade. Doing so is a sure-fire way to hurt your final grade. Instead, listen attentively to what your preceptors are saying and be receptive to their feedback. Look at their criticisms as a chance to grow and improve as an individual.
Remember, you don’t go to medical school to be a doctor. You go to medical school to become a doctor.
4 | Take Advantage of Your Downtime
During your clinical rotations, it’s also important to take advantage of your downtime. Step 2 CK is generally taken at the end of your third year, and since Step 1 has transitioned to pass/fail, Step 2 CK is now going to be more heavily weighted on your residency application. As such, you need to make sure you’re taking the time to prepare adequately.
That being said, it can be difficult to find dedicated time to study between clinic, research, and all of your other responsibilities. To be successful on Step 2 CK you need to be creative with your studying.
Two things that worked well for me when I was preparing for Step 2 during medical school were to study in the morning and to do flashcards whenever I had downtime.
Although I’m not naturally a morning person, I convinced myself that I was during my third-year clerkships. I would get to the hospital early, get everything prepared for the day, and then study with whatever time I had left before rounds started. It’s easy to tell yourself that you’ll study when you get home, but after a long and challenging day, studying is often the last thing you want to do. By getting the bulk of my studying done before my shift, I ensured that it wouldn’t get missed and cut down the work that I needed to do at the end of the day.
I also strived to make the most of whatever downtime I had throughout the day. My strategy for preparing for Step 2 CK relied heavily on the use of flashcards and spaced repetition. I even created my own deck covering every single topic that would be tested on the exam.
I would spend every bit of downtime I had throughout the day going through flashcards. Whether it was a couple of minutes here or there while waiting for the resident or attending physician, or downtime between cases, I would pull up Anki and start going through flashcards. It may sound excessive, but a few minutes here and there can add up quickly.
I didn’t just do this while I was in the hospital either. If I was at the grocery store, waiting in line, doing my morning stretches, or had any other moment of downtime throughout the day, I would go through flashcards.
The point is that you don’t always have to set aside large chunks of time to study. Little bits of studying throughout the day add up. You’ll be surprised at how much you know come exam time if you do this.
5 | Focus on Being Instead of Doing
My last tip for crushing your clerkships is to focus on being instead of doing. Oftentimes when we’re trying to do well at something we focus too heavily on tactics.
We think “what can I do” or “what can I say” to look good to my preceptors, but you don’t want to spend so much time worrying about how to come across as a good medical student that you miss out on the opportunity to be a good medical student.
For example, if you’re on your OB/GYN rotation but know for a fact that you don’t want to go into obstetrics or gynecology, that’s okay. But instead of trying to act like you’re interested in it to look good to your preceptor, try to keep an open mind and find genuine interest in the specialty for what it is.
Be curious, ask questions, and have fun learning about the specialty, even if you have no interest in going into it yourself.
When I was in my third year of medical school, I tried to approach clerkships from the perspective that “I’m here to learn – not just get my grade and move on.” By having this mentality, I was able to lean into the aspects that I found interesting and show genuine curiosity.
For instance, while I was on my general surgery rotation during medical school, there was a patient that needed to have a Whipple procedure. For those of you who are unfamiliar, this is a pretty major surgery. It’s often done to treat pancreatic cancer and involves removing a part of the patient’s pancreas, small intestine, gallbladder, and bile duct. In short, it’s extremely complex and difficult – even for seasoned surgeons.
Even though I knew I wasn’t going into gen surg, I had never seen one done before and wanted to take advantage of the opportunity, so I asked the surgeon if I could scrub in. The surgeon could tell that I was genuinely enthusiastic about the case and agreed. My enthusiasm and eagerness to learn contributed to my evaluation and ultimate honors on that rotation, but I also got a special experience that I’ll always remember.
If you adopt this mindset, not only will you be a better, more engaged medical student, but you’ll also learn more from the experience and become a better, more knowledgeable physician. You never know when that obscure fact you learned during your clerkships will come up again and how that might help you years or even decades down the road.
If you go on Reddit or SDN, you’ll find most students asking the “how”, the checklist they must do to ensure a top grade. These students ultimately find themselves frustrated and have mixed results. It’s no surprise, since most blogs, resources, and tutors focus on the same thing – the tactical actionable list of things to do, rather than changing the inner dialogue and perspective in becoming a top student.
My focus with Med School Insiders has been to deliver maximal value to our clients. That means getting beyond the parroted cliche advice and into the actual substance that separates top students from the rest. That includes not only the nitty-gritty details but the mindset and perspective you must adopt to realize your potential.
When you shift your way of being to align with your goals, you accomplish what you want with far less friction and effort. Things almost seem to naturally fall into place. And as I like to say, reality is in our perception, not in events.
At Med School Insiders, we’ve been empowering a generation of happier, healthier, and more effective doctors since 2016. And as a younger company led by an optimization-obsessed physician, yours truly, we do things quite differently than the rest of the industry.
If you want to become the best, you need to learn from the best, not those that got through in the middle of the pack. By recruiting the top talent and pioneering a systems-focused approach to our services, we’ve become the fastest growing company in the space with industry-leading customer satisfaction for one simple reason – we deliver results.
If you want to honor all your clinical rotations, ace your shelf exams or USMLE, match into the most desirable residency programs, and become the best doctor you can be, be sure to check out our admissions and tutoring services.