Whether a bad clinical rotation is due to your own lack of effort or circumstances beyond your control, this post will provide you with the strategies you need to bounce back after a bad rotation.
Clinical rotations take medical students out of the classroom and place them in a real medical setting under the supervision of established physicians. You’ll gain hands-on experience interacting with patients and medical staff in all parts of the hospital and healthcare clinic. It’s an exciting time, but also an extremely stressful one.
Each rotation provides essential training, but some rotations will be more challenging or interesting to you than others. For example, if you know you want to get into psychiatry, you may struggle with surgery, and vice versa. However, even if you don’t like a specialty you’re rotating in, do not let it show in your performance. You never know what connections you might make or how they could impact your future career, and while working in a hospital, your colleagues and patients are counting on you.
Take each rotation seriously. However, even with the best intentions, it’s possible that some rotations may not go your way.
How to Prevent a Bad Rotation
What’s Within Your Control
One of the biggest mistakes students make is arriving at the rotation and assuming learning starts on day one. In reality, students must lay the foundation well in advance. This is especially true for complex clerkships like surgery or internal medicine.
While this will be challenging if you’re doing back to back rotations, in the one or two weeks before the next rotation starts, you must gain a foundational understanding of what to expect.
Fortunately, we have comprehensive guides to each of the core clerkships, including what to expect, what to learn before the rotation starts, essential specialty-specific tips, as well as apps and resources for success on the rotation:
In addition to these comprehensive Med School Insiders guides, you can also start an Anki deck for the specific rotation. This preparation will help you hit the ground running on day one—which is just what your attendings will expect.
Now, on the flipside, you may also be studying for your current rotation’s shelf, so it’s also important not to move on to your next rotation too fast. Ending on a weak note could negate your accomplishments from the past month or two. Do not move on before you finish strong.
You should also have a firm grasp of how you will be graded. If your program is not pass/fail, getting a high pass on the shelf is vital. This is extremely difficult, and in these cases, you must dedicate ample time to studying.
However, remember that the other components of the rotation, such as your professionalism, patient care skills, and the overall comments you receive from your attending, can technically comprise a larger portion of the rotation’s grade than the single shelf grade itself.
If you want to maximize your chance of having a high-yield rotation, put more of your focus on applying yourself during your day-to-day. While doing some Anki at lunch or before you start may be necessary, depending on your program, do not sacrifice the other elements of the rotation to get a higher score on the shelf.
It’s a delicate balancing act between applying yourself during the rotation and finding the time to study.
Another thing that’s inside your control is asking your attendings to fill out your feedback forms. You must go above and beyond to ensure your supervisors fill out these forms. Schools often put the responsibility on your shoulders to get as much feedback as possible, especially if you’re rotating with a high number of faculty and residents.
While this can feel intimidating, you must make it clear how much their comments will affect your future. Do not underestimate the power of continuing to ask for feedback. You are not asking for favors; you’re asking for evaluations. Fewer comments could mean worse grades.
One more thing in your circle of control is your own mental and physical health. Your rotations are not sprints, and you can easily burn out if you’re not careful. You’ll need to put some social events and hobbies on hold to maintain your focus and overall health during your rotation years. Eat right, exercise, and get all the sleep you can.
What’s Outside of Your Control
Now, while there’s plenty that’s inside your control, there are a few things outside of it. For example, you can’t control who you’re on the rotation with or who your attendings are.
The people who are evaluating you can have bad days or even bad months. Know going in that this is out of your control. All you can do is continue to do your best.
If anyone you encounter in the hospital, whether it’s your attending, residents, nurses, cleaning staff, etc., is having a bad day, don’t stoop to their level. Remain calm and treat everyone with respect, even if you aren’t getting that respect back.
You will likely also have difficult experiences with patients, and these moments can severely tax your mental health. This part of the job isn’t within your control, but you can control how you react. Again, don’t lose your temper. You never know someone’s full story. The best thing you can do is treat everyone with patience, kindness, and empathy.
How to Bounce Back From a Bad Clinical Rotation
1. Reflect and Don’t Act Right Away
If you receive a poor score on your rotation, it’s imperative not to react right away. Losing your temper with a fellow student or an attending will be a great deal worse for your future career than a few harsh comments on a feedback form or a poor shelf score.
Take some time to yourself to process your feelings. Breathe. Remember that it’s only one rotation. You will likely have ten or more rotations, eight of which could be on your Dean’s Letter. It’s all about your composite story. A single bad rotation will likely not even be included in your Dean’s Letter.
Whether it was a bad grade or you didn’t get along with your attendings, residents, or fellow students—or both of those things together—that experience is over now, and the best thing you can do is determine what went wrong so that it doesn’t carry over into your next rotation.
2. Determine the Root Cause of What Went Wrong
Reflect on why you received a bad score. Does this experience show a pattern, or is this more of a one-off instance? In other words, was it you, or was it bad luck because of who you worked with?
If it does show a pattern, it’s time to course correct. If you’re getting poor reviews, you must go back to your clerkship directors or residents, seek clarification, and ask for help. Clerkship directors want to see you succeed. It could be that you’ve developed a poor habit or that you have not yet developed the key knowledge, practical skills, or communication skills you need to succeed.
If it’s a one-off circumstance, you may already know the root cause. Did you get distracted, go through a breakup, lose a family member, or have a personal physical or mental health concern during the rotation? If it wasn’t your personal life, you may not have gotten along with the residents or attendings, or it’s possible they weren’t able to give you the proper attention for reasons totally outside of your control. Bad months happen to everyone. In these cases, there’s not much you can do about it.
However, do not carry the weight of the negativity into your next rotation, especially if you know you did your best despite the adversity you faced. Do not create a self-fulfilling prophecy for yourself.
What do the comments say? Clarify anything you do not understand so that you can work to rectify any poor habits in the future. Seeking feedback shouldn’t turn into arguing about what’s right and what’s wrong or what grade you should have received. Demonstrate that you’re coachable. Be a listener. What can you do better so that you can continue to provide the best care while also being the best learner?
If you approach these conversations with that in mind, you can determine the root cause of the negative score and experience to ensure it does not interfere with future rotations.
3. See the Learning Opportunity
While most of the time, you cannot go back and repeat a rotation, you can take the lessons learned and translate them to the next rotation.
Aspects of professionalism and patient care almost always translate between rotations, whereas knowledge may not. For example, knowledge between OB/GYN and psychiatry may not overlap much. However, if there are traits you’re currently lacking, such as failing to identify a need in the team and being proactive about solving problems, then you can focus on being more proactive during your next rotation and all future clinical endeavors.
If, unfortunately, you find you have a great deal to work on, focus on the larger issues first. If you try to tackle them all at once, you will quickly become overwhelmed. Think of it like a New Year’s resolution. If it’s too big, you likely won’t succeed. Focus on small, actionable goals that will have the most impact for your next rotation.
Rotations, and medical education in general, is all about the process of forming small habits and taking small steps to get to that larger goal. If your comments suggested you were too timid or too often waited around to be told what to do, how can you be more proactive on your next rotation? If you were told you were too cold or impersonal with patients, what can you do to put patients at ease next time?
4. Get in a Healthy Headspace
Oftentimes, you’ll be going from rotation to rotation with only a weekend between them, so there’s not a great deal of time to recover. You likely need this time to catch up on some sleep and continue building your foundational knowledge for the next rotation. This means you may need to sacrifice seeing friends and family and put off leisure activities that aren’t directly tied to your physical and mental health.
This can be a real challenge if you have a wide circle of close-knit friends or are in a relationship. It is okay to step away from the social scene and tell your family and friends that you have to knuckle down and get through this rotation. Do not spread yourself too thin. If you have a significant other, before you enter a tough rotation like surgery, explain the reality of how much you’ll be working so they know what to expect.
Beyond your relationships, evaluate what it is that’s preventing you from putting your best foot forward during your rotations. Is it a lack of sleep? A poor diet? Are you making time for exercise? Have you committed to too many clubs or extracurriculars? Are you heavily pursuing research on top of your rotations?
While research and publications are important, the most crucial thing to focus on during rotations is the clerkship you’re currently on. The grades and comments you receive from rotations are not only key to securing you an ideal residency match, but they also almost always contribute to the majority of your Dean’s Letter.
Do not overcommit and underperform. Find time for mindfulness and exercise, and pay close attention to your sleep quality. Shake off the dust of the previous rotation so that you can put your best forward on the next one—both physically and mentally.
5. Don’t Shy Away From Asking for Help
If you aren’t receiving the grades or comments you hoped for and don’t know why, it is vital that you ask for help. Fumbling around in the dark will only make things worse. Like we previously mentioned: Ask the residents or clerkship rotation director who evaluated you about what you could be doing better.
Remember that your medical school wants you to do well. Your program is filled with resources aimed at helping all of its students have successful clerkship experiences and, ultimately, helping everyone successfully match into the best residency programs.
While these rotations do reflect on you as a future physician, they are not static. An amazing performance on one rotation does not guarantee the next rotation will go as smoothly, just as a poor performance on a rotation does not automatically mean the next one will be bad too. Each rotation is a formative experience, and your performance will continue to evolve.
It all comes down to valuing each experience and being an excellent learner. Failure is the greatest teacher, so be proactive rather than reactive and focus on continuous improvement.
Don’t Let One Bad Rotation Hold You Back
Bouncing back from a bad rotation comes down to your own mindset and commitment to improvement. If you go into your next rotation with a negative attitude, a chip on your shoulder, or waning confidence, that one bad rotation will snowball into many bad rotations.
All setbacks build resilience. What you learn from a bad rotation will prevent you from making the same mistakes down the road in residency and your future career. Continue to learn, build your skills, take feedback seriously, and always act with humility. Every failure is a learning opportunity.