The clinical years of medical school provide an experiential learning format. Students are supervised in an on-the-job work/learning environment.  There is far less classroom learning. It is imperative that students “be there” when things are happening. Students who are not present, or quickly available, lose the experience of responding to rapidly changing clinical situations, and thus, lose the learning that comes from the experience.

 

Clinical medicine requires much more than a growing body of factual information. It requires relating data and factual information to real people with unique and individual expectations of what is right or wrong for them, or for their family members; and often, unrealistic expectations of what medical science can do.  The individuals and families that students will be caring for may or may not have the resources or desire to do what the student and the patient care team think is best for them. Physicians must learn to work in this context. Discovering one's capacity to work effectively with other health care professionals and with patients and their families in the face of uncertainty, fatigue, or differing views of what should be done is a dimension of education many medical students have not previously experienced.

 

What follows are some general comments regarding the transition to learning in the clinical settings. It is impossible to describe succinctly in a short space all that is expected of students during their professional development.  This summary will not describe individual clerkships.  Although much of what faculty and residents expect of students is common to the profession of medicine in general, students must learn the variations of those expectations made by each of the medical disciplines.

 

General Deportment and Guidelines for Attire

 

The Medical Student and the Patient Care Team

Each time students begin a new level of training, they may feel as if they are at the bottom of a ladder.  It is both similar and dissimilar to starting anew.  The fact is, senior students, residents and faculty and other health professionals will consider new third-year students to be at the bottom of the clinical training ladder.

 

This does not mean that students' opinions will necessarily be ignored or demeaned. Students will, however, need to be diplomatic in presenting their opinions, especially if they differ from those of the residents or attending physicians.  Students should avoid arguing points in a confrontational or angry manner.  Students should listen to the other viewpoint and the reasons for it.  They should avoid questioning medical decisions of the team in front of patients and staff or in chart notes.

 

Being the novice in the clinical setting means that a student would be wise to defer to the supervising resident or attending physician when patients ask questions that could have sensitive or potentially upsetting answers.  Avoid sharing with patients any personal uncertainties about the way in which they are being medically managed.  If a supervising resident or attending physician feels that a student has exceeded his/her role, or projected a personal agenda onto a patient, this will probably be reflected in the evaluation of that student's performance.

 

Seeking Feedback

It is important to recognize that, rightly or wrongly, not all residents and faculty will let students know in a timely way the areas where student work does not meet expectations.  We all learn to encourage others and to avoid saying something that might make another angry or upset.  Attendings and residents are like everybody else.  They too like to avoid giving negative feedback.

 

Students must be willing to take the initiative to go to residents and faculty to learn of those areas of performance that are satisfactory, that are very good, and those specific areas that need work. Students who are working hard and yet do not take this initiative may think that they are doing quite well on a clerkship, when, in fact, they have performance deficiencies.  An attending or resident may say that a student is "doing a good job" or “doing fine.”  Avoid interpreting that as an "H" or "HS" performance.  What does "…doing a good job" mean? Seek specifics. "How are my presentations?" "What could I do to improve them?" "Is the content of my chart notes too much? Too little? Too vague? Too specific or too speculative?"  Ask! A student who receives no feedback is often one who sought none.  It is not easy, but it is easier than having to cope weeks after a clerkship with an unexpected weak evaluation when there is no time to modify performance.

 

If there is little relationship between a student's perception of his/her work and the way the evaluation describes that performance, it is a time to go to the course director.  Not to say..."This evaluation is all wrong.  Who said that about me?  Give me an example! I'm not like that at all! I worked so hard! I can't understand this!"...Try to separate ego from work in order to find out what resulted in the work (not the self) being perceived as inadequate in some way. What students think they did, can do, or could have done, is not always what they did as perceived by others.

 

Course and Clerkship Evaluation

 

Standard Precautions

The health and safety of its students during clinical training are very important to the faculty and administration of the Drexel University College of Medicine.  Students entering the clinical years will have had instruction in the use of standard precautions in several courses and orientations. Each hospital in which medical students learn has a published version of standard precautions policies, and policies for actions a health care worker should take if exposed to blood borne pathogens.  These policies will be similar but not necessarily identical at each site.  It is the student's responsibility to learn the procedures at each site where he or she trains.

 

Steps To Take After an Exposure