Four core rotations down. Three more to go. Today marks my second week of clinical duties on the psychiatric ward. It’d be a lie to say I’m not nervous about this rotation in particular. I mentioned some of my anxiety to one of my colleagues today and he responded: “oh c’mon, Ajibike, you’re always nervous at the start of a new rotation.” To an extent, he is right. There’s an overwhelming sense of I know nothing that accompanies the start of each rotation. It seems as though the moment when I feel comfortable on a new service is exactly when it is time for me to move onto a new team.
Everyone who knows me knows that I love F. Scott Fitzgerald. Many of his works are fixtures in my list of favorite novels. When I stumbled upon this quote, I knew it would serve as an honest introduction for this post. This quote = mood.
MS3 is the year during which you amass a ton of clinical knowledge.
MS3 is the year during which you learn to not “sweat the small stuff.”
A MS4 told me at the start of my MS3 year that I should be prepared for moments when 150% effort will be rewarded with an evaluation that reads: “Good student.” She told me that it’s important to hold learning the art and practice of medicine as my main priority rather than impressing attending and resident physicians. Unsurprisingly, I followed her advice with: “Okay…I hear what you’re saying but what can I do to be a good medical student.”
She gave me three pieces of advice that I still find incredibly valuable:
1. Know your place.
2. Take ownership of responsibilities related to your patient(s).
3. Present well.
What does it mean to present well? Each discipline has their own twist on the history & physical or SOAP note…but at the end of the day, a good presentation is: concise, thorough, and accurate.
The major 🗝 to a good presentation is: organization. On my first couple of clerkships I made my own templates to record information on each of my patients. I also toted around an myriad of documents (physical exam maneuvers listed and described and an extensive review of systems). On each team, I learned what my attending wanted from me and adjusted my presentations accordingly.
I felt a lot of pressure when I started my pediatrics rotation. I came into medical school with an interest in pediatrics and so when the rotation rolled around, I wanted to impress my attendings. At that time, I got my hands on a Perfect H&P notebook.
This notebook fits in a white coat pocket and is affordable – only $15 guys! The notebook supplanted all of the documents I was carrying around in my pockets. I’ll talk a little bit about how the notebook is constructed in a moment. I will say that this notebook is perfect for wards work. Sure, certain disciplines may require a bit more material on topics not specifically mentioned in the notebook. I’d say that this notebook is a great organizing tool for internal medicine, surgery, family medicine, and pediatrics. I can’t speak to neurology or OB/GYN as I haven’t completed those rotations yet. I will say that I don’t think the notebook is as helpful for psychiatry.
The template has checkboxes for basically ALL the physical examination findings and symptoms (for review of systems) you could possibly want. I will say that the section for laboratory results is on the small side.
One aspect that I really appreciated is the sect ion for differential diagnosis. On so many rotations, I haven’t been required to present my differential for each aspect of the problem list. That’s honestly been a disservice to my education but I’ve found that forcing myself to think of a differential (of at least 3) has helped me to present more sound assessments and plans.
I’m hooked on this notebook and I fully intend to pick up another one before I start my sub-I in June!
If you guys have tips and tricks for presenting on the wards, I’d love to see them in the comments below!
Disclosure: Perfect H & P provided this notebook for free to be reviewed on this blog. All opinions are my own.