Office of Academic Support & Counseling

Top Ten Clinical Rotation Mistakes

By Kendra Campbell, MD and other Medscape Contributors  

Last week, I watched a med student argue for 20 minutes with a patient about whether or not they were ambulating enough. His actions inspired me to make a top 10 list of mistakes that I've seen students make during their clinical rotations: 

  1. Arguing with a patient:
    This is an exercise in futility, and is very unprofessional.

    “One of your role's as a physician is to invoke a shared decision making process with your patients who have decision making capacity.” 

  2. Reporting a physical finding without actually observing it:
    I've even seen a student get in trouble for documenting a physical finding on a patient who had been discharged already.

  3. Berating (aka “pimping”) your resident or attending:
    Med school is similar to the military when it comes to respecting your place in the chain of command. Attendings “pimp” residents and med students. Residents berate med students. Thou shalt not berate up the chain. That said, the institutionalized nature of “pimping” does not absolve the word of its offensive and unethical practice. Eradicate it from your vocabulary and practice.

    “Most of the time it is to show power, how smart they are and embarrass those lower in the "Hierarchy". If  residents and attendings really want to teach, than have a real discussion of the issues.  Yes, ask questions but don't berate someone if they don't know the answer. Good attendings approach it like that, and if a student or resident doesn't know the answer, they are told to look it up. 

    A few times, when I was a student, a hotshot resident would try to "pimp" me and they had the wrong answer and tried to correct me. I looked up a relevant article and proved my position. There is nothing wrong with that, as long as it is done respectfully.  

    Medicine is a life long learning experience. Everyone can learn something new including residents and attendings. Don't automatically discount someone’s opinion because they are lower on the hospital chain. A student might have a Ph.D. or master’s in some field and truly knows more about a subject than the resident or attending.” 

  4. Disrespecting the nurses:
    Seriously, this is a huge no-no. If you want to make your life miserable, make the nurses hate you. If you want to enjoy your time at the hospital, befriend every nurse you meet.

  5. Dressing inappropriately:
    Dressing appropriately is important, and applies to men as well as women. For example, no sandals, no jeans, no T-shirts (unless they're under scrubs), a mohawk wouldn't go over well, nor would wearing 4-inch stiletto heels, or a need to exhibit one’s cleavage.  There's a time and a place for everything, and the hospital is not a place to dress provocatively.

    “Include personal hygiene. Use your dental floss and brush your teeth. Patients do not deserve a doctor with bad breath. Poor personal hygiene raises doubts in the minds of all about whether you are scrupulous about everything else.” 

  6. Documenting an important positive finding without alerting your resident or attending:
    If you discover that a patient has rebound tenderness, or a temperature of 103.7, don't write this in a note and walk away. You must always alert your higher-ups to significant findings, or else you will find yourself getting chewed out for a good while.

  7. Showing up late:
    This is a particular pet peeve of mine, and one that some students seem to think is insignificant. People notice when you're late. It's unprofessional and disrespectful to the rest of the group. Traffic is not an excuse. Leave your residence early enough to get to the hospital with plenty of time to spare. 

  8. Performing a procedure without having been authorized to do so:
    If the resident walks in on you placing a central line on a patient without their authorization, you will find yourself in deep trouble with the doctor, hospital, and potentially a courtroom.

  9. Forgetting you are in a hospital:
    This is something that is easier said than done. We spend so many hours in the hospital that it's easy to forget that we are surrounded by very ill, helpless, and frightened people. It's not a high school football game; it's a hospital.  Patient’s lives are in the hands of the healthcare workers surrounding them. We are each one of the healthcare workers.

  10. Being a slacker:
    We all have seen students who try to get by with the bare minimum in everything they do. If you want to throw away a ridiculous amount of money, not learn anything, and end up being a crappy doctor, then by all means slack off during your clinical years. If you want to learn a lot and become an incredible doctor, then put in the time and effort.