As student doctors across the country prepare for their first clinical rotation experiences, PNWU Osteopathic Medicine Scholar Katie Ackerman offers five tips to maximize the potential of third year.

“Once third year starts, our focus switches to real people; patients with real concerns,” explains Student Doctor Ackerman. “Suddenly, you have an opportunity to make a real difference.”

Year three of medical school is quite a change from first and second year.

In our first two years, we spend every waking moment cramming new (and sometimes obscure) information into our brains. Once third year starts, our focus switches to real people; patients with real concerns. Suddenly, you have an opportunity to make a real difference.

For me, that change was a breath of fresh air. It was a reminder of why I chose to pursue a career in medicine.

The first time I walked into an operating room (OR) as a medical student was a surreal experience.

I had been in ORs before – both as a patient and shadowing – but somehow this was different. This time I would be involved in the surgery. Of course, the classic elegance of the OR was nowhere to be found. This was a cesarean section, which we were performing during our lunch hour.

We arrived to the OR having run from clinic. Again, this was day one day of the rotation…

I put some knee-high shoe covers over my dress shoes, scrubbed in, and stood there in my gown and gloves, holding the bladder blade, watching as two new lives were brought into this world. It was a magical moment; an adrenaline rush, and more than a little overwhelming.

While the rest of my third year did not have the same drama that my first day did, every interaction and every procedure brought with it a new, exciting, and nerve-wracking experience.

“I put some knee-high shoe covers over my dress shoes, scrubbed in, and stood there in my gown and gloves, holding the bladder blade, watching as two new lives were brought into this world.”

But third year is hard. Every four- to six-weeks, you essentially start a new job. With evaluations hanging in the back of your mind, it is always important to make sure you are putting your best foot forward.

I came up with a few basic rules for myself, which allowed me to excel on rotations, Level 2, and get the most out of each experience:

Rule #1: Treat every rotation as if it’s your favorite specialty.

It doesn’t matter if you have wanted to be a pediatric cardiothoracic surgeon since you were five, you never know what you might fall in love with once you start rotations.

Thankfully, I went into rotations unsure of what specialty I wanted to pursue. I had a sense of what I might want to do, but if I was honest with myself, I wasn’t sure. Even though it was uncomfortable to admit that, I embraced it, and it allowed me to fully invest in each and every rotation.

Rule #2: There’s ALWAYS something to do.

I often saw students from other institutions standing around chatting before surgeries; saying that they didn’t need to help the nursing staff prep the patient because “that wasn’t their job.”

I also heard physicians complaining about the students who chose to take that approach.

So, my advice?

Keep yourself busy.

This might be helping transfer a patient from the OR table to the bed or it could be restocking the exam rooms with clean towels. No job is too “insignificant” for you to do.

With this approach, you’ll not only learn all the ins-and-outs of what makes hospitals and clinics run, but show your preceptors and everyone around you that you are a team player and are interested in being productive and helping.

Rule #3 – Be present.

I don’t just mean physically, although you should show up early and stay late.

Be reachable at all times when you are at work. If you are on call, always have your phone on you with a recognizable ringtone for your preceptor. I am a deep sleeper, and was worried I would miss a call on OB/GYN, so I set the ringtone for my preceptor to be the most obnoxious alarm I could find.

I never missed a call.

Also be present mentally. With a few exceptions, I never studied during the day on my rotations. When I did, I tried to involve my preceptor in the questions I was doing, or discuss a topic I felt I didn’t understand well.

Unless I was on call, I left my phone in my backpack. If I needed to look something up, I could do that on the computer I was using to access the EMR (MDCalc as a web browser version, FYI).

By being present every day, you are studying, and by the time you reach Level 2 dedicated, you will have learned far more than you realized.

Rule #4 – It’s okay to say “I don’t know” …once.

Upon entering your third year, you have an incredible amount of knowledge… most of which is not immediately relevant to the patient sitting in front of you.

It’s okay if you’ve forgotten what patellofemoral syndrome is when your preceptor asks you, but you should – at lunch, at home, or in between patients – be reading or talking about that topic so that the next time you are asked (and there will be a next time) you know the answer.

In fact, you may find that your preceptor is both impressed that you didn’t try to fake your way through something you didn’t know, and that you took the time to learn it. A common line I used when I wasn’t sure of the answer but had a guess was, “I’m not sure, but based on what I do know, this is what I would anticipate…”

Explaining my thought process allowed my preceptors to know where I needed help, and showed them that I really had learned something first and second year. Eventually, I tried to anticipate questions I may get by looking up the next day’s patients and reading UpToDate or other relevant materials based on their chief complaint or history.

Rule #5 – Push yourself, but know when to ask for help.

Third year is all about new experiences, which means you will be uncomfortable most of the time. By the time you get comfortable with one thing, its time to move on to the next rotation.

I never turned down an offer for an experience, even if I had absolutely no clue what I was doing. I’d let my preceptor know and they would walk me through the procedure or counseling session (hello, counseling preteens). This was something that I initially really struggled with.

I was so nervous for my first day of OB/GYN (my first in-person rotation) that I secretly hoped it would all be shadowing.

Spoiler alert: it was not.

My first day, as previously mentioned, I scrubbed in on a twin C-section over lunch in my dress shoes. Later that afternoon I performed my first pap smear. My preceptor was there the whole time, and when I felt out of my depth, he stepped in to help.

The pace at which I learned manual skills and gained knowledge astounded me and taught me that I needed to lean into those uncomfortable experiences. Throughout the rest of my third year, I never said no to an offer to see a patient, do a procedure, or participate in any way.

When I felt like I was in too deep and did not know what I was doing, I chose to ask for help and guidance in completing the task. I think I was offered more opportunities because I was willing to do anything and everything (even if it sounded gross!).

“The pace at which I learned manual skills and gained knowledge astounded me and taught me that I needed to lean into those uncomfortable experiences.”

A few other tidbits

- UpToDate is your friend

- Use the evenings to study cases and conditions you saw that day, questions you missed, and patients for tomorrow

- Use weekends or days off to study for the COMAT, Level 2, and to take some time off and enjoy time with your loved ones.

- A cool surgery website (subscription) is Incision (https://academy.incision.care/login/signup). They have surgical videos and explanations for almost every procedure you can think of. I got a 1-month subscription while on my surgical rotation and it was wonderful. They do also have a free trial if you want to see what one of their videos looks like!

- Try and keep a record of the things you liked or didn’t like on rotations. If you like to journal, keep a journal, or find one of several “rotation evaluation” forms online that go through various questions about that rotation for your reflection (I pulled mine from the AAMC’s Careers in Medicine Page). This will allow you to remember parts of your rotation you might forget (which you will), and you can look back on it to help you decide your specialty or even write your personal statement.

Katie Ackerman

Osteopathic Medical Student - 4th Year (OMS IV)

Osteopathic Medicine Scholar 2021-2022
Pacific Northwest University of Health Sciences

My Five Rules of Rotation