Studying and Clinical Rotations: How to Find A Balance

Unless you try to do something beyond what you have already mastered, you will never grow.

Ronald Osborn, teacher and writer Once again we're talking about balance. This time it's regarding how to find balance during 4th year clinical rotations.  Within the past week, I have switched teams for my Internal Medicine rotation. It has it's advantages and disadvantages and although it's already been five weeks, I cannot honestly admit that I have found a routine just as yet. I will say however, that since I've been on this new team, I have found time to find balance which I lacked initially that I can now apply to the remainder of this rotation and carry on to my next rotation which is Surgery.  When we discuss balance, we evaluate ourselves holistically. We take into consideration our daily personal well being that encompasses our physical, emotional and spiritual make up. With medicine and as students this still applies because as we are doing our best to learn and study ways to properly manage and treat patients, we must also know how to firstly, take care of ourselves and our health.  Let's get into it. Here are 6 tips on how to balance studying and clinical rotations based on my first 2 months of Internal Medicine rotation which can be adapted as you switch rotations.  6 Tips for Balancing Clinical Rotations and Studying  1. Read  As we know, as medical students we tend to learn best not simply hunched over a textbook in a quiet spot with Starbucks and a variety of highlighters, but by actually taking care of patients. This last week I had the pleasure of taking care of doctor, who told me that the best way to learn is by examining patients EVERY day and by taking a good history. By spending the time at the bedside, you are actively learning and this is one of the BEST ways to make knowledge stick. Once you've sat and taken a detailed history and constructed a problem list based upon the presenting complaint and the laboratory values and other investigations results, do your best to READ up on your patient and then go the extra mile and read up on ALL of the patients that are on your team or those admitted to the rotation that you're in at the time. Yes it does sound tedious, but as time is limited and you don't have the luxury of spending 8+ hours a day to study as you would have during the first three years, every minute counts. What I've found that works for me is that after gaining as much information as I can from my patient, I try to access Up-to-Date either by mobile or on the wards and read as much as I can about the patients I am seeing first and then those on the service I am on. After doing this, I make notes or questions and then discuss the assessment and plan with my Senior House Officer or Intern and do my best at actively participating or contributing to the discussion on rounds. Also, reading an hour consistently throughout the month helps reduce the need to cram and allows you to construct a plan of care for the patients on your team.  2. Practice Questions Practice questions may be hard to source during the first few weeks, however they are easy to come by if you do your best to network with those in higher years OR simply by searching the internet for exam questions based on the specific rotation you are in. By getting in the habit of answering practice questions EVERY night, you're exposing yourself to a range of questions, some of which you can even ask on rounds which will benefit everyone on your team.  NOTE: By reading intensely during the first half of the rotation and doing lots of practice questions as well as compiling notes, by the week before exams you're able to simply review your notes and the answers to the questions as well as focus on the more important or weaker areas the week of the exam.  3. Early to bed; Early to rise Trust me, you will want to do nothing more but to sleep at the end of each day. You will be mentally and physically exhausted, however try not to crash every day. By getting to bed early after reading and waking up early you would be able to get some reading done in the mornings. Use your time wisely and as far as possible abandon the thinking that what reading you did not do or complete the night before will be done the next day. It seldom happens and what you'd want to do this year is to tackle the work as it comes rather than letting it all pile up.  4. Take advantage of the down time While on call do your best to get things done. Be it working on your clinical examination skills for OSCEs or completing other tasks that may be required for your school. Accident and Emergency is the ideal place to work on venipuncture, peripheral line insertions, inserting nasogastric tubes an catheters and watching procedures. I was able to get some of these things signed off on, in less than an hour and gained the confidence as well. During call hours, make use of the time you have to read as well and to study, these times are ideal for learning normal reference ranges and interpreting laboratory data.  5. Ask questions Questions are ways by which we learn. Gaining the confidence to ask them on rounds may take time especially if you spent the last three years as a small fish in a big pond (in a class with 200+ students). Moving from a large class size to a team consisting of less than six people can be intimidating at first but it gets easier with time and the more you read. Whatever you do, DO NOT leave questions that you have (and these are those questions you have after reading articles or textbooks) for later. You will forget, another patient will be added to the team and you'll never know the answer. Take advantage of the teams you may be on that consist of interns or SHOs that LOVE to teach, also, don't simply take their word for it either; be sure to find the answer as well as guidelines and practices often change of which they may not have had the time to look up.  6. Don't lose yourself  Be sure to stay true to who you are. Try not to give up the simple pleasures of exercising, health eating and spending time with family. Schedule a day off and do something other than medicine but be sure you're also scheduling time to study, read and practice exams as well.

Unless you try to do something beyond what you have already mastered, you will never grow.

Ronald Osborn,
teacher and writer

Once again we're talking about balance. This time it's regarding how to find balance during 4th year clinical rotations. 

Within the past week, I have switched teams for my Internal Medicine rotation. It has it's advantages and disadvantages and although it's already been five weeks, I cannot honestly admit that I have found a routine just as yet. I will say however, that since I've been on this new team, I have found time to find balance which I lacked initially that I can now apply to the remainder of this rotation and carry on to my next rotation which is Surgery. 

When we discuss balance, we evaluate ourselves holistically. We take into consideration our daily personal well being that encompasses our physical, emotional and spiritual make up. With medicine and as students this still applies because as we are doing our best to learn and study ways to properly manage and treat patients, we must also know how to firstly, take care of ourselves and our health. 


Let's get into it. Here are 6 tips on how to balance studying and clinical rotations based on my first 2 months of Internal Medicine rotation which can be adapted as you switch rotations. 

6 Tips for Balancing Clinical Rotations and Studying 

1. Read 

As we know, as medical students we tend to learn best not simply hunched over a textbook in a quiet spot with Starbucks and a variety of highlighters, but by actually taking care of patients.

This last week I had the pleasure of taking care of doctor, who told me that the best way to learn is by examining patients EVERY day and by taking a good history. By spending the time at the bedside, you are actively learning and this is one of the BEST ways to make knowledge stick.

Once you've sat and taken a detailed history and constructed a problem list based upon the presenting complaint and the laboratory values and other investigations results, do your best to READ up on your patient and then go the extra mile and read up on ALL of the patients that are on your team or those admitted to the rotation that you're in at the time.

Yes it does sound tedious, but as time is limited and you don't have the luxury of spending 8+ hours a day to study as you would have during the first three years, every minute counts. What I've found that works for me is that after gaining as much information as I can from my patient, I try to access Up-to-Date either by mobile or on the wards and read as much as I can about the patients I am seeing first and then those on the service I am on. After doing this, I make notes or questions and then discuss the assessment and plan with my Senior House Officer or Intern and do my best at actively participating or contributing to the discussion on rounds.

Also, reading an hour consistently throughout the month helps reduce the need to cram and allows you to construct a plan of care for the patients on your team. 

2. Practice Questions

Practice questions may be hard to source during the first few weeks, however they are easy to come by if you do your best to network with those in higher years OR simply by searching the internet for exam questions based on the specific rotation you are in.

By getting in the habit of answering practice questions EVERY night, you're exposing yourself to a range of questions, some of which you can even ask on rounds which will benefit everyone on your team. 

NOTE: By reading intensely during the first half of the rotation and doing lots of practice questions as well as compiling notes, by the week before exams you're able to simply review your notes and the answers to the questions as well as focus on the more important or weaker areas the week of the exam. 

3. Early to bed; Early to rise

Trust me, you will want to do nothing more but to sleep at the end of each day. You will be mentally and physically exhausted, however try not to crash every day. By getting to bed early after reading and waking up early you would be able to get some reading done in the mornings.

Use your time wisely and as far as possible abandon the thinking that what reading you did not do or complete the night before will be done the next day. It seldom happens and what you'd want to do this year is to tackle the work as it comes rather than letting it all pile up. 

4. Take advantage of the down time

While on call do your best to get things done. Be it working on your clinical examination skills for OSCEs or completing other tasks that may be required for your school.

Accident and Emergency is the ideal place to work on venipuncture, peripheral line insertions, inserting nasogastric tubes an catheters and watching procedures. I was able to get some of these things signed off on, in less than an hour and gained the confidence as well.

During call hours, make use of the time you have to read as well and to study, these times are ideal for learning normal reference ranges and interpreting laboratory data. 

5. Ask questions

Questions are ways by which we learn. Gaining the confidence to ask them on rounds may take time especially if you spent the last three years as a small fish in a big pond (in a class with 200+ students). Moving from a large class size to a team consisting of less than six people can be intimidating at first but it gets easier with time and the more you read.

Whatever you do, DO NOT leave questions that you have (and these are those questions you have after reading articles or textbooks) for later. You will forget, another patient will be added to the team and you'll never know the answer. Take advantage of the teams you may be on that consist of interns or SHOs that LOVE to teach, also, don't simply take their word for it either; be sure to find the answer as well as guidelines and practices often change of which they may not have had the time to look up. 

6. Don't lose yourself 

Be sure to stay true to who you are. Try not to give up the simple pleasures of exercising, health eating and spending time with family.

Schedule a day off and do something other than medicine but be sure you're also scheduling time to study, read and practice exams as well.