The “Secret” to a Successful Clerkship

What is the “secret” to a successful clerkship? It is something that may seem obvious, but I’ve found is all too easy to forget under the crushing stress of a third-year clerkship program. The “secret” is seeing, talking to, and examining as many patients as you can. I love applying an athletic mindset to medicine, and just as professional NBA players hone their craft by practicing their jump shots and moves over and over again, we need to do the same as medical students by seeing as many patients as we can.

I know it’s not sexy, but it works. Today was a wonderful day as it was the last day of my week of ophthalmology. However, what made it such a great experience was that due to the flexibility of the Integrated Community Clerkship program at UBC, I was able to spend a couple of days in the office before beginning my ophthalmology week seeing patients in the office and the operating room. This made the week much more educational since I was able to master the basics of the instruments like the direct ophthalmoscope and the slit lamp.

The first day at the office I felt unequivocally useless, which was quite demoralizing. I talked about this before in my last post  (why everybody sucks at everything in the beginning). I find that this is the point where it’s easiest to give up. But in reality, it is the most important time to keep going forward. As many of my preceptors say, the only way to know pathology is too see so many normal variants that when you see/hear something abnormal you know something is off. The same holds true for examining the optic disc with a direct ophthalmoscope.

At first, I felt as if I should just ignore ophthalmology as it seemed I could never hope to see the optic disc (the raised disk on the retina at the point of entry of the optic nerve). However, as I kept trying and chipping along, I finally saw my first optic disc and it was such a rush! Then, the patient moved their eye and I couldn’t find it again. I realized, maybe I wasn’t instructing the patients appropriately and that is why I was having such a tough time finding it. I continued trying to locate every patient’s optic disc. After I’d seen my 100th patient, I’d made a multitude of various adjustments in my technique that have drastically improved my accuracy and efficacy.

One of my biggest mistakes I’ve noticed, like many of my peers, is that I seem to only want to examine patients with pathology, since it is so fascinating. However, what I have learned firsthand by seeing the serious changes that occur with uncontrolled glaucoma is that you can’t appreciate pathological optic discs until you have looked at hundreds of healthy optic discs. The same applies to mastering any other clinical skill.

Yes, it is important to sharpen our fundamentals by learning from books, but don’t forget that even though medical school (and undergrad) can make us think medicine is all about exams, it is really all about serving our patients. The best way to be able to serve patients is to master our craft by seeing and examining as many patients as we can, regardless of if they have pathology. As a medical school clerk, our role first, is to learn (as long as it doesn’t impair patient care) and then, as a secondary benefit, to help our preceptors to increase productivity and the number of patients seen. So I remind myself to take my time, be thorough and do all those cool physical exam maneuvers we learned in our first two years of medicine. The vast amount of learning the art of medicine does not occur with our textbooks but is a shared experience with our patients.