7 EXPERIENCES TO BE SUCCESSFUL IN A CLINICAL INTERNSHIP IN THE US
I have gone through a formal training program in medical school as well as a residency training program in the US. And now, I am a clinical instructor for medical students.
That’s why, today I want to share with you these things from the perspective of someone who has experienced and gone through the path that you are on.
And now Now I am in the position of being a person who comments and evaluates students. And when I was a student, I also really wished that someone had shared it with me and pointed it out to me.
That’s why, today I want to share it with you again to help you avoid unnecessary mistakes and be successful right from the first time when working with your instructor.
1. CHANGES IN THE USMLE EXAM
As you all know, recently there was a new rule that the USMLE – Step 2: Clinical Skills (CS) exam was eliminated. And besides, USMLE – Step 1 is also transferred to a pass and fail system and scores are no longer as important as before.
As such, clinical instructors’ evaluation comments become more important than ever. Perhaps you are worried that if you only depend entirely on the evaluation comments of your clinical instructor, there will be inadequacies.
For example, it’s a subjective matter of evaluation, if the instructor doesn’t like you, they can give you an evaluation that could affect your future while you apply for boarding, for example.
Or if If you are a resident doctor in the US, connecting and creating a good relationship with your clinical instructor is also very important. Because these doctors will also be the ones who write letters of recommendation for us when we look for a job, or enroll in a more specialized program such as a Fellowship.
This is also a big obstacle for many Vietnamese students and doctors, because of the obstacle in the ability to communicate in English and the Vietnamese cultural environment is different from the cultural environment of foreigners.
That’s why today I want to share with you all The secrets that I know help you get these Insider Tips so you can be more successful on your path.
2. BE ACTIVE IN YOUR LEARNING
The first secret to being successful in a clinical internship is to be proactive in your learning.
Whether you are a medical student or a resident doctor, you should consider it a blessing for you to go to school, go to the clinic, go to the hospital, and work with clinicians every day. It is also an opportunity for me to learn and improve more.
I study to study for myself and my future, not to study for grades or to study for a clinical instructor. The reason is because they have already become clinical instructors. They have already succeeded.
If you study well, it’s good for you. If you study poorly, it’s a loss for you.
If you have this proactive mindset, you will feel much more comfortable. I feel like I’m building for my future. And when we have that mindset, we won’t feel like others are holding us back, or that others are trying to make our lives more difficult.
For example, you are on duty in the hospital and have a case that is difficult to get into. And instead of feeling
“Oh! This case is so difficult and why did the teacher give me this case?”
Then you should think:
“Oh! The teacher gave me this case is a good opportunity for me to learn and I can understand more so that in the future when I become an independent doctor, if I encounter such difficulties, I also have the experience of going through them before during my time in school.”
When you are still in school and under the guidance of a current clinical doctor, you should feel that it is a blessing. Because when we start being independent doctors, you will have to take 100% responsibility for all the patients you care for.
And then it will definitely be more difficult. If you have a question or concern, you won’t have someone who can help you answer your questions as easily as if you were a student.
If you are still a resident doctor, at that time, although you have the opportunity to practice, have the opportunity to learn and try to make diagnoses, as well as treat patients, the ultimate responsibility is still the responsibility of the treating doctor, who is your current clinical doctor. So that is also something that you should feel lucky about at the present time.
So what should we do to be proactive in our learning? One thing that I feel is very useful for students and resident doctors when entering a specialty that is unfamiliar to them is to read about at least 5 to 10 common cases in that specialty.
For example, if you are in an obstetrics department, you should know what taking care of pregnant women during pregnancy entails, what diagnostic tests there are, what ultrasound is like, and what cases are very important in that specialty.
For example, pre-eclampsia, difficult births, cases requiring cesarean section. These are the basic things that you should know, and you should set a self-study schedule for yourself.
You should also know what you need to learn in this specialty, and you have to divide your time to learn most effectively. Because if you don’t have such a clear schedule, it will be very easy for you to fall behind.
Because every day when you’re tired from clinical practice at the hospital or clinic and you go home, it’s very easy to throw your bag down and you watch TV or you do something relaxing and don’t want to think about studying anymore.
That’s why if you You just need to set for yourself that every day we need to read about half an hour or an hour and do it consistently every day, then you will be much more successful in that clinical internship.
3. LEARN THE NEW SCIENCE CAREFULLY BEFORE STARTING
Each clinical practice specialty is a different environment and they have different requirements. Therefore, you need to know everything possible and related.
For example, what is the duty schedule and daily work schedule, what are the final assessment requirements? You will have to take a test or your score will depend entirely on the instructor.
The more you know, the better prepared you will be. Even things like where will you eat, where will you sleep, what kind of uniform will you have to wear for that specialty.
For example, when I’m on duty in the hospital, I’ll often wear scrubs and blue hospital clothes, and then outside, I’ll wear my blue shirt. But when I go to practice at the clinic, I have to wear very formal and polite Western clothes, and outside, I wear a blouse.
Each major will have different requirements.
If you practice family medicine with me, for example, your work schedule will follow office hours from 8 a.m. to 5 p.m. But if you practice for a hospital, or you intern in an emergency room, you will work 12-hour shifts.
Usually in America, people will work 12 hours: 6 am to 6 pm, or 6 pm to 6 am. And you won’t have to work every day, but in a week, for example, you’re only on duty 3 days.
In the US, both students and resident doctors have to be on duty at many different hospitals, not just one hospital. That’s why each hospital has different systems. I still remember that between my 1st and 2nd year when I was studying in medical school, I had a month of clinical internship in the countryside, also
4.5 hours drive from my home and this clinical internship course was mandatory for all medical students to get acquainted with the suburban and rural environment of America.
It was the same when I practiced as a resident doctor. I also have two months where I am required to go to a rural area to do clinical internship there.
And when I went to a new hospital like that, their way of working was different from the hospitals I was used to. And their electronic medical record system is also different from the electronic medical record system that I am using at the current hospital, so I also have to learn and get used to how they work there.
A few things that I find useful to be able to learn more about the results of the clinical internship I am about to go are
First, I can email and contact the coordinator of the internship course. clinical. And, I asked them if I was going to enter this clinical internship course in the near future, what instructions or documents did they have for me to refer to before I went.
The second thing was that I discussed with those who had gone through and done that clinical internship course and asked them what their daily work consisted of and what was the schedule like?
What are the things I should pay attention to, what should I do? What can you do to please the clinical instructor there, and what should you avoid and what should you do?
Some specialties require students to have an orientation day, which is a day to get acquainted with that specialty. In the US, each clinical internship course usually lasts 1 month, and at the beginning of each month we will change to a new clinical internship course.
Some specialties require students and resident doctors to do an orientation from the previous month, which means that at the end of last month, we have to go and do the orientation for the following month. Some other specialties use the first day as orientation, but in some more difficult specialties, they want to be ready from the first day they enter.
Therefore, if you learn clearly and prepare in advance, it will be beneficial for you. On the first day, you will not feel confused and can catch up with everyone in that specialty more easily and have a better start.
4. THINK FROM YOUR SUPERIOR'S PERSPECTIVE
This is also a very important secret that I want to share with you.
If you are a medical student, your supervisor may be a resident doctor or the main doctor instructing you. And if you are a resident doctor, your supervisor is Attending – the doctor who is your main instructor.
If you can understand what they want, what they need, and what they fear, you will be much more successful in your clinical internship.
Now let’s give a simple example. What is the thing that makes your clinician most worried and afraid?
It is a bad outcome for the patient, misdiagnosis, wrong treatment given leading to poor outcomes. This will affect their reputation, their credibility as well as the consequences, as well as the possibility that they may be sued in the future.
Therefore, it is your responsibility as a student or a resident doctor to help your clinical supervisor avoid these risks.
Because one thing you need to understand is that once a clinical instructor guides you, it means they are responsible for everything you do. They are taking more risks when they let you talk to their patients.
Often, medical students and residents will be the first people a patient meets when entering a hospital or clinic. Therefore, you are the face and the person who creates the first impression of the clinic for your hospital and clinicians.
So you need to try your best to create this good impression on the patient. Therefore, your task is to create a good impression with the patient that will make for a smooth future conversation with the clinical instructor.
Besides, taking an accurate medical history is very important. This will support accurate diagnosis as well as provide the most effective treatment course for that patient.
If you are a medical student, you should also find out and ask your clinical instructor: what do they expect from you? For example, if you are a first or second year medical student in the US, the scope of your responsibility is to take the most accurate medical history and report back to the instructor.
If you are in your third or fourth year or are already a resident doctor, the requirements will be higher and your instructor will want you to do more than accurately take a medical history.
After that, you need to make a diagnosis as well as provide an assessment of the patient’s condition at the present time and come up with an effective and appropriate treatment plan for the patient in this case.
When you report to your clinical supervisor, you must also put yourself in the clinical instructor’s position: what do they want, what do they want to hear, what do they need?
Usually, clinical instructors are very busy and they have a lot of tasks and when they listen to your report, they want your report to be short, concise but very complete and accurate.
If you want to learn more about how to report your medical history to your doctor, please comment “Yes” to me. I will make a more detailed video on this topic for you. Because this is also a very important issue.
I have encountered many cases when students gave me very long and rambling reports. That made me feel unhappy and created a bad impression of me for that student. And I feel like that student hasn’t really done their tasks well, and I feel like that student isn’t really good, hasn’t really understood the problem, and hasn’t really understood this case.
When we report in such a discursive and unfocused way, it makes the listener feel very angry, very bored, and impatient, and from there they will have a bad opinion of us.
They will have bad reviews: I don’t know whether I really understand the patient or not, whether I really know the medical knowledge or not?
Although maybe you know, maybe the student knows, but when we cannot convey that information to the listener in a concise and concise way, the listener will have a bad view of us.
5. BECOME A USEFUL PERSON IN THE TEAM
This is very important even if you are only a first or second year medical student, or if you are a third or fourth year medical student, it is even more important.
So how can we become a useful member of our team?
The first thing is that you need to clearly understand what the purpose of your team is.
In a medical environment The sole purpose of that team is to take good care of patients. This is the goal of the attending physician, the resident physician, the nurse, as well as all other members of the care team.
You must take this goal to heart and do everything possible to help your team achieve this goal.
So how can we best care for patients?
The best way to care for patients is to think from the patient’s perspective. Think that if you were a person going to the doctor, you were a person having to be hospitalized, what would you want, what would you need?
What do you expect and if there is something you can do within the scope of your ability as a student or a resident doctor, then try to do the best you can?
Because when you try like that, the effort and time you spend and the results you achieve will definitely be seen and understood by your primary physician.
Let me give you an example.
Currently in my clinic, I am the main instructor and I have medical students come to practice with me. For every patient, after I finish examining that patient, I will write an instruction in English for that person and print it out and give it to that person to take home so they can review it if they forget something.
For example, if a doctor says something but they don’t remember everything and they forget, they will have that sheet of paper to read and refer back to. And after I’m done with that one patient, I’ll move on to another patient. Because there are so many patients, I have to move very quickly from one clinic to another.
And when I finish writing the summary, I will print it out, but there are some cases where the printer has some problem and it cannot print. And when I go into the clinic with a new patient, my nurse will usually take that piece of paper and bring it to the patient and help them leave.
One thing that the students who come to work at my clinic do that I really like and have a good impression of is that they help me print that piece of paper, then take that piece of paper and give it to the patient to help the nurse with those tasks to the extent they can do.
Nursing has a lot of work to do, so when those students do that, I’m very happy and my nurse is also very happy, and also likes that student very much.
It’s very simple things like that, but it makes a difference between a student who makes a good impression and another student who just comes and goes for a day, then goes home, without any concern. if you work without your mind in it, your instructors – your superiors will also see it and they certainly won’t say anything, they certainly won’t have any demands on you.
Those who are kind will still say, they will even share with you
“Oh! You should do that, it will help everyone, or you should try to do this or that.” There.”
But people don’t like you and they don’t say it, but they give you bad reviews or they will be more strict with you in their evaluation.
Evaluations are often very subjective and based on emotions, so if you can do something that will help your instructor as well as the entire team, then you should do.
That way it will be better for me.
6. ACTIVELY ASK FOR EVALUATION FROM YOUR INSTRUCTING DOCTOR
Please proactively ask your supervisor for comments and evaluation right from the first days of your internship.
I have a student and he does something that I really like. That was the first day that friend came to work with me in my clinic, and he proactively asked me:
“Miss, I want to do well in these internship courses. And I want to know what you want from me, what you want me to do and what standards are there in your assessment for me. If you can tell me, I will try to complete the tasks well.” that.”
A week later, when she had worked with me for a week, she continued to ask me. She said:
“Miss, I have been working like that for the past week, do you have any comments?
Do you have anything you want to guide me?
What do you think I did well and what didn’t work well?
And where can I do better, please share with me.”
And then in the middle of the class, he asked me the same thing. And he also informed me that in the near future, the class will send me a form so that I can give him feedback in that form. Let me know that I will receive such a form so that I can prepare and write for him.
The things that this student does make me feel very happy and I feel that he has a sense of initiative in his learning and that he has the will to progress. You want to try to do your job better.
Perhaps you also have the will to progress, perhaps you are also a person who tries very hard and wants to succeed in your clinical internship.
But you feel a bit shy, you feel a bit self-conscious, you feel scared, you don’t share those things, you don’t dare to ask questions to your clinical instructor, then invisibly you make the other person feel:
“Oh! I don’t know if this student really cares about my studies or not, but I don’t see any questions, I don’t see any interest. I don’t see any move to ask for feedback from the teacher.”
I share this with you to help you avoid this unnecessary mistake. Because I firmly believe that when we go to school, everyone wants to do better. But the important thing here is that we convey those messages, that we make the other person understand us better.
Therefore, please be proactive, don’t hesitate, ask, and share these things with your clinical instructors. I’m sure your clinical instructor will give you a plus sign for that.
7. WHAT TO DO AFTER ASKING FOR REVIEWS
After you receive evaluation comments from your instructor, what should you do?
When you receive these evaluation comments, try to take notes, pay close attention to these things – the things your teacher shares with you and try to change as quickly as possible.
And when you change like that, continue to ask your teacher if you have changed like that and I think it’s okay.
Once the teacher gives you honest comments and assessments, it means they care about you, and they are thinking about your future. They are giving out the things they have experienced and they want me to achieve the same, so they share with me so much.
Sometimes in the comments and sharings of my clinical instructors, I hear that I feel dissatisfied or that I don’t agree with them, so I often ask them if they feel that I am that way, why it’s wrong, and how it’s wrong, or what I have to do to improve.
And when the teachers share with me, they are dedicated and attentive. Please pay attention when sharing carefully because you should know that these are teachers who are dedicated and dedicated to you.
Because actually sitting down and talking and sharing those specific things with you takes a lot of time on the part of the teacher and when the teacher shares those things, they only want the best for you.
Actually speaking, whether you are good or bad doesn’t have much impact on their life or their future career.
And if you learn, and you grow, and try to get better day by day, it will only benefit you. Therefore, please accept those comments and reviews with an open mind and ask yourself a question in your mind:
“With this information, with these comments, what should I do to be better, what should I do to achieve my goals of becoming an independent doctor?”
8. GET Familiar with the ELECTRONIC MEDICAL RECORDS SYSTEM
In the US, almost all clinics, hospitals, and medical centers have used electronic medical record systems.
Usually these electronic medical record systems are very powerful and have very special details and functions.
And the key is to leave on time every day, or have to stay an hour or two after work to complete your medical records. That’s because you can use it in the most effective, flexible, and time-saving way for you.
I still remember the first day I became a resident doctor and during my family doctor training program, I did a clinical internship in the hospital. Every morning I will go in early to look at the patient’s medical records from last night, go to the room, and then have to write the medical records.
Everything needs to be completed and adjusted within a very short time of just two hours, before the clinical instructor arrives. He will just need to look over my medical record and just sign that medical record in just two hours like that.
But I have to look at medical records for 5 to 6 patients. All of these patients are new patients, there are a few old patients but most are new patients who were admitted to the hospital last night.
And I have to read their medical records and I have to review and evaluate and make a plan for today about what we need to do, which patients can go home, which patients have to stay to continue treatment, which patients need to call for consultation, and many other issues.
I also have to go to the doctor, my hospital is very large and the patients are scattered on many floors, many different areas and I have to move very quickly from one room to another very quickly.
After that, I have to write the project alone and everything needs to be done very quickly within 2 hours. The first few days, I found it very difficult to do everything in a short period of time. I felt confused when the instructing doctor came and had to present the medical case to him. I was also not confident about my medical records when I submitted them to him.
Besides, there are also days when I am the one responsible for carrying the payture. In my team, there will usually be three resident doctors divided to take care of patients. For example, I will take five patients and the other two will each have five patients or all four patients or all six patients, for example.
We’ll take turns carrying the payture when the payture gets too loud and I have to drop everything and I have to answer the phone.
For example, if there is a patient in the emergency room reporting that this patient needs to be hospitalized, I must be the one to run down to the emergency room to be admitted to the hospital. Therefore, the amount of work is very large, requiring me to work quickly, efficiently, and save as much time as possible.
At that time, if I still had to sit and tinker and find out what the electronic medical records were like, where I had to find the test results, what happened, where the supporting results were, it would take a lot of time.
There are also some patients transferred from other hospitals and I have to find their records to provide the most accurate diagnosis and treatment results. See what treatments the patient has tried and is there anything that might affect future treatment?
Those tiny things, those nameless things, take up a lot of time and like I said, as long as the instructor will arrive on time, the resident doctor’s responsibility is to have everything neat, complete, and done so that it can be presented and reported to the instructor.
Not only must resident doctors learn these things, but even medical students must become familiar with these things when they go to practice.
For example, third and fourth year medical students in the US will also do clinical internships in hospitals like that. And if it’s a resident doctor, they are responsible. For example, if there are five patients a day, medical students are encouraged to get used to it and start taking on one to two patients a day and be responsible for those two patients.
However, if you can get the hang of it and you can do the work, you will be better off and you will get better reviews from your resident and chief clinical instructor.
If you want to hear about my experiences during my time as a resident doctor, please comment below. I will share more with you about these experiences.
