How Can I Be a Self-Starter on Clerkships?

Alisa R. Gutman, MD, PhD

Disclosures

April 15, 2011

Question

Halfway through my third year, I realized that my biggest weakness is that I'm not enough of a self-starter. I am somewhat anxious and shy, and if I'm not asked to do something, I tend to stand around watching. How can I get over my shyness and take initiative without getting in the way or being really obnoxious?

Response from Alisa R. Gutman, MD, PhD
Psychiatry Resident, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

You’ve hit on a common concern for rotating medical students: how to be active and interested without coming off as annoying. Being naturally shy can make it even more challenging to take the initiative.

First, your team knows that medical students have different dispositions. You're not expected to be bubbly if you're reserved or outgoing if you have social anxiety. But one lesson you should learn during your inpatient months is that your home personality should not necessarily match your work personality. Being a professional means knowing how to leave your personal life at home. Likewise, shyness has no place in the hospital as it pertains to interacting with your residents and attendings. To your team, shyness can look like disinterest or even boredom.

Here are some ways for any medical student, shy or otherwise, to become a self-starter during clerkships:

1. Take ownership of your patients. For almost all rotations, you should arrive in the hospital before your intern. By the time your intern is rounding on your patients, you should already have looked up the labs and probably should have seen your patient and written your SOAP ("subjective, objective, assessment, and plan") note. (Ask your intern and resident about expectations for prerounding at the start of each rotation because this varies by team.) I notice and am always impressed by students who seek me out and give me a patient's lab or imaging results beforeI've already looked them up. In contrast, an intern caring for 10 patients will find it irritating when a medical student shows up late and asks for an update.

2. Read about your patients. I'm sure you've heard that your most important teachers are your patients. Medical facts stick better when you've attached them to a human instead of a book. You will look more engaged and active on your team if you know the steps for managing a particular problem. Keep Pocket Medicine with you. Quickly read about the treatment of pancreatitis when you're given a patient with an elevated amylase. That way, when you present to your resident you'll already have ideas about what needs to happen next. For the shy student, it will be even more important to tune up your knowledge base so that you're confident enough to actively participate in discussions about patient care. Being knowledgeable is not the same as being a "know-it-all." But for goodness' sake, don't correct your post-call intern about an esoteric medical fact in front of the attending.

3. Do some scut. Don't be the medical student who thinks he or she is above anything that isn't patient care. A good portion of an intern's time is spent doing patient-based menial tasks. As a medical student, you are practicing to be an intern. I'm not telling you to fetch coffee and make photocopies, but if there is something that you can do to help your team, it will not go unnoticed or unappreciated. Does your team have a complicated patient who's been in the hospital for months? Do a chart review and map out a timeline for the different treatments. Is your intern managing an acute issue during a busy morning? Check the charts on other patients and give a brief report. This will make you a team player, and you will find that your interns and residents do more teaching when they feel like you're part of the team.

4. Make sure you're always doing something. The reality on an inpatient service is that sometimes you're in the way or your team doesn't have a task for you. During those moments, have a book to study or an article to read. Stay within eyesight of your team or tell your intern where you'll be. Take the downtime as an opportunity to write a progress note or look up articles relevant to your interesting patient. Pay attention to social cues and be available.

And let's be clear about something: "sucking up" is always obvious and always irritating. Medical school is grueling and expensive, and I hope you're doing it for the right reasons. If that's the case, then you will probably see each rotation as your one and only opportunity to try out that specialty. I knew I wanted to be a psychiatrist, but I felt privileged during my month as an obstetrician. After all, it's an honor to catch a baby! I also cherished my month as an orthopedic surgeon. (When would I ever get to drill bones again?) Instead of being the student who is acting like you're interested in each rotation, be the person who is interested in every rotation. It will show.

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