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Success in the clinical year
Introduction to the clinical phase
Welcome to the clinical phase of your education! This year is the critical link between being a student and graduate physician assistant (PA). Through the guidance of your preceptors, faculty, and peers, you will have many opportunities to apply your newly acquired clinical knowledge and skills in the patient care environment. The transition into the clinical phase is often exciting but also anxiety-provoking. Students with previous clinical experience may yearn to cut the cord of the didactic year in favor of the freedom and autonomy that the clinical year offers. Others, who have embraced the structure, organization, and comfort of the didactic year may have palpitations thinking about starting a new rotation every 4 to 8 weeks. This chapter serves as a roadmap for PA students entering their clinical year and provides tips for success, regardless of the rotation type.
Understanding the anatomy of the clinical setting is crucial for success during clinical rotations. In a teaching hospital, a student may encounter fellow PAs as well as medical students (MS) and physicians ( Table 18.1 ). From the lowest to highest in the medical hierarchy, there are MS-3s, MS-4s, interns, residents, fellows, and attending physicians. When approaching an unknown practitioner, it is recommended that you assume they are at the highest level (attending) until told otherwise. Other important professionals include the charge nurses (in charge of the hospital ward, emergency room, or nursing home), scrub nurses (in charge of the operating room), case managers (advocates for the patients) and administrative staff. Each of these team members will impact your education during the clinical year and should be treated with equal respect. Oftentimes, the character of a student can be determined by the way they treat the other members of the team. Being kind and respectful to everyone will reap benefits and provide you with extra learning opportunities.
Table 18.1
Medical staff definitions.
| Title | Function |
|---|---|
| MS–3 MS–4 |
Third-year medical student Fourth-year medical student |
| Intern | The first year of training after graduating from medical school. Interns may rotate through various specialties. |
| Residency | 3 or more years of specialty training after the internship. Length of residency varies by specialty. |
| PGY–1 | Postgraduate year 1 or first year of residency. |
| PGY–2 | Postgraduate year 2 or second year of residency. |
| PGY–3 | Postgraduate year 3 or third year of residency. |
| Chief resident | Senior resident that assumes a leadership role over the team of residents, interns, medical students, and PA students. |
| Fellow | Physician who pursues additional years of training (typically 1–5 years) in a subspecialty after completing residency. |
| Attending physician | Physician that provides leadership over the medical team. The attending is ultimately responsible for the care delivered by the medical team. |
| Hospitalist | Physician that works primarily on the inpatient medical units. Can be employed by the hospital or an outside medical group. |
| Rounds | Medical team visits to hospitalized patients (usually in the morning) to discuss the care plan. |
| House Staff | Providers, often resident physicians, who care for patients under the direction of attendings. “House” refers to the hospital. |
Setting and managing expectations
You are far more likely to have a fun and rewarding experience if you set realistic expectations for the clinical year.
Understand and embrace the physician assistant student role
A clinical year student is a guest in a preceptor’s “home.” The preceptor’s priority is, and always should be, the patient. Teaching students may be a second priority at times. If you start the clinical year with this expectation and with your focus on the patient, you and your preceptor will have a common goal. You will be a good team. Remember that it is a privilege to care for patients. Take a moment to acknowledge the power of your position and the opportunities afforded to you to make a positive impact on the lives of others. Practice humility and concentrate on the patients and their needs.
Avoid the pitfalls of perfectionism
No one is perfect. You will be wrong this year, so prepare yourself. Be humble and admit when you don’t know the answer. Stating “I don’t know” shows honesty and humility. When you are uncertain of an answer, let your preceptor know that you will research the answer and will report back once you have completed the task. Your focus should not be on grades but on improving your skills in patient care each day. Clinical rotations offer the opportunity to incorporate all of the knowledge obtained in your first year into real patient interactions. The didactic year provided a great foundation of medical knowledge. In the second year, you will build on your foundation by applying your knowledge. Don’t get discouraged: keep reading and volunteering to see challenging patients. Be confident, even in situations that scare you.
Make learning your first priority
Students find many demands on their time in the clinical year. Overscheduled clinics, long commutes to a clinical site, and call responsibilities may decrease the time available for formal study. Therefore it is critical that you schedule time to study for upcoming cases, assignments, patient logging, presentations, and your end of rotation exams. Make a study schedule and keep it. Find resources you can rely on during the year ( Box 18.1 ){which should include Figs. 1 to 8 .} Although you may become overwhelmed with the demands on your time, remember that the clinical year is short. When you are tempted to leave for a nonessential appointment or because you are not “feeling it” today, remind yourself that your time as a PA student is short. Even if your preceptor says it is fine for you to leave for the day, consider staying longer if there are still learning opportunities to be had. What is more important than seeing patients and learning medicine this year? Everything else can wait.
Box 18.1
Must-Have Phone Apps and Quick References
Suggestions for phone app use on rotations:
- 1.
Download material when possible; Wi-Fi is unreliable.
- 2.
Select two or three go-to apps.
- 3.
Review the smartphone use policy of the institution and use proper etiquette.
Be flexible
Flexibility is an essential personal attribute for any medical provider. Fortunately, you will have ample opportunities during the clinical year to practice flexibility. The PA program will make changes to your rotation schedule. The preceptor you have been looking forward to working with may suddenly leave their job. The rotation may now require you to work nights and weekends, interfering with a planned event. Instead of focusing on the disappointment, actively look for ways in which the change may present a new learning opportunity. No rotation, site, or preceptor will make or break your career. Remember that PA school is short and that even if you are unhappy in a particular environment, you will soon be off to your next rotation.
Avoid spoilers
Each student has their own experience with rotations. Avoid being influenced by other students’ experiences. Start each rotation with an open mind. Actively work to develop your own experience at that site and in that specialty. Although another student may not have enjoyed working with particular preceptors, you may find their teaching styles mesh well with your learning needs. Realize that circumstances change, personalities interact in different ways, and staff changes from month to month. If you come to the site expecting a bad experience, you are likely to see that expectation fulfilled. You may find that certain students in your class complain about every rotation, whereas others seem to find interesting opportunities and positive experiences at each site. Strive to be a member of the latter group. If you do, you will find the year more educational and enjoyable.
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