My first day on Hospitalized Adult Care clerkship

Overall, I think today was a good day.

Orientations

My day started off with the clerkship orientation at the University. Most orientations tend to be rather tedious, but the HAC block director livened up her presentation. For example, she interrupted her presentation periodically to ask us trivia questions and threw a piece of candy to the person who answered it first. I got some rice crispy treats for identifying Dr. Leonard McCoy. Another example: she talked extensively about double-plays and triple-plays in baseball as an analogy for the management of patient care as a patient is discharged from the hospital. This was an unexpectedly fun way to start a clerkship with a solid reputation for being difficult and stressful.

I also had a site-specific orientation at Presbyterian Saint Luke's (PSL) hospital, first with the chief medical resident and second with the site director. These orientations were a bit more down-to-business, but both the chief resident and the site director seem very nice and approachable.

We got yet another ID badge, and we got some pizza at the noon conference on pathology. The basic format was the pathologist showing pathology slides ordered by the residents and interns; when he pulled up slides from a new patient, the intern or resident caring for the patient gave a brief clinical history before the pathologist continued. It was very interesting, but I have to admit that I didn't learn too much pathology during that session because I wasn't personally familiar with any of the patients.

Afterward, I finally got to meet my team, all of whom are very nice and seem eager to help me learn. It turns out, though, that I'm starting my HAC clerkship at a time of transition. The intern with whom I was working today will be leaving in two days to become a first-year resident, and a freshly-graduated medical student will take her place.

On call

It turns out that I am on call today on the first day of my HAC clerkship. What does it mean to be on call? The short answer is that my team admits new patients, and we will care for all of those new admits. I am on-call every fourth night. If we don't admit many patients, then the next few days will be relatively quiet. Third-year medical students are required to stay until midnight when on-call, while the interns and residents stay overnight. On post-call days, third-year medical students are generally sent home early after we have completed our clinical duties.

My first impression of being on call was watching the Travel Channel with the team. Apparently, today is a very slow day. They said that for some reason the Summer months are typically slow. This was a good way to get to know the team, even though it did feel weird to be watching TV in the middle of the day.

I did finally get one patient, but this was an atypical patient in that he was being admitted from another department and had already been "worked up." This meant that he had already been diagnosed and treated and that we were just providing follow-up care. My resident had me see the patient anyways, so I took it as an opportunity to practice my History and Physical and my oral presentation. I'm actually glad that it worked out this way, because having zero experience, it takes me a very long time to do a H&P that would take a resident 20 minutes max.

Hidden curriculum versus on-call?

One wrench that was thrown into my day was a meeting with my old problem-based learning (PBL) group from the first two years to talk about the so-called "hidden curriculum." I'll save a discussion of that for later, but my conflict was: Should I go to this hidden curriculum meeting or stay at the hospital since I'm on-call? Both the block director and the site director told me to go to the hidden curriculum meeting, so I went.

But that didn't keep me from feeling like I was making a poor first impression when I told my resident that I was leaving for a few hours. He told me that I didn't need to come back to the hospital afterward since it was a slow night and I could just pick up a patient tomorrow morning. This just didn't feel right to me.

This meeting is run by two new interns. Both of these interns just graduated from CU Denver, and I know one of them from before. As fortune would have it, the second intern will be on my medicine team starting in two days! I told my group leaders that I was on call tonight and what had happened with my resident; they both recommended that I check back in with him before going home.

So after the hidden curriculum meeting, I headed back to PSL and paged my resident. "I know you told me that I didn't have to come back in tonight, but I thought I would check back in to see whether we got any new patients that I could take on." He was surprised when I told him that I was back at the hospital. We didn't have any new patients, but he said that we could go over the H&P that I prepared for our patient from earlier in the afternoon.

This turned out to be super-helpful, especially because at this point I feel like I still have so much more room for improvement in both the H&P and the oral presentation. I got positive feedback on certain aspects of the presentation and helpful criticisms on others. Most importantly, though, I feel that I righted what could have been a poor first impression. After presenting the H&P, my resident more forcefully sent me home early.

Some reflection

Taking a step back, I recognize that I have a relatively high level of anxiety about how I am perceived by my team and by my ability to perform at an education-appropriate level. But I think that this anxiety is normal and helps me to more quickly adapt to my new learning environment. At some point, I will be writing specifically about transitions between clerkships as a third-year medical student.

For now, though, I'm going to spend my energies acclimating to life on the internal medicine service at PSL.