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Third-Year Med Student Talks About Her First Clinical Rotation

Cassidy in front of a small plane
By Vivian Mason

Meet Cassidy Stout, 2nd Lt, U.S. Air Force/Class of 2021

The first rotation cycle for third-year medical students at the Uniformed Services University (USU) recently wrapped, including Cassidy Stout’s first-ever rotation of five focused weeks of inpatient Internal Medicine at the Washington DC Veterans Administration (DC/VA) Medical Center. She talks about her experience and what a student encounters on the road to becoming a physician.

Studio head shot
Q. How were you feeling the night before you were about to go into your first rotation?

A. I was slightly stressed. I worry a little bit about things, like most people in med school, I suppose. Yet, oddly, I was also more relaxed than I thought I was going to be. I was thinking that I can’t be too hard on myself during these rotations. I told myself, ‘You’re going to be learning a lot, and you’ll need to be open to that.’ I also reminded myself that this is what I’m training for because I’m not a doctor yet. I have a lot to learn. There’s such a huge learning curve in the transition from academics to clinical medicine that you cannot get bogged down by it or else the experience won’t be beneficial.
Cassidy’s Tip: Mentally prepare as much as you can and do your best. Try not to be extremely hard on yourself.

Q. Did you have any preconceived ideas of what the rotation experience would be like?

A. A lot of us didn’t know exactly what to expect going into rotations. I guess everyone felt a little unsure, but this is to be expected with any kind of major change, such as transitioning from pure academics to a clinical setting. It’s the first time in a hospital for many people, and I had heard that the Internal Medicine rotation was one of the more difficult ones.

Q. Did you feel prepared?

A. USU has been constantly prepping us throughout our academic years and encouraging us to keep information in our back pockets for use during clinicals. Our professors did a really good job of keeping things clinically-relevant for what we’d need later on. For instance, we took the Integrated Clinical Skills session, where we applied academic info to highly relevant clinical situations. During each of the modules, there were one or two sessions that would walk you through patient interactions.

Q. Can you talk a little about the inpatient Internal Medicine clinical rotation?

A. I worked with civilians at the DC/VA, which has been a great experience. To give some perspective, as active duty officers, we typically work at military treatment facilities taking care of active duty military personnel and their families. For the most part, the schedules/rotation placements are different for all students. My first rotation was five weeks long. During inpatient Internal Medicine (there’s also an outpatient Internal Medicine rotation), I was at the hospital six days a week. I’d get there around 6:30 a.m., read about my patients, go over any lab abnormalities or any overnight events, and then I’d go see them. I wouldn’t leave the hospital until around 5 or 6 p.m., or sometimes 7 p.m., depending on how busy we were. Yes, I was tired, but it was a different kind of tired. I was mentally stimulated all day, every day. Just to give a bit more detail, after seeing my patients in the morning, I asked them about how they were feeling that day. The information I gathered would make me think, ‘Well, the current differential is x-y-z, but does the info I just collected change anything about the differential? If my patient is not feeling well today, what can we, as the inpatient team, do to better manage that?’ Going into the rotation, I wasn’t sure what the residents were expecting of me regarding patient planning, management, and oral case presentations. I had some anxiety about it. However, the first resident I had talked with me and my colleague. He explained his expectations for our level and how he wanted us to do our oral presentation on rounds. Expectations were set the very first day. We were all very grateful that the resident took the time to talk with us. I like to be prepared, and I like to plan. So, I did as much of that as I could. Inpatient Internal Medicine is very heavy on teamwork. Medical students work closely with the interns, fourth-year students, residents, and attending physicians on each patient they see during the day. Typically, medical students will carry one to three patients, sometimes even four. I had the pleasure of working on my inpatient Internal Medicine rotation with a USU colleague. We each had our own separate patients, which enabled independence while also fostering mutual support. I really did enjoy the team aspect of inpatient Internal Medicine.

Q. What was it like to work at the DC/VA?

A. I feel extremely fortunate to work at the DC/VA. I’m still there for my outpatient Internal Medicine rotation as well. Inpatient Internal Medicine at the DC/VA was challenging, but great, too! We took care of people who were retired or discharged from the military. There were a lot of different things to consider when dealing with that particular aspect: their PCS (permanent change of station) status, their military history, any exposures they had from combat areas, etc. There are some extra aspects that you have to stay up on, especially when questioning patients with a military history. For example, if a civilian patient came in with a lung problem, you probably wouldn’t be thinking that they he might have been exposed to Agent Orange. However, for the DC/VA patient, you might consider this a possibility and include it in your differential/analysis. Also, the patient population that I saw was older, which enabled exposure to extremely involved disease processes.

Q. Did confidence come easily to you during this rotation?

A. I saw a lot of change in the way my confidence grew. However, I knew that USU had prepared us for this rotation. There is always more room to grow, and the only way to go from here is up. I knew going into this process that I wasn’t going to be perfect, and have always been open to criticism and feedback.

Cassidy posing in front of a USU sign
Cassidy’s first day at USU as an MS1. (Image credit: Courtesy of Cassidy Stout)

Q. Did you find doing the oral case presentations difficult?

A. On rounds, presenting patient information is more like “just the facts, please,” with your interpretation of the findings following at the end. The preceptors taught us a very systematic way of presenting information. It is important to have a consistent way of presenting your patient’s information so that you’re comfortable with that particular way. Every physician who you report to is going to be different and may want certain things to be present in your presentation style. So, you may just have to learn to tweak your presentation style on every rotation. If this is something that you practice regularly and get good at, you’ll look very strong. In rotations, your preceptors, residents, interns, and attending all want you to be a fantastic “reporter.” I practiced doing my oral presentation with a med student colleague, as well as with the interns. The first week, I did a lot of practicing. I was still a bit nervous on rounds. But, after practicing for a few weeks, I felt a lot better. Really, it’s trial and error, and practice, practice, practice. Eventually, you get more efficient.
Cassidy’s Tip: Students should take every opportunity to practice presenting. Practice doing it the same way every time so that when you get on the wards, you’ll be able to do it effectively.

Q. Do you remember your very first patient?

A. Absolutely!!! My first patient had metastatic cancer, but he had a great attitude. He was the kind of person who’d say, ‘Whatever you need to do, let’s do it. I’m going to get through this.’ When he was assigned to me, I felt very overwhelmed. I would see him every morning. I didn’t exactly know the order of how I was to do things, how to ask my questions, how focused the physical exam needed to be, etc. However, the intern I was working with did a fantastic job of walking me through what he expected of me and what I should be doing for the patient. I enjoyed following this patient for a week and then actually seeing him return to the DC/VA during a later point in my rotation for a follow-up treatment. The bonds you make with patients during inpatient Internal Medicine are special.
Cassidy’s Tip: Inpatient Internal Medicine was a lot, and I was constantly thinking. There was never a moment in the day that I wasn’t thinking about my patients or what was going on with them or how I could better manage their conditions. It’s a very rapid-paced specialty. Be ready for it!

Q. Can you discuss that relationship?

A. When talking with patients, I try not to be too uptight. I strive to remain professional and respectful. I got to know my first patient very well. I carried him for probably one week and was sad when he left. We had conversations about his smoking and that he smoked the same cigarettes as my grandmother. It was those kinds of things that I really enjoyed during inpatient Internal Medicine because you had time to develop a nice relationship with the patient. Later, I saw him when he returned for radiation. He had regained some weight. We had a conversation….just talking about life. For me, that’s why I really enjoyed this rotation. I had the opportunity to develop relationships without crossing that patient–doctor boundary. It gave me a chance to help patients feel like they were really cared for. It’s something that everyone can work on, but Internal Medicine gives you ample opportunity to let that part of you shine.
Cassidy’s Tip:  Relationships are something you can work on. It’s all about communication, mutual trust, and understanding.

Students walking through the white coat ceremony
Cassidy walking toward the White Coat placement at the 2018 White Coat Ceremony. (Image credit: Courtesy of Cassidy Stout)

Q. Did you have time to study during the rotation?

A. It was hard to have a consistent study schedule during inpatient. I studied based on what I saw during the day, which is a common way to study on inpatient. For example, my first patient had metastatic lung cancer. Therefore, I read up on that when I went home. When I was on rounds the next day, I was able to answer more questions about lung cancer. When you’re on rounds, they’re going to ask you questions. You do your oral presentation and then they ask questions until you don’t know the answers, which is the way most rotations work. The questions are designed to help you learn. If I saw something that day that I didn’t really know a lot about, I would watch a lecture on it, do practice questions about it, then hopefully the next day be more prepared on the subject. Sometimes, the resident might task you with things to look up and present along with your oral presentations the next day. This facilitated learning and the ability to study in a different way. In general, seeing patients is an amazing way to learn about different disease processes. It can be easier to think about that process as it related to your patient when it comes to exam time.
Cassidy’s Tip: There are a lot of assignments that you’ll just have to do. They take several hours because you have to also do literature reviews, which is also a great way to learn. Be prepared to manage your time efficiently during Internal Medicine.

Q. Overall, how do you think your first rotation experience went?

A. It was a fantastic experience!!! I really enjoyed the rotation. I have a long way to go. I wouldn’t say that I’ve perfected anything. I still have a lot to learn, to study up on, and to practice. There are many things that I can really work on. Toward the end of the rotation, I was able to better manage my patients and explain things to them. For instance, I could describe to patients why they should be taking a certain medication or seeing a certain specialist for follow-up. I could explain what would happen if they didn’t take the medications or not follow through with their new consult. I discussed the pathology and diagnosis in a way that the patients could understand. I was really happy to see the midpoint and final feedback evaluations. We get feedback from the preceptors, interns, and residents. The amount of growth that I experienced between the midpoint and the final was tremendous. I was personally proud of that because I took the feedback that I received at the midpoint and really tried to apply it to what I was doing, and it showed. USU sets us up for success. The people we work with on our clinicals are simply fantastic, and we have great teachers who’re always willing to answer questions to help us better ourselves as aspiring physicians.

Q. Have you gotten any flashes within that rotation of truly seeing yourself as a doctor?

A. Definitely. Being able to explain to a patient why he’s in the hospital, why we’re doing the management the way we are, and how that affects his life is important. I think the connection between medicine and the person’s actual life is happening a lot more. I ask my patients: “What are your other concerns? How are you getting home from the hospital? What else can we do to make your stay more comfortable here?” All of these extra things make medicine more humane. That has been the key to me seeing that, “Yes, this is the right profession for me.” And, seeing a patient smile when I walk into the room is priceless. Being able to really tap into that humanity was a real aha moment for me. This is what I was meant to do. I felt as if my actions were actually making an impact on someone else’s life, which is the reason I went into medicine.