Before I started medical school, I was curious about what students do on a daily basis in the clinical years, and more specifically the Clinical Trunk. I understood I would work with patients and professors, but what does that look like? Now, I know schedules depend on the clinical environment; inpatient services, outpatient clinics, surgical, procedural, and emergency services all run differently. Students experience all of these settings and are part of the medical team in each one. The Clinical Trunk is filled with profound connection and learning from real-life experience from patients, guided by teamwork. In order to help shed some light on the daily responsibilities of a clinical student, I want to share my experiences on a recent Friday of the Pediatrics clerkship.
5:00 am- Good morning! I like to ease into my day, so I eat oatmeal while reading an article in the New York Times. Then I wake up my critical-thinking brain by sipping coffee and watching a video on Sketchy Medical, which is a medical education review program.
5:45 am- Walk to Mott. From my apartment in the White Coat Area, it is a brisk, 10-minute walk to the closest hospital entrance. Once in the hospital complex, I head to C.S. Mott Children’s Hospital, passing through different patient care areas, clinical departments, and research facilities.
6:05 am- Arrive to team room and pre-round. I am part of a general Pediatrics team during the inpatient portion of this clerkship. The medical team includes one attending physician, one “senior” resident who is in their second or third year of residency, two interns who are first-year residents, one Branches “sub-intern” who is a medical student who completed the Pediatrics clerkship last year and now has more clinical responsibilities, and two Clinical Trunk med students. The residents and students work together in our team room, our home-base. Spending time in the team room leads to some of the most entertaining moments of clinical year; shared clinical experiences can bring people together.
In the morning, we start by pre-rounding, which means reviewing the patient’s chart for overnight changes, checking in with the overnight team, and walking over to the patient’s room to talk about how they are feeling and to examine them. After gathering all this information, I synthesize my assessment of how the patient is doing and draft a treatment plan for the day. This morning routine is one of the most important learning experiences of the day because I challenge myself make clinical judgments and practice deciding what diagnostic and therapeutic options I would suggest to the patient if I was in the position of the residents and attendings. Next, I review my ideas with the intern and the senior resident. When our plan aligns, I am receiving feedback that my clinical reasoning skills are improving. Often, residents have additional treatment considerations, and I learn from their explanations and update my plan. This learning process is iterative each time the team receives new data about the patient, whether that is a new set of labs or information the patient shares about their values.
8:30 am- Start patient-centered rounds. The rounding team is large and multi-disciplinary, including the medical team, a pharmacist and pharmacy students, a dietitian, a Care Coordinator, and a Resident Assistant. This morning, I have a question about a side effect of my patient’s medication, so as we wait for the team to assemble, I chat with the pharmacist and pharmacy student. Next, in most specialties, students and residents propose the plan to the attending, the team discusses the treatment options outside the patient’s room, and then we enter to discuss with the patient. In Pediatrics, the team enters the patient’s room for family-centered rounds first, and the entire process occurs with the patient and their parents. Family-centered rounds promote shared-decision making, and they are also an excellent challenge for medical students to make sure we explain our thoughts in ways that everyone can understand.
10:30 am- Finished rounds (early today). The team “census,” or number of patients that we are taking care of, happens to be a little less than average. I hope that means kids in the area are safe and healthy! The larger team disperses to work and the medical team heads back to the team room. Now it is time to carry out the plans that we discussed on rounds. I page the Speech Language Pathology team about one of my patients, and they call me back to talk about how they can help. After I finish the discussion and check-in with the intern, I work on my patient’s daily progress note and share it with the residents when I’m done. Our attending physician returns to the team room and spends a half-hour teaching us about a research subject that came up during rounds; the evidence for and against car-seat angle testing before babies are discharged from the hospital.
11:30 am- Lunch break. My Clinical Trunk student partner and I head to the Mott Cafeteria. I bring my lunch and he buys, so we meet outside to eat. We talk about politics and family. My peers have diverse past experiences, and I love learning about their perspectives. After finishing off an afternoon coffee, we head back to work.
12:15 pm- Afternoon work. The intern and I review the progress note that I wrote and then we share it with the attending. Next, I check in with my patients and their families. With one patient, I sit on the floor and play with toy farm animals while I chat with the patient’s mom. We talk about how the patient was initially diagnosed with several conditions at birth, and I learn about her perspective on the patient’s progress. After spending time with this family, I take a walk around the floor with one of the school-age patients and their mom. It feels rewarding to be able to learn more about the patients beyond what I can read in their medical chart.
1:45 pm- Education. Our team carried out our plans for the day, and we await another admission. One of the interns teaches me about common pediatric gastrointestinal concerns. The Speech Language Pathology team that I consulted earlier calls back to discuss their suggestions, and I chat with them and then share their suggestions with the intern.
2:30 pm- Walk home. On Fridays, like today, clinical students have educational lectures, so we leave the clinical world early. If we did not have lectures, I would have stayed until the senior resident sends the students home, usually around 4-5 pm or after we complete an admission.
3:00 pm- Pediatric learning session, Zoom edition. Usually these lectures are conducted in person, but due to the COVID-19 pandemic, we are adapting to Zoom versions. During the first hour, we review pediatric developmental milestones (Do you know how many words a baby should be saying at 18 months?) and then we discuss pediatric rashes.
5:00 pm- Chat, eat, study. Lectures are finished and my roommate arrives home. She is also a Clinical Trunk student, on a different “track” than me, which means her clerkships are in a different order. She’s on Internal Medicine now. I love having a med student roommate; it feels so refreshing to talk and laugh together, and having a friend at home helps me to be socially connected during demanding studying times. After we chat, I heat up leftover spaghetti and study for the Pediatrics shelf exam. The shelf exam is a test that takes place at the end of each clerkship.
7:00 pm- Short running break. I need a study break, so I decide to go on a short run. There are many places to run in Ann Arbor, including my favorite route that winds through the White Coat Area and Island Park. I am not a great runner, but it has been a convenient “high-yield” (a favorite medical student adjective) way to stay active. The last part of my run faces the hospital. I always look up and feel inspired by all the patients, providers, and staff inside at that moment, who are collectively working to help patients go home comfortable and healthy.
7:30 pm- Back to studying. I return to studying practice questions.
9:00 pm- Talking time. I call my significant other via Google Hangouts. Since it’s Friday, I do not have to wake up early the next day, and I look forward to a long chat. He lives and works in California, so we make long-distance work by talking each day. Our calls are a source of support and encouragement during the successes and stresses of medical school. We also visit each other on switch weekends, which are the weekends between different clerkship rotations when I do not have studying obligations. I am so proud that while we work toward our professional goals, our relationship has strengthened.
10:00 pm- Bedtime. Time to catch some rest! I look forward to a Saturday of studying, followed by having dinner with my family in the evening.
During a typical inpatient day, I learn through clinical practice, didactic teaching, and independent study. Some days have more time dedicated to rounds and others have more direct patient care. What remains constant is the opportunity to learn about caring for patients and to work with talented teammates toward a common patient-centered goal. Studying and activities that support my well-being are also personal priorities. Whatever the schedule, bringing an eagerness to learn and an open mind to each encounter allows me to build on what I learn each day to become a caring and thoughtful physician.
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Paulina is a rising M3 in the Clinical Trunk. One of her career priorities is advocating for more inclusion of diverse patients and providers in the health system. She also enjoys ballet, art, and sipping coffee outside on a peaceful morning.