Travis Crook, MD, still remembers the day when, as a third-year medical student on Neurology rounds, there was a patient who had a urinary tract infection, and the attending neurologist didn’t know which antibiotic to use to treat it. So, the doctor called for an infectious disease consult. Crook knew which antibiotic to prescribe, but he didn’t speak up.
“‘Who am I to tell my attending neurologist that I think I know how to do this?’” he thought at the time.
Years later and now a pediatrician, Crook said he regrets not saying something. He could have spared that patient a potential delay in care as well as the expense of a consult. In medicine, patients always come first, Crook said, and so his advice to medical students is to get over any anxiety they may feel and share their questions and medical knowledge with their supervising doctors anyway.
“If you think you can contribute to patient care, you should speak up,” he said.
For medical students, it might be hard to know exactly what to expect during the clinical years, the past 2 years of medical school where students start seeing patients regularly.
Medical school is a time to learn, a time to make mistakes, and a time to grow from them, said Crook, now associate dean of Student Affairs at The University of Texas at Austin Dell Medical School. He worked for years before this role directly supervising medical students during their clerkships at Vanderbilt University School of Medicine, Nashville, Tennessee.
“The joke that we talk about is like 90% of being successful in clerkship the first time you’re exposed to clinicals is showing up and smile,” Crook said. “And honestly, that’s not far from the truth.”
“If you’re doing those two things, the rest of it honestly will fall into place.”
But some doctors have a different viewpoint. It’s a hard question because there are different perspectives on what makes a “good” medical student, which varies from person to person and specialty to specialty, Annelise Silva, MD, said.
“I think generally qualities like resourcefulness, initiative, excitement to learn, receptiveness to feedback, and general engagement in the material are valued highly across all members of the healthcare team,” said Silva, president of the American Medical Student Association and a recent medical school graduate.
“But this is really a generic sort of thing, and that is one of the more difficult parts of experience in the clinical years,” she said. “Many students are graded subjectively by preceptors, but how one preceptor might grade ‘professionalism’ might be completely different to how another preceptor grades ‘professionalism.’”
We asked doctors and medical students about how to make the most of their medical education all while making a good impression on their supervisors. Here is what they said.
‘Are You Switched On?’
The first thing supervising doctors notice about medical students is how engaged they are, Crook said. “Like, are you paying attention? Are you switched on?”
He looks for medical students who are asking questions and actively processing new information.
“When it comes to patients’ lives, there is no such thing as a dumb question,” Crook said.
“If you see something wrong, but that is the way it has been, that doesn’t mean it is the way that it should be,” Silva said. “Ask questions. Ask why, and don’t be afraid to explore it.”
“I think attendings really like it when you’re enthusiastic and ready to be there, and especially keeping in mind that you don’t have to be right. But you do have to have reasoning for why you’re doing something,” said Lindsay Kohan, a fourth-year medical student at the University of Maryland School of Medicine, Baltimore.
Jump In
Medical students should try to take part in the clinical experience fully, experts said.
“The best piece of advice I received in medical school is that success in medicine is really how you define the education that you need,” Silva said, “meaning, education doesn’t happen to you; it is what you seek it to be.”
It can be tempting to blend into the background and try to stay out of the way, said Nidhi Goel, MD, but try to resist that. “It’s not what doctors want. We want medical students to take a proactive approach to learning,” she said.
She recalled the beginning of her surgery clerkship when she had felt scared about making a mistake in the operating room. The attending surgeon met with her and other students.
"He was like, ‘you know, your job here is not to be invisible. It’s to really get involved and shape your learning experience. And if you don’t, we’re not going to come find you and beg you to learn, right? Like, this is your show,’” Goel recalled him saying.
What he said was “unbelievable impactful,” she said. It freed her up to accept that she might make mistakes, and that’s OK. Goel is currently the director of the Medicine Clerkship for third-year medical students at the University of Maryland School of Medicine.
Making mistakes is part of the process, Crook said. “It’s a time where you should be making mistakes so you can learn so you don’t make them later on.”
‘They Deserve All of Us’
Doctors have a duty to serve their patients, Crook said. Medical students are part of that. If a student is just there to get through the day, it shows, and patients pick up on that. That’s not acceptable, he says.
“I think when we are caring for our patients, they deserve all of us, our fullest,” Crook said, adding later, “I want them to be present in the moment, sharing with that patient, sharing that specialness of what that patient care bond looks like.”
One of the third-year medical students on the pediatric rotation recently sat for over an hour with an adolescent patient who had symptoms of recurrent cannabis use but was reticent to talk about it with the medical team.
"And ultimately, that patient was able to more effectively engage in her care plan because the student took the time to sit with her and meet her where she was,” Goel said.
“We can teach medical knowledge, but those softer skills are the things that oftentimes matter more to our patients than even the knowledge that we share,” she said.
Asking for Help
The clinical years can be challenging. Crook’s advice to students who are putting in the effort, showing up, working hard, and still not clicking with the work is to ask for help. We have them come in and talk through things and possibly send them for testing, he said.
Sometimes the solution is to develop an organizational system and stick to it. “The granularity of detail that you have to keep track of — while still seeing the bigger picture at the same time — is just really hard,” Crook said.
And sometimes there is more to work through.
“I can’t tell you the number of times that I have had students who have [been] newly diagnosed with learning disorders, dyslexia, things like that they never knew they had” because it had never been unmasked before, he said. In terms of remediation, the first step is determining where the issue lies.
The students who just soldier on and don’t want to admit weakness “are the ones who are going to really struggle,” Crook said. “It’s the ones who start saying ‘you know what, this is harder than I think it should be. What’s going on? Let me talk to somebody.’ Those are the ones who will ultimately come out very successful in the end.”
Becoming the Doctor You Want to Be
Most medical students are engaged learners, and they want to be there, Crook said. But how do they shape themselves into the doctors they want to be?
His advice is to keep two notebooks, one in a favorite color and one in a least favorite color. In the first notebook, students should write about supervisor qualities that they want to emulate. In the other notebook, they should write down behaviors that they want to avoid doing. Then in 3-6 months, try reading over the writings.
Students may be surprised to find how often they actually do both the behaviors they most admire and most detest, he said. These notes can also help them define and ultimately become the physician and person they want to be, he said.
As a medical student, Crook wanted to emulate a senior-level resident who had an exceptional ability to understand patients.
“And so, it really shaped how I have approached patient care,” Crook said.
He wanted to avoid becoming so specialized that he would not be able to treat basic things like a urinary tract infection (like the attending neurologist who called for the infectious disease consult). Doctors have neighbors, and they can get called to help with emergencies on airplanes, which has happened to him. It’s important to “have enough of that foundation of knowledge of all the disciplines” to be able to have a sense of what’s going on in situations like that, he said.
But “there’s no one way to do things,” he admits about how to become the doctor you want to be. Medical students need to find their own “true north,” he said.
“What’s your moral compass that’s going to lead you to what being a physician means to you?”