11 Important Things I Learned In My Clinical Clerkship

Since my last post on this blog, a lot happened in both of my personal and professional life. One of the biggest milestones for me definitely was passing my oral revalida (a.k.a the oral component of the graduation exam), which added the coveted “MD” to the end of my name.

…And just like that, I finished my last duty ever as a clinical clerk, and said goodbye to the pre-duty-from life (for now).

…And walked out of the arch of the centuries for the second time in my life, during the baccalaureate mass. With less than 20 days till my graduation, I think it’s safe to say I know a thing or two about clerkship know.

Previously, I have discussed the technicalities of becoming a clinical clerk in the Philippines. But this time, instead of focusing on those things, I thought I’d share some of the life lessons I learned about the work, about people, and about myself. I know a lot of the incoming clinical clerks are nervous, excited and maybe even terrified. I hope these will be helpful for you moving forward!

1. You are the least knowledgeable person, and that’s okay.

I know a lot of people who got discouraged during clerkship, because we constantly get reminded by our superiors daily that we know so little. It may happen during consultant’s rounds, or when presenting to a resident who is looking for that one basic detail in the patient’s history that you forgot to ask.

But that’s okay. We all learn as we go. They all did too. Just remember the volume of knowledge we had to go through in med school for 3 years, and how retaining everything from the classroom is impossible.

I recently encountered the quote “Be willing to be a beginner every single morning” and I swear by it ever since. The faster you let down your pride and accept that there are magnitudes of things we have yet to learn, it’s easier to accept. Trust me, you have your confidence built by the end of clerkship. And remember, we are being trained to be good doctors. Don’t take critiques personally.

2. Be an assertive learner.

Keeping number one in mind, it is important to supply our knowledge pool. Of course, studying for topics in advance, say in preparation for a discussion topic, is very important. But take every opportunity to learn.

OB-GYN was my first rotation. I remember during one of the resident’s rounds, we were tasked to discuss the history and the case of a patient to the group. Because we had so little, sometimes none, patients in the team, we got so lenient. We only had a total of two patients in the ward, and none of us could discuss just one of them with mastery, and we were… quite a lot in the group. We were told by the resident that “We always get complains that the clerks don’t learn because there are little patients. But you can’t even present the only two patients we have in the ward?”. It was one of the most embarrassing moments of my clerkship, and I decided to invest more in the patients we handle.

What I learned from that instance was that, you get to learn so much just from one patient. It doesn’t have to be a complicated case. Something as simple as taking a complete history and doing a head-to-toe physical examination, can provide you a lot of learnings. And just studying that one case will make a huge impact moving forward in clerkship.

Similarly with skills, if you have the chance to do an IV insertion, blood extraction, or scrub in the operating room, take every chance. Do not stop when you reach the quota. Yes, it can become daunting, and eventually a chore that is tiring, but skills are something to be honed. You learn by mastery.

3. Be a team player.

This might be controversial for some. But I personally don’t like counting the amount of work I, and others do. I also don’t like having a clear division of task among depending on the post, especially if there are many things to be accomplished (e.g. Only from duty people discharging the patients, or pre-duty people strictly only doing VS for the day). Obviously, if they can handle things on their own, they should be doing everything they can, since that is their job for the day. But some days call for a little help. It might have been a rough duty for the from posts, and doing paper works get delayed. Or maybe the duty posts are having an admission so toxic that they need some aid.

So if you clearly have more work than you can handle at the moment, don’t hesitate to ask for help from your teammates. It is not only for the good of the patients, but also for the team who’ll be having less backlogs of work. Similarly, always ask for your teammates if they could use some helping hands, especially if you see them having a hard time. Whether that’s running errands, or even just helping them out with vital signs, small gestures go a long way.

In the future, as we further in our career as interns, and eventually residents, we won’t be able to say “welp, I’m done with my duty, yung ibang post naman gumawa”. It is a great start to train yourself for good team dynamics.

I was personally lucky to have been blessed with great teammates. They have made my life a whole bunch easier. I hope you get lucky with yours too.

4. Health allied professionals are your…allies.

I know way too many people who treat other members of the healthcare team terribly. Being a doctor does not give you a license to feel entitled. If anything, these veterans in the healthcare teams know way more than a clinical clerk who’s only been in the field for less than a year when it comes to work. Always humble yourself not only to your superiors, but to everyone who’s working with you. Do not alienate them with your attitude towards them. You will be needing them more than they need you. Being able to work with them will make your life a lot easier too, trust me.

5. Do not forget, you are a professional.

You might still feel like you are just a med student, completing requirements to graduate. But the patients don’t owe you anything. Whether you’re a clerk, intern or a resident, your patients will have no idea. And the underprivileged patients just need help from a doctor. Any doctor. And no matter where you work, patients will be paying for the healthcare services they receive, and they expect and deserve nothing less than a professional care. As the first line doctors who see patients, you are the face of the institution. Keep that in mind when you are in front of the patient. Trust me, courtesy and good manners will go a long way. I know this may sound unfair, knowing that we our parents still pay a lot of money for our tuition fee when we work for free, but we knew what we signed up for, didn’t we?

6. Have compassion for your patients, no matter what.

No matter how toxic your day is, be the bigger person. Always learn to understand, especially in front of a sick patient, or their worried relatives. It is normal to get overwhelmed with work. There are days that you don’t even know how you’re gonna go through everything at once. But when when you let the frustration get to you, the patient suffers. A lot of them are at your care because they can’t afford the expensive healthcare system of this country. Think about what they must’ve been through, before thinking about raising your voice at them, or treating them like they are such a burden to your day.

7. Take time for yourself.

As an introvert, I get overwhelmed with the amount of interactions during my working hours. having said that, it’s okay to disconnect from people from time to time. It’s okay not to talk to people after a long day. You’re constantly surrounded by people at the hospital, and some (for me, a lot) “me time” always feels refreshing. Find a something outside medicine that helps you unwind from the hospital stress. Know what works for you.

In clerkship, the line between your professional and personal becomes blurred. You start becoming friends with the people you are working with. Even after your working hours, you might have to make a report, two or three, and to top it all off, you might have to study for an exam. Through all of that, make sure to allocate some time for yourself, aside from resting, which is purely dedicated for your personal use.

8. Make time for family and friends.

“Sorry, duty ako” and “Sorry napagod kasi from ako” will be one of your most used lines in clerkship. Especially if you are having your clerkship in places with no holidays, this becomes significant. If you are an aspiring first generation doctor in the family like me, expect to explain yourself to your family members over and over again.

But trust me, with the pre-duty-from life continuously passing by, time goes by pretty fast. You will be spending less and less time with the people you love, and they are not getting any younger. Some days may feel like you just wanna rest, but sometimes, just showing up and giving a hug may mean the world for your loved ones.

Medicine is hard, and they’ve been there for you the entire time. Don’t forget to be there for them too.

9. Know your (healthy) coping mechanism for stress.

Clerkship is stressful, and sometimes, work may seem endless. So it is easy for us to think to postpone de-stressing, and wait for a the right timing to splurge for #selfcare. Sure, there are some de-stressing that I plan ahead, like the much needed massage or a party to unwind.

But on the day to day, you must know how to de-stress in a healthy manner. Don’t let your stress carry over to another day. Find easy and cheap way to reset your day. Now I know a lot of people turn to food for this, but using food as a reward can be a potentially unhealthy and destructive habit. I personally love to meditate with my favorite music on. Working out has been a good outlet for me too.

10.Remember why you started.

Back when I was a 3rd year med student, I heard about several people quitting or taking a leave when they were so close to finishing clerkship. At that time, I didn’t understand it. I’d usually say “I wish they would’ve just finished med school, they were so close to finishing”.

Fast forward to January, just 5 months till graduation, I felt like I was losing my mind. I was in mid-IM rotation and the pre-duty-from cycle was driving me nuts. I was getting so tired of the environment, the work schedule, and I started thinking if that was what I wanted in my life moving forward. With the overwhelming amount of work and the fatigue that comes after it, it is so easy to find yourself not motivated to get out of bed and head to work. I was crying every morning when I woke up from frustration, and I was just keeping it together until I left to Japan for electives.

At that point, I was so homesick and tired of the pre-duty-from cycle, so going home to Japan for me at that timing came in handy While I was there, I launched this blog, and that help me bring back my drive for this journey again. That’s when I realized that I have to revisit from time-to-time what made me want to be a doctor in the first place.

For me, it was a childhood dream. Even at a young age, I knew what my calling was.

It was my way of helping my family for a better future, and making them proud meant the world for me.

It was for the people in of this country in need, who I wanted to help.

When you lose your way, when you are unimaginatively tired, and when you feel unmotivated when everyone else seems to be just fine, revisit your “why”.

11. It is the best year of your med school

I promise you, if you made it through the first 3 years, clerkship is a breeze. Well, maybe a tornado. But nonetheless, way more fulfilling. It is physically draining, and takes up your time, but the stress and pressure is nothing compared to the past 3 years of constant anxiety of failing a subject. You will feel accomplished when applying the knowledge you’ve accumulated over those years. Everyday has something different to offer, and this year has rekindled my passion for serving the people.

You will be building a lot of incredible memories through clerkship. Everything from the happy ones to the sad ones. The ones that make you grow. The small victories and big losses. The ones you’ll be carrying on moving forward in your life. I could share you my stories, but I’d love you guys to build these unexpected but incredible memories of your own.

The concept of clerkship can be overwhelming. But take it easy, doctors. You have been equipped for this since day 1 of your med school.

Trust me, you got this in the (med) bag.

Happy duty, clerkoids!

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