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Developing Practical Clinical Competence During Clerkships

A group of medical students on clinical clerkships examining x-rays.


Clinical rotations, or clerkships, are crucial in medical education, bridging classroom knowledge to real-world patient care settings. During clerkships, medical students have the opportunity to develop and refine essential clinical skills under the guidance of experienced healthcare professionals. While much can be learned in the classroom, it’s not until you step into the role of a healthcare provider and learn medicine as an apprentice that you can truly master the practice. In this blog post, we will explore the skills required for successful clinical rotations, strategies for developing clinical competence, and the benefits and significance of participating in clerkships.



Skills Needed for Clinical Rotations


Success during your clinical rotations can be measured in many different ways. Objectively, students often turn to their clinical grades. These are primarily composed of evaluations from their residents, fellows, and attendings, as well as their shelf exam scores. Subjectively, however, students can measure success through confidence levels, ability to treat specific conditions, and the level of responsibility they can handle during the rotation. As a result, there is a vast array of skills that are needed to succeed during your clinical training. These include (but definitely not limited to):


Communication Skills


Effective communication with patients, families, and healthcare team members is essential for building rapport, gathering medical history, explaining treatment plans, and ensuring patient understanding and compliance. When working with patients and families, you want to ensure that you are being thorough with the information you are providing, but presenting the information in a way that is easily understandable given their medical knowledge. You also want to practice patient-centered care and include them in the decision-making process. When communicating with other healthcare providers, you need to be thorough, but also efficient.


Clinical Reasoning


The ability to apply medical knowledge to clinical scenarios, analyze patient data, formulate differential diagnoses, and develop evidence-based management plans is critical for effective patient care. As a medical student, your residents, fellows, and attendings will not expect you to know everything! However, they want to see that you are reading about your patients and understanding their entire medical history, diving into the primary literature to learn more about the most up-to-date treatments and diagnostics, and also preparing for yourself shelf examinations as information on these tests is directly applicable to the patient care. Your supervisors do not expect you to know about the intricacies and nuances of clinical medicine. Rather, they want you to demonstrate a foundational understanding of the core concepts in their area of medicine.


Physical Examination Skills


Proficiency in performing thorough physical examinations, including inspection, palpation, percussion, and auscultation (among other maneuvers) enables accurate assessment of patients’ health status and identification of physical findings relevant to diagnosis and treatment. Importantly, knowing how to efficiently and accurately convey your physical exam findings is another often overlooked skill. You should present your physical exam with precision. How you present your exam will often shape how you structure your differential diagnosis, assessment, and plan. An accurate physical examination and presentation of these findings are crucial for excellent clinical care and demonstrating your skills as an independent healthcare professional.


Procedural Skills


Competency in performing common medical procedures, such as venipuncture, wound care, suturing, and basic life support measures, are less essential components that medical students are expected to demonstrate during their clerkship. However, for those hoping to go into a surgical specialty, the skills will be assessed to a higher degree than in less procedural specialties like internal medicine.


Failing With Grace


You will undoubtedly make many mistakes as a medical student. This is normal! Your residents, fellows, and attendings do not expect you to know how to properly manage a patient at this point. However, we want to see you try!


When you are presenting a patient and are talking about diagnostic or therapeutic strategies you wish to pursue, give it your best shot! Say that you want to treat the patient with X treatment and justify why. Even if you are wrong, it is OK! We will appreciate that you are trying. We prefer this approach rather than simply listing off every possible treatment option that exists for a certain condition and not actually thinking about and deciding which one is best for the patient. Give it your best shot! If you are wrong, you will learn how to do it correctly. Take nothing personally, and remember that in order to know how to do something correctly, you need to know how to do that thing incorrectly.



Developing Clinical Skills


Developing clinical competence during clerkships involves a combination of hands-on experience, active learning, self-reflection, and feedback from preceptors and colleagues. As a medical student, you need to actively engage in patient care activities, including history-taking, physical examinations, bedside procedures, and patient rounds, under the supervision of your attending, residents, and other healthcare providers. Even if you are rounding on a patient that you are not following, pay attention! There is always something to learn from a patient, even if it is the fifteenth case of acute decompensated heart failure you have seen this week.


Solicit feedback from preceptors and colleagues regarding your clinical performance, communication skills, and clinical reasoning. Constructive feedback provides valuable insights for identifying areas of strength and areas for improvement. Importantly, you should seek feedback at multiple times throughout your clinical rotation, to ensure that you are progressing at an appropriate rate. Often, medical students only seek feedback at the end of rotations, and if they receive negative feedback, they no longer have the opportunity to improve their performance. Seek feedback early and often.


Additionally, you should supplement your hands-on experience with self-directed learning. This includes textbook readings, online resources, case studies, and medical simulations. Prepare for clinical encounters by reviewing relevant medical guidelines, protocols, and evidence-based practices. If there is downtime during the day, read about your patients and their medical conditions and resources like UpToDate. Lastly, reflect on your experiences by critically analyzing clinical encounters, identifying learning points, and setting goals for professional growth. Regular self-assessment promotes continuous improvement and enhances clinical competence over time.



Benefits of Clinical Rotations


Almost all students prefer their clinical years of medical school over their didactic years. Not only are these years more engaging, but this is your first experience serving as a healthcare provider! Participating in clinical rotations offers numerous benefits for medical students, including:


Hands-on Experience


Clinical rotations provide firsthand training in patient care, allowing students to apply theoretical knowledge to real-world clinical settings and develop practical skills.


Professional Development


Clerkships offer opportunities for professional development, including refining communication skills, clinical reasoning abilities, teamwork, and leadership skills under the guidance of experienced healthcare professionals. If you find a resident, fellow, or attending that you look up to, try and foster a relationship with them. Ask them about their path to where they ended up, and seek out career advice from multiple different people.


Exposure to Specialty Areas


Rotating through different clinical specialties exposes students to diverse patient populations, medical conditions, and healthcare settings, helping them explore potential career paths and make informed specialty decisions. Even if you enter your clinical year knowing that you want to do neurology, keep an open mind! There is always something to learn when you are in the hospital. Something you learn on obstetrics and gynecology may make you a better neurologist! You never know.


Networking and Mentoring


As mentioned above, clerkships facilitate networking opportunities with attending physicians, residents, and other healthcare professionals, fostering mentorship relationships and providing guidance and support for career development. State your personal and career goals to your superiors and ask them to connect you with leaders who can help you grow.


Patient-Centered Care


Learning to prioritize patient needs, preferences, and values in decision-making and care delivery.


Interprofessional Collaboration


Understanding the importance of teamwork and collaboration among healthcare providers from different disciplines to optimize patient outcomes. Importantly, you must learn how to work effectively with nurses, pharmacists, respiratory therapists, physical therapists, occupational therapists, and more! Medicine is a team sport.


Cultural Competence


Recognizing and respecting cultural diversity and its impact on healthcare beliefs, practices, and outcomes.


Professionalism and Ethics


Upholding ethical principles, maintaining patient confidentiality, and demonstrating professionalism in all interactions with patients, families, and colleagues.


Clinical rotations are valuable experiences that enhance students’ readiness for residency training and future clinical practice. Participating in clerkships enables students to experience patient care, develop clinical skills, and show dedication to medicine. Admissions committees for residency programs consider clinical rotations as an essential, if not one of the most important, component of applicants’ qualifications and evaluate candidates based on their clinical experiences, performance evaluations, and letters of recommendation.


In conclusion, developing practical clinical competence during clerkships is essential for medical students’ professional growth and readiness for clinical practice. By honing essential clinical skills, actively participating in patient care activities, seeking feedback, and reflecting on clinical experiences, you can enhance your skill set and excel in your future role as a healthcare provider. Clinical rotations offer invaluable opportunities for professional development and personal growth, shaping students into competent, compassionate, and well-rounded physicians prepared to meet the challenges of modern healthcare.

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About the Author

Dylan Eiger, MD/PhD Candidate

In 2016, Dylan Eiger graduated Cum Laude from Duke University with a BS in Chemistry with a concentration in Biochemistry. Matriculated in the MD/PhD Duke…

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