On the Wards: The Unwritten Rules of Clerkship Etiquette

Anna Piazza - Aug 06, 2020
students doing their clerkship

You’re kicking off your clerkships this year, and there’s plenty to finally sink your teeth into as you begin to practice medicine. You’ll round, write notes, place orders, and present patients, as well as learn new skills like suturing and knotting, management of pregnancy, and more. It’s all part of the typical clinical routine, each task with its own standard rules and protocols to follow. 

But some rules of the clinic aren’t always obvious or can be traced back to the books. So, while your studying has most certainly provided a sturdy foundation to stand on, the trick to truly succeeding on the wards requires the subtle art of picking up on the unwritten rules. 

We did some digging and have rounded up the most important unwritten rules of the clinic you need to succeed in all your clerkships.


 

Preparing for the wards or your NBME® Shelf Exams?
Check out our Shelf and clerkship resources.

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Be a team player

While you’ll want to stand out to your attending, remember that success on the wards isn’t yours alone to achieve. You and your fellow students need to support and encourage each other, and by making everyone look good, you’ll look good, too. On top of that, peers who respect and root for you will more readily step up to act as a second set of eyes, ears, and hands when you need it most.

Or, consider it from the other side: stoking unhealthy competition (by talking negatively about colleagues behind their backs or trying to pimp other students yourself) will only work against you. Same goes for not keeping fellow students up-to-date on information they’ve missed, like last-minute shift changes.  More broadly, it only creates a toxic environment and ultimately jeopardizes effective clinical care.

That same team-player mentality should also extend to residents and attendings. Don’t interrupt attendings when they’re taking the time to explain something, and don’t jump in to answer questions directed at a resident just because you know the answer.

Pro tip: Get everyone’s number on the first day and make an effort to keep each other up-to-date on news and other developments.

Never be late to rounds

If there’s one unwritten rule that pops up again and again among clerkship advice it’s that you should never be late to any meeting or appointment. Being late once, even if you otherwise have a perfect track record, will be a lasting mark on your record and what you’re remembered for—for having wasted your attending’s time, as well as that of your fellow students.

It’s not just about being late—it’s about acting like a professional in a professional environment. Being punctual, looking groomed (tip: don’t sacrifice a brush for an extra five minutes of sleep!), and showing respect and kindness to everyone you encounter proves you take the job and yourself seriously. 

Pro tip:  Being in the clinic is being on the job, and that means acting like the doctor you’re working so hard to become.

Say yes to every clinical experience

Whenever an attending asks you to execute a maneuver or tie a surgical knot, always say yes—it’s your chance to step up and try something new, and it’s your job to do the task at hand. Clerkships offer a variety of opportunities to really sink your teeth into practical medicine, and, as a student, you have the advantage of getting to try something out and not get it right the first time. Saying yes shows initiative and enthusiasm, which your attending will remember when it’s time to offer their evaluation. Being involved also allows you more facetime with the patients, which is key to the role that medical students play in establishing a good relationship with care providers.

The willingness to contribute and stay engaged also applies to clerkships you’re not gunning for. Even if you don’t intend to specialize in, say, Surgery, the soft skills, camaraderie, and medical knowledge that applies to that specialty will still be in your interest to learn and master.

Pro tip: No matter what your attending asks you to do, make sure to say yes and throw yourself at the opportunity with plenty of enthusiasm.

Be responsible for your own medical knowledge

You’ll cover a lot of ground between your coursework and clinical work, but for any knowledge gaps that do remain, it’s up to you to be responsible and do your homework.

Read, study, and review using all the reliable texts (like AMBOSS) you know and love during your downtime. In the mornings, look over patient charts until your intern or resident arrives. It’s important that you read your patients’ diagnostics so that you can follow and contribute to every conversation. Knowing everything about your patients is part of the job, and will definitely impress the attending.

On a side note, never misrepresent your knowledge or abilities just to save face. As a medical student, it will be expected that you haven't mastered many items of clinical relevance. Being upfront about this not only creates educational opportunities but also ensures that the insights you do have to offer are best utilized by the care team around you. On top of that, medicine is constantly changing, and being a lifelong learner will always be an aspect of your career.

Pro tip: Showing off what you know is the only real way to impress your attending, so even though your schedule might be tight, don’t neglect your studies.



The unwritten rules to succeeding in the clinic aren’t so hard to follow once you know what they are. In essence, they're about keeping your common sense and professionalism at the front of your mind as you learn on the wards. And when you’re looking for a bit more guidance, you can always turn to
AMBOSS and our clerkship resources.

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