The Osmosis Ultimate

Guide to Clinical Rotations

Version 1. Created August 2023.
 The Osmosis Ultimate Guide
to Clinical Rotations
Contents

The Osmosis Ultimate Guide to Clinical Rotations 1

Contents 2
Getting Started with Clinicals 4
Preparing for Clinical Rotations 5
Expectations and Responsibilities 5
Managing Communication 5
Before Your First Day 6
The Dress Code 6
Communication Skills 7
Understanding Team Hierarchy 8
Interacting with Patients 10
Basic Skills 11
Clinical Rotation Basics 12
Rotation Types 12
Getting the Most from Your Clinical Rotations 13
Roundsmanship 15
Outpatient Versus Inpatient Expectations 16
On Writing Notes 17
What to Expect During Your Shift 18
How to Prepare for Away Rotations 19
Should you do an away rotation? 20
How many away rotations should you apply for? 21
Clinical Evaluation and Feedback 22
Giving Feedback 23
Getting Feedback 24
When There’s an Issue During Your Rotation 26

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 About Medical Student Performance Evaluations (MSPE) 26
Challenges and Opportunities During Clinicals 28
Finding Work/Life Balance 29
How to Recognize and Avoid Burnout 30
Deciding on a Career Path 32
Finding a Mentor 33
Conclusion 34
Contributors 37

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Getting Started with Clinicals

In the span of four years, the average medical student will learn over 30,000 new words, or the
equivalent to learning three languages. Congratulations on meeting such a huge milestone!

Now it's time to apply what you’ve learned and step into the world of patient care. This
guide will get you through those first days and help you walk into your clinical rotations
with confidence!

It’s important to understand that every medical school, hospital, and clinic has unique
expectations. Some rotations will focus on outpatient clinical settings, while some will occur in
an inpatient hospital setting. And while most schools will administer an end-of-rotation test
for the pre-clerkship rotations, your evaluations during clerkship rotations will likely be based
on the subjective input of the physicians and team members you work with. More intensive
sub-internships (4th year rotations) are evaluated solely on subjective input. You’ve likely never
had a totally subjective experience for evaluation and grading, and it's hard to know how to be
successful under these circumstances. This guide will cover the general “rules of the road”,
with basic guiding principles to get you on the right track.

Remember, no matter your location, you’re continuously learning how to care for patients, and
each day brings its own special set of circumstances and challenges. Give yourself room to
learn, grace to make mistakes, and be open to understanding the needs of others (especially
your fellow classmates).

In this guide we’ll be covering everything (and we mean everything) about clinical rotations,
including:

● Preparing for Clinical Rotations

● Clinical Rotation Basics
● How to Prepare for Away Rotations
● Clinical Evaluation and Feedback
● Challenges and Opportunities During Clinicals
● Deciding on a Career Path
● DIAAMONNDS

Now, without further ado, let’s get started with the most fundamental question to help you
prepare for clinical rotations: How do I prepare for clinical rotations?

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Preparing for Clinical Rotations

Expectations and Responsibilities

Preparation for clinical rotations starts long before your first day. Remember all those basic
science classes and problem-based learning cases? It’s time to apply all of that knowledge to
real people. You’ve dedicated the time to studying and passing USMLE® Step 1. Maybe even
Step 2. For those of you who haven’t, it’s important to plan your exams so that you can focus
on patient care and have your scores ready when applying for residency slots. Requesting time
away from rotation to study for exams isn’t appropriate since all physicians have to take their
board exams and recertifications throughout their career, emphasizing the importance of time
management skills.

Managing Communication

Before you start, it’s crucial to regularly read and respond to your emails, as clerkship
instructions and other important messages will arrive often. Take the time to check your spam
folder to make sure you don’t miss any important information or clerkship instructions. If you
haven't heard from the clerkship coordinator at least three days prior to the start of a rotation,
send a polite email asking for clarification.

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Before starting rotations, check for messages on where to report for orientation at clinical
locations. Orientation days are not repeated, so attendance at the specified day and time is
required. If you can’t attend due to unforeseen circumstances, contact the clerkship coordinator
immediately. Rotations usually have a non-MD coordinator and you should always know who
that person is before you start a rotation (don’t say we didn’t warn you)! Medical school
directories usually list these coordinators, but if you’re unable to find the information, reach out
to an upperclassman and ask for it. Or, if you’re at a new medical school, the Dean of Students
or Curriculum is a great place to begin.

TIP: Make sure to find out who the clerkship coordinator is as soon as possible and make note
of their contact information. They’ll provide you with vital information for your rotation!

Before Your First Day

Make sure to give yourself plenty of time to get familiar with

your surroundings. Before the first day of any rotation,
determine how long it will take for you to commute to the site.
Find out where to park and how long it will take you to get
from your car to the orientation room. Plan to get lost! And,
most importantly, embrace the idea that being ten minutes
early is considered “on time.”

The Dress Code

Unless told otherwise, wear your white coat and make sure it’s clean and wrinkle-free. Stash
an extra white coat in the car or a locker, for the inevitable coffee (or other substance) spill.
Speaking of attire, choose clothing that’s appropriate for the context. There are tons of articles
about assumptions that people will make based on what you wear. You may not agree with
their take, but the first day of a rotation is not the time to make a fashion statement. Keep it
professional.

TIP: Buy at least two white coats and keep the second one clean and pressed in your car (or
locker, if available).

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Note that hospitals and clinics may not have space for you to securely store valuables. The
items you need with you should fit into your white coat pockets or a small bag or backpack.
Avoid wearing your most valued jewelry, watches, or accessories, as they may get stolen. The
last thing you want is to add to your stress by worrying about where you left something
precious. In addition, many clinical settings have rules about covering tattoos, wearing
perfume/cologne, nail polish and acrylic nails (which pose a significant infection risk to the
patient). Get familiar with the policies and adhere to them.

Communication Skills

When you start a rotation, it’s normal to feel like

you’ve entered unfamiliar territory. You won’t know
your way around, the terms people use may be
unfamiliar, and you’ll be uncertain about how things
work. You’ll interact with a lot of different people and

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communication skills are paramount during the initial days of your rotation. Being a good
listener and observer will make a good impression.

Always be kind, especially to those who aren’t on your direct team. For example, the
housekeeping staff can help you find your way around. The Unit Coordinator will often have
insights into the residents’ and nurses’ preferences.

Most importantly, remember that nurses are a wealth of knowledge! Don’t be afraid to
introduce yourself and work closely with your nursing team, not only to learn, but also to give
the patient effective care. By communicating effectively with nurses, you ensure everyone on
the team is informed and aligned, which is crucial. In taking the time to understand how a team
works, you’ll benefit from extra support and will likely earn a great evaluation at the end of the
rotation.

Understanding Team Hierarchy

Maintaining a balance between demonstrating humility and showcasing your knowledge is

often challenging. Get familiar with the hierarchy within the team, starting with the attending
physician to the chief resident, senior resident, intern, and sub-intern.

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The attending physician leads rounds and ultimately has the final say on behalf of the patient.
In some clinics or rotations, you may work directly with a specific attending. However, in many
instances, you may be on a large team with multiple attending physicians (e.g., the emergency
room or ICU). The team will have a lot of say in the day-to-day work and people you’ll work
with.

Residents are the people closest to you in education and can be your best allies. They have key
roles in everyday operations and are the people with whom you’ll spend the majority of your
time. While residents don’t always directly participate in writing your final evaluation, their
input is important to the supervising attending. So, be collegial, respect social boundaries, and
be careful about fraternizing while you're on the rotation.

Always keep in mind that you won’t make yourself look better by stepping all over your fellow
med students or residents. Everyone on the team is working toward the common goal of
helping the patient.

TIP: The attending physicians you work with during clinical rotations are good people to ask for
a letter of recommendation!

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Interacting with Patients

As a medical student, you’ll often have the most time to interact with patients. Patients may
have questions about their disease process and treatment. Always be cautious with your
responses and don’t make any promises on behalf of the team. When the patient has concerns
and questions you cannot easily answer, tell them that you’ll consult with the team. Provide a
timeline for the patient and keep them updated (see example above). Then, be sure to check in
periodically. If there’s a delay, be sure to let the patient know so they’re not concerned if there’s
a “bad” reason you might not be getting back to them.

TIP: Always be cautious with your responses and don’t make any promises on behalf of the
team.

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Basic Skills

Most medical schools offer a basic skill workshop like “Introduction to Medicine” to learn things
like taking a patient’s history and performing a physical exam. There are some procedures that
you may learn in a simulation lab, like starting an IV, drawing blood, and placing a nasogastric
tube or a foley catheter. A lot of skills are taught “on the job” and the residents will often teach
you how to do the skill. Always be respectful of the patient and be sure you know the steps
prior to entering the room.

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Clinical Rotation Basics

Rotation Types

Many schools are transitioning to integrated clerkships, which involve longer clerkships across
various specialties. While the following list encompasses the majority of rotations you’ll
encounter, please note it may not include all the requirements of an individual school.

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There are also specialty-specific rotations including Dermatology, Ear, Nose & Throat (ENT),
Neurosurgery, Orthopedic, Ophthalmology, and Urology (to name a few).

Getting the Most from Your

Clinical Rotations

Embrace your time on each rotation; it

may offer you unique experiences caring
for specific populations like children or
patients with a particular diagnosis.
Remember that you’re not expected to be
a specialist at this point in your training.
Instead, note that the main goals of core
rotations are to develop your differential
diagnosis skills so you know when to
involve a specialist.

If you’re interested in getting experience

in a speciality that’s not included in your
school’s core curriculum, make sure to ask
about opportunities to spend time in that
area. This is a great time to ask your
career advisor or mentor about what it
takes to be competitive in a specialty. The
AAMC Careers in Medicine website offers
a wealth of information about each
specialty’s competitiveness and how to
obtain a residency position.

TIP: Need more information? Check out our How To Choose Your Medical Specialty article from
fourth-year med student and Osmosis Fellow, Elad Eylat.

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No matter which type of rotation, you’ll be expected to present patients. In clinics, you may
present solely to your supervising attending, while you may present to a larger group of people
for inpatient service. You may even present in front of the patient, as patient-centered rounds
are increasingly common. (Don’t worry! You’ve got this!)

Believe it or not, it’s likely that you’ll have the most time and the lightest patient load of
anyone on your team. Take the time to write your daily progress note in SOAP format
(Subjective, Objective, Assessment/Plan) in draft prior to your presentation so you’ve had the
chance to think through the problem at hand.

In addition, always be prepared with the patient’s basic demographic information. NEVER make
up something about a patient that you don’t know. If you’re asked about something you haven’t
checked, simply say that you didn’t check it. If you don’t know something, don’t make excuses.

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Just own it. Because, even though you’re working in a “teaching hospital”, the goal is to keep
the focus on providing the best possible patient care and knowing when to seek input from
specialists.

Roundsmanship

Once you’ve finished with orientation, you’ll take part in rounds, a common practice in
hospitals. Expect to be asked questions, some related to the patient, some related to specific
medical knowledge.

Generally speaking, the most senior team member, like the senior resident or intern, is
expected to answer first. If they’re unsure, the question may be passed “down the line” to the
team. Take this opportunity to watch the team dynamics and take note of how questions are
handled. Some teams will be more open to you knowing the answer above the senior member,
and some won’t.

If a question is directed to you

and you know the answer, feel
free to respond. If you don’t
know the answer, consider
offering to look up the
information and report back to
the team. Honesty and a
willingness to learn are highly
valued qualities during rotations.
For example, if you’re asked a
specific question about a patient
data point, such as the blood
pressure at a point in time or a
lab value that you don’t know,
once again, do NOT make up an
answer. Consider saying
something like, “I see that knowing the BP trend is important because of concerns that the
patient is becoming septic. I didn’t write that down when I saw the patient this morning and I
will be sure to note that in my pre-rounding going forward.”

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Is it okay to ask questions during rounds? YES! Absolutely. You’re there to learn, so having
questions is natural. The key is in knowing the best time and place to ask them. Avoid asking
questions during a serious emergency or when your senior attending appears overwhelmed.
Many teams designate specific times for answering questions, so make sure to prepare
relevant questions in advance.

Outpatient Versus Inpatient Expectations

Now let’s talk a little bit about expectations for outpatient medicine and how it differs from
inpatient medicine. Often, your outpatient experience will include a clinic of some sort. If you
can, try to know which provider you are working with before your clinic day, and even try to
look up a patient or two to get a gauge on presentations. You can also look at the note

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templates that the providers use so you know some of the information they like to ask that is
relevant to their clinic. No matter what, always be on time to the clinic - in fact, be early if you
can! Do let your supervisors know of any commitments you have that disrupts your time in their
clinic. For example, if you have a mandatory medical school lecture to attend, let the supervisor
know the date and time. The end of the day is a good time to ask for feedback about how you
did during the day and the improvements that you can make the next time you come. Be
prepared with specific questions about the patients you have seen that day.

On Writing Notes

You'll also need to write notes in both the

inpatient and outpatient settings. Be sure to
get these done in a timely manner, as your
supervisors have deadlines to turn in the notes
for a billing purpose or will face ramifications.
Know the differences in the specialties. A daily
progress note for surgery may be quite
different than for internal medicine or a consult
service.

For example, ophthalmology has a very

specialized note. Reading charts in advance
will help you get familiar with how notes are
written for your service. If in doubt, write a note
for practice and show your resident before placing it in the chart. You should also be careful
about copying and pasting in your note. While you may cut and paste vital signs, be sure you
have reviewed the trends carefully and not simply press control-C!

Finally, you may use another’s assessment and plan to help guide what you put in your note,
but do not copy and paste the assessment and plan from someone else. The note should be
your own work, written in your own words.

TIP: Having a tough time with electronic health records (EHR)? Read The Anatomy of a Chart:
How to read and interpret an EHR, on our blog.

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What to Expect During Your Shift

People get sick twenty four hours a day, seven days a week, 365 days a year, so expect a
demanding schedule. In the US, there’s a strong desire to keep to an 80-hour work week, with
uninterrupted sleep and rest. Comparatively in the UK, resident physicians are limited to no
more than forty-eight hours of work weekly, with variations ranging up to 100 hours across the
globe.

Each rotation has its own norms. Make sure to arrive early enough to review everything that’s
happened overnight to the patients you’re following. Take the time to review the new data and
notes left by the nursing team or specialists while you’re away. Then, organize your thoughts
into a coherent patient story before rounds and allocate time for research (i.e., consider
developing a differential diagnosis) to determine the best plan for your patient.

Be prepared to accompany your patient to studies or gather information about other patients
when requested by the team. If the day is coming to an end, it’s okay to ask about finishing up,
but do your best to ask with enthusiasm for the rotation. For instance, rather than saying,
“Are we done yet?” consider saying, “I’ve tucked in my patients for the evening. Is there
anything else I can do to help the team?”

Finally, you’ll likely be asked about the specialty you’re considering. This is NOT a trick
question. It’s important to be honest about your aspirations. If the team/Attending knows your
chosen field, they may be able to direct their comments and teaching to that specialty. For
example, if you want to be a surgeon, but struggle with tying surgical knots, it may not be the

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right specialty for you. However, if you want to be a psychiatrist, simply knowing how to tie
basic knots is fine.

Last, but not least, it’s common for good-natured jesting to take place. Humor is a valuable tool
for coping with the challenges of a rough day. Feel free to smile and laugh (when appropriate,
of course) to foster a positive atmosphere and navigate through tough times.

How to Prepare for Away Rotations

Once you successfully complete your home core rotations, consider doing “away rotations”,
which are essentially extended job and performance interviews. To explore different places for
your rotations, take a look at the AAMC’s guide to Visiting Student Learning Opportunities®

(VSLO). For most away rotations, you’ll need to show that you’ve passed USMLE® Step 1 and
have an updated vaccination record. Many programs also need a letter of recommendation,
which should come from a clinician (like your senior attending) who can vouch for your skills
and reliability as a medical provider.

Your personal statement for away rotations should be brief, sharing why you have an interest
in that particular facility and why you’re the best choice. You don’t need this statement to be as
extensive as your residency application statement, but it should include a letter from a clinician
who can attest to your skills and trustworthiness as a healthcare provider.

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TIP: It's crucial that you apply for away rotations as soon as they open because competition is
very intense for those positions. Keep an eye out on the VSLO platform and apply promptly.

Should you do an away rotation?

Deciding on whether to take part in an away rotation depends on your specialty. Most schools
will limit the number of away rotations so that you have a more complete education by the end
of medical school. Residency programs will often ask about your fourth year schedule and

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want to know you’re ready to be a well-rounded MD as they have years to train you as a
specialist.

Some specialties (especially very competitive ones) may expect you to agree to two or three
away rotations. However, some medical schools may not have traditional departments or
residency programs, making away rotations necessary. If this applies to you, try to do a rotation
with a full complement of residents at a “home site” (a group associated with your med school)
before venturing to an away rotation.

Before applying through VSLO, make sure your immunizations

are up-to-date. Your medical school needs to send an official
transcript and confirm that you’re a full-time student that has
appropriate insurance coverage (personal healthcare,
malpractice and disability). An affiliation agreement between
your school and the away rotation site is necessary. Consult
with the registrar of your school for this information. You can
also check to see where other students from your school have
rotated.

If you attend a new medical school, make sure it has full

accreditation status (not just preliminary/provisional
accreditation) from the Liaison Committee on Medical Education (LCME), as some programs
won’t accept a student unless the school is fully accredited. (The LCME grants accreditation to
medical schools. New schools often have preliminary/provisional accreditation, which isn’t
considered full accreditation.)

How many away rotations should you apply for?

There’s no guarantee that you'll get the spot or time that you request, so apply for several sites
at several time slots. Be sure to accept promptly and then withdraw outstanding applications
once you have secured a slot.

Communicate with the coordinator prior to your arrival and make sure you leave yourself time
for travel to be there for orientation. Plan for business casual, but always bring an “interview
suit” (business formal) in case you have the opportunity to speak with the residency program
director during the rotation. Try to schedule this in advance of your arrival, so they’re aware of
how interested you are in their program.

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 Last, but not least, going on away rotations can
be expensive; you have to find a place to live as
well as arranging regular transport to your
clinical site. Be sure to check whether a
program offers scholarships to cover the cost of
living or if there are alumni from your school in
the area willing to host a visiting student. If
possible, consider living with family. If costs are
prohibitive, consider staying closer to home for
residency.

TIP: When it comes to away rotations, make

sure to apply for several sites at several time slots to secure a space. If you’re chosen for
several rotations, you’ll have the opportunity to consider which one will best suit you.

Clinical Evaluation and Feedback

One of the most challenging aspects of starting rotations is adjusting to evaluations shifting
from objective to subjective. Up to this point in your medical school journey, test taking has
become your superpower; you’ve survived any number of standardized and subject
matter-focused tests that depend on having one right answer. However, working with patients
often inspires more questions than it answers, which can result in a variety of possible
approaches to a diagnosis and treatment plan.

This is where feedback and evaluation come into play. It’s hard to be evaluated by subjective
feedback, and there will be days when it just doesn’t feel good. You did everything you were
supposed to do: you’ve read everything relevant, you showed up early, you knew lots and lots
about your patient, and then you’re asked the one question during rounds that you can’t
answer. Just know, everyone has those days. This is a learning moment; humbly
acknowledging that you’ve identified an issue will demonstrate resilience and a commitment to
improvement.

TIP: When facing challenging situations, acknowledge them as learning opportunities.

Embrace feedback, even if you disagree with it.

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Giving Feedback

When the rotation is complete, you'll be asked to give feedback on the members of your team.
While most evaluations are anonymous, making it tempting to speak your mind, carefully
consider what you want to share. Be constructive and thoughtful. Even if it’s tempting, avoid
being insulting, since it’s neither kind nor helpful (and you may have to continue working with
that person). Focus on feedback that can potentially contribute to growth and positive change.

For example, you might be hurt that someone ignored you on the rotation and didn’t teach you
much. So, instead of writing “Dr. X ignored me”, consider writing “Dr. X has a lot of knowledge

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to share. However, they didn’t seem comfortable teaching students and we missed out on the
opportunity to learn from Dr. X”.

Getting Feedback

During rotations, you’ll be evaluated based on how well you interact with the medical team
and patients, as well as your ability to learn and grow. To excel, be prepared. If you’re in a
surgery rotation, make sure you’re familiar with the relevant anatomy for the procedure and
read ahead for your cases.

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If you don’t know the answer to a question, try offering a reasonable answer rather than
guessing. Follow up and ask residents about the best source for further reading. Look the
answer up on your phone, but be careful! Don’t focus so much on your phone that you appear
disengaged. Most importantly, be prepared to answer why you’re choosing a diagnosis or
suggesting a particular treatment plan. This type of reasoning/questioning will occur on every
patient, every day, several times a day and is the basis of your clinical evaluation.

Note that you'll get feedback both in real time and at the end of your rotation. Some of the
feedback may be vague. Embrace the process and don’t hesitate to share any concerns early
on. For example, perhaps you receive a comment like, “You need to read more.” A good
response would be, “What are sources that you like to use?” Stay curious!

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When There’s an Issue During Your Rotation

While it feels awkward to be the center of attention, it’s even worse when you feel ignored. If
this happens, have a private conversation with the person closest to you in training (the intern
or resident). There’s also a clerkship director for all rotations and they’re usually the final
arbiter of any problematic issue.

Don’t wait until you get a lukewarm evaluation and then speak up, as that can be perceived as
“grade grubbing” or trying to get a grade changed rather than being proactive about an issue
while it’s happening. Keep in mind it’s okay not to know every answer and seeking advice and
feedback is a sign of dedication and willingness to learn.

TIP: Have an issue during your rotation? Speak with the people closest to you in training for
suggestions, or reach out to the clerkship director. Being proactive is a good thing.

There will be days that you don’t feel you’ve been able to meet expectations. Don’t be too hard
on yourself. Reach out to an advisor, resident, counselor, or friends to decompress and cope
with challenges. Asking for feedback or creating a list of skills you need to improve on can also
help your preceptor guide you more effectively.

Be aware that you may not always recognize

when you’re being given feedback. This is
especially true if the feedback is informal, such
as an offhand remark about your presentation
skills on rounds. If you feel you’re not getting
consistent or enough feedback, share that with
your team.

About Medical Student

Performance Evaluations (MSPE)

In the US, the comments from the clinical

rotations end up in a summary letter from the
medical school called the MSPE, or medical
student performance evaluation (formerly known as the “Dean’s letter”). Most schools put the
letter together in the summer before you apply for residency. The comments are taken
verbatim, so make sure to read your evaluation comments promptly, before the letter is crafted,

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and review them with a trusted senior advisor. Residency program directors like to see
specific examples; what made your performance “excellent” and what are some ways that
you stood out while on rotation?

The MSPE starts out with a section on “Noteworthy Characteristics”. Most schools will ask you
to write this about yourself. This section is written in third person, as if you were the Dean.
Think about what you want the reader to know about you that’s not in your application. In
general, you want to focus on topics that make you stand out. For example, mentioning your
efficient time management skills because you excelled at medical school while volunteering
and working a job is more impressive than getting a top mark on an exam.

The MSPE also has sections that show your clinical grades, with a spread of grades for your
class. The free text comments from rotation evaluations are always important. Many med
schools have shifted to a pass/fail system, meaning the only objective score on your residency
application will be your USMLE or COMLEX Step 2. This means that subjective input will be
very important and includes the personal statement you give your Dean, as well as meaningful
experiences and clinical comments. This is where you distinguish yourself from others. Be sure

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you show these parts of your application to your advisors to get feedback and don’t wait until
the last minute to start working on these essays.

Overall, success in rotations relies on adaptability, a commitment to learning, and the ability to
handle feedback constructively. Embrace the learning process; it will pave the way for a
successful medical career.

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Challenges and Opportunities During Clinicals
In the world of medicine, you need to be prepared for the unexpected. Patients and diseases
often defy textbook descriptions, and sometimes it feels like everything you see is a clinical
zebra rather than a standard diagnostic horse. Don’t despair, embrace it! This aspect of
medicine is part of the adventure and the thrill of discovery. Remember that there are those
who’ve walked the path you’re on now, and they’re eager to share their wisdom and
experiences with you. Seek them out and learn from them.

Finding Work/Life Balance

Perhaps one of the biggest challenges of medicine is finding work/life balance. Here are some
tips to help you find and keep it!

● Stay organized with a calendar/organizer

● Get enough quality sleep
● Exercise regularly
● Eat a balanced diet whenever possible

It can be hard to maintain a healthy daily practice, but it’s crucial to your ongoing success.
Remember, becoming a doctor is a marathon, not a sprint! So, how can you make sure that you
get in that session of yoga? Try using fitness apps! What if you have a mandatory event you
need to attend that’s not related to your medical duties? Tell your clinical supervisor as soon as
possible, before starting a rotation if you can.

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How to Recognize and Avoid Burnout
Taking care of patients can be emotionally rewarding and draining at the same time. If you find
yourself experiencing feelings of apathy, exhaustion, low motivation, or if you’re feeling like
you’re a failure, experiencing a sense of helplessness, or you get feedback from colleagues and
friends that you don’t seem like yourself, you may be facing burnout. So, how can you prevent
or cope with burnout?

First, take advantage of opportunities related to stress management like yoga classes, sleep
health, or mindfulness sessions. Incorporate regular self-care activities into your day, even if
they’re just small moments like five minutes on a bench outside or taking a quick walk when
you feel overwhelmed.

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Second, build and maintain a support network with peers, colleagues, friends and family who
uplift and encourage you. Engage with patients. Pursue research projects that align with your
interests and goals. Find extracurricular activities that offer flexible scheduling so you can
enjoy them when you have the time. While there’s no one-size-fits-all approach, choices like
this contribute to your overall well-being and sense of fulfillment, helping to stave off burnout.

Next, make sure to celebrate your accomplishments and achievements, no matter how small,
and give yourself grace as you make your way through your learning journey. Research shows
that acknowledging gratitude is one of the best ways to reduce feelings of stress and anxiety.

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Consider reframing your thoughts. For example, your sleep pattern will likely be disrupted
when you’re on-call or have to shift from working days to nights. Think of the schedule shift
like a case of jet lag. What works for you when you travel? Would gradually shifting your sleep
schedule leading up to the change help make it easier?

Above all, in times of overwhelming stress or when experiencing persistent symptoms of

burnout, don't hesitate to seek professional help. Reach out to counselors, therapists, or mental
health services. Prioritizing your well-being throughout medical school and beyond is crucial
for long-term success and resilience in your career. Afterall, if you don’t take care of yourself,
how can you take care of others? Taking the time to discover what it takes to stay healthy (both
physically and mentally) is critical to being a good physician.

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Deciding on a Career Path
The AAMC has a comprehensive resource called Careers in Medicine that takes a four-part
approach to career decision making. It begins with understanding yourself and provides tools
to explore career options, choose a specialty, and prepare for residency. It also includes
resources to help you determine how competitive a specialty is based on reliable information
they’ve collected nationally.

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Finding a Mentor
As you explore various specialties, make sure to seek out people in those fields to get their
perspective and understand their journey. Mentors can be found beyond medical school. For
example, attending webinars is a great way to meet experts and get answers to your burning
questions. Avoid relying on online forums like Reddit. The best information comes from
professionals with experience, who can help you make an informed decision.

Once you decide on a specialty, the next step is understanding residency application
requirements. Letters of recommendation are crucial, and while program websites may ask for
a minimum of three, plan on four, preferably from those who’ve worked with you on clinical
rotations (unless you are applying for a research fellowship).

Ask for strong letters of recommendation

and provide an updated CV and a draft of
your personal statement. Remind your
letter writers about the time you rotated
with them and include any relevant
clinical comments from your evaluation.
Include a high quality headshot as letter
writers often have many students and
perhaps many letters to write.

TIP: Some specialties require a letter

from the Department Chair, even if you
didn’t have a rotation with them. In that
case, ask your institution about acquiring
this letter and ask well in advance!

For application submissions, ERAS® or the Electronic Residency Application System is most
commonly used in the US. However, different specialties may have their application systems:

● Urology uses the ERAS application, but has a different timeline for the Urology Match.
● Plastic Surgery uses the ERAS application but is also trialing a specific Plastic Surgery
Common Application that has different timelines.
● Ophthalmology uses the San Francisco Match application.

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 ● The military branches have a separate application system.

Stay informed and prepared by checking the relevant specialty society websites.

Conclusion
Going through clinical rotations is an unforgettable journey where learning and theory become
reality. Clinical rotations expose students to a variety of medical specialties, each with their own
unique challenges and objectives. From internal medicine to surgery, pediatrics to psychiatry,
rotations go beyond knowledge gathering. It’s about connecting with patients, mastering
communication, becoming a quality team member, and learning how to stay resilient under a lot of
pressure.

As you evolve into a compassionate healer, let this guide serve as a guiding start to light
the path. And don’t forget to practice…DIAAMONNDS! 👇

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Contributors & Reviewers
Yolanda Becker, MD, FACS, Clinical Content Editor, Surgery
Antonella Melani, MD, Content Manager, Script Team
Katie Schultz, MD, MEd, FAAP, Clinical Content Editor, Pediatric
Stephanie Stevens, Brand Marketing Lead, Marketing

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Make your study time more efficient and stay a step ahead during clinical rotations with
Osmosis! Try it free today!

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