Two Weeks in Cardiology

bright cardiac cardiology care
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The first few days of my clerkship were an absolute mess. This was not anyone’s fault, but the lack of organization made for a harrowing introduction into cardiology, and possibly a humorous one in reflection. Prior to the start of clerkship, an IT training session, for the purpose of learning to use the hospital’s electronic medical record sharing system, was cancelled because of a miscommunication resulting in no instructor being booked for the session. As a result, this training session had to be scheduled during the first few weeks of clerkship for the students who were scheduled to attend the cancelled session. I was under the impression that the administration would inform my preceptor (doctor/teacher I follow around during my days on the ward), that I would be absent in the morning, however, I was incorrect, or at least another miscommunication occurred. I finished up with the long but informative IT session and headed over to the ward. My preceptor was not around, but this is not abnormal as most doctors are running around between a few different wards. I was given his number by the nurses and instructed to call him. From this communication I learned that he was not at the hospital anymore and had left because he did not realize I was starting on the ward that day. He told me vaguely “see you tomorrow” and I said “around 8?” and he said “yeah, yeah whatever you want” and hung up. I was unsure if I was to go home or if there was work I should do on the ward. I wasn’t even sure what my responsibilities and range of authority was. Therefore, I ran downstairs, in my fresh white coat (that no one else wears) with my stethoscope tangled around my neck, to the clerkship office to ask the administration what I should do. After several calls, I was finally placed with another preceptor for that afternoon and learned all about stress testing (which was actually a really good experience as this was a topic that came up several times in the following weeks).

The following day I had an academic half day, which I had forgotten about when I asked my preceptor if I should show up at eight, so I frantically ran upstairs to the ward to inform him I wouldn’t be there. He wasn’t there and I had to call him again. He was completely unconcerned and replied with “just show up whenever”- such a laid back person, as I learned throughout the week. However, I was late to my academic half day seminar and the teacher there was not pleased. I ended up explaining the situation to her and all was well. Finally, on my second day, I got to meet my preceptor for all of five minutes. He told me to familiarize myself with the ward (which I had already done the previous day and had read charts for like 2 hours) before he left. Luckily he had a resident who was just finishing her rotation with him. She filled me in on this preceptor’s schedule and what I should do on the ward on a daily basis. I am incredibly thankful for her words of wisdom that carried me through my next two weeks. On the third day of my clerkship, I was finally ready. I arrived at 8:00am sharp and started rounding with the patients on my own. I took a history and physical on all of these patients and reported on them to my preceptor when he arrived. He was very impressed by this. The routine for the next few days was similar to this and as long as I finished my charting, I was free to go home around 1 or 2 in the afternoon which was great- I had many naps on my couch and did lots of reading. This preceptor and I parted on excellent terms and he was very impressed by the initiative I showed in “going to work without being told”.

My second week, I was with a very intense and busy cardiologist who performed angiography and stenting as well as doing medical cardiology. As a result, I was often seeing his patients on the wards and attending to nurses’ concerns, then reporting to this doctor while he was doing procedures in the catheterization laboratory. During my first day with this preceptor I was sent to observe a cardiac surgeon place a pacemaker in a patient. This was a completely unexpected part of the day but was very cool. I didn’t scrub in, which was a mistake because the surgeon told me that I should have because he would have let me put in the subclavian line on the patient. When observing surgery, ALWAYS SCRUB IN; Don’t ask, don’t wait, just do it. This surgeon was very personable, and I felt we made a connection on the basis of a mutual love for comic books and our backgrounds in martial arts. He had done a collection of different kinds whereas I spent 12 years in Karate. One of his daughters was even training in Judo in Japan! So cool. Try to be personable with everyone you meet. Don’t be afraid to let people know your interests, even if you think they might be odd (within reason… for example, I never lead with the fact that I worked with lab rats and my dream is to adopt some of them because they’re so freaking adorable and start showing people rat selfies… some things you’ll need to tone down).

The cardiologist I was assigned to this week assigned me homework daily and I was expected to present this homework to him the next day. However, we were always too busy and he ended up keeping me as his student for an extra day so we could finish my student evaluations and so that I could present all my homework. I really appreciated him assigning me these topics because they were things he believed I would be tested on at some point in the future. Always look at homework as an opportunity rather than a burden. I always typed out my homework, colour coded it, and drew diagrams when it was appropriate. My preceptor was very impressed by this and happy that I took such initiative with my homework. During the last few hours of my rotation, I took the opportunity to summarize the problems for some of my patients and hand them over to the next cardiologist that was taking over for the week (they run in weekly rotations for inpatient cardiology). I stayed late to make sure that one patient had a plan for discharge and to sort out her insulin dosing. Additionally, I checked back the following week, despite not being on cardiac service anymore, to see how she was doing and if she was cleared for discharge. Unfortunately, her story didn’t have the happiest ending despite my efforts. Developing a genuine interest in your patients helps you to be a kind and empathetic doctor, but you will find that it can hurt when the outcome is poor for a patient you have invested your time and emotion in. Don’t let this discourage you from being invested in your patients, just recognize that you’ll win some battles, but you may often lose them.

One of the things you’ll learn quickly when you are on the wards as a medical student is that you must demonstrate this grandiose and sometimes intangible quality of initiative.  Although it may seem confusing at first there are a few things you can do that will make a good impression with your preceptors and to show them that you have this quality. So my parting advice is this:

1) never be later than your preceptor. Most of the time they will be late. Get to know your preceptor and their schedule and arrive 5-10 minutes before them (or you know, you could just actually be on time…).

2) Do absolutely everything that is in your power to do. As a subset of this point, learn ASAP how to do things that you are asked and don’t know how to do yet.

3) Make a plan for the patient and then present it to your preceptor for confirmation. Don’t run to them for every little thing. Even if you’re not quite sure if you’re right, try to come up with something before approaching your preceptor.

4) Practice your procedural skills in advance of your rotation. Anticipate what sort of things you’ll be expected to do. Your preceptor will not be impressed if you are fumbling things in front of your patient. They’ll likely jump in and take over if they don’t feel like you’re confident/competent which leads to point #5.

5) Be confident with your words, even when you’re owning up to something that you don’t know.

6) Only use the “I don’t know, but I can find out” line with patients, when asked questions about patients, and when you are letting a preceptor know you are unable to perform some sort of task or procedure that is out of your realm of knowledge. If your preceptor is asking you a question to test your medical knowledge, come up with some sort of answer, even if it is only partially right. They will be more impressed by you trying to think through a problem rather than retreating because you didn’t 100% know something.

7) Relax and have fun but read something every day.

8) Smile, because you’re going to do great.

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