Sole Purpose 19
From Rookie Mistakes to Glowing Recommendations -
Surviving and Thriving in 3rd Year Clinical Rotations - Part 2

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I hope everyone enjoyed my article last week about my first podiatry patient and my general advice for 3rd-year clinical rotations. Today, I want to delve deeper into my specific 3rd-year rotations, discussing how I approached setting intentions for each rotation and the impact that they had on my overall education. Before diving in, I want to emphasize that I don't believe that I did anything particularly special on my rotations other than showing up early and being willing to work with a smile on my face.

The start of clinical rotations was nerve-wracking for me due to imposter syndrome, which often made me feel like a fraud who didn't know what they were doing. To counter this, I took proactive steps. Firstly, I set "goals" or intentions for each month of my third year. I did this independently and then discussed them with my faculty mentor (shout-out to Dr Parks, an incredible mentor and overall human!). Setting these monthly intentions helped me stay motivated, especially during challenging rotations or those that seemed less directly related to podiatry.

During my time at WesternU, I had the option to choose between two "general areas" for rotations in Southern California. The selection of our clinical tract was based on our class rank after ranking the different options. Ultimately, I ended up with a hybrid experience that combined aspects from both areas.

My rotations during my 3rd to 4th year were as follows:

July: Telemedicine (general surgery, ENT, ortho, neurosurgery)
August: Radiology
September: Vascular surgery
October: Orthopedic Surgery
November: Podiatry (both clinical and surgical)
December: Internal Medicine outpatient
January: Podiatry (both clinical and surgical)
February: Family medicine
March: Podiatry (both clinical and surgical)
------- start of “4th year”---------------

My intentions and rotations for each month of 3rd year were as follows:

July: Telemedicine
Intention: Note writing
In July, I had a telemedicine rotation, which was relatively light. I dedicated this month to honing my note-writing skills and delving into research projects. Whenever I wrapped up my telemedicine appointments ahead of schedule, I seized the opportunity to volunteer at the podiatry clinic on campus for additional hands-on experience. Of course, this required completing onboarding procedures and obtaining permission beforehand.

August: Radiology
Intention: Image reading
Another relaxed and slower-paced rotation. My aim for this month was to improve my skills in reading MRIs and CT scans. I must admit, I was somewhat deluded in thinking I was already proficient at interpreting radiographs (which I later realized wasn't the case; I don't think I truly grasped reading X-rays effectively and quickly until my residency interviews, and there's always room for improvement even now). Since this was a more laid-back month, I prioritized completing my research before the upcoming intensive surgical rotations. Additionally, whenever I finished early, I volunteered at the podiatry clinic. As before, I obtained the necessary permissions and filled out the required paperwork.

September: Vascular Surgery
Intention: Vascular workup and surgical experience
My inaugural stint in the OR—what an adventure! As a future podiatrist, this rotation was like a crash course in awesomeness, with a hefty dose of hard work that undoubtedly made me a better professional. My main goals were to nail down OR etiquette, master the art of scrubbing, and ace a vascular workup. Plus, I got to dive into the world of pre-rounding (coffee in hand, of course), crafting inpatient notes, doing intricate wound dressings, and proudly carrying that supply bucket like a champ. This month was filled with a whirlwind of all my OR firsts.

Unfortunately, this month marked my first up-close experience with amputations, which deeply affected my empathetic nature as a diabetic. Additionally, it was my initial encounter using my language skills to translate difficult news to a patient. This experience added significant value to my ability to fluently speak Spanish, but let's just say there were some tearful drives home during my first week. I personally put myself in the shoes of every patient and wanted to save everyone, and it weighed very heavily on me.

However, by the end of the rotation, I learned to maintain better emotional distance while still being empathetic and clear. I also learned that I love seeing the same patients daily and inpatient work. This rotation taught me invaluable lessons about bedside manner, empathy, emotional management, and delivering bad news. It undoubtedly contributed to shaping me into a more adept future surgeon and healthcare provider.

October: Orthopedic Surgery
Intention: Surgical experience, efficiency in clinic
It was quite a tough month with long hours, but the learning experience has been incredibly valuable. My main goals were to improve my suturing skills, gain more OR experience, and handle my first 24-hour shift. Interestingly, I was the only 3rd-year podiatry student among 4 sub-Is (MD/DO 4th-year students), and I worked so diligently that they mistook me for a sub-I the whole time, leading to an awkward interview at month's end where I explained I’m going into podiatry and only a 3rd year. I also achieved significant milestones like performing my first reduction (albeit a wrist, the arm's ankle!), removing a screw, giving a concise sign-out, and realizing my capability to assist in a busy clinic with over 90 patients a day.

November: Podiatry (both clinical and surgical)
Intention: My goal was to have read the 100 landmark articles of podiatry by this point, become proficient in reading and interpreting radiographs accurately and concisely, and develop multiple differential diagnoses when evaluating patients.

Fortunately, I had volunteered extensively at the podiatry clinic during my first two months, which led the clinic director to permit me to scrub into surgery with the residents. The agreement was that I would also volunteer for a week of on-call duty, which I gladly accepted. It was another amazing rotation that provided me with a wealth of learning opportunities. It was one of my favorite months of the entire year as it significantly enhanced my skills in presenting clinic patients, writing concise notes, gaining confidence in assisting in the OR, and experiencing being on call for the first time.

This month was one of the months where I could see how much my knowledge base improved, I began to gain confidence with pimp questions and was starting to feel more comfortable in the OR. This month was also my first podiatry surgery, a ganglion cyst removal. I got to do the ankle block and throw some superficial sutures and I smiled for the rest of the day following.

December: Internal Medicine Outpatient
Intention: General Medicine knowledge, full patient workup

This month honed my skills in conducting comprehensive physical exams across all major systems and conducting thorough workups. Being at the VA, it provided an excellent opportunity to practice evaluating patients with multiple complaints and comorbidities, making it a valuable learning experience.

January: Podiatry (surgery and clinic)
Intention: Step up and pretend I’m an extern
BEST. MONTH. EVER. Although, it demanded a lot of effort, I had the incredible opportunity to be the sole student on service, which meant I could scrub into surgery nearly every day. My primary goal for this month was to enhance my dexterity and readiness for externships. The attendings set high expectations, treating me like a resident, which motivated me to exceed those standards. I had my first skin-to-skin surgery experience, a 3rd toe amputation. I had seen multiples of these and had come to the OR having documented all the steps, and after reciting each step from start to finish and exactly what I would do and ask for, I was permitted to perform the amputation under VERY close supervision. It was the best feeling in the world knowing the attending surgeon trusted me and believed I was ready. Looking back the toe was basically ready to fall off. However, this month marked a significant milestone in feeling prepared for externships, despite the long days and intensive learning.

February: Family Medicine (outpatient)
Intention: Pharmacology
This month, my objective was to enhance my understanding of pharmacology, and let me tell you, it was put to the test! One of the advantages/challenges of being bilingual is that I ended up with every Spanish-speaking patient, regardless of whether their condition was podiatry-related or not. This month also provided ample opportunities to expand my general medicine knowledge.

March: Podiatry (clinic and surgery)
Intention: Make sure I was externship-ready
This rotation was more hands-off. I requested additional responsibilities such as weekend call duties and morning rounds, understanding that it meant extra work for me, which I fully committed to. I approached this rotation as if it were an externship, aiming to prepare myself thoroughly for interviews.

After that, I was in my 4^th year and began my externship journey!

I hope this gives students a clearer insight into my monthly learning experiences. The effort you put into 3rd year significantly impacts your readiness for 4th year and can propel you forward. Being prepared for your first externship makes a substantial difference compared to using it as a wake-up call to take rotations seriously. However, there's no need to fear your 3rd-year rotations; instead, embrace them with excitement! I still smile when I remember how thrilled I was for my first "solo" (though heavily supervised) surgery of a 2nd toe amputation, and how my joy knew no bounds when I could finally suture without the surgeon cutting any out. Once again, I want to emphasize that everything will work out fine. I'm genuinely excited for all of you!