For a medical clerk starting his rotation in Internal Medicine, endorsements were never easy. This anxiety-inducing initiation to the clinics has been the bread and butter of Internal Medicine and is far from being defunct. I, too, became a clerk and had my own fair share of grueling moments in the battlefield with residents prying on newbies of the hospital.
Times have changed. Endorsements became lighter and lighter over the years probably because the new generation of doctors knew that learning shouldn’t be manned by terror and anxiety but rather by a healthy environment of learning.
Whatever it is, the endorsements remain to be a staple in medical school and students should be prepared especially after a duty.
1. Do your own history and physical examination.
Make sure to conduct your own history and physical examination. Whether the patient has done it 6 times already, nothing defeats the value of your own thought process asking for the history. Some parts may actually be left out by the resident but known to the clerk so never belittle your own history and physical examination. For all you know, you might outsmart your resident.
2. Read up on the cases that might interest everyone.
A case of a rare type of malignancy was admitted last night and none of the residents know about it. It’s best to read up on the rare interesting cases because it’ll spark curiosity amongst the crowd. Google and Medscape come in handy if you left your book at home.
3. Predict what they usually ask in endorsements.
It’s the same questions over and over again. Whether it be the criteria for Systemic Lupus Erythematosus or the Latest Guidelines on Tuberculosis, the questions and must-knows remain practically the same with minor changes. Black books come in handy so a quick browse on your pocket references save you a lot of time in endorsements.
4. Stay confident, know your patient, even if you know little.
You will always know little. There will always be a question you can’t answer. You will miss certain details in the history. Nonetheless, that’s why you’re in medical school. Stay confident and show them you know your patient well.
5. Look around for answers.
There are times other students will save you from questions. Coaching is not prohibited in endorsements. Residents used to do it before too. Some of your good junior residents and interns might actually be the ones to save you in questions you know nothing of. Look around but don’t make it too obvious.
6. Stay calm.
If a senior doctor scolds you for poor endorsements, stay calm. Learn the lessons. Learn from the experience.
Some of them will shout at you. I’m not saying it’s a good culture to proliferate but remember to stay above it. Don’t repeat the mistakes of the past so that when you become a resident yourself, you proliferate the culture of learning rather than showing off and feeding your ego in front of newbies.
Endorsements are here to stay and remain an inevitable part of medical school. It’ll be a mixed feeling but they’re made to teach you the lessons in medicine that aren’t read in the books. The experiences of your seniors remain invaluable in medicine. They’ve seen more patients than you.
Happy duty everyone. May the odds ever be in your favor.