Tips for Making the Most of Your PA Clinical Rotations

September 9, 2020
I never had a sister growing up. My older and younger brother and I convened daily to either play video games or soccer, with all encounters ending in a dog pile and us retreating to our respective rooms. During clinical rotations, I imagine PA students feel like a younger sister (or what I’d heard having a little sister was like). Most often the student is attached to the preceptor’s hip, very eager to interject or assist, and often oversteps their responsibility. In an effort to avoid this potentially negative association, I have some suggestions from my experience as both a student and preceptor.

Do your homework

Prior to a rotation, I searched my preceptor’s name to learn about their education, affiliations, publications, and areas of interest. If you learn a preceptor’s publication history and interests, you can study the subjects in more detail…so you won’t be surprised when you’re “pimped” on rounds. Also, preceptors enjoy when you acknowledge that they trained at the same medical school, and thanking them for precepting is a wonderful compliment.

Show up prepared

I always arrived 10 minutes prior to any rotation. This means I wasn’t parking my car and running into the clinic with my bag and a stained whitecoat at the designated time. Rather, I presented myself as a confident medical professional. I treated every rotation as though I were interviewing for a position at the end of the 5 weeks. Would I feel confident advocating for myself if I had been late even once? I laid out my supplies and clothes the night before, washed and pressed my whitecoat on weekends, kept my car filled with gas, and had a handful of routes planned to get to each rotation. You’re there for the experience, but you don’t want to be remembered as the student who was always late, unprepared, or dirty.

Make a good first impression

First impressions are important. I like looking people in the eye when I introduce myself and as I speak with them. Notice whether they are engaged or distracted, and use a positive tone and inflection to greet people. A confident “Good morning, my name is Jessica, and I’m the PA student” can create a respectful and welcoming environment. I used the same friendly introduction with preceptors, office managers, nurses, medical assistants, and all members of the rotation staff. Surprisingly, I heard several staff at rotations mention how rude prior students were because they didn’t even introduce themselves to the people they saw every day for 5 weeks. 

Your first contact with a preceptor is your opportunity to make an impression. Try this strategy:

  • Introduce your name and title
  • Ask for clarification about rotation particulars:
    Clarify where you can keep your valuables, where the restroom and lunchroom are, what the expected dress (business or scrubs) during clinic is, and the rounding time and location.
  • Ask the preferred way for students to function in clinic:
    Set expectations for both you and the preceptor throughout the experience. Prior to walking into any patient encounter, the preceptor needs to explain what their preferences are for taking the history, performing a physical exam, developing an assessment and plan, and presenting your findings. I’ve heard colleagues describe students who interrupted them while they were discussing treatment options. Believe me, this does not create a good impression.
  • Ask what an appropriate time to discuss questions or interesting cases is:
    By solidifying an appropriate time, you can develop thoughtful questions and research cases without interrupting the preceptor’s flow in clinic.
  • Ask how the preceptor would like you to spend downtime:
    Do they recommend specific resources for you to review? Are you allowed to work on your end-of-rotation presentation? Or are there other tasks that you should practice? There is nothing more frustrating than having students take up space in clinic, standing in a group talking, and checking their phones. Even if you are reviewing for your rotation exam, be engaged and productive—this will help earn you a favorable evaluation.
Admit your mistakes 

It is crucial to acknowledge any errors, apologize to the affected parties, and ask how to correct the mistake. Preceptors do not expect you to be experts at every skill or nuance of the rotation, but they will expect you to be adult enough to admit that you made a mistake and ask for help.

Close on a high note

Even my least favorite rotations taught me something I use in practice today. I’m more thoughtful when listening to my patients, considering factors like medication costs and access to follow-up before developing a treatment plan. I concluded all of my rotations by thanking my preceptor for the experience and handing them a hand-written thank you card. (Boxes of blank thank you cards are nice to have handy!) I made sure to thank the preceptor for supporting the PA program, and I always included one reference to a topic, skill, or special encounter that I appreciated being involved in. Even a small gesture like a hand-written card acknowledges your gratitude for the preceptor volunteering time and energy to train you.

Be truthful about your rotation 

My program provided students with end-of-rotation evaluations. One particular rotation, a nurse told me, “You know, Dr. X doesn’t like PAs. He never makes medical students research topics like he did with you.” I noticed this preceptor was especially difficult and would shred my presentations, only to provide the same treatment plan in front of the patient. In my evaluation, I made sure to note the examples of differential treatment and the nurse’s comment. My program no longer placed students with the preceptor, and I received a 100% for my rotation grade. Similarly, I made it a point to list specific preceptors and staff by name who were excellent teachers and clinicians.

Clinical year rotations challenge students and preceptors to create new relationships and work cooperatively in a real medical environment. By following the guidelines above, being flexible, and having a positive attitude, I was able to navigate clinical year with a better understanding of the clinician I wanted to be, areas I aspired to practice, and a few job opportunities to boot. Hopefully you will also succeed and will have guidance to share with other students.

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