Starting Clinical Rotations: Wear the White Coat

Every year, I end up counseling a student who, from day one, was absolutely certain they wanted to go into surgery.  They scheduled their rotations to put surgery last, so they would get really good evaluations.  They cruised through pediatrics, medicine, ob-gyn, etc as observers, rather than real participants, because they were so sure they were going to be a surgeon.  Finally, the big day arrives – they start their surgery rotation.  Within a few weeks they begin to realize….. they hate surgery.  Now they are really stuck.  What kind of doctor should they be?

There is an easy way to prevent this from happening.

Wear the white coat.

When you start your pediatrics rotation, be a pediatrician. When the residents and attendings ask what you are interested in, tell them you think pediatrics is really interesting.  It will be true, if you are “trying on the white coat”.  (It will also inevitably lead to better evaluations, by the way, but that is secondary gain.)  When you are on medicine, be an internist.  When you are on surgery, be a surgeon.  You get the idea.  Really immerse yourself in the field, imagine it will be your future.  It’s necessary, but not sufficient to learn what you need to know for the shelf exam.  If you are going to wear the white coat, you have to go beyond what you learn from patients and about patient care.  How does an internist think?  What makes a particular case in surgery more challenging than another?  How does an obstetrician deal with a difficulty delivery at 2am?  What defines the culture of pediatrics?  Does the “coat” of a neurologist fit you?

Over 80% of students change their mind about what specialty they want to pursue as they go through their rotations. Choosing your specialty is not hard, but you have to genuinely keep an open mind as you “try on” all the specialties.  One of them will fit better than others, but it’s probably not the one you expected!

2 thoughts on “Starting Clinical Rotations: Wear the White Coat

  1. I love this site and generally think the advice is golden, but I feel I have to voice some disagreement here. I have always disliked the advice to say that you’re interested in whatever specialty you happen to be rotating on. First, it is dishonest, and that is a policy I can never support. While I agree with the sentiment to truly “try on” each specialty, you can do so without lying to your faculty and staff about where your true interests lie. Secondly, I don’t think that stating an interest in the field of the superior will necessarily lead to higher grades or better comments. If anything, I think it leads to closer scrutiny and higher expectations, which you may not meet. And finally, I think there is something to be learned in every rotation that will be relevant to any specialty. By voicing your interest, your faculty and staff can focus their teaching on things that will be relevant. For example, I could not be less interested in the field of neurology, but I loved that rotation because my resident was aware of my interest in OB and so directed me toward learning about seizures, eclampsia, PRESS, and other neurologic conditions that overlap into the realm of OB. I would never have had that experience – or such a positive interaction with my resident, which resulted in great comments – if I had not been honest about what I was truly interested in.

    Thanks for all your good advice and for the opportunity to add my thoughts to the mix.

    • I agree with you! You make some really great points here. Many students aren’t sure about what they want to do – or are “sure” about their specialty choice prematurely. Unfortunately, that can lead to missing out on learning about specialties that might “fit” them better. Even if you are sure (and it’s the right choice for you) it’s not a bad idea to “try on” other specialities. If nothing else, it will make you more sure about your choice. But it’s perfectly ok to be honest! “I’m thinking about ob/gyn, but this is really interesting” is not a bad way to go!

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