Success on the Wards 250 Rules for Clerkship Success by Samir Desai and Rajani Katta, builds upon their successful library of medical student books with this terrific follow up. The purpose of the book is to guide 3rd year medical students thru life on the wards, with particular interest in getting things done right.
The book goes thru lists of “Rules†of what to do and what not to do. Some are general guidelines, and others are true things that you definitely should not do. The intro is very useful, summarizing what it means to be on a clinical clerkship and to be able to take care of patients. The chapter does a good job recapping why clerkships are important and what the various core clerkships are, and why they are important. When reading forward, you will find that some of the key points in the first few chapters are already mentioned in the intro, but we found the actual evidence and references made by the book particularly interesting. They cite residency directors and programs and reveal what programs find most important on various clerkships. There are also references to studies on what makes students successful on the wards, and what may reveal future problems as junior residents.
After the intro, we get right into the various clerkships from internal medicine, surgery, pediatrics, psychiatry, OBGyn, and Family Medicine. If you read these straight thru, you may find some things rather repetitive, such as recommendations to always be on time to rounds, and meetings. The overall information is very helpful, so it may be best to read each of these chapters are you are preparing to start the actual clerkship. There is great info on the nuances in how each specialty likes their progress notes, case presentations, and what to carry in your coat. In addition there are keys for success including how and who to ask to write letters of recommendation and some basic things to look for if applying to that specialty for residency. From an organizational perspective we would have put these chapters at the end of the book.
Probably one of the most overlooked parts of clerkships is really a few reminders on how to treat patients. There is a section on medical errors which even seasoned attendings should review, including things like preventing nosocomial infections and medication errors. There are also some real pearls on helping students introduce themselves to patients properly, how to convey confidence without being overbearing, and how to instill trust in your patients. This section has great information on conducting an effective patient interview, including things like asking open ended questions and not interrupting patients. Some of this may go un-noticed by your residents on the rotation, but will get noticed by patients and will help all students in the future as physicians. This key section of the book reminds students on respecting patients, clear communication, and staying professional.
The book moves on from there to go over how to prep and behave on new rotations, including what to wear, how to get things done, and how to stay focused. Clerkship keys including on-call where much of your time will be spent with the team (and therefore more eyes on the student) are discussed in detail, as well as how to review charts and write admitting orders. From there is a section on lab test interpretation as well as a few keys on abnormal labs. We found it a bit odd that it went into rather extensive detail on hyponatremia (a good review), but not other lab tests. This seemed a bit out of place from an editorial perspective.
Attending rounds, and the importance of observing bedside teaching is discussed, as well as ways to get residents or attendings to show you things that you may never learn again, like interpreting JVD or murmurs. In addition, the chapter gives nice tips on how to survive being pimped on the wards. The book goes on to talk about case presentations, write ups, outpatient clinics, evaluations, exams, rotations, attendings, teamwork, and everyone’s hated clerkship experience: giving talks to your team.
Success on the Wards 250 Rules for Clerkship Success is an excellent reference for any 3rd year medical student and some is probably great reading for advanced students and even residents and interns. The book would also be a terrific reference for international students or beginning interns to learn the US clerkship system. The book is well written and an easy read. The numerous literature supported references gives the book some real relevance and makes the evidence believable, instead of being heavily opinionated and only a few of one or two people. Given the heavy importance of being successful on the wards as a student for future residency, it’s really easy to recommend this book. Outside of 2 tiny quirks mentioned above on Hyponatremia and a preference to put a few chapters later in the book, really there are no real negatives at all!