Wednesday 29 June 2011

Guidelines for a successful observership

Guidelines for a successful observership

These days doing an observership has become more of a norm than anything else. IMGs strive to get an observership position with the anticipation that it will increase their chances of obtaining interviews and consecutively up the chances of matching into the residency of their choice. For tips on getting observerships click ---> here. Many graduates are lucky to land an opportunity and go on to rotate through hospitals for shadowing, however if you plan to optimize your experience as an observer and ensure that you get the most out of your participation, here is a guide which will help you do just that.


Don't be rude
This is number one no for a reason, if you are rude to other member of your team or even patients for that matter you ARE going to burn the very same bridges that will help you secure a residency. 

Don't be arrogant
This can particularly tick some junior members of your team like the intern or resident. Remember, control yourself don't look down on them, they may know less than you but they have what you don't - they are in a residency and they can help you get there. Being arrogant is going to rub people the wrong way and limit you chances
I know of a IMG from india who had come to do an observership in the medicine department. He was a good fellow but he had finished his post graduate education in medicine and there fore knew a lot more than the interns. But his knowledge was portrayed in a wrong light as he came off being arrogant and this became a big issue for the team. He was not asked to continue his observership after one month.
Don't be a know it all
This goes hand in hand with the point number 1 and 2. If you know it then keep quite till you are asked or if no one is saying anything. Don't blurt out the answer, politely interject and ask permission to answer. Remember, the rounds are NOT for your education, they are for the interns, residents and medical students. You are sadly the bottom of the educational food chain(but hopefully not long!)

Do not intrude the 'space'
American people have a high sense of personal space, do not invade it. Standing too close to someone you met can be construed as aggression or downright creepy. A safe distance is 2 to 3 feet. 

Put you arms by the side hanging down and now flex your elbow keeping your shoulder straight. That is the minimum distance the other person needs to be at.

Limit the desire to get carried away with 'impressing' your residents and attending.
Realize that your goal is to 'observe' and not run the show. Though the inherent nature of the job is such that a good recommendation hinges on how much you impress the attending, this can also have a negative impact as you can over-do the 'impressing' and land in more trouble than you need. 

Help not hinder
Rounds are the busiest part of the day. They can be chaotic and unexpected. Let the residents and interns do their job of collecting patient data, reviewing charts and talking to patients. The busiest time for a team is just before the rounds when everyone is running around scurrying to collect all the information they need to make a good informed clinical judgement, try and limit your interruption of this process and the team members will be thankful!

Another IMG from Egypt who was doing an observership at my institution had the uncanny and annoying ability to ask all of his questions during the pre-round times, the busiest time for a resident and his team. He would ask the interns, residents and even the medical students about the patients they were covering. It quickly became evident, he did that because he wanted to look informed on rounds with the attending. Essentially, he did sabotage his experience. Don't do that.

No need to stay all day
There is not need to hang around all day, you can excuse yourself right after the rounds are done. Before you leave though, ask the residents if there is anything they need help with. They might ask you to call a consultant or look something up related to the patient and that way you can increase your involvement in patient care!


Do be punctual
Never, ever be late for rounds. Running in late when the rounds have started will make the attending remember you for the wrong reasons. If you are going to be late for reasons not in your control, call up the resident and tell then to inform the attending that you are being late because (did not have ride etc…)

Be committed
Getting an opportunity to do an observership is difficult, don't misuse it. If done well, it can have the power to change your fortunes as far as match is concerned. If you are not enthusiastic or appear lackadaisical or non-committed then you will get a 'satisfactory' recommendation or non at all. You don't want to have a satisfactory recommendation, check this out --> How to ask for a letter of recommendation (LoR)

One other IMG that I worked with used to ride in with a friend who was doing residency in prelim surgery. This IMG was doing an observership in medicine, so he used to come in at 5 AM out of necessity as he did not have a ride for later on. After a first few days, he started to help the interns and residents write down vitals or lab data. He stood out overall and received a glowing commendation for his rotation. 

Do be humble
Humility will go a very long way to secure personal success. Be humble, listen to everyone and speak when spoken to.

Do dress well
Unless, explicitly stated by the attending or team that days X or Y you can wear scrubs, don't wear them. Be professional and dress smartly. This includes no flashy body jewelry, bling-bling, grilles, extra chunky rings, tacky globys earrings or necklaces. Be sophisticated. wear a good deodorant. It does not matter what the resident is wearing or medical student is wearing, they are not needing a residency spot, you are.  Dress well. 

Do make the team feel comfortable and safe in your presence
Don't start hitting on the junior medical students or flirt with other members of the team. The minute one gets a 'creepy' vibe from you, you are done for. Look people in the eye, keep conversation safe, steer clear off controversial topics.

Do be aware of the limits of your involvement in patient care
Be involved but not passive and realize what you CAN do and what you CANNOT do. It is a good practice to outline you role in the day to day activities of the team with the upper level resident. 

Help the team
Discuss medical topics with the medical students and interns. Help the team by looking up articles or answers to questions that came up during rounds. Make a list of all such questions as you round, the residents have so many other things to keep in mind, they may forget. If you write down and revisit the questions during rounds with the answers that you have looked up, you will shine. Help them find articles that they may want to person in morning report or journal club. 

All in all, observership can be a very valuable or wasteful experience depending on how you conduct yourself. It can even be detrimental if not done right but can be a rewarding experience if you do well. 

The above is applicable for those you end up getting the coveted observership experience. In case you dont get this typical experience, there are other ways to bag an 'observership experience'. Read about it ---> here

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