Clinical Rotations

Clerkships: How medical students can hone situational awareness

Brendan Murphy , Senior News Writer

The knowledge piece of clinical clerkship is often what medical students focus on as they prepare for those key rotations. Understanding the environments a student will be entering and how they work is an often overlooked, yet important, part of preparing for rotations such as surgery or obstetrics and gynecology.

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To help medical students gain situational awareness before they enter new, often complex settings, a faculty member and a medical student at Harvard Medical School created a simulation curriculum. Their program was presented during the most recent AMA ChangeMedEd® conference in Chicago.

“Medical students can lack situational awareness in new and complex learning environments,” said Celeste Royce, MD, assistant professor of obstetrics, gynecology and reproductive biology at Harvard who co-founded the curriculum. “Some may have some work experience in the medical field, but very few of them had work experience in any kind of operating room or labor and delivery setting. These are very complex, team-dynamic situations.”

For medical students preparing to enter new environments, Dr. Royce and Salvatore Daddario—a fourth-year Harvard medical student who co-created the curriculum—offered medical students a few tips.

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Medical student sitting on a stack of textbooks

While training in interprofessional teams has become a focus of education across the spectrum of health professions careers, medical students are often not given a clear understanding of their role in a team dynamic. Because of that, it might take some observation to fully understand how you fit in.

“Students are not expected to make significant contributions,” Dr. Royce said. “Part of what they can do is step back and observe and learn how these environments actually work.”

That’s not to say that students should remain silent at all times. But understanding when and where is the time for questions and dialogue is another key aspect of situational awareness.

“You as a student have a lot to offer,” Dr. Royce said. “Your asking questions, your challenging of paradigms, your ability to help people really think for themselves and question their beliefs is a really powerful tool that students can use.” 

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Situational awareness focuses specifically on the operating room and labor and delivery. Those two environments are among the most foreign for students. While not every medical student will get to do a simulation, getting a tour of the space at the start of your clerkship can be helpful.

“Something that has helped me is trying to see the space before I go in and am expected to contribute,” Daddario said. “That might mean asking a resident to give you a run down when you start, take you in an empty room and do things like show you where the gloves are.”

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A desire to contribute, especially as students gain confidence during the course of the rotation, is natural. But respecting the order of operations is key.

“One thing I tell students—and this is something that was mentioned to me many times—is never grab an instrument that isn’t handed directly to you,” Daddario said. “Sometimes a scrub tech or nurse will be holding a tool out for a surgeon for a while, and the surgeon asked for it. Your hand may be free and you may want to grab something and take that load off. You shouldn’t.”