5 Reasons to Take the Difficult Patients on Your Clerkships

When joining a clinical team during clerkships, one of the first things you will be asked is, “Are there any patients you are particularly interested in following?” When you are nervous about performance, it can be tempting to choose a relatively simple patient. Here, I will encourage you to choose difficult patients.

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1. Faster Learning

Taking on the most challenging patients on service as a medical student will force you to learn more efficiently and develop your skills. The patients with complex, multi-system diseases or an unknown diagnostic mystery can be very difficult for a student to understand. But you’ll find that by reading on their pathophysiology, talking the case through with your residents and attending, and seeing the patient’s disease process firsthand, you will learn and develop clinical reasoning at a faster pace compared to the “simple” patients. It won’t be long until you feel more comfortable with patient evaluation, disease progression, and condensing numerous problems into a comprehensible patient presentation on rounds.

2. You’ll Impress Your Team

Core clerkships are designed for medical students to learn firsthand how to take care of patients. But it’s no secret that students are doing their best to show the team that they are worthy of a positive evaluation, “honors” designation, or strong letter of recommendation. Your performance on clerkships can have a big impact on the quality of your residency application. So, when your team asks which patients you want to follow, answer with one or two complex cases “because they seem like a great learning opportunity”. The team will be impressed with your eagerness and initiative. I got numerous positive evaluations that specifically mentioned my willingness to take on the challenge of difficult cases, even if I felt I hadn’t done anything impressive.

3. Better Learning Environment

If you work hard at the challenge with enthusiasm, you’ll quickly find yourself as a valuable team member. Everyone loves to spend more time teaching a student that is eager to learn. You’ll find more pearls of knowledge and chalk talks coming your way from the residents. I have also found that residents and attendings will see your efforts and give you more leeway with any missteps while simultaneously trusting you more with more responsibility. By taking the initiative to challenge yourself, you’ll create a much richer learning environment.

“By taking the initiative to challenge yourself, you’ll create a much richer learning environment.”

Dr. Alan Gambril, Contributor, Med Student Edge

4. Interview Question Answers

Taking on complex patients leads to exciting experiences. There will be complex cases that are fascinating, unusual presentations that baffle experts, and rare diagnoses. Because you will examine and question these patients more frequently, you will spend more time with these patients and families. This naturally leads to memorable anecdotes that are helpful for fielding interview questions. Here are some questions I was able to answer based off of challenging cases:

  • What is the most interesting case you were involved with?
  • Tell me a patient story that moved you.
  • Tell me about a time you learned a lesson from a patient experience.
  • How do you challenge yourself?
  • What are your personal strategies for self-directed learning?
  • How did you become interested in [fill in specialty]
  • Tell me about a time there was conflict with a patient.
  • Tell me about a time you used effective communication skills

5. Creates Opportunities

Difficult cases are often unique or unusual. This inherently opens the door to the possibility of writing the patient up in a case report. Case reports are a great way to get your name on a publication without having to be involved with a drawn-out research project. It is a high reward for a relatively minimal time-investment. Because you helped manage the patient, you are as much of an expert on the clinical course as the rest of your team. Utilize this opportunity to contribute to science, bolster your CV, and develop a mentor-relationship with a resident or attending.

So next time your senior resident asks you which patient you want to see, pick the case that’s daunting. You’ll grow quickly, impress the team, and open opportunities for yourself. You’ll be glad you tackled the challenge, and your patients will too!

Do you eagerly take on complex patient cases on your rotations? Why or why not? Comment below.

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Alan Gambril, MD
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