"Nuts & Bolts 2" - A Guide to the Clinical Years Section 4: Insider’s Guide to Ambulatory Settings Table of Contents Call Schedule During ambulatory rotations there is no call. Although you will have most weekends off, some clerkships may assign you to evening or Saturday morning clinics. The Cast of Characters The Attendings: In the outpatient setting, you will work with a variety of attending physicians at any given site. On one extreme, you may present to a different cluster of attendings each half day depending on the clinic, while at other times, you will be working with one attending during most of your rotation. You will rely on the attendings for learning, patient presentations, and feedback. Attendings can be anyone from recent graduates of residency programs, to full-time clinical faculty members, to community physicians. The attendings will review the notes you write and are great sources of feedback and information. It may be intimidating to work directly with them at first, but they can be a really great source of learning. Interns/Residents/Fellows: Medical students less commonly work with interns, residents, and fellows while in the outpatient setting. They may be around seeing their own patients and on occasion you may present to a resident. They are great to run ideas and questions by; they are good resources for learning the ropes at each site, and they have great information on residencies when you get around to thinking about that kind of stuff. Clinic Staff: Nurses, Social Workers, Clerks, Translators: These are all very important members of the outpatient team. They can get you out of jams even if you created them yourself. Their roles are often overlooked, but crucial to the clinic's success. They help with the overwhelming details of paperwork, scheduling patients for follow-up, dealing with difficult patients, and MORE! Show your appreciation say "Thank you." The Students: Patient visits can vary from urgent care drop-in (i.e., no appointment) to scheduled appointments with you as their primary provider. Your experience can be feast or famineeither too many patients show up or none at all! Be flexible and bring something to read. Keep in mind that volume and scheduling are site-dependent. In the ambulatory setting, you will be given a lot of autonomy. In a typical situation, you will see a patient by yourself (interview and exam) and present your findings, assessment and plan immediately afterwards. After discussing the patient, you and your attending will return to see the patient to review any important issues. This can be kind of unnerving because you have to develop a coherent assessment and plan with little time to collect your thoughts. However, because you are on your own, you quickly begin to develop your skills. Recognize that forming an assessment and plan as well as developing clinical skills come with time and practice. Be patient with yourself! Hint: If there is time, look over a patient's chart and/or computer information before you see them. Try to read briefly before presenting to the attending if possible. It is better to be slow and prepared than fast, confused, and not thorough at this stage.