Tips for an ICU Medical Student Rotation
Written by Sara Kurtevski, MD
The ICU, or Intensive Care Unit, is arguably one of the most challenging rotations. The majority of the patients have complex medical problems, plans for care change daily, and things can take a turn very quickly. In addition to all of these more obvious challenges, the ICU has a vast “hidden curriculum” with lessons that are usually more difficult to find in a lecture or a textbook. It is these hidden lessons that can be the most challenging aspects of the rotation, especially as a medical student. Given all of this, medical students often feel nervous and intimidated.
If you are reading this, I want to reassure you of something…absolutely nobody will expect you to know everything. If you don’t know something, this opens the door for excellent teaching opportunities. So, what can a medical student do to thrive on an ICU rotation?
1. Know the patient
Patients in the ICU are usually complex and it is important to know details about the patient. Some patients may not be able to communicate at all, and helping the resident chart review, contact families or a healthcare proxy, and keeping track of events that occurred to work on a hospital course is extremely helpful. In a setting like the ICU, understanding the patient includes learning the lines a patient has, the drips they are on, their oxygen and nutritional requirements, and detecting changes on a physical exam. As a medical student, you can gather a lot of that information and the team will greatly appreciate your help.
2. Get to know the team, be kind, and communicate
The ICU is a team effort. Nurses are essential when you are in the ICU (as well as anywhere else) and they are exceptional at detecting patient changes and issues. Introduce yourself to the nurses, especially to the nurse taking care of your patient. Speaking to the nurses before rounds about the patient you are assigned to present is a great way to gain their input for your presentation.
3. Speak up and ask questions
Speaking up in the ICU is key. If you are worried about a patient, ask about it. If you are not aware of the way a certain medication works or how to do a procedure, ask about it. You can be an advocate for a patient and their family.
If you’re supposed to check on something you haven’t done (or have any clue about), ask for help from one of the team members. Understanding what you feel comfortable doing and knowing your limitations shows maturity and humility, and will allow the team to know what they can teach you so that you can get the most out of your ICU experience.
Part of the “hidden curriculum” of the ICU is learning about a goals of care discussion and family communication. It is a great opportunity for you to observe residents and attending physicians engage in these tough conversations. Asking questions and debriefing after will help you process these emotionally charged moments, as well as deal with the psychological and emotional aspects of being in the ICU.
Being an active learner in the ICU will show that you are engaged, interested in learning, and want to continue developing as a physician, which is the only true expectation of a medical student. Learning these skills will help create a more enjoyable rotation.
