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Number 2: Learn How to Do Patient Notes ASAP
This is a great way to impress your residents and your attending physicians. Regardless of how well-versed you are in writing a patient note, each resident has a different style that they like in their notes and during a clinical elective, the best thing you can do is make the resident's life easier. This is the most important thing you can do if you are wanting to have a strong letter of recommendation. You may not like the idea of doing someone else's work without getting paid, but when interviews are being handed out, Testimony from a resident can go a long way into determining whether you will get that invitation. It is in your best interest to start typing as quickly as possible.
This is what residents spend at least 75% of their day doing so if you are able to help a resident with these tasks, then they will definitely put in a good word for you to the attending physician and that will make a letter of recommendation very strong for you.

Number 3: Do an Elective in a Category You ARE NOT Interested In First
No matter how much effort you put into preparing for an elective in the US, there are going to be growing pains that can make your experiences in the US frustrating at first. It is a foreign system and can be tricky to maneuver through if you do not have anything to compare it to before. A good policy to follow is to not do an elective in the field you are interested in doing as your first elective. If you are interested in Internal Medicine, do an elective in Family Medicine first to learn how to talk to patients, learn how to write notes, and then by the time you do your Internal Medicine rotation in 4 weeks, you will have a higher level of comfort in that field so you can impress more.
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During a clinical elective, 4 weeks fly by quickly so you have to make your impression count as best as you can. You need to be one of the first ones in the hospital every morning and one of the last to leave at night. You do not have a long time to get familiar with the US system and if you are worried about the "New York rule," you only have 12 weeks to get letters and make your impression in the system. Physicians can easily tell who is motivated or not during rounding so make sure you are always prepared for rounds, have logical support for your management recommendations, and ask intelligent questions. Reading journal articles or peer-reviewed journals are good habits to learn too because you will be doing these soon enough anyway so you might as well get accustomed to it now and use it as another opportunity to show off and set you apart from your peers.
If you are still uncomfortable with some aspect of the process, ask a resident or even a nurse to help you at the end of their obligations. Most people in Medicine are willing to help if you ask them politely so "ask and you shall receive" the help that you need. Being able to improve quickly in a short period of time reflects great on your work ethic and character. Do not waste these opportunities.
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- Photo courtesy of www.ilmicrofono.it: www.flickr.com/photos/115089924@N02/16070083419/
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