As you begin clinical rotations, the shift from classroom learning to patient care can feel exciting, intimidating, and deeply personal.

Early rounds may bring new responsibilities, difficult patient encounters, mistakes, uncertainty and at times, grief. Learning how to process those moments while continuing to show up for patients, your team, and yourself is an important part of becoming a physician, experienced doctors told Medscape Medical News.

“When students begin their clinical rotations, they are thrust into a new environment with new expectations,” said Laine Young-Walker, MD, chair of the Department of Psychiatry and professor of psychiatry at University of Missouri School of Medicine, Columbia, Missouri. “This is a time where there is a pressure to perform in what is sometimes a high-stakes environment. Exposure to patients can be emotionally challenging as they navigate taking care of sick patients during what may be their most vulnerable times.”

Processing Grief in Clinical Setbacks

If you are grieving after a difficult patient encounter, give yourself permission to notice what you are feeling rather than pushing it aside. Talk with a trusted peer, resident, faculty member or wellness resource so you do not have to carry the experience alone. Reflect on what happened, what you learned, and what you may need before returning to patient care with compassion for your patients and yourself, said Young-Walker.

Furthermore, students studying in medical field need to understand that it is OK to grieve and have emotions when they see their patients suffering or pass away, said Jennifer Gold, MD, vice dean for education at Ohio State University College of Medicine in Columbus, Ohio. “It does notmean that they are not meant for medicine, and they do not need to hide or cover up their emotions. It is helpful to debrief the experience with their peers, residents, and faculty,” Gold told Medscape Medical News.

The Dynamics of Early Rounds and Clinical Setbacks

For many medical students, entry to direct clinical care can be exciting yet emotionally challenging.

“This may be their first time directly interacting with death and dying, which they can be exposed to on any clinical service,” said DaCarla M. Albright, MD, associate dean for Student Affairs & Wellness, and a professor of Clinical Obstetrics & Gynecology, Perelman School of Medicine, University of Pennsylvania in Philadelphia.

“This runs the gamut of losing an elderly patient on a medicine service, seeing the results of gun-related or other trauma on an emergency medicine or surgery rotation, or the pains of an early pregnancy loss or stillbirth during their time on the ob/gyn clerkship.”

Students may see residents and attendings “package” these feelings in real time, to attend to the clinical matter at hand, and continue the necessary medical care, Albright outlined.

She said debriefing helps students understand that clinicians often process difficult moments after the immediate clinical work is done.

“What they may not see is how each clinician manages the emotional load behind the scenes,” she said. Talking through these moments with the team can help students name what they are feeling, make sense of their confusion, and recognize when they may need more support.

Processing Grief While Learning to Care on Clinical Teams

Albright said students may need to stay involved until a clinical situation is stable, especially if their role is important to the team.

“Patient safety comes first,” she said. If a student feels too overwhelmed to continue, it is appropriate to ask for a brief break and notify the resident or attending they report to. “Students should seek support through counseling services and trusted advisors,” Albright said.

Guidance After Tough Encounters on Rounds

Faculty should take the time after a difficult patient encounter or patient death to speak with the team and the medical student, said Gold. “If the faculty member is comfortable, sharing one of their early experiences can be helpful, letting students know that it’s OK to be greatly affected and that it is something they likely will keep with them for their career,” she said. It can also be helpful to go through the case and identify what went well, what could have gone better. and what things were beyond their control.

Spotting Warning Signs During Clinical Training

Gold said students should hear clearly that it is normal, and still professional, to grieve after a patient dies. It is also common to feel overwhelmed while adjusting to the clinical setting, and some students may even wonder whether they chose the right field. Over time, those doubts and feelings of uncertainty should ease and should not get in the way of daily functioning. Warning signs include symptoms of depression or anxiety that begin to interfere with a student’s ability to function, such as sleeping too little or too much, feeling persistently sad for several weeks, avoiding care for other seriously ill patients or having repeated intrusive thoughts, she summarized.

Practical Strategies to Implement to Manage Clinical Setbacks

As a medical student, you can build resilience by leaning on the people around you, including classmates, residents, faculty, and mentors. Protect the basics as much as possible: sleep, movement, regular meals, and time for interests outside medicine when your schedule allows. Remember that clinical competence develops over years, not overnight, and your role in early training is to learn as much as you can from each patient experience, Gold expressed. “I think one of the most important things is that students recognize that having emotions regarding patients they take care of such as grief with a patient death is not a sign of being unprofessional; it means they have compassion and care, which are two excellent attributes for physicians,” Gold further said.

Building Resilience Without Losing Compassion After Setbacks

Albright said students should debrief tough moments with the team when possible and lean on mentors who understand what clinical training can feel like.

“Seeking the support of trusted advisors and mentors who have experienced similar challenges can validate and normalize the emotional responses to stressful clinical experiences,” she said.

Furthermore, Albright told Medscape Medical News that students should not ignore the event, especially if counseling or psychological support would help, and should keep using the self-care practices that help them manage stress.

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