Residency Advisor
The attending is judging you long before you think the “teaching” even starts.
On rounds, pre‑med volunteers think they’re invisible. You are not. From the moment you step out of the elevator, attendings are clocking details that never show up in any handbook or pre‑health advising packet. Let me walk you through what people like me actually notice – and what quietly gets you invited in versus mentally written off.
This is the stuff faculty talk about in the workroom when you’re not there. The reason one pre‑med gets pulled into opportunities, and the other just becomes “that shadow we had last month… what was their name again?”
You want the insider rules? Here they are.
The First 30 Seconds: You’ve Already Sent a Message
The most critical judgment about you happens before the first patient encounter.
We clock three things immediately: timing, appearance, and how you enter the space.
Timing.
If rounds start at 8:00 and you walk up at 7:59:59, the residents may shrug. The attending does not. In our heads, we’re thinking: “As a pre‑med, you had one job – show up early and be ready. This is your Super Bowl and you arrived at kickoff.”
The pre‑med who quietly shows up at 7:40, finds the unit, checks where rounds usually start, politely asks a nurse, “Is this where the team usually meets?”, then stands out of everyone’s way but obviously ready – that person has already differentiated themself. They’re signaling: I understand I’m a guest in a high‑stakes environment.
Appearance.
Let me be blunt. We are not checking if your shirt cost $20 or $200. We are asking: “Did this person understand this is a professional, vulnerable environment with very sick people?”
Things attendings register instantly:
- Clean, simple, professional clothing – not wrinkled, not tight, not flashy.
- Closed‑toe shoes (you’d be amazed how often this is ignored).
- Visible hospital ID badge worn high and clear, not on your belt or hidden in a pocket.
- Minimal fragrance. The attending may not comment, but the nurse will – and word travels.
If you show up in scrubs you bought on Amazon because you “want to look like a doctor,” you’ve already missed something fundamental about roles, boundaries, and humility. Most attendings read that as cosplay, not commitment.
How you enter the space.
Pre‑meds blow this constantly. They either:
- Burst into the workroom and start introducing themselves to everyone mid‑charting, or
- Hug the door, looking terrified, never making eye contact.
We’re looking for a specific balance: someone who quietly approaches when there’s a pause, introduces themselves clearly, then gets out of the workflow.
The best opening I’ve seen from a pre‑med sounded like this:
“Hi, excuse me – I’m Alex, a pre‑med volunteer today. Dr. Sharma said I could join your rounds if it doesn’t disrupt the team. Where would you like me to stand so I’m not in the way?”
In two sentences, that student showed:
- They respect hierarchy and space.
- They’re thinking about not being a burden.
- They know they are a guest, not the main character.
Every attending on that unit noticed.
What We Actually Watch During Patient Encounters
Here’s the uncomfortable truth: during the first few patients, the attending is observing you more than you think. While the resident presents, we’re watching your eyes, your posture, your distance from the bed, and how the patient reacts to you.
We’re silently answering three questions:
- Can I trust this person around my patients?
- Do they understand boundaries and confidentiality?
- Will they add value or just be another body in an already crowded room?
Your body language is louder than your questions
If you’re leaning on the wall, arms crossed, staring at the monitor, you read as disengaged, no matter how “interested” you feel inside.
The students who get remembered:
- Look at the patient, not the monitor.
- Keep their hands free – not in pockets, not fiddling with their phone, not clutching a water bottle like a shield.
- Stand at an appropriate distance – not crowding the bedside, not hiding behind the team like wallpaper.
There is a very particular type of eye contact that stands out. It’s the volunteer who listens to the patient like the patient is the only person in the room, while still tracking the attending’s questions. Attending physicians notice that kind of presence instantly, because it’s the same presence we look for in interns and fellows.
Respect for privacy and dignity
This is where many pre‑med volunteers fail, because no one has taught you the unwritten rules.
If we step into a room with a curtain partially open, and the patient is disheveled or exposed, attendings watch what you do. Do you:
- Walk in without hesitation, staring, because you “want to see everything”?
- Or pause at the threshold and wait for the attending to invite you closer, after the patient consents?
That small hesitation, that moment of “I know I’m a stranger to this person,” reads as emotional maturity.
Another red flag every attending recognizes: the pre‑med who looks too fascinated by the wound, the rash, the procedure, and not at all tuned to the patient’s discomfort. We pick up on faces. We notice the student who looks excited instead of appropriately serious when a tragedy is being discussed.
No one will call you out directly. But you will never be invited for that central line placement, that bedside procedure, or that debrief afterwards. You’re quietly moved into the “not ready” category.
Questions: The Fastest Way To Impress – Or Expose Yourself
You’ve been told to “ask good questions.” That’s vague nonsense. Here’s the real breakdown of how attendings sort questions into three mental buckets.
Bucket 1: “Google it” questions (bad)
These are questions that could be answered in 10 seconds with a basic search or a textbook. When a pre‑med asks on rounds:
- “What’s pneumonia again?”
- “What does that medication do?”
- “What’s an MRI?”
We don’t think you’re curious. We think you came unprepared to your one shot.
No one expects you to know medical management, but every attending expects a pre‑med shadowing on an internal medicine team to know what “COPD” stands for and the difference between a nurse and a respiratory therapist. It’s harsh, but that’s reality.
Bucket 2: “You’re paying attention” questions (good)
These are the questions that tell us you’re listening to the human story, not just the pathophysiology.
Things like:
- “I noticed you spent a while explaining the plan to the daughter, not just the patient. Is that because you were worried about his capacity to understand, or more about family dynamics?”
- “You asked permission three separate times before touching the patient’s leg. Is that your usual approach, or was something specific going on in this case?”
These questions signal that you’re watching communication, consent, and power – the real heart of clinical work. Many residents do not ask questions at that level. When a pre‑med does, it stands out aggressively.
Bucket 3: “You might be one of us” questions (excellent)
Those are the questions that reveal reflection rather than data‑collecting.
Examples:
- “When I watched that family meeting, I found myself feeling really frustrated with the son who kept interrupting. How do you manage your own reactions in the room so they don’t interfere with care?”
- “It struck me how different the patient’s tone was when the nurse spoke compared to when you did. How do you think about your role versus the nurse’s when building trust with patients?”
These are not questions you throw out in front of the patient. These are questions you ask in the hallway, after rounds, when the team has a moment. If you ask these at the right time, you’ll see attendings shift into mentor mode, even if they hadn’t planned to teach today.
Timing matters. Content matters more. But what we really remember is whether your questions show introspection, not just ambition.
The Hidden Rubric: What Attendings Secretly Score You On
There is no written evaluation for a pre‑med volunteer on rounds, but every attending is mentally scoring you on four axes:
- Self‑awareness
- Impact on workflow
- Emotional intelligence
- Trajectory
Self‑awareness: Do you know who you are in this hierarchy?
Self‑aware pre‑meds:
- Don’t introduce themselves to patients as “part of the medical team.” They say, “I’m a pre‑med student shadowing Dr. X today, is it alright if I listen in?”
- Do not touch patients without explicit permission from both the patient and the attending. Not to “help adjust the bed.” Not to check a pulse. Nothing.
- Step back when the room gets crowded, reading the cues quickly.
When a pre‑med reaches for the stethoscope hanging on the bed rail or starts lifting a blanket uninvited, alarms go off in an attending’s head. That is how you get banned from the unit and never told why.
Impact on workflow: Are you a drag or a multiplier?
You might think the attending is only focused on patient care. During rounds, we also track how much you slow or smooth the workflow.
Red flags:
- You’re always in the doorway everyone needs to use.
- You ask case questions in the room while the nurse is trying to administer meds.
- You whisper to the resident while they’re clearly calculating doses in their head.
Green lights:
- You move quickly and silently when the team shifts to another room.
- You ask, “Is this a good time to ask a question, or should I wait until after rounds?”
- When the attending gets pulled away for a call, you don’t hover – you step to the side, let the residents regroup, and wait for a more natural opening.
We remember the pre‑med who made the morning feel smoother, not choppier.
Emotional intelligence: How do you handle discomfort?
Rounds are full of awkwardness. Bad news. Angry families. Confused patients. That’s where we really see who you are.
Two composite examples from real students:
Student A watched a patient cry after being told they likely had metastatic cancer. As we walked out, Student A immediately asked, “What stage does that mean? What’s their prognosis?” Technically valid questions. Terrible timing. Every senior on that team wrote that student off as emotionally tone‑deaf.
Student B watched almost the same scene. Outside the room, they stayed quiet. At the end of rounds, when everyone was seated and charting, they approached and said, “I felt really heavy after that last patient. Is it alright if I ask how you decide how much detail to share in moments like that?” Same curiosity, completely different read.
We are not looking for you to be stoic. Some of the most impressive pre‑meds I’ve seen were visibly moved but stayed focused, asked thoughtful questions later, and did not make their emotional reaction the center of the scene.
Trajectory: Are you early‑career material?
Here’s the real secret: when you’re on rounds, attendings are not deciding if you’d be a good volunteer. We are projecting you five, seven, ten years into the future and asking:
“Could I see this person as a resident on my service at 2 am?”
That filter changes everything. It’s why we care about:
- Whether you admit when you don’t understand, instead of nodding along.
- How you react when you’re gently corrected in front of others.
- Whether you say “thank you for letting me join you today” and mean it, not as a script.
We’re not hunting for brilliance. We’re hunting for coachability and reliability.
The Social Web: How Staff Talk About You When You’re Gone
One thing pre‑meds rarely understand: the attending’s impression is heavily shaped by everyone else’s read on you. Nurses, residents, PCAs, unit clerks – they see you more than we do.
If a nurse pops their head in later and says, “That student was really respectful with the family earlier,” that single sentence weighs more than any personal introduction you gave me.
On the flip side, I’ve had this exact conversation in the workroom:
Nurse: “Hey, is that student with you? They were asking me to explain basic stuff right in the middle of med pass.”
Me: “Thanks for telling me.”
Internal note made: This student does not understand workflow or boundaries.
Residents are even more blunt. They will tell us outright if a pre‑med was:
- Clueless but eager and humble (we’ll often invite them back), or
- Entitled, performative, and trying too hard to look smart at others’ expense (we will not).
Here’s a secret few will admit: when residents genuinely like a pre‑med, they will push the attending to invest in them.
“Hey, Dr. Patel, that student from last week? They were actually great. You should connect them with the student interest group / let them see that procedure / write them a brief note.”
So the way you treat the intern, the senior, the nurse, the clerk – every one of them is effectively a mini‑evaluation sent upstream.
How To Be The Pre‑Med Attendings Remember (For Good Reasons)
You do not need to be brilliant. You do not need to know medicine. That’s what training is for. But you do need to show the raw material of a safe, mature future colleague.
Let me distill the behaviors that consistently separate the memorable from the forgettable.
Before rounds:
- Arrive early enough to orient yourself without drama.
- Know the basics: what unit you’re on, the language for common roles (RN, PA, RT).
- Have a small notebook and pen. Not your phone. Not a tablet. Something that doesn’t scream distraction.
During rounds:
- Anchor your attention on the patient first, then the medicine.
- Ask patients for permission with language like: “Is it okay if I stay and listen during this conversation?”
- Keep your physical footprint small. Move when others need space.
- Save most questions for the hallway, and ask, “Is this a good time?” before launching.
After rounds:
- Reflect. Even five minutes in a quiet corner, writing: “What surprised me? What bothered me? What did I admire?” That kind of reflection deepens your questions the next day.
- If an attending or resident went out of their way for you, send a brief, specific thank‑you email. Not gushy, not transactional. Something like:
“Thank you for letting me join rounds today on 6 South. Watching how you explained the treatment plan to the patient with limited English really expanded how I think about communication. I appreciated the chance to observe.”
That’s it. You’re signaling professional courtesy, not angling for a letter.
FAQs
1. Should I ever introduce myself directly to patients, or wait for the attending to do it?
Introduce yourself, but do it concisely and with clear role boundaries. A safe script is: “Hi, I’m [Name], a pre‑med student shadowing Dr. X today. Is it alright if I stay and listen while they talk with you?” If the patient hesitates or says no, you leave without argument. Attendings notice when you respect that boundary instantly.
2. Is it okay to step out of the room if I feel faint or overwhelmed?
Yes. It is far better to quietly step back and leave than to try to “tough it out” and become the collapsing student in a patient’s room. Ideally, step out between sentences, not in the middle of critical news, and let a resident know afterward: “I started feeling lightheaded and didn’t want to disrupt the conversation, so I stepped out.” That reads as self‑awareness, not weakness.
3. Can I ever ask to do something hands‑on as a pre‑med volunteer?
Only after trust has been built, and only if someone else suggests the possibility first. For example, if a resident says, “Do you want to listen to this murmur?” you can say yes and then ask, “Is it okay with you, and with the patient, if I try?” Do not be the one to propose: “Can I place the IV? Can I examine them?” That’s jumping several levels ahead of your role.
4. How much medical knowledge should I review before joining rounds?
You don’t need deep pathophysiology, but you should know the language of the environment. That means basic vocab for common conditions on the service (e.g., for medicine: pneumonia, heart failure, diabetes), what vital signs are, and what common tests (CT, MRI, labs) broadly represent. The goal is not to impress anyone but to avoid burning precious face‑time on Google‑able questions.
If you remember nothing else, remember this: attendings are not looking for mini‑doctors. They are looking for future colleagues who are safe around patients, perceptive in complex spaces, and humble enough to learn.
Show that on rounds, and doors start opening that most pre‑meds never even see.
