What Supervisors Really Notice During Externships (It's Not Your Skills)

Your externship is more than just completing hours—it's an extended audition for your healthcare career. But here's what most students miss: supervisors aren't just watching your clinical skills. They're watching how you show up, how you adapt, and how you handle the moments when nobody's looking.

In this episode, we break down what really matters during your externship experience. From the small actions that signal professionalism to the mistakes that can actually help you grow, you'll learn how to stand out for all the right reasons.

We'll cover:

• What supervisors are really watching for (hint: it's not perfection)
• The difference between being present and being perfect
• How to handle mistakes like a professional
• Why your attitude during slow days matters just as much as busy ones
• The simple habits that turn externs into employees
• How to have "the conversation" about job opportunities before your externship ends

Whether you're about to start your externship, in the middle of it, or preparing for what comes next, this episode will help you approach every shift with purpose and confidence.

Your externship is your launching pad. Let's make sure you're ready to take off.

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Transcript

0:01

Picture this, it's your first day. You walk into your externship site and everyone seems to know exactly what they're doing. There's a rhythm to the place, people moving with purpose, patients waiting, phones ringing. And you? You're wondering if your name tag is straight and trying to remember where they said the supply closet is. Welcome back to MAP, Medical Pathways for Success. I'm your host, Fred Nazario Alvarado. And if that feeling I just described sounds familiar, or if it's coming up for you soon, I want you to take a breath, because here's what I need you to know right now. That nervous feeling? That's not a bad thing. It means you're about to step into something real, something meaningful. Today we're talking about externships, but not the way your handbook talks about them. We're not going through a checklist of requirements or competencies. We're talking about what actually happens when you show up. What people are really watching for and how students just like you, maybe even quieter than you, maybe less confident than you, turn a few weeks on site into job offers. Because here's the truth most people don't tell you upfront. Your externship isn't just a graduation requirement. It's your first real interview. And in a lot of ways, it's already started the moment you accept your placement. So let's talk about how to make the most of it. not just to complete your hours, but to truly launch your career. Let me tell you about Maria. She was in her second week of her externship at a busy outpatient clinic, part of a medical assisting program. One morning, she's shadowing a phlebotomist who's clearly having a rough day, running behind schedule, patients stacking up in the waiting room, and you could just feel the stress building. Maria didn't say much. She just quietly started helping. She grabbed the labels, organized the collection tubes by order of draw, prepped the tourniquets, and when the phlebotomist finished with one patient, Everything for the next one was already set up and ready to go. A phlebotomist looked at her and said, thank you, that actually helped. Fast forward three months, that phlebotomist, she's now Maria's direct supervisor. Maria got hired at that clinic before she even finished her extra shift hours. So what did Maria understand that a lot of students miss? She understood something critical. It's not about being perfect, it's about being present. It's about paying attention and stepping up when you see a need. Maria didn't wait to be asked. She saw the need and responded. That's what professionalism looks like in action. Now I want to break down what supervisors are actually watching for during your extranethip. Because here's the good news. None of this requires you to be the top student in your class. None of it requires you to have perfect clinical skills on day one. First, they notice who's ready. And I don't mean just physically ready. Though yes, that matters. Clean scrubs, supplies organized, name badge on. But I'm talking about mentally ready. Who walks in focused? Who's present from the moment they arrive? Who puts their phone away without being reminded? Those small things tell a supervisor, this person is taking this seriously. This person respects this opportunity. Second, they notice who adapts. Some days at your externship, you're going to be slammed. Phones ringing off the hook, back to back patience, barely time for you to catch your breath. Other days, It might be slower, maybe even uncomfortably slow, while you're standing around wondering what you should be doing. The student who gets hired, they're the ones who find something productive to do in both situations. When it's busy, they jump in and help without waiting to be asked. When it's slow, they restock supplies, review protocols, ask if anyone needs assistance with tasks, or even just observes more closely and asks thoughtful questions. That's initiative. and initiative is one of the most valuable traits you can demonstrate. Third, and this is a big one, they notice how you handle mistakes. And let me be clear, you will make mistakes. Everyone does. I did. Your instructors did. Every single person working at that site has made mistakes during their career. But here's what separates the student who gets job offers from the ones who just get their completion forms signed. Ownership. I heard from a supervisor recently about a student who accidentally entered vitals into the wrong patient's chart. The moment she realized it, she didn't try to quietly fix it and move on. She immediately informed her preceptor, documented the error, and asked what the proper correction protocols was. That's the response of a professional. When something goes wrong, and at some point it will, what matters most is how you respond. Do you take responsibility and treat it as a learning experience? Or do you make excuses? Get defensive or try to hide it. Supervisors are watching for that. They want to see that you can take feedback, learn from it, and grow. That's maturity. That's professionalism. And here's the one that really matters. They notice your attitude when nobody's watching. How do you talk about patients after they leave the room? How do you treat the environment's staff? The front desk team. What's your energy like at 4.45 p.m. when everyone's tired and ready to go home? Those moments when you think no one's paying attention, those actually matter more than you might realize. There is a popular expression in healthcare, although its exact origins is unknown, but it resonates well with what we are discussing. It states, can teach anyone to take vitals. I could teach them to draw blood, to run an EKG, to navigate our system. What I can't teach is compassion. I can't teach work ethic. I can't teach someone to care. So here's my advice. Bring a notebook with you every single day. Write things down, techniques you see, terms you hear, questions you want to ask later. That simple act shows curiosity and commitment. And those are traits that every great employer is looking for. Ask thoughtful questions, not just, what do I do next? But why do we do it this way? Or what's the reasoning behind that protocol? That kind of curiosity shows you're not just trying to get through your hours. you're trying to truly understand the work. Because at the end of the day, your externship is an extended audition. Every shift is a performance. Every interaction, every task, every question you ask, it's all building your professional reputation. And here's the beautiful part. You get to decide what that reputation looks like. You get to show up and prove who you are every single day. So don't think of your externship as just completing a requirement. Think of it as an audition for your career. Be teachable. Stay humble. Show that you're serious about growing in this field. That's how you stand out. That's how you go from extern to employee. Now, let's talk about two things that can completely shape your externship experience. Professionalism and confidence. When you first walk into that site, whether it's your first day or you're already a few weeks in, it's completely normal to feel nervous. You're entering a new environment, meeting new people, trying to prove yourself. So there's a lot of pressure. But here's what I want you to remember. And I really want this to sink in. You are not expected to know everything. What's expected is that you're willing to learn. everything you can. There's a huge difference between those two things. Professionalism starts the moment you step through the door. And it builds on some really fundamental things. Be on time. Actually, be early. If your shift starts at 8am, plan to arrive at 7.45. Give yourself that buffer. It shows respect for the other's time, and it gives you a moment to mentally prepare before you jump into the day. In the military, we live by a simple rule. 15 minutes early is on time. That discipline has stayed with me ever since, and it's become more than just showing up early. It's about being prepared, respecting others' time, and setting myself up for success before the day even begins. Another thing to remember is to dress appropriately. Follow your site's dress code. Keep your scrubs clean and pressed. Make sure your shoes are professional. These details matter because they signal that you take this seriously. Also, Treat everyone with respect, and I mean everyone, from patients to providers to the housekeeping staff. Every single person in that facility plays a role in patient care. Every person deserves your respect and courtesy. Showing respect to all levels of staff speaks volumes about your character. It shows that you understand healthcare is a team effort, and that no one is above helping or being kind. Now let's talk about confidence, because I think there's lot of misunderstanding about what confidence actually means. especially in a clinical setting. Real confidence doesn't mean acting like you know everything. In fact, that's usually a sign of someone who's trying to hide their insecurity. Real confidence comes from two things, preparation and presence. Be prepared. Bring your tools, your notepad, your stethoscope, if you have one, your badge, whatever supplies you need. Bring your curiosity too. Come in ready to engage with whatever the day brings. Be present. Listen actively. Pay attention during procedures, even if you've seen them before. Stay off your phone unless it's absolutely necessary for a work-related reason. The best externs, the ones who leave a lasting impression that leads to job offers, they're the ones who ask thoughtful questions, offer to help when they can, and show genuine interest in what's happening around them. They're not trying to impress anyone. They're just fully there, engaged in the moment, soaking it all in. And let's talk about communication for a minute. Because this is so important. How you communicate says everything about your professionalism. Speak clearly. Make eye contact. Not in an intense way, just in a warm, attentive way. Listen more than you talk. Really listen. Don't just wait for your turn to speak. And if you're not sure about something, and you won't be sure about a lot of things, especially at first, ask respectfully. Try saying things like, can you walk me through that again? I want to make sure I understand before I try it on my own. Or, I haven't done this procedure yet, but I'd really like to learn. Could I observe you first? Another one could be, I want to make sure I'm doing this correctly. Can you check my technique? Phrases like these show initiative and humility. Two qualities that every good healthcare professional need. They show that you care more about doing things right than about protecting your ego. Now here's something I want you to understand about confidence. It grows with experience. but it also grows from mindset. Don't compare yourself to any other externs that may be there. Don't compare yourself to the staff member who's been doing this for years. Everyone learns at a different pace. Your extraship is about growth, not your perfection. If you make a mistake, and you will at some point, because we all do, own it, learn from it, and then move forward. Don't let it shake your confidence or make you doubt whether you belong here. Mistakes aren't failures. There are lessons wrapped in experience. What matters most is that you use them to get better. One of the best ways to build confidence and professionalism is through reflection. And this is something I really encourage you to do. At the end of each day, maybe on your drive home, or before you go to bed, take a few minutes to write down these things. What you learned today, what challenged you, and what you want to work on or improve next time. That's it. Just three simple reflections. You'll be surprised at how much progress you see over time when you track it this way. You'll start noticing patterns. You'll see yourself grow. And that evidence, that tangible proof of your development, builds real lasting confidence. And here's something else that's really important to understand. Every externship site is different. Some will be fast-paced and high-energy. Others might move slower and be more methodical. Some preceptors will want you hands-on right away, jumping in and doing procedures under supervision. Others might expect you to observe for a while first, before they let you participate. Different approaches, different teaching styles, different clinic cultures. Adaptability is key. No matter what the setting is like, there's always something valuable to learn if you're paying attention. There's always an opportunity to grow. Whether you're placed in a small family practice or a large hospital system, whether it's pediatrics or geriatrics, whether it's fast or slow, your attitude determines your experience. Bring positivity, stay teachable, treat each day as an opportunity to become better than you were yesterday. That mindset doesn't just make you a great extern. It makes you someone people want to work with. It makes you someone they remember when a position opens up. Because at the end of the day, professionalism and confidence aren't really about what you know. They're about how you show up. Every patient interaction, every task you complete, every challenge you face, it all helps shape the professional you're becoming. And trust me on this, that version of you, the one you're working toward, the one you're building day by day, that version is absolutely worth it. You're not just checking off hours, you're becoming someone. All right, let's talk about what happens next, the transition. That moment when you go from extern to employee, from student to professional. This is one of the most exciting moments in your entire medical journey, because it's when everything you've been working towards starts to take real, tangible shape. All those late nights studying, all those practice sessions, all those exams and skill checks, they've been preparing you for this. Now here's something really important to understand. A lot of externs do get hired where they complete their externships. It's actually one of the biggest opportunities your externship offers. But whether or not that happens for you depends on more than just your clinical skills. It depends on your attitude, your reliability, how you carry yourself day in and day out, and the impression you leave on people. Think about it this way. Your externship is essentially a long, hands-on job interview. Every single day you show up, you're demonstrating whether you're capable, whether you're dependable, whether you fit in with the team's culture. Supervisors notice the students who go the extra mile. They notice who shows up early, who stays engaged even during slow periods, and who's looking for ways to help without being asked to do so. They notice who brings positive energy and who makes their job easier. So when your externship starts winding down, maybe two weeks before your last scheduled day, don't be afraid to speak up. Have a conversation with your site supervisor or the office manager. It doesn't have to be complicated or overly formal. You could say something like, I've really enjoyed my time here, and I've learned so much from working with your team. This experience has shown me that this is exactly the kind of environment where I want to work. If any positions open up now or in the future, I'd love to be considered. Is there an application process I should follow? or someone specific I should speak with about opportunities. That's it. Simple, direct, professional. And here's what the conversation does. It shows initiative. It puts you on their radar, and it lets them know you're serious about wanting to work there. Even if they don't have an opening right away, that conversation plants a seed. And sometimes, positions open up faster than you'd expect. Or sometimes, they create a position because they don't want to lose such a great candidate. Now let's look at this from another perspective. Maybe your externship site doesn't have any openings. Maybe they just hired someone last month or their budget doesn't allow for a new position right now. That happens and it doesn't mean you did anything wrong. Sometimes these things just don't work in your favor. But here's the good news. Even if your externship site can't hire you, your professionalism still pays off in a big way. Many times, supervisor will recommend great students to other clinics in the area. they'll put in a good word for you. They might even call around on your behalf or mention your name when they hear about openings elsewhere. Your reputation follows you, and in healthcare, which can feel like a surprisingly small world once you're in it, that reputation can open doors faster than you might think. This is also why networking is so important during your externship, building genuine relationships with your coworkers, your preceptors, and your supervisors. Add them on LinkedIn. Stay in touch after your externship ends. Keep them updated on your job search and your career progress. And send them a message when you land your first position. Those connections, those relationships you're building right now, they matter. The medical field is interconnected. The people you work with during your externship might end up being colleagues at another facility down the road. Or they might know someone who's hiring. They might even move to a different practice and remember you when they need to build their team. Networking isn't about being fake or using people. It's about building authentic professional relationships. It's about staying connected with people who've invested in your growth. And since we're talking about being hired, let's talk about the resume. When it's time to start applying for positions, whether at your externship site or elsewhere, make sure you're highlighting your externship experience effectively on your resume. Don't just list what you did. Explain what you learned and how it prepared you for the workplace. Use specific, concrete examples. Instead of just saying assisted with patient care, Try something like perform intake assessments and documented patient histories and electronic health records for 100 plus patients. Another one you could use is assisted with clinical procedures, including phlebotomy, EKG, and vital signs in high volume outpatient settings. Or even collaborated with multidisciplinary teams to ensure efficient patient flow and quality care delivery. Those real world details show employers that you've been in the field, not just the classroom. They show that you understand the pace and demand of actual clinical work. But beyond all the logistics, the resumes and applications and networking, let's talk about the mindset for a moment. Transitioning from student to professional can feel intimidating. Suddenly there's no instructor standing beside you to double check your work. There's no safety net of, I'm just a student. You're the real deal now. And yeah, that can feel scary. But here's what you need to remember. You've trained for this. You've studied, you've practiced, you've been tested. And you've grown into someone who's ready to make a difference in people's lives. Confidence doesn't come from knowing everything. It never has. And it never will. Because healthcare is always evolving. And there will always be more to learn. Real confidence comes from being willing to keep learning. It comes from knowing that you have a solid foundation and that you're committed to building on it every single day. Every new hire starts somewhere. Every experienced medical professional you admire once stood exactly where you are right now. On the edge of something new, feeling nervous and excited and uncertain all at once. So as you make this transition from extern to employee, hold on to that habit that got you here. Stay curious, stay humble, stay committed to growth. Show up with the same energy and professionalism in your first job that you brought to your externship. Because those qualities never stop mattering, no matter how experienced you become. And remember, the externship may end, but your learning never stops. Your growth never stops. Every patient you meet, every procedure you perform, every challenge you face, it's all part of your ongoing education. The people you worked besides during your externship, they could become your coworkers, your mentors, and maybe even lifelong friends in the field. You've earned this moment. You've put in the work. You've shown up, learned, grown, and proven yourself. Now step into this transition with confidence. You're not just an extern anymore. You're a professional. And the healthcare world needs people like you. People who care. Who work hard. Who never stop trying to be better. Your journey is just beginning. Now let's take a second and complete your MAP moment for this week. It's time for your map moment A quick little push to keep you going Stay focused, keep strong Your pathway to success is on Alright, it's time for your map moment. That one powerful, actionable takeaway that's going to help you move forward with real purpose. During your externship, you're going to learn a lot of technical skills. How to take vitals accurately, how to handle equipment, how to document in the electronic health record, and how to follow protocols and procedures. Those clinical skills are important, absolutely. But beyond those hands-on tasks, your externship is also your chance to grow as a professional. To develop the qualities that make people want to hire you. To work with you. To trust you with their patience and their team. So here's your map moment challenge and I want you to really think about this. Identify one professional skill you want to intentionally improve during your externship. Not a technical skill, a professional one. And if you're not on an externship, this applies to you too. It'll make you a better professional. Maybe it's communication. Learning how to speak clearly and confidently with patients, coworkers, and supervisors. Learning how to ask questions effectively. Learning how to explain procedures in a way that puts people at ease. Or maybe it's time management. Figuring out how to stay organized and efficient during busy clinic hours. How to prioritize tasks. And how to handle multiple responsibilities without getting overwhelmed. Or maybe it's teamwork. Learning how to collaborate. How to ask for help when you need it. How to support others without being asked. How to read the room and understand what the team needs from you in any given moment. And maybe it's confidence. Learning how to volunteer for tasks instead of waiting to be asked. Learning to speak up when you have a question instead of staying quiet. Or learning to trust your training and your instincts. And lastly, maybe it's adaptability. Learning to handle unexpected situations with grace. Learning to pivot when plans change. And learning to stay calm and perturbed when things don't go as expected. Whatever the skill is for you, and only you know what you need to work on most, I want you to write it down. Right now if you can. Write it on a sticky note and put it in your planner. Set it as a reminder on your phone. Write it on a small card and keep it in your scrub pocket. If you're driving right now, just say it out loud and promise me you'll write it down when you park. Make it visible. Make it present in your mind. And then, each day you're on site, Do one small thing to practice it. Just one thing. If your skill is communication, practice greeting every patient with eye contact and a smile. Practice introducing yourself clearly, or practice asking one thoughtful question during a procedure. If it's confidence, volunteer to do one thing before someone asks you to do it. Raise your hand when your preceptor asks if anyone wants to try. If it's professionalism, pay attention to how the experienced staff handle difficult situations. Challenging patients, busy days, unexpected problems, and learn from their examples. Growth doesn't happen all at once. It doesn't happen in some dramatic transformation. It happens in small intentional moments, in daily choices, in the decision to show up and try to be a little better than you were yesterday. And when you look back at your externship, whether it's weeks from now or months from now, it won't just be about what you learned, it'll be about who you became. You'll be the extern who took every challenge as an opportunity. who learned from feedback instead of taking it personally, who walked out of that experience ready to take on your next chapter with confidence and purpose. So take a moment right now. Think of that one skill. Say it out loud, even if you're just listening to this alone. During my externship, I'm going to improve my... Write it down. Make it real. Make it your focus. Because every small effort you make, every intentional choice to grow, that's what builds the professional you're becoming. You're not just preparing for a job. You're shaping your entire career. You're becoming the person you're meant to be in this field. And that person? That person you're working towards? They're absolutely worth it. And that's it for today's episode of MAP, Medical Pathways for Success. Listen, I know your externship might feel overwhelming right now. Whether you're about to start and feeling nervous, you're in the middle of it wondering if you're doing enough, or you're near the end and hoping it leads somewhere. I want you to know something. You belong here. You've earned this opportunity and every single day you show up, you're proving that you have what it takes. Your externship isn't just a requirement to check out. It's a launching pad. It's where all that classroom learning meets real life experience. It's where you start to prove yourself, not just to your supervisors or instructors, but to yourself that you belong in this field. Whether you're just taking vitals, assisting with procedures, Answering phones or just observing how a clinic runs day to day. You're not just gaining skills, you're building trust, building confidence, and you're building the professional habits that are going to carry you through your first job and every job after that. Be the extant who shows up early and stays engaged. Be the one who asks good questions and owns their mistakes. Be the one who treats everyone with respect and stays curious. That effort gets noticed. And more often than you'd think, it's exactly what turns an externship into a full-time position. If this episode helped you, if something I said resonated or gave you a new perspective, share it with a classmate or someone who's about to start their externship. Sometimes, just knowing someone else understands what you're going through makes all the difference. And if you've got a story to share, a question you'd like me to answer, or a topic you want me to cover in a future episode, I'd love to hear from you. Email me at mattpodcasts at outlook.com. or connect with us on Facebook or Instagram. Your ideas and experiences could inspire someone else on their path. Your questions might be exactly what someone else is wondering, but hasn't asked yet. So please reach out. I'm here to support you however I can. Next time on Medical Pathways for Success, we're diving into soft skills that set you apart in healthcare. We're going to talk about how communication, empathy, and professionalism can truly open doors and set you apart in any healthcare setting. Because technical skills might get you the interview. But these soft skills are what are going to get you the job and help you build a lasting career. That's coming up next, so make sure you're subscribed so you don't miss it. Until then, keep learning, keep growing, keep showing up as the best version of yourself, and keep following your map, your medical pathway for success. Your future is closer than you think, and you're ready for it. I'll see you in the next episode.