10 Unwritten Rules About Surviving the Third Year

Farook W. Taha; Adeleke T. Adesina


May 10, 2011

We took the boards after second year and celebrated our achievements. Overnight, we became third-year medical students. The beginning of a new world awaited us as we wore our white coats and strode through the doors of the hospital. Excitement, mixed with a sense of uncertainty, lingered in our minds. We were unfamiliar with the hospital environment.

There are many reasons to celebrate being a third-year medical student. Medicine becomes more practical and hands-on; there are no more endless lectures packed with information. You get to "play doctor" and meet the patients you read about in the books. You apply what you've studied -- or at least see it applied practically to real patients. You experience different aspects of medicine that will help you decide what you want to do for the rest of your life.

Unfortunately, there are also reasons to feel anxious about third year. You will miss having a flexible schedule. As a second-year medical student, your attendance was not mandatory, and you had the luxury of listening and relistening to lectures in the convenience of your own home. In third year, however, rotations are more like work: You never want to be late. If you are on surgery rotation, you have no option but to be there at 6 AM or earlier for the entire rotation. And because you're not in a classroom you no longer have a structured schedule. In addition, you and your classmates will get different experiences and learn different things. You will be tired after rotations and you won't feel like studying at the end of the day. Many third-year students will tell you it is vacation time. Should you believe them? No!

There are many unwritten rules that we are all supposed to know, and sometimes we must learn them through our mistakes. The simple rule in medicine is that if you fail once, you must learn never to repeat that mistake. As third-year students, we learned some guidelines that have helped us excel in our clinical rotations and impress our residents and attending physicians. We hope that these tips will also help you move seamlessly from the classroom to both in-patient and out-patient clinical settings.

1. Do not take anything that happens in the hospital personally. The hospital is a high-stress environment. Many situations that arise as you rotate -- for example, issues with unhappy patients, doctors who disagree with other doctors -- will be completely new to you, and you will not be sure how to handle them. No matter the situation, make sure you act professionally at all times. In particular, a common problem for students is learning to accept criticism from interns, residents, and attendings. Try to focus on the reason why you are on the rotation: to learn! Try to accept constructive criticism with a smile because it will ultimately make you a better doctor.

2. Read! Read! Read! We cannot overemphasize the extreme importance of keeping up with information. This is the only way to impress your attending -- with what you know! We realized how easy it was to neglect our studies, but we made it a priority to read constantly on our rotations. It quickly becomes apparent when you do not read on clinical rotations, and you quickly realize how much you do not know. You cannot afford the luxury of not studying.

3. Do not expect every attending physician to be a teacher. Although we know it is our attendings' responsibility to teach, we also came to realize that we will meet only a few good teachers. Let's face it: Many of us are going to become attending physicians someday, and we cannot assume that everyone knows how to teach well. It is a skill, and the attending must be willing and able to do it. As for us, we learned a lot from the doctors who taught us and we read up on the rest.

4. Be on time to every rotation. In fact, getting there early is safer and better. You can spend some time reading the charts until your intern/resident arrives.

5. Be professional in your attire and in the way you carry yourself. Remember, these physicians will fill out your evaluations and possibly write you a letter of recommendation for your residency application. They will remember you, so always leave a good impression.

6. Ask for letters of recommendations early. Doctors are busy and can take months to write a letter.

7. Read up on your patients' conditions, especially if they have a diagnosis that you are not familiar with. You should be able to understand what the doctors are discussing.

8. Do not ask questions if you can look up the answers. Jot down your questions somewhere so that you don't forget them, and look them up when you get home. It looks bad if you ask simple questions that you should know or can easily research.

9. Study early. Remember, you have a shelf exam or school exam at the end of each rotation. This test usually counts as a big portion of your rotation grade. These clinical grades are important for when you apply to residency, so you want to do really well on them. Also, you have 2 board examinations at the end of third year: the clinical knowledge and the clinical skills exams. Thus, studying early is crucial.

10. Strengthen your residency applications (and don't put this off). Keep up with the work; we started working on our curriculum vitae right after taking the boards. You will need this to request a letter of recommendation from your attending physicians. It is also important that you find tangible projects or research to pursue which will help strengthen your residency application.

The third year is all about what you decide to make it, in terms of both academic learning and clinical experience. Most hospitals have few lectures for each rotation, if any. That leaves learning in your hands, to a certain extent. The best advice we can give is to read as much as you can during third year. Seek advice from upper classmates and find out what resources are the best to use for each rotation. Read books, journals, and exam questions every night. Even if you are tired after a grueling 12-hour surgery shift, make it a point to read for at least 1 hour every night and catch up more on weekends. Also, keep a pocket-sized review book with you at all times. There will be a lot of time to kill that you can use wisely to read.

Each person's experience is different as a third-year student. We are not saying that we had a blast on every rotation, but we made the best out of each one. Try to maintain your self-confidence and believe in yourself. Do not be ashamed of being wrong! You have earned the right to be part of this elite group. Use every opportunity as a chance to learn and keep your eyes on the prize. Then you will be well on your way to becoming a good physician.