Change Is the Only Constant

Sarah Averill, MD

Disclosures

March 16, 2012

Question

Question: How do I cope with the number and pace of changes that take place in medical school?

Response from Sarah Averill
Resident, University of Iowa Hospitals and Clinics, Iowa City

Medical education and training well beyond medical school is filled with change. At times it seems the only constant. Having just started my categorical training in diagnostic radiology, I am on a new rotation every 3 to weeks, with new staff, including attendings, senior residents, nurses, and technologists, as well as new procedures, protocols, and technology to understand. I am reminded again that one of the big challenges of medical education is the number and pace of transitions that take place. Learning to cope with constant change is one of the major lessons in medical training. Success in medical training requires mental flexibility, a constant willingness to take on new responsibilities as your skills develop.

One of the most difficult transitions is the leap from the first 2 years of basic science training to the clinical training environment. Most medical schools have introduced some clinical experience into the first 2 years to give students early exposure and allow for some hands-on experience taking histories and performing physical exams. Even so, the shift from mostly book learning and written exams to being in hospitals and clinics is a dramatic change.

As a student I recall having anxiety about where to find information I was expected to know about my patients (UpToDate, the electronic medical record, the nurses at the bedside, various charts?) and whom to share it with when I found something that concerned me (the nurse, the resident, the attending, the social worker, a family member?), as well as how to share it without seeming to question the authority or wisdom of those above me. When I was asked to get consent from patients to perform procedures, I was sometimes anxious that I didn't understand the procedure well enough to answer a given patient's questions.

Asking for help was one of the ways to ease the anxiety of transition: Always ask for help or clarity if you don't feel comfortable doing something. Remember that you are in training and let your resident or attending know your concerns. This may require humility.

Also remember to ask yourself if you are just afraid or if there is potential for harm. Your residents and attendings will push you to take steps to do things on your own so that you develop skills and confidence, usually well aware of the real risks, if any, to the patient of having a medical student perform the task. So, don't be shy; step up and take risks. That's how you will learn.

If you are finding this transition stressful, rest assured that you are not alone. Despite the introduction to some aspect of clinical medicine in the preclinical curriculum, students the world over find clinical medicine to be a vastly different experience.

Some liken the stress to what it would be like to start a new job every 4 to 6 to 12 weeks, depending on the length of your rotation. Even within rotations there can be dramatic changes from week to week in the expectations of those supervising or working with you. If you are lucky, a resident who has been on the rotation before you will tell you the eccentricities of the staff you will be working with so that you are not caught off guard.

In one survey, students who had completed their clinical training were more concerned with learning time management and self-care than students who were just starting, who were more anxious about practical skills such as oral presentations and physical exam skills.[1]

So, if you're in the middle of your training, don't forget to take care of yourself. Run, go out dancing, play drums, try to make at least one friend outside of medicine to keep things in perspective. And if you don't like a particular rotation or are having a rough go with a particular attending, one of the benefits of the frequent transitions is that what you are doing and who you are working with, just like the weather, will change soon.

Keys to survival lie less in specific skills and more in core values like flexibility, hard work, and personal integrity. In our medical school we were reminded even during the preclinical years that ultimately in life there is no written test to validate your performance. You are accountable to yourself. Your attending may not see the best history and physical exam that you perform because every time he or she is watching you, you get anxious and can't find the words, or maybe even your stethoscope. The real test is how you treat living, breathing human beings -- yourself included -- who really are someone's mother, father, sister, brother, son, or daughter.

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