Stranger in a Short, White Coat: The Third-Year Student Experience

Neil Bhavsar

Disclosures

August 27, 2019

Have you ever watched that classic episode of SpongeBob SquarePants where the titular character forgets his name after turning the Krusty Krab restaurant into a five-star eatery? His mind goes into a chaotic maelstrom in search of his name after having memorized everything about the restaurant. My transition to clinical rotations has been somewhat similar.

As I wrote in 2017, I was extremely excited for medical school following my acceptance. But as it turns out, I honestly wasn't a huge fan of the first 2 years. So much of it focused on lecture slides and sitting in the classroom, which I wrote about in the second part of my ongoing "time capsule" of my experience. The closest we got to patient care was preparing for our quarterly simulated patient cases with "standardized patients." These were actors who helped us learn how to take a patient history, write a note, and present, all in less than 20 minutes.

I understand that all of this is done in order to prepare us for the national medical board examinations; however, like so many other students, I was eager to learn the clinical skills that make a physician "a physician." Sure enough, the first day of my clinical rotation, I was thrown into the emergency department to obtain the history and physical of a patient with aphasia who just had a stroke. The neurology residents saw me floundering and immediately came to assist.

Although I'm excited to be in my clinical rotations, I can admit that no amount of reading Reddit or mentoring from my upperclassmen peers could prepare me for what came next. Even after preparing for 2 months to take the dreaded Step 1, I found myself quite useless on the neurology floors, my first ever clinical rotation.

Learning the management and treatment of various neurologic pathology was only part of the battle; taking a good history, performing clinical assessments, and presenting information succinctly were important skills with which I found myself constantly fumbling. Most residents and attendings understand that freshly minted third-year students can't do much, and they don't have many expectations for us other than to improve. The real struggle comes from within the medical student community itself.

Knowing that most of our grade in clinical rotations comes from evaluations by the attending physician and our standardized examination at the end of each rotation, students often create expectations of themselves, virtually from thin air.

Med Students' Greatest Enemy Is Themselves

I found that my peers were often upset at themselves when they were struggling to communicate using medical Spanish or French with patients who couldn't speak English.

I found that my peers were routinely frustrated at themselves when they couldn't formulate a differential diagnosis as quickly as the consult team when discussing rounds.

I found that my peers were speechless when the seniors would "pimp" them on details surrounding pertinent cases on the floors.

Much of the anxiety and grief that medical students face seems built out of a need to become better than we were before. The standard of self-improvement is reinforced every time we make a mistake. Our role seems quite simple: Be as helpful as possible without getting in the way. Most attendings, residents, nurses, and other house staff are excited to teach us new things or help us navigate throughout the rotation, provided we make it clear that we are willing to learn. However, much of this is easier said than done.

The greatest hurdle I've faced with the transition to wards is time management. In the first 2 years of medical school, most of your time is your own. Don't like sitting in lectures? Okay, listen to a podcast. Don't like the lecturer's presentation? Okay, watch the online resource instead. Club meetings on Monday, Wednesday, or Thursday? No problem, schedule your studying around meeting times.

However, in third year, you're not sure when you will be out of the hospital or even where you will be rotating until a week before the rotation starts. My first rotation, neurology, is known to be a relatively nicer rotation for the third-year schedule. I found myself in the hospital by 6:30 AM to pre-round on my assigned patients, and I got home around 5:30 PM. Studying became a struggle.

In the first and second years, you could almost always study at the same time every day. With the variability of third year, you may not know when you'll be free, or if you will have the energy to crank out 40 UWorld questions, 100 Anki cards, and some Online MedEd before turning into bed and getting ready for the next day.

From what I have heard, it all gets better over time; throughout the year, you learn techniques that make you a better student clinician while also optimizing your study time.

Right now, I'm patiently waiting for that moment to hit me.

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