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Stanford University School of Medicine

Countdown to clinics: 7 challenges of jumping into third year

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category

Recently, on Match Day, medical students around the country learned where they would land for residency. But the fourth-years aren’t the only ones graduating; the current second-year medical students are leaping from pre-clinical to clinical trainees.

If you haven’t heard from your second-year friends recently, they’re probably studying for the Step 1 Board exam. Before starting clinics, students must pass the exam that tests two years' worth of knowledge and generates a score that will stick with them until their own Match Day. Beginning clinical rotations is a step that feels as big as the one from medical school to residency, albeit with less fanfare.

Third year, like residency, traditionally starts on July 1. It marks the time when doctors-in-training finally start doing what we signed up for: actually doctoring. No more patients-on-paper; third year means real patients with real issues, many of which the pre-clinical curriculum doesn’t teach. No more spending all day in class and studying at home all night; third year means spending all day in the hospital, and then studying at home all night. And no more summer break; third-years transition to the year-round world of working adults.

Here at SMS Unplugged, we’ll be counting down to July 1st with a three-part series about the soon-to-be-clinical student experience. Below are seven challenges of starting third year.

7. The early mornings
Medical students usually arrive even earlier than residents, in order to “pre-round” on patients before making rounds with the full team. Be prepared for at least a few months of reaching the hospital at 5 AM – or earlier. If you’re not a morning person already, you will be soon.

6. Making decisions
Putting on the white coat is a privilege that comes with huge responsibilities. It’s jarring when someone calls you ‘doctor’ and asks you to make a clinical decision: Is it OK for the patient to eat? When can we turn off their IV fluids? What’s the plan for pain medications? It doesn't matter that you’re still a student, or that you’re only on each rotation for a few weeks – just long enough to start feeling competent before starting over elsewhere. Third year students have to learn fast, or at least think of a few ways to say, “I don’t know. Let me ask the resident.”

5. Not making decisions
Thankfully, most clinical decisions aren’t in the hands of medical students; a resident or faculty member must approve every order. But that, too, poses a challenge for medical students. It’s easy to get complacent when someone else is calling the shots, and it’s frustrating to feel vestigial when it comes to most aspects of patient care. Much of third year is an exercise in finding a way to be useful, or playing catch-up to figure out why the team is doing things a certain way.

4. Being judged
Anyone in medical school is familiar with the rigors of earning strong grades. But third year grades, which feature prominently in residency applications, are not just objective performance measures. They also include a major subjective component, and so enter the gray area between being graded and being judged. While most medical schools carefully review subjective evaluations for fairness, it’s possible that rubbing one resident or faculty member the wrong way can submarine a student’s chances for a high grade on a rotation. This is compounded by the problem of small sample sizes: An evaluator may only interact with a student for half a day, and sometimes not in any meaningful capacity. Third year involves not only assimilating clinical knowledge, but also navigating personalities and being under a microscope constantly.

3. You’ll never get this training again
Unless you’re going into obstetrics, third year might be the only time you get to deliver a baby. And unless you’re heading toward surgery, you may never suture another wound. (Until years later when you’re in a parking lot and a woman suddenly goes into labor, or on a camping trip when a friend falls and needs stitches.) There’s a huge sense of accomplishment after each rotation, mixed with anxiety – even if you don’t plan to use it again, you have to remember this stuff for the rest of your life.

2. The times nothing can be done
One eye-opening part of third year is seeing what modern medicine can’t do. Doctors can image the body with exquisite resolution and treat cancers using genetically tailored therapy. But even the greatest physician can only watch as an end-stage leukemia patient slowly passes away while on hospice care. Even idealistic students may question whether they can do this every day. And everyone will (hopefully) find a source of stress relief, a safety valve that keeps them going and prevents burnout.

1. The anticipation
You worked for years to get into medical school, memorized tomes for two long pre-clinical years, made it through Step 1, and now it’s the evening before your first rotation starts. If you get any sleep that night, you’re ahead of the curve. But if you can make it to it, you can make it through it.

Stay tuned for the next two installments in this series, when we’ll count down the most surprising and most rewarding parts of third year. To all the second-year medical students out there: good luck and keep your chin up!

Mihir Gupta is a third-year medical student at Stanford. He grew up in Minnesota and attended Harvard College. Prior to writing for Scope, Mihir served as co-editor in chief of H&P, Stanford medical school’s student journal. 

Photo by Mike Baird

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