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Stanford University School of Medicine

Why the third year of medical school is like first grade all over again

line-of-chairsThere is no feeling that is quite the same as the “first day of school” – a blend of excitement, nervousness, and uncertainty that almost every student experiences from first grade through college (and sometimes beyond). By now, I’ve had a lot of “first days” in my life. Even so, when I officially started my clinical rotations just over three months ago, that all-too-familiar feeling of nervous excitement was reliably present.

In fact, what I didn’t appreciate about the clinical years until recently is just how often these first days come around during third year. As I’ve quickly learned, our clinical clerkships are known as “rotations” for a reason, and one of the unique aspects of being a third-year medical student is that we get to experience that “first day of school” feeling when we rotate to a new site every few weeks.

As it turns out, when we go to medical school to learn “medicine," we are actually being exposed to a large number of distinct fields that all have their own unique working environments, practices, and expectations. My third-year journey began on the inpatient locked psychiatry unit, where medical equipment such as IV poles, cardiac monitors, and oxygen masks is notably absent. Our daily exams were focused on a patient’s mood, thoughts, and behaviors, and one of our goals was for the unit to remain quiet and to avoid overstimulation.

Skipping ahead, I’m currently on my surgery rotation, where many of our patients are on hospital units where “overstimulation” is almost routine. Some patients have so many lines and monitors that the cacophony of beeping can be overwhelming and examining a patient requires untangling a handful of tubes and wires first. And rather than being concerned about a patient’s thoughts and behaviors, we find ourselves more worried about whether or not they’ve been going to the bathroom.

The result is that while third year is a time of incredible discovery and excitement, it’s hard to escape the feeling that you’re constantly starting over from step one. That one month of psychiatry experience asking patients about suicidal thoughts and behaviors is rewarding, but it doesn’t help much when you’re struggling to put on a pair of sterile gloves in the operating room. In that moment, it feels obvious that everybody else in the room has been doing their job for years, while you’ve been doing it for only days.

Ultimately, the most rewarding period of a rotation occurs once I’ve had a couple weeks to adapt. I can finally get my sterile gloves on without missing a finger. I know all of the shortcuts and how to navigate my way around the the areas where we work. Most importantly, I understand what my team expects of me and what things to look for and report when I see my patients every day. Inevitably, at about the same time that I reach this point, the rotation ends, and it’s time for a new “first day of school” all over again. Oh, well – back to square one!

Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category. 

Nathaniel Fleming is a third-year medical student and a native Oregonian. His interests include health policy and clinical research. 

Photo by laterjay

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