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Halfway through med school: Looking back and moving forward

In this Stanford Medicine Unplugged article, a second-year student reflects on how much she's learned since beginning medical school.

In the blink of a weary eye, I finished my pre-clinical coursework. I'm halfway done with medical school. This milestone pales in comparison to big moments like Match Day or even medium-sized ones like completing the surgery rotation. Nonetheless, I'm forcing myself to acknowledge the accomplishment, however small, because this education is a long haul, and I need pit stops of satisfaction and pride.

Recently, one exam reminded me both of how far I've come and of how much is left to learn. 

In one of our final acts as pre-clinical students, my classmates and I participated in the Mini-CPX exam. This test, a requirement for starting clerkships, is a five-hour whirlwind of cases with patient actors as well as written assignments and oral presentations. We were warned that the exam would be a "wake-up call" to help us identify and address weaknesses before we step onto the wards. I certainly woke up to the new challenges that lie ahead -- and, like many of my classmates, I fixated on my errors and shortcomings following the exam. 

For almost two years I've studied and stuffed my brain full of facts about diseases: their etiologies, how they present, and how to treat each one. And yet, when confronted with an actor describing their illness, their lives, medical histories, and medications, suddenly my mind felt empty. Lab values, once so clear on a multiple choice test, looked like a secret code I no longer knew how to crack. Symptom lists felt like leaves scattered on the ground, almost impossible to locate their source. I struggled to synthesize the information and come up with all the possible diagnoses. 

Putting the pieces together, it turns out, might be harder than learning each one in the first place. 

Still, part of me enjoyed the exam. For the first time, I was tested in a way that felt relevant to becoming a doctor. I wasn't just sitting at a computer or bubbling in answers on a Scantron, I was facing a person who asked, "What do you think is going on?"

To quiet the other side of me, the part that wanted to focus only on my far-from-perfect performance, I made myself measure how far I've come -- and I did it in the most cringe-worthy way possible: I re-watched a recording of one of my first-year patient encounters.

Over spring break, I poured a cup of coffee and sat down to watch a slightly younger version of myself interview a patient. I saw myself enter the room, gel my hands, and state that I was a first-year medical student and "part of the care team." My hair was a little shorter back then. It was pulled back in a clip that is now either broken or lost, and I wore shoes that I have since decided are too uncomfortable for a full day on my feet. But other than those little details, nothing visible has changed.

I scrunched up my nose and grinned as I watched the encounter unfold. I now know the questions I missed, the physical exam maneuvers that I rushed through like practicing a choreographed dance without fully understanding what it means.

I have learned so much since then. Not only about medicine, but also about how to carry myself in the clinical space. I not only know a little bit more about what to ask, but I feel much more confident in how I ask it. I not only have a better understanding of what to listen and feel for, but I am much more comfortable taking my time to palpate a patient's belly thoroughly or to listen to their lungs carefully. 

There are some things I would've done differently today, but I smiled at the moments where I recognized myself most, where I observed a practice I brought here with me and have continued to carry forward. My cadence is unchanged, my eye contact and attentive head nod are the same. These are the things I did not need to be taught, but that I hope I never unlearn.

I have so much learning ahead of me -- a lifetime of it, really -- but I'm taking the time here and now to acknowledge how far I've come today. Even if we felt knocked down by the Mini-CPX, my classmates and I have earned a moment of satisfaction for successfully treading water in the medical world. Soon, we'll dive into the deep end and continue to stay afloat.

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

Orly Farber is a second-year medical student from Washington D.C. She graduated from UChicago in 2015 and spent the following two years in an allergy lab at the National Institutes of Health. While Orly's heart remains in Chicago, her body is thrilled to be in the Bay Area! She loves running, hiking, rock climbing, baking bread, and tending to her plants -- fully embracing the West Coast lifestyle.

Photo by Ake

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