“We rise by lifting others.”
Robert Ingersoll
It’s finally getting real that I’m about to be starting my final year of medical school. Our friends in the year behind us are getting ready to take their board exams and will soon be joining us in the hospital. I’m so excited for them! It seems like just yesterday I was about to start my first rotation, so nervous about what the year would hold. With my final rotation soon wrapping up, now seems as good a time as any to reflect on what I’ve learned over the last year and hopefully pass on some advice for those going into their first rotations.
When I began my third year, I had three burning questions: How should I study? How do I get people to like me? How do I choose a specialty? I’ll share some thoughts I have about each of these and along the way answer a few other questions you may have.
- How do I study?
Third year is much different than the first two years of medical school. You now will be spending many hours of your day in the hospital caring for patients with your team. That is your primary responsibility. Depending on the rotation, the setting you’re in, the team you are working with, or even the day, your experiences will vary. Some settings lend themselves better to opportunities for formal teaching. In others, your attendings or residents may add in teaching points sporadically throughout rounds. Stay as engaged as you can. There are days where you’re tired and it’s just hard, but it’s worth it. One, it shows how excited you are about learning medicine. Two, you won’t miss these pearls. True, they may not all end up on the exam, but some will. The others will be high yield for your future practice. Much of your learning will be up to you and many lessons won’t be found in a textbook. Pay attention to what’s going on around you. Learn from how your team interacts with one another and how others interact with patients. Listen your patients’ stories. Some of the most impactful moments I’ve had this year were the result of being present and involved with my patients and the team. Alas, there still is an exam at the end of each rotation that you must prepare for. Many of the resources you’re already familiar with (FirstAid, UWorld, Sketchy, Boards and Beyond) have content for the clinical years as well. The key here is to use your time wisely. Your time is more limited, so it is important to make good use of any “down time” you have. If there’s time during the afternoon once you’ve followed up on your patients or if you have a moment while you’re waiting between cases, use that opportunity to work through some questions. Now if you’re in a lecture or your resident/attending is trying to get your attention, obviously that’s not the time to have UWorld open. If you’re just chilling in the lounge with some time on your hands, go for it! There’ll be less studying you need to do later and it really helps make the material seem more manageable. Lots of people will say to read about your patients. It’s a good idea, but I’ve found few actually tell you how to do that. I really am trying to get into a habit of looking up topics related to my patients on something like UpToDate, but it’s hard when you’re pulled in many different directions. Honestly, I don’t do this much. Don’t beat yourself up if you aren’t a walking encyclopedia who’s read thousands of journal articles. You will still be fine. If you have a commute, put on a good podcast as you drive to/from the hospital. Since it’s hard to make myself read articles, I’ve started listening to “The Curbsiders” and “PedsCases” instead. 10/10 highly recommend if you have a limited attention span like me.
2. How do I get people to like me?
For the first time in medical school (OK beside clinical skills), a portion of your grade will be based on others’ subjective evaluation of your performance. It can be anxiety inducing. At times you may feel you have no control over your evaluations, but that’s not entirely true. You hold a great deal of power here. Being yourself, keeping a positive attitude, working hard and maintaining professionalism will take you far! For the love of all that is good in this world, don’t lie about the specialty you’re interested in. Your preceptors truly don’t care and lying is a bad look. Also, don’t say you asked a question/did an exam maneuver when you didn’t. You don’t want to be known as someone who can’t be trusted. Show up early. Take pride in your work. Don’t wait for someone to tell you to check up on your patient. Learn everything you can about them so that you can be thorough in your presentations, assessments and plans. If you’ve been given a task to do, make sure to come back to the team and close the loop with any updates. Get to know your residents and attendings. I promise they’re not scary. They’re just people like you and me. You will be discerning which specialty you want to pursue this year, so ask all kinds of questions (maybe not during a code). People love to talk about why they chose their field. At the end of the rotation, if you and a preceptor clicked well, feel free to ask for a letter of recommendation. Some may offer to write you a letter before you even ask, but don’t assume that will be the case. You’ll need several for your residency application, so better to ask sooner rather than later. They might tell you to reach out again closer to 4th year, or may appreciate the opportunity to write it now while their memory of working with you is fresh. Don’t get in your head thinking about whether they’ll say no or worrying that you’re bothering them by asking. They worst they can say is no. If they do, count that as a blessing. You want thoughtful letters that showcase your talents and abilities to residency programs, so ask upfront whether your writer is able to write you a strong letter.
3. How do I choose a specialty?
The biggest dilemma of 3rd year is choosing what specialty you want to pursue. It’s a big decision that deserves thought and reflection. My advice would be to do some self-assessment. The Careers in Medicine page on the AAMC website has some great surveys to get you thinking. During each rotation, keep an open mind. Be fully engaged and try to picture yourself in the shoes of your residents and attendings. Do you like being in the hospital or clinic more? Do you like doing procedures, or could you spend the rest of your life without setting foot into an OR again and be perfectly happy? Do you like working with adults, kids or both? How do I truly want to practice medicine? These questions can help you figure out where your strengths lie. Take notes as you go through your rotations about what you’re thinking and feeling. For me, my blog has served that purpose well. Writing your thoughts down helps you process your experiences and capture your reactions. You’ll want to look back later as you’re trying to finalize your specialty choice, and it’s easy to forget how you felt on a rotation when it’s no longer fresh. Make sure to talk to your mentors and ask questions. They have so much insight to offer. You might just be surprised what they have to say. I’m incredibly thankful for mentors who saw qualities in me I never realized existed. In the end, this is a decision only you can make. Take what others say with a grain of salt. If their advice is helpful, listen to it. If people try to tell you that you won’t make it in the field you’re interested in because you don’t fit the mold of what x-type of physician is, I would politely ignore them. You know yourself the best. Don’t let other people stop you from pursuing your dream!
I hope this helps! Thinking back on all I’ve learned this year has been a crazy experience. It’s hard to believe that in one short year I will be a doctor and getting ready to start residency. As I continue to research residency programs and prepare to register for my key fourth year rotations this week, I’m humbled and excited to see where this next leg of the journey takes me.
The Music of Medicine 