Not too long ago, I was still in the world of “pre-clerkship”, the realm of lectures, teaching sessions, attendance and classrooms. That time seems so long ago now after entering the wards as a third-year student on clerkships.
That world of preclerkship seems so much simpler, and safer, than being in the hospital right now, with its fluorescent lights, long hallways, and patient rooms. Classrooms were a world to which I had become accustomed and had understood for so long. After seven years of post-secondary education, being a student, “medical” or not, was the longest full time job I had ever had. And then, suddenly, I was dropped into a very different world.
On my first shift, I could not help but think back to the clinical methods sessions and observerships I had done previously and how they were not quite adequate substitutes for the real thing. They were short vignettes, like learning about a country through the Travel Channel instead of touring it on your own two feet. In fact, the whole transition to clerkship was very much like moving to an unfamiliar country. The locals all have distinct customs and unspoken rules to which you are supposed to adopt. Language is different, familiar words have new meanings, and new jargon is introduced daily. Even our hospital swipe cards parallels a passport! (At least we are allowed to smile in our swipe card photographs.)
Further adding to the confusion is how quickly we move through our rotations. For the students at my school, depending on which clerkship group you are assigned, you could be rapidly cycling through two-week rotations at the very start. It is hard enough trying to study and look knowledgeable enough when the residents drop pop quizzes on you. On top of that, you constantly have to relearn how the most basic things are done around in the new clinic. Two weeks is just enough time to get dumped in, flail around for a bit trying to get your bearings, and learn the new faces and names. By the time you start to feel a bit comfortable with what you are doing, you are gone. On to the next one, and back to the flailing around!
It must have been one particular “scared animal in the headlights” look that raised attention to one of my attendings last week while I was in the emergency department. Midway through the shift, she called me over to talk. My initial responses were instinctively guarded, as I was reluctant to divulge how lost and incompetent I felt, somehow assuming if I did, it would betray me as a weak link in the ER.
Like any experienced physician, she was able to figure out the problem from this typical (med student) presentation. “Listen Jimmy,” she started, “it’s okay to not know everything right now, because if you did, you would not be a clerk. You are progressing fine for your level, and part of that is to be lost. You’re just a baby clerk, not a first year resident, so we aren’t going to expect you to answer every question like a resident.”
“It’s just that I spent the last few nights reading on these topics and I thought I would not forget them already…” I began to reply, but she dismissed me.
“Listen, you’re going to be feeling lost now. You’re going to feel lost when you start residency. And when you become an attending, you’ll still feel lost. It’s just a part of medicine. There’s always going to be something new to learn or a subject to learn better. Medicine is such an evolving field, especially these days, that you’re going to constantly relearning. It’s part of the excitement of being on the cutting edge. So just remember that and do your best, because you’re just a baby clerk and it’s okay.”
Two thoughts entered my mind while listening to her words. The first was realizing my own arrogance, based on my assumption that I could enter my clerkship and be at the level of the residents. The second realization was that the feeling of being lost did not have to evoke such a stressful response from myself. The negative associations my mind with not knowing an answer are only constructs as strong as I make them to be. Being pushed out of one’s comfort zone encourages growth. I could stay comfortable in the world of “pre-clerkship” forever, but then I would never become a doctor.
With my next rotation change coming up in a mere few days, I anticipate another rough transition in which I will be free spinning for a few days. But I am coming to terms with this. Fittingly enough, my American neighbors to the south are celebrating Columbus Day weekend as I finish this piece. After all, how many explorers shied away from the feelings of being lost in the face of the unknown?
The clerkship experience can be the definition of tumultuous. As we’re suddenly tossed into the wards, it’s easy to become caught up in the shuffle as we move through our service rotation. These posts try to take a step back and become “a fly on the wall” observing and reflecting on the overall movement through clerkships.