In the third year of medical school, book smart but clinically naive learners are thrust into the daily routines of the hospital and outpatient clinics and are suddenly expected to assist with the care of real patients while learning on the job. It’s a difficult year in every sense, and entering this crucible of learning naturally incites a mix of confusion, excitement, apprehension, anxiety and horror. I’ve been asked by medical students in the classes below me about my third year experiences. Every student’s experience is unique, but listed below are the things I’ve discovered along the way that have helped me survive and even enjoy my third year. Hopefully, they will prove helpful to you.
- You will cry. It is inevitable that the highs and lows of third year will evoke the full spectrum of emotional responses. I’ve fought back tears watching parents welcome their babies into the world and watching children grieve over their dying parents. I’ve cried in the bathroom hiding from my team until I composed myself after being yelled at by an angry patient who didn’t want me participating as a part of the care team. I’ve cried in the car driving home from the hospital due to sleep deprivation, hunger and the prospect of a 45 minute commute. When your emotions well up, remember that you’re not the first or last medical student to feel that way, then find whatever helps you process and move on after those moments. Debrief the difficult family meeting with your resident or attending. Write down the moments you’re thankful for and re-read them when you have a discouraging day. Find a soundtrack for your commute that lifts your spirits. Reset your mind with a work-out at the gym, dinner with a friend or an episode of your favorite show.
- You will find your people. It may take you a few rotations, but you will find others who share your passions, your perspective on medicine and your sense of humor. You may find closest friends among fellow medical students, residents, attending physicians, social workers, nurses or administrators, and you may find them among more than one specialty. When you find them, they will mentor you, gossip with you, laugh with you and watch out for you. If you haven’t found them yet, keep looking! The sense of belonging you will eventually feel is worth the wait.
- Residents and attending physicians are people too. Since they’re only human, give them grace. They’re typically more sleep deprived than you and have far more responsibility. Ask what you can do to help them out. Thank them for the time that they take teaching you. Bring an extra sachet of your favorite kind of tea or a sweet treat to perk up their afternoon in the physician lounge. The occasional plate of cookies to share with the team is not expected but definitely appreciated.
As time and clinical demands allow, I would encourage you to ask your attending physicians and residents non-clinical questions because these conversations will help shape your professional identity. I’ve had some really interesting conversations with these supervisors and teachers about questions such as:
“How do you see your personal spirituality or faith intersect with your medical practice?”
“What led you to choose your specialty?”
“What advice do you have for someone who is undecided on a career trajectory?”
“How do you approach a difficult patient or family member?”
“How do you think medical trainees can combat burnout?”
Be on the lookout for opportunities to learn from the life experiences of your teachers.
- You are ineffective if your mental health is in shambles. You only have so many free hours in the week, but some of those should be set aside for self-care actions such as going to the gym, adding on an extra hour of sleep instead of another UWorld problem set, making healthy food or meeting up with friends whenever possible. For me, it meant attending church on Sundays and a weekly Bible study, meal prepping healthy-ish foods on the weekend, keeping a gratitude journal and following a consistent sleep schedule that allowed me seven hours of sleep most nights. I found that I learn better when I’m valuing my mental health.
- Remind yourself frequently that you belong. “I belong here” became my silent mantra during my rotations, and I believe that reminder to myself helped me address my own feelings of impostor syndrome. You are not an outsider; you are a contributing member of the care team. You are not inadequate for the task. You were made for this. You have trained and prepared for these moments. This mindset is rooted in sports psychology. Athletes who see an event as a challenge to overcome perform better than those who see an event as a dangerous threat to their abilities. Likewise, you will perform better if you have the mindset that you are up to the challenge. Stay humble, but approach third year knowing that your first two years prepared you for the challenges ahead.
- Be teachable. Walk into the hospital each day with the conscious mindset that you are there to learn. Armed with this attitude, when the attending doctor criticizes your knot-tying technique or your inability to name ten causes of post-operative fever, you will accept the critique more gracefully because you primed yourself with the mindset that you are there to learn and improve. Study hard to know that answer for next time, but don’t expect yourself to know everything yet. Ask for feedback with a genuine desire to discover how you can improve for next time. Ask questions for the sake of learning and taking better care of your patients, even if it’s not a “high yield” topic for your upcoming shelf exam. Medicine in the real world isn’t a multiple choice exam, and your patients will rarely present like the textbook. Cultivate genuine, intellectual curiosity, and you will end up learning more and being better prepared for the next patient you see.
- Have fun. Joke with your team. Follow interesting cases. Familiarize yourself with your patients’ journeys, not just their past medical histories. Think back to all of the work you have put in to get to where you are now. While it is your job to work hard and do well, it is your responsibility to soak in every moment and enjoy the experience. Never again after your core rotations will you see such a wide spectrum of medicine: from pediatric check-ups to in-patient psychiatry to colorectal surgery. Try to appreciate the novelty of whatever each new week brings, and enjoy the ride.
Your third year is, perhaps, the year of the greatest personal and professional growth that you will encounter in all of your many years of education and training. No amount of advice will make it an easy year, but hopefully following these tips will ease the transition and help your third year to be your best one yet. You are laying the foundation of who you will become as a physician, and for that reason alone, it is a task worth doing with the best of all that is in you.