The entirety of the third year of medical school is an act. If you want to be a good medical student, you are what your team wants you to be. Amenable, pliant, easygoing — even when inside you are a bitter angry little thing who’s tired of being pushed around. The paradoxically best and worst piece of advice I’ve heard about being a good M3: “smile, even when you’re not happy.”
The reasoning behind it is essentially this: medical students are tired, but everyone else is more tired. Smiling is, therefore, a way to be a positive emotional support to the team when you may be useless otherwise, and since residents are definitely stretched thinner than we are, smiling — or at the very least, not complaining — can be helpful to overall team morale.
I hated it. So much for all the talk about self-care and healthy coping — what’s the point of introducing all these methods of maintaining mental health when the core of being a successful medical student is to never express your stress?
Yet, as hypocritical as I found the advice, it was fundamental to my third year. For those who haven’t experienced it, clerkships can be a bit confusing — you’re switching sites every couple weeks, sometimes even daily. It requires constant social recalibration, between different residents, attendings and even entire hospitals and medical record systems. Interactions, expectations and your role as a student vary widely in each environment, but there’s one constant: you’re always being evaluated.
So I found myself smiling a lot over the course of my third year. I smiled when I felt awkward, angry, sad, happy, validated and everything in between. I smiled when I asked for a nurse’s help, when I apologized for making a mistake, every time someone asked me where I’m really from, when sometimes, all I really wanted to do was scream.
I didn’t do it for my team or the people around me — sorry, but being an emotional support for other people wasn’t my priority when I felt like a bundle of nerves most of the time. No, smiling was for me. It was my defense mechanism in the times that I felt thoroughly out of my element or was just trying to be professional when I knew my true emotions were quite the opposite. It was the mechanical voice of my social interactions’ GPS saying, “Recalculating. Recalculating.”
The third year is often considered the hardest year of medical school. The unexpected social isolation, the uncertainty of the medical student’s role, and just the sheer gruel of working sixty-plus hours a week in addition to studying for a shelf exam are only a few factors that make clerkships so challenging.
There’s also the constant exposure to humanity that can be simultaneously demoralizing and rejuvenating. We’ve seen things that we likely shouldn’t be exposed to, from the technical miracles of reconstructive surgery to the intimate tears and fears of humans confronting mortality. We’ve felt everything from frustration to glowing validation from patients. It’s an intense emotional rollercoaster and also an incredible amount of information to take in, let alone process, in a very compressed amount of time.
Many medical students experience imposter syndrome, characterized by “chronic feelings of self-doubt and fear of being discovered as an intellectual fraud,” with a recent study showing almost half of all female students experience this during their training. I felt this syndrome strongly throughout this year, but the self-doubt extended to my second-guessing absolutely everything, from social interactions to my own emotional reactions — was I being too sensitive? Thinking too much? Is it an appropriate time to bring up an article I looked up, ask this question, point out this error?
Yet, truth be told, despite the challenge, third year was by far my favorite year of medical school. There’s direct and constant patient interaction, more hands-on opportunities, and honestly, just the sheer fact that I’ve grown to know more and as a consequence, the flow of medicine simply makes more sense. I feel more comfortable. I can be useful to a team. I can envision just what kind of physician I want to be, from bedside manner to parts of medication management. And in retrospect, all these realizations result from having the fortune to have enough good attendings and residents who became goals and mentors for me. More importantly, though, I had classmates and friends I could rely on. After everyone goes through the same rotations, there’s a strange kind of camaraderie that we reach, an understanding you come to after a communal trial by fire. Everyone exits with different experiences and different goals, but it’s hard to exit the year without feeling some degree of accomplishment.
The positives of third year don’t take away from its difficulties, and I don’t expect to be cured of imposter syndrome anytime soon. There is too much information to learn, too many diseases we collectively still do not understand. And as challenging as dealing with that feeling of inadequacy can be, it is also humbling. The growth of medicine as a field is rooted in an atmosphere of constant self-betterment.
So my only advice is this: smile — one day, it’ll be real.