Before I started my fourth year of medical school, while I was preparing for the Level 2 exam and audition rotations, I spent a lot of time reflecting on what I learned from my third-year clinical rotations. As a student who wants to pursue emergency medicine, I liked that my core clerkships gave me greater insights into what happens before and after that ED visit.
Third-year students are in a unique position. Most of us probably started our first clinical rotation as confused, awkward students who felt more in the way than anything else. After spending two years knowing exactly what needed to be done to pass classes and crush boards, we were suddenly thrust into a world where there was no Pathoma and those long uWorld vignettes were now hourlong patient interviews, with differential diagnoses much narrower than A through N answer choices.
But once you get a little more comfortable in your new role, things aren’t so bad. You have got the basic anatomy and physiology down, and now you get to apply it to real patients.
As your preceptors start to give you more responsibility with charting and orders, you can learn to develop treatment plans for your patients with the safety net of having a physician behind you to catch your mistakes before you make them. You get to explore different specialties and hopefully begin to figure out where your best fit may be.
And if you already know what specialty you want to pursue, third year is the perfect opportunity to gain exposure to areas of medicine you may not see again once you begin residency. So what’s the best way to take advantage of this year?
Keep an open mind.
It can be tempting to want to blow off a rotation just because you think you will never end up in that specialty. Ultimately, you never know what you might end up loving, or hating, if you do not give every clerkship a fair shot. At the most, it will only be eight weeks of your life. Dedicate yourself to it, and you may end up surprising yourself.
Listen to every heart, and look in everyone’s ears.
Pathology will be easier to spot when you know what normal is supposed to look and sound like. After a month of screaming children in pediatrics, looking at the ears of a calm adult should be a piece of cake. Practice your physical exam skills as best as you can while your preceptors still don’t expect you to know very much. That way once they do start to expect more, you know what you are doing.
Take the time to get the full story.
Your third year is the time where you get to spend an hour with a patient trying to learn how to elicit a good history. Use this time to get to know the full story.
Remember why you chose medicine.
I asked each of my preceptors for one piece of advice, and I think part of me was hoping for some tangible piece of medicine that I could write in my notebook and never forget during a patient visit. Instead, everyone seemed to tell me variations of the same ideas: Never forget why you pursued medicine in the first place. If you find something you love, chase it. Never let the job keep you from remembering why you care about people. Remember, while it may be just another day of work for you, many of your patients will be people who are enduring a really rough day.