Having just finished the first 6 weeks of my Intern year of Residency, I’ve become more reflective than ever. I can’t emphasize enough how different medicine is from what I had imagined it to be in the first two years of medical school preparing for my exams, in both great ways and sometimes less than great ways.
Beginning in a new hospital system in a new role these days opened the floodgates to the memories of how terrifying it was to begin in the hospital in my third year of medical school. I remember only knowing one route to the Emergency Department (no matter how long it was) and only taking that route because if I didn’t, I would get lost. I remember not knowing acronyms, workflow, the electronic medical record system, or even my role in this whole system. Did I mention the goofy short white coat...?
In retrospect, some of these memories are HILARIOUS, but if I take a second to think about how terrified I was, I get anxiety all over again about starting my first rotation of third year of medical school. So, if you are about to begin or are already drowning in your first rotation of third year, take a seat, get your game face on and let’s talk about how to simply survive.
1. Find yourself.
You may think I’m being introspective and deep here, but I actually mean for you to literally ‘figure out where the hell you are.’ Hospitals are notorious mazes that don’t come with a map. The first step is knowing the best entrance to get to where you're going fastest. The next step is understanding the layout of the floor you're working on: Where is the supply closet? What is the code? Where is the bathroom? These are the basics. The next level is to figure out where everything else is: the lab, the emergency department, radiology, patient registration. There's nothing worse than being in a short white coat and having a patient ask “Where is the help desk?” and you go, “Errr… I don’t know. I’m a new medical student.” Learning the lay of the land will give you much more confidence walking through the halls!
2. Learn the inside scoop from other students.
Is there a resident who will teach you a ton? One that will give you crap? Does one attending prefer a short patient presentation? Is there a question that you are always asked on rounds? What will your schedule be like? What are you expected to do? These are all things your fellow classmates that have been through it will know. I suggest getting the scoop from a friend before starting any rotation. Know what you're walking into. Having that heads up will give you an advantage and make you look SO prepared when you know exactly what you are supposed to be doing.
3. Get organized!
Everyone has a different way to stay organized on rounds. Especially on the medicine rotation, it's essential for you to figure out how to organize all your patient information. Most people like to use the patient census and fold it over to write important lab values, consult updates, or imaging results. Some people have a special notebook. Some people have a template they print out. Look at what everyone else is doing and find a way that works for you. What I highly recommend is getting one of those medical cheat sheet clipboards that folds in half. One thing I advise against is just using random scraps of paper and shoving them into your coat—NOT ORGANIZED!
4. Stock your coat with tools for success… and snacks.
At any given time, your white coat should have what you need to get by. In addition to your stethoscope you should always have a pen light, a few actual pens, highlighter, some sort of reference book, and a notebook to take a few notes in throughout the day. Depending on the rotation, you should also have a few other things that can help you. Luckily in the age of technology, there are a million apps that can help you keep up, but make sure you don’t look like you are just chillin on your phone.
As for books, I highly recommend for you to have a book like Pocket Medicine for your medicine rotation, and Pestanas for your surgery rotation. If you're on surgery rotation, you will need to have a mobile supply closet in your coat pocket. It's never a bad idea to carry a few common supplies with you including alcohol swabs, a few 4x4 pads. Another great tool to carry around with you is a pulse oximeter — the easiest way to figure out how your patient is breathing on the go! Oh also, never forget to have some sort of snack in your pocket. You never know when rounds are going to last 4 hours and you don’t want to become nauseated and pass out!
5. Ask 1000 questions… but don’t be annoying.
Let’s be real, most people going into third year don’t have major experience working in a hospital, and there are a lot of logistical things to learn! How do I fax something? How should I label the culture tubes? How do I adjust oxygen on a patient? What do all these signs mean outside a patient door? These are all excellent questions and often have a wide variety of answers depending on which hospital you are in. Don’t just sit in the dark, ask these questions! But try to spread it out amongst many different people. There's nothing more annoying than bombarding someone with so many questions it gets in the way of their work flow. You can also figure out a lot of stuff on your own or by taking a look at a hospital manual (I know it sounds dorky, but it's there for a reason).
6. Take control of your learning.
Third year can be an amazing learning experience if you take control. Don’t wait for the knowledge to come to you, but look things up. You have the luxury of only being ‘responsible’ for about 2 patients at a time, and because of this, there is no reason you shouldn’t be reading up on their conditions. For every patient you care for, look up their condition in Uptodate, or Step up to Medicine, or whichever resource you are using, and learn the common causes, signs/symptoms, lab findings, treatments and outcomes for that condition. If you do this every day (literally read about one thing), you will not only be prepared for rounds and impress your attending, but you will be that much more prepared for your Shelf Exams and for the next time you see a patient like this!
7. Help. Your. Resident.
Everyone knows that being a medical student can really stink. You just don’t know what you are supposed to be doing and you're often overwhelmed with the new schedule and balancing when you're supposed to be studying. No matter what you're going through, understand that your resident is going through much more right now! Anything you can do to make his or her life easier (checking on labs, calling a specialist, filling out a form, helping out on an admission) will make you look great. Furthermore, when your resident sees how helpful you are, he or she will be much more interested in helping YOU out and teaching you everything you need to know to succeed on this rotation. They also might be more willing to let you go early if nothing is going on!
8. Make a great first impression.
While we would love to think that people will give you a chance to show who you really are, you should know by now that the first impression is the lasting impression. In fact, if you make an amazing first impression, often times it gives you a lot more leeway in the future if you make a mistake or slack a little bit. To make a good impression it is essential to try your best to be courteous to everyone, make an effort to learn, pay attention during rounds, be involved in your patient’s care, and always have a great attitude. If you start off on this good foot, slipping a little bit later on will be forgiven and forgotten. Those who make a lazy, aggressive, rude or disinterested first impression will have a difficult time shaking it. Every single one of their indiscretions will be added to the pile to support this reputation. Avoid all that by making a fantastic first impression.
9.It’s ok to cry sometimes, but remember to laugh!
Third year is the worst. And not everyone gets emotional about it, but those of us who do (ahem) will find themselves welling up with tears sometimes even on the floors. It’s okay. It’s good to embrace your emotions rather than bottle them up or stuff them down. It’s better to find a private place to do this, but it’s perfectly normal to cry sometimes. But if I could do anything different if I could go back to third year, I would try to choose laughing over crying many times. When a doctor is screaming in your face “WHAT MAKES AN OVARY AN OVARY!?!?!!?” and you have no idea what she is talking about, walk away and laugh at how ridiculous that was rather than cry. Because, holy crap, that was really funny! You have to laugh sometimes or you will implode. This goes for anything in life but I feel like it is more important than ever during third year.
10. Don’t forget to call Mom.
While you are already used to being overwhelmed with your schedule as a medical student, it seems like third year actually gets worse where you just can’t find a balance at all. I could sit here and tell you all the things you should do to maintain a healthy mind, body and spirit, but until you figure that out for yourself, it just won’t happen. I’m still working on that, myself. So if you do nothing else, make sure to call your mom… and be nice!
Just remember: everyone knows third year is the WORST. But if you start out keeping these 10 things in mind, I personally guarantee you will survive your first rotation. GODSPEED!