Dave again, time to write about my 3rd and 4th
years of medical school. This post
is much longer than I wanted it to be, so you may want to skip this one and
wait for Natalie’s posts. They have
more pictures. Once I start typing
it’s hard to stop. I’m pounding
this out very quickly while kids are napping and don’t plan on
proofreading. This could get
ugly.
3rd Year
The 3rd year of medical school was awesome. I’ve thought about it today, and the
setup to medical school is somewhat similar to Driver’s Ed. I say that because in both you learn a
bunch of stuff in a classroom or in books and then are thrust into a situation
where you have to apply what you have learned in a practical situation (with a
properly trained instructor to help you not drive off a cliff or kill someone).
I can’t even
describe how different 3rd year is from the 1st 2
years. The 1st 2 years
consist mainly of sitting in class listening to lectures. The 3rd year, in contrast,
has basically no class and you are in a hospital or clinic all of the time
getting hands on experience.
For those
that don’t really know what medical students do, I’ll give you an example of
what often happens. A typical
internal medicine team (at Intermountain Medical Center (IMC), at least)
consists of an attending physician, resident, two interns (1st year
resident), and a medical student. It’s
a big system with lots of supervision, checks, and balances. For example, when we are deciding
whether or not to admit somebody to the hospital from the emergency room, often
times the team will let the medical student go down alone to the ER, see the
patient, and come up with a treatment plan and present everything to the entire
team. However, the interns are
always watching over our shoulders (and also see the patient) and the resident
and attending have often seen the patient or heard about them in advance and
already have what they want to do in mind. They just like to hear us present and see what we would do. The
game for 3rd years is to try and present the correct course of
action for a particular patient.
It’s no big
deal if we don’t get the exact plan down, they’ll just correct us if we’re
wrong. Maybe the biggest advice I have for 3rd years is to just
present a plan with confidence.
Even if you are wrong (and you probably will be), your attending
physician wants to see you take a stand and will appreciate that. It’s how you grow. If you just say “I don’t know what to
do. What should we do?”, you are
not getting the point of 3rd year and your progress will be slower
and your evaluations won’t be as good.
Gotta take a leap of faith sometimes and just go for it.
I’m just
going to write a few sentences about each rotation, as briefly as I can. We could do our rotations at 3
different sites, the VA, U of Utah, and Intermountain Medical Center. I did the majority of mine at IMC,
because we live 5 minutes away from there and they gave us free food and free
covered parking.
Psychiatry
was much more interesting than I thought it would be, and I’ll always remember
the time I was able to spend with people that suffered from serious mental
illnesses (schizophrenia, bipolar).
I saw some absolutely mind-blowing things, and came to appreciate the
power of the mind and how nutty things can get when the mind gets messed up
(nutty enough to see several people get wrestled down and tranquilized with
Haldol).
Pediatrics
was a fantastic rotation. In high school, I thought I was going to be a
pediatrician. I love kids, always
have. It’s dealing with those
paranoid parents (I’m one of them) that drove me away from the field. Just kidding. Kind of...
Anyways, Primary Children’s was a great place. Aside from their awesome cafeteria, working with kids and
newborns every day was rewarding. It
was incredibly satisfying to help a little one navigate through tough
times. It was hard, however, to
see kids going through such tough times. My heartstrings were tugged more on
this rotation than any other.
Internal Medicine
was also a great rotation. I
thoroughly enjoyed my time at Intermountain Medical Center (IMC). I was blessed to have many great
preceptors that helped me learn how to formulate solid treatment plans. I saw my fair share of pneumonia, COPD,
heart disease, GI bleeds, pancreatitis, and nasty infections. It was fascinating to see the
manifestation of diseases that we learned about in the 1st 2
years. It was also the 1st
rotation where I got to actually get some real hands on experience. One thing that I was disappointed with
in regards to 3rd year in general was the lack of procedures we got
to take part in. We got to
participate in some, but it was tough with interns, residents, and fellows all
clamoring to do more procedures. I
was able to do some cool things, though, like put in a chest tube (aka jamming
a tube through someone’s chest into the pleural space). I loved getting my hands dirty, just
wish I got to do it more. The
amount of hands on experience depended upon the willingness of your resident to
teach you and patients to be guinea pigs.
OB/GYN was
wonderful. I just spoke about
wanting to get my hands dirty, well on this rotation they got dirtier than I probably
ever wanted them to be. I love the
IMC staff for letting us be an integral part of deliveries and C-sections. It was truly a blessing to help bring
newborns into the world. It was a
great feeling. We would ask
patients if we could assist with their delivery, and then patiently wait until
the delivery was near and we would jump in and help the attending physician out. Some physicians let us help more than
others, just like in any rotation.
Some let us catch the baby ourselves (newborns are slippery little
buggers) and others wouldn’t let us do hardly anything. All in all, a great rotation. IMC has the most amazing OB staff ever. Highly recommend delivering there.
Surgery
was probably my favorite rotation.
Again, the docs at IMC were absolutely fantastic. I loved being in the operating room all
day and seeing these docs work magic.
I was a bit nervous about how I would react being around all the blood
and guts, but surprisingly it didn’t bother me at all and I was enthralled on
the first day with operating. Some
people faint during their first OR experience, I’m glad I wasn’t one of them. Again, we weren’t allowed to do much as
3rd years but I did get a lot of practice suturing and driving the
laparoscopic cameras. I even
enjoyed the insane amounts of pimping in the OR. Surgeons seem to love asking medical students tough
questions during surgeries about anatomy or pathophysiology, but I enjoyed it
and thought it made things interesting.
Plus, when I didn’t know the answer they’d teach me and I’d learn
something new. I was in some
super, super long procedures that lasted 8 hours or more. It was soooo nice to sit down after
standing for a long surgery like that.
That’s one nice thing about Ophthalmology, it’s a surgical subspecialty
that will allow me to sit down while I operate!
Anyways, there’s a joke about internist and surgeons. They say internists think and never
act, and surgeons act and never think.
Obviously that isn’t true, but the general idea is kind of funny when
you’ve seen both worlds.
Family Medicine
was also great. I did that
rotation down in St. George and was able to stay in my in-laws amazing place
down there. It was another awesome
rotation where I saw a bit of everything.
The doc I was with saw a lot of kids, and I saw more sore throats and
ear infections down there than I did on my pediatrics rotation. It was the only rotation where I was in
clinic most of the time instead of a hospital. I learned to love clinic, and enjoy the continuity of seeing
people over a long period of time.
Another reason I like Ophthalmology is that I get almost a 50/50 mix of
things I love, surgery and clinic.
Anyways, the family medicine rotation was the one rotation with a bunch
of assignments like essays and community projects and the like. They were interesting, but to be honest
I’m not a fan of essays and would have preferred doing something else.
All in all, 3rd year was when I learned the most
in medical school. It was the most
demanding year hours wise by far.
I don’t know the exact hours, but on tough rotations you’d be there 6
days a week working around 65-80+ hours/week. That isn’t too bad, but then you have to study when you get
home, because at the end of each rotation there is a national exam you have to
take that factors into your grade and whether you pass or fail the rotation.
One frustrating thing about 3rd year was the
subjectivity of the grades you were given, but that wasn’t really a big deal
and everything worked out great for me.
There was some luck to the game, though, because some physicians or
residents basically gave everybody and A (you really wanted to be on their
teams) and other physicians were notorious for being harsh graders (you didn’t
want to be on their teams). Like I
said, though, I have no complaints.
I don’t love the system, but I don’t have any great improvements to fix
it. All I know is that I’m going
to be an easy grader when it comes time for me to grade medical students!
Quick general tips
for future 3rd years
- Be interested in every rotation that you are
on. Even if you know you aren’t
going into Psychiatry and really don’t care about it, just remember that it’s
the only time you’ll ever spend in an inpatient psychiatry ward. The people you will work with will appreciate
enthusiasm about their field.
-
3rd year grades are subjective, like
I mentioned above. Being smart
isn’t everything. It helps to be
likeable and personable. People
are likely to give you a better subjective grade if they enjoyed your presence,
trust me on that. Make residents
and physicians lives easier by helping out, but try to not be too over the top
(nobody likes a suck-up).
-
The hours of 3rd year are
brutal. You have to get to the
hospital sometimes at 4:30 AM or so and stay until very late. Work hour restrictions don’t apply to
us, as I learned. That being said,
days fly by and I found 3rd year was less stressful than studying
for Step 1. Have a good attitude,
and 3rd year won’t be bad.
Those going into 3rd year thinking they will hate it usually
do.
-
Be early, stay late (but if a resident tells you
to go home, just do it. It’s not a trick to see how dedicated you are), don’t
complain, and read about your patient’s diseases because you will be pimped on
it.
-
Don’t annoy your resident or physician. Know when to ask salient questions and
when to shut up.
-
The more work you can take off your team’s plate,
the more they’ll like you. Talk to people in the year before you and ask them
what to do on each rotation to be helpful (SOAP notes, etc...)
-
Get Pocket Medicine for quick treatment
suggestions. If you have an
Iphone, get familiar with epocrates or other apps. I often would see a patient in the ER, figure out what I
thought they had, and quickly look at Pocket Medicine on the way up the
elevator to make sure my treatment plan was the correct one. That saved me a bunch of times, and it
makes you look smarter than you are. Same thing with Surgical Recall for
surgery pimping questions.
-
Practice suturing before surgery if you
can. I did with shoelaces and
youtube videos. They will let you
do more in the operating room if you can suture well.
-
Try to keep sane and do fun things outside of
the hospital when you can and
don’t neglect your wife/family.
-
Try to do as many procedures as possible. Don’t be pushy, but express interest in
doing procedures. Better to learn
how to do things now then when you’re a resident.
-
Do Step 2 CS shortly after 3rd year
ends. It’s easy. Don’t put it off. Study for a few days (if that) and take
it. You literally only get dumber
as more time passes from the end of 3rd year.
-
Leave your ego at the door. Proud people struggle
with the criticism that comes their way.
Just learn how to secretly make fun of people in your head, like I
did. I even made myself laugh
once, and got a strange look from a critical doc that had said nothing even
close to funny.
-
Like I said above, take a stand and propose a
course of action for a patient if asked.
Don’t say “I don’t know” unless you truly have no idea. If you have an idea, just say it.
-
This one is important. Do your very best, and try to be happy with the result. It’s so easy to beat yourself up or be
disappointed with things that happen during 3rd year but try to
avoid that. You will make
mistakes. You don’t have to be
miserable because of them. Use
them to improve.
-
There are probably a billion more, but that’s
all I got for now.
4th year
I'm tired of typing so I’ll
make this brief. 4th
year was awesome. The only
stressful part was getting residency applications together and scheduling and
attending interviews (and how to finance such activities). I had about 3 months off to interview
for residency, which was very convenient.
I’ll talk about that in my last post. Other than that, 4th year was pretty stress
free. I had two hard rotations
(neurology and ICU) that were incredibly educational. I was even on the team that made the news when all the prisoners
came to the hospital with botulism they contracted from a homemade brew they
were making (Pruno). Here is a
link to the news story.
I still don’t
understand why there allowed to make that stuff in jail.
4th year is designed partly so medical students
can pick what rotations they want to do, whereas 3rd year they tell
you what you have to do. People
usually pick rotations based off of what they are planning on specializing
in. So, I did some ophthalmology,
dermatology, and research rotations that were great. Unlike 3rd year rotations and neurology and ICU,
these were all outpatient rotations, so the schedule wasn’t as crazy
(in-patient rotations typically had us working 6 days a week with pretty bad
hours). This is the year to
do what you are interested in and what you feel will help you in the future
down the road.
Other than those rotations, your mind is focused on where on
earth you are going to end up for residency. Match day is early for Ophthalmology, and I remember being
sooo happy in January to find out that I matched at the University of
Michigan. Anyways, I’ll save the
residency stuff for my next post.
Lastly, I would be ungrateful if I didn’t mention how
awesome, supportive, and understanding my wife Natalie was through all of this. I’m sure it wasn’t easy with a husband
being gone a lot of the time, but she didn’t complain and always expressed
appreciation for my hard work instead of guilt-tripping me because I was gone
so much. Couldn’t have done
it without her.
