I remember starting the third year of medical school with some anxiety. I had a lot of questions:
- What is it going to be like?
- Will it require a lot of work?
- Will I have to study?
- Will I have enough free time?
Many people told me that it is better than second year. And they are right … but not by much.
For those who are clueless about medical school, you begin rotations or clerkships in your third year. While you are on rotations, you will spend time in the hospital or in the office, hopefully around patients. This is the year you transition from being a student to being a doctor. Yes, that means you will have to put on your big boy (or big girl) pants; you will have to dress up. And, it totally sucks. (Check out the interview attire section if you are not sure how to dress up.)
Not only do you have to dress to impress the patients, you will have to interact with them. Be prepared to take their history and to conduct the physical exam. Be prepared to check up on the patients every so often. Be prepared to document, document, and document. Thanks to the litigious society of America, you will write lots and lots of notes.
Why Third Year Kinda Sucks
Dressing up and writing notes are a pain. But by themselves, they are tolerable. However, rotations really tested my patience for three main reasons:
- They are a huge waste of time.
- Crap rolls downhill.
- Medical students are powerless.
Waste of Time
In the first two years, you can choose whether to go to class or not. You can choose when to wake up. You can choose if and when to study. But once you start third year, your time is no longer your own anymore. Basically, you will be working, but without salary. Instead, you are paying to work. Ridiculous.
So that means you will have to show up at a certain time. Leave only when the doctor dismisses you. Even if you finish all your work early, you will still have to stay. Rotations are a very inefficient use of a medical student’s time.
Expect to interact with people. Patients. Their family. Nurses. Doctors. Whoever. You will meet some really cool people, but you will also meet very nasty people, in terms of hygiene and in terms of attitude. The latter is worse. Some of the nastiest and most pissed-off people were medical staff — nurses and doctors. Remember, crap rolls downhill. And as a medical student, you are at the bottom of the hill. The attending is having a bad day? Yell at medical students. The resident is having a bad day? Yell at medical students. The nurse is having a bad day? Yell at medical students. The patient is having a bad day? Yell at medical students.
Having power means you can give some kind of benefit that the other person wants, or inflict some kind of punishment the other person avoids. As a medical student, what benefit can you provide? What punishment can you inflict? Not much. As a result, you are powerless.
Usually, in a customer-business relationship, the customer has the power because he is the one paying. However, in the student-school relationship, the school pretty much holds all the power. It doesn’t matter if you are paying tens of thousands of dollars that you do not have, every year, just to attend. Too many people wants to go to medical school, so if you don’t like it, some other over-eager student can easily replace you.
Without power, you will have to suck up the abuse, bear with the attitude, and waste your time … all with a crap-eating grin. Thank you, sir, may I have another?
Just as a side note, not all medical students are powerless. Here are some examples of medical students people don’t mess with:
- flirty / slutty / pretty girls: They have something horny / lonely guys want. Girl power is obvious in this situation. However, their charm only work on some of the guys.
Let me tell you the story of the whipped fellow. During the last month (May) of the first year of medical school, I was learning about the head and the neck in anatomy. There was a fellow from ENT (ear, nose, throat) who was assisting with the dissections. Whenever my group had questions, he would help us out … but only briefly. He was too busy helping the group of girls that was one table over. Ok, whatever. For the very last dissection, my group decided to do it in the morning instead of the scheduled time in the afternoon. We wanted the afternoon off. We showed up at the anatomy lab. It was empty and quiet. Great, we can finish our work without distraction and peace out before noon. After 20 minutes of dissecting, Mr. ENT fellow walks in. Since there is no one else around, I thought we can get all the help we needed. Wrong! We asked him for help. He very briskly helped us. Then he proceeded to work on the cadaver next to us. He wasn’t here to help us. He was here to do the dissection for the group of girls! I chuckled and muttered under my breath, “Whipped.”
- people with family members connected to the school or hospital: If you are not in power, the next best thing is to know people who are. Even better, be related to powerful people. Connected kids get into medical school with the sub-par grades and get through medical school by having special privileges.
I am going to tell you another story. I have not personally witness the event, but I have heard it from my good friend. There is a girl from my class who has a parent with a well-established medical practice near my school. The parent has connections to a lot of the local doctors, some who work for the school. For example, he refers a lot of patients to a certain surgical group. The members of this surgical group are the attendings for my school’s rotation. This girl constantly shows up late and avoids work without any repercussion. (Surgery is supposed to be one of the rotations that require the most work. The surgical doctors are among the most malignant ones. The ability for this girl to get away with so much was no small feat.) She is very attractive and is also a very big flirt. But as I mentioned before, that only works with some guys. There was a doctor who did not fall for that and could not stand her. But once he found out who her father was, his attitude did a complete 180 and totally changed. He was kissing her butt! “I hope this rotations was not too hard on you. I hope the people was not too mean to you.”
- people with easy access to lawyers (i.e. rich families, lawyers in the family): I have never heard of a medical student suing a hospital. But I have heard of residents suing hospitals and program directors for unfairly kicking them out of the residency.
In one example, Dr. Oscar Serrano was kicked out during this third year of surgical residency at Johns Hopkins University. The administrators thought he was making too much trouble by objecting to “what appeared to be the administration’s effort to cover up the existing problems within the residency program.” As a result of being kicked out of the program, Dr. Serrano filed a lawsuit against JHU, seeking $24 million. In the end, “Johns Hopkins has agreed to reinstate Dr. Serrano as a resident in good standing and Dr. Serrano has agreed to resign and seek admission to another general surgery program.” You can read more about the case here.
Most importantly, if the doctor or hospital tries to take advantage of you by breaking any law, get a lawyer. I wouldn’t inform the administrators of your intentions at first. They would be more concerned about covering their own behinds instead of making sure you receive fair treatment. There is no reason why you have to endure through sexual harassment or racial / handicap discrimination just because you are a student. If you want more information on how to proceed, Med School Hell has a good guide on what to do.
There Were Some Good Things
As you can probably tell, overall, I did not enjoy rotations. But I would be lying if I said everything was bad. There were some benefits of third year: knowing some of my classmates better. Since you will have no control of whom you rotate with, you will be forced to meet and work with classmates that you do not normally associate with. I have a met quite a few kids from my class that are actually quite cool. (Or maybe our common goal of slacking off without getting in trouble made them looking cooler than they really are.)
Meeting pleasant and passionate people was really uplifting. Doctors. Patients. Secretaries. I had my fair share of genuine laughs and overall good time. However, the good things were far and few in between.
Things to Bring
Make sure you bring the following things to all your rotations:
- white coat
- pen (black ink)
- Maxwell Quick Medical Reference
- stethoscope (I personally use the 3M Littmann Cardiology III Stethoscope)
- smart phone (I personally use the Apple iPod Touch)
How to Stay Sane in Rotations
Third year does not make sense. Why do some people get out so much earlier than you? Why is your attending such a dickhead? Why don’t they let you do anything meaningful? Don’t waste time figuring out why this and why that. Because more likely than not, the doctors don’t even know why. I’m going to give you some tips on how to get through third year without too much anxiety.
- Don’t care so much about grades. Grading is subjective and is based on what the doctor feels. Right about now, you may object and say you need straight A’s to get into an E-ROAD (or whatever highly competitive and highly paid specialty) residency. If your goal is to become a board-certified specialist, then fine, get your good grades. But if your goal is to practice medicine or make good money, grades are overrated.
Let me explain. Let’s say you want to be a board-certified dermatologist. You bust your butt to get your A’s. You do everything right and get into a dermatology residency. You complete the residency and pass your certification exam. You have now achieved your dream. You are now a board-certified dermatologist. You join a practice and make good money. This is what most dermatologists do.
Now I come along. I can’t care any less about my grades as long as I pass. I do my work and get by. My scores are average. And I get into a transitional residency and complete my internship. I then decide not to pursue residency. I get my medical license with just 1 year of post-graduate training under my belt. (This is totally legit in many states.) I am not eligible for the dermatology certification exam because I did not go through a dermatology residency. And even if I was eligible, I would not take it just because renewing the certification is a hassle. I am not board certified in anything at all and I open a dermatology practice. I opened my practice in a place without much competition because dermatologists don’t want to live here. I only attract cash-paying patients because insurance companies don’t want to work with me. (And I don’t want to work with them either.) My marketing is so successful I have no problems attracting patients. I attend conferences, keep up with literature, and seek out training to expand my skills. By my 3rd year of practice, I am able to treat almost all the dermatological problems I see. And also, I am making what a board-certified dermatologist makes.
Would you be pissed? You shouldn’t be. You got your wish. You got your grades and become a board-certified dermatologist. In this potentially real scenario, whatever I lacked in certification, I made up in business acumen. A license physician can legally practice any form of medicine, so it is not as far-fetch as it may seem. Basically, don’t worry too much about grades. Not getting perfect grades won’t keep you from practicing medicine. It won’t keep you from making money. If you want something bad enough, and as long as it is not illegal, you will get it, with enough perseverance.
- Don’t memorize everything. The doctors who stress memorization are not up-to-date with modern times. The doctors who stress understanding over memorization are wise. Get a smart phone. If you don’t know something, look it up. That is what good doctors do anyways. Even Atul Gawande agrees that you should not rely too much on memorization.
- Don’t be afraid to make mistakes. You are still learning. Mentally ignore the doctor who gets pissed off just because you didn’t know something off the top of your head. Most likely than not, the answer to the question is easily found with 2 minutes on your smart phone. And if something is important, you’ll know it eventually.
- Don’t take rotations too seriously. Most doctors care a lot less than you think. They are more concerned about their own situation (of getting the work done and getting home on time). The doctors (and nurses) who make a big fuss about the little things are just on a power trip.
- Don’t forget to study. At the end of the core rotations, you will take your shelf exams. For osteopathic schools, the shelf exams are similar to mini COMLEXes. Studying for the shelf exam will help you understand the specialty. In addition, it will prepare you for the real COMLEX.
In the End …
Third year is something you must get through. Don’t take it too seriously, but make sure you pass. It certainly is not worth the tens of thousands of dollars in tuition. But if you really want to be a gunner and impress the heck out of your attendings and residents, make sure you read Success on the Wards: 250 Rules for Clerkship Success.
Third Year Courses
- Family Medicine Rotation / Clerkship – How to Survive It
- Geriatric Rotation / Clerkship – How to Survive It
- Internal Medicine Rotation / Clerkship – How to Survive It
- OB/GYN Rotation / Clerkship – How to Survive It
- Pediatric Rotation / Clerkship – How to Survive It
- Psychiatry Rotation / Clerkship – How to Survive It
- Surgery Rotation / Clerkship – How to Survive It
This article is part of the How to Survive Medical School series. Click on the link if you want more tips and hints about surviving academic hell.