Third Year of Medical School: The Real Truth About Rotations

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:

  1. They are a huge waste of time.
  2. Crap rolls downhill.
  3. 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.

Downhill Crap

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.

Powerless

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:

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

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.

Comments

  1. Hi Alex, thanks for a great post. I am currently a nursing student and doing my clinical rotation. I totally understand how it feels when we are students at the hospital. You experience really reflects mine. There were some nice nurses, but some were really bad. I feel like everything bad the staff have is just dumped onto the students :'(

    • Alex Ding says:

      Hey Cang,

      I’m glad you liked it. You have to develop a thick skin and not over-think about why someone is mean to you. And when you are working and have students under you, you know how to treat them better.

  2. Hi Alex,
    I was curious to hear your thoughts on 3rd year regarding time for family, friends, hobbies, working out, etc. I’ve heard some say they had absolutely no time to dedicate to any significant outside interests or family outings. I’ve got a wife and family, so I’d love to hear your thoughts. Also, from your experience how do already married couples/families do during years 3 and 4?

    Thanks so much for putting on this site and answering our questions. It’s been helpful reading through when certain questions pop up.

    Take care,
    Luke

    • Hey Luke,

      It is very possible that during the 3rd year, you will not have time for anything besides work, study, sleep, and eating. I’m thinking of surgery rotation in particular. If you make time for family, you can spend some time together. (If you want something enough, you can get it.) But then you’ll have to sacrifice something else. Are you willing to sleep less or study less?

      Medical school would be very tough on the marriage. There are couples who make it through in once piece. Then there are others who divorce. (Divorced doctors are quite common.)

      4th year could be better, depending on the electives you have.

  3. Thank you, Alex!

    I presume that this doesn’t get a hint better during internship/residency, am I correct? I am nervous about giving up on this ambition since it’s been a goal for years now, but after seeing and hearing from various people, I’m beginning to feel that this may not be the wisest life choice, not only for me but for my family as a whole. Yet, I have a hard time getting over myself. I will have days when I feel I’ve safely laid the beast to rest, but then it comes beckoning again! I think it’s a pride thing, but even so I have a hard time fighting it.
    Also, just to get the info straight from a med student, what is the likelihood of being able to practice a hobby 3-4x a week, have a newborn, and make it through school adequately? How probable/possible during residency years (e.g. family med)? I kind of think I know the answer, but are there people attempting this that you know now and what does it seem the outcomes have been?

    Thanks again!

    – Luke

    • Alex Ding says:

      Hey Luke,

      It definitely gets worse during internship / residency.

      It will be stressful for the family. Spending 12+ hours in the hospital is very real. You need a really supporting wife to make it through.

      I’m not saying it is impossible. Some of my classmates are married and from my knowledge, their marriage is still intact. Most of the married students did not have kids. Some even got married during medical school. But there is only 24 hours in a day. When a lot of it is spent in the hospital, how much time will you dedicate towards sleep, study, basic personal maintenance, wife, baby, hobby?

      Obviously, you’ll have to give something up.

      If you’re thinking of family medicine, the hours are a little better. If you’re thinking of surgery, you can essentially kiss your marriage goodbye.

      I mean, if you want something bad enough — such as staying married and being with the kids while becoming a doctor, you can do it.

  4. Alex,

    I think that is where it gets dicey for myself. I don’t think I would be willing to burn myself at both ends in order to accomplish this task. However, I then feel left with the notion of “Well, what career now?”. I tend to have a bit of an all or nothing mentality, which is a personal fault, in my opinion. I can’t see myself being unavailable for my future kids and current wife as they grow and mature and begin to branch out. I’m terrified of catching up to professional requirements, debt, etc. and then seeing my kids turn 15 and having missed so much. If I had a child today, they would (ideally) be 8-9 by the time I started my first year as an attending FM doctor. Not to mention the time eaten up getting there.

    Yet, when I think of becoming any other profession I feel jaded. I think I may need to simply make the call and run with it. If I can’t be both a great dad, husband, avid weightlifter, reader, musician, etc. AND a great physician, then I don’t think I can fuse with the career field. Still it feels like my pride has taken a right hook from Cassius Clay.
    ;]

    I often wish I had gotten myself worked up about the “right” career. Too bad, I guess. Maybe I simply have the wrong mentality? Seems like it, doesn’t it?

    Thanks again, Alex!

    – Luke

  5. can’t agree more

  6. I just learned the hard way recently. On my rotation I had an amazing preceptor(s) then a couple that could not get over themselves. The good preceptors understood what it is like to be a student and taught as well as let me do things. They did not expect me to know everything. They said themselves that they use UP TO DATE a lot, and none can possible know everything. The bad ones, moaned and groaned about having a student, ignored me, and actually would say roll their eyes and turn their backs when I would show up in the morning. Also while with the bad ones, patients even made comments to them about how their treatment sounded rehearsed or recorded and that they seemed rushed. I took it very personal the other day and let it get to me. I regret it 100% and it will not happen again. After talking to others….I am reassured because it happens a lot unfortunately and it was just not me. Thanks for the blog. I appreciate it.
    Jamie

  7. Can you clue me in about going in to psych? Would that be the same stress for 3rd/4th year but then less hours in Residency if you follow a 9-5’er? Or even in Derm, if you follow a 9-5’er in Residency would it be less crazy?

    • Alex Ding says:

      It really depends on the residency. But as a general rule of thumb, do not expect 9-5 in residency (especially during intern year). Expect to live and breath medicine. With that being said, psychiatry and dermatology are among the more chill specialties.

  8. Well thanks for the write up.am an aspirant intoxicated about studying medicine(lol)…but seriously when i hear of all the stress,life and many things u have to give up to study or while studying medicine,i always feel like ‘hope i can do this sha’?.but am just so bent on making the whole extended family proud by producing a doctor from the family,which is me.(lol),but seriously i mean it.but what bothers me is that of divorce that occurs to doctor(most expecially those in the surgery specialty or area)due to time and all that(and that is where i am also aspiring to specialise in).how can i make my (future) wife understands that? or should i just pray to God fervently for a wife that will understand me and my profession…..anyway still have a long way to go but once again thanx.i enjoyed reading it.

Speak Your Mind

*