Ah yes....so you've passed the vilified Step 1 Board exam, and are cleared to start third year - the year of core clinical rotations. At my school this consisted of 8 six week blocks, one block each of: psychiatry, OB/GYN, Pediatrics, Family Medicine, and surgery, and two blocks of internal medicine. One of the six week blocks was made up of four weeks of "community medicine" (basically family medicine in a rural area or working with an underserved/ underinsured population), and two weeks of elective time (I did mine in emergency medicine).
Different schools do slightly different rotations, and some do them in four week blocks, but (as I've said before), I can't comment too much on that since there's only one of me, and therefore I could only attend one school (which, believe me, was plenty)!
My school was not associated with one major teaching center, so we went through a "lottery" system to determine which one of the roughly 10 hospitals our school contracts with we would be going to for our third year. I was lucky enough to end up at the site that is closest to my home town, which was also one of the sites where you could stay for the whole year and didn't have to move to another site to complete one (or more) rotations. We were also the first group of medical students that this site had ever had, which was a bit of a gamble on our part since we didn't know how well the hospital would do in terms of teaching, but being "guinea pigs" really worked out in my opinion - they were really eager to have us there, and very interested in our feedback on what worked and what didn't.
Third year is basically the time when medical students have that "oh, yeah, this is why I went to medical school!" moment that reminds them why they put up with the hellishness that is the first two years of medical school. Essentially the third year experience is made up of a combination of shadowing attending doctors (as well as residents if the hospital you're rotating at is also a residency teaching hospital), and seeing patients and "precepting" them to the doctor you're working with. For the uninitiated, precepting means that you go in and see a patient first - gather their history (ie what brought them into the office, and all the questions that go into figuring out what might be causing their complaint) and in most cases do a brief physical exam (obviously anything "sensitive" such as a PAP smear or rectal exam isn't done at this point in most cases during third year). After you've done the history and physical (H&P), you go out and present the patient to the doctor you're working with ("Mrs. Smith is a 65 year old Caucasian female with a past medical history significant for hypertension, and diabetes, who presents to the office today with a complaint of a wound on her foot that isn't healing.....and so on). Once you've told the doctor all about why the patient came in, and any information you gathered and what you found on your exam, the two of you go back into the room with the patient and see them together. Sometimes this involves the physician asking all of the same questions and doing all of the physical exam over again (which as a third year, especially first off is a good thing, but towards the end of fourth year it's like really? I just told you all of this, so it looks to the patient like either I wasn't paying attention when I was in here with them/ am really dumb, or you weren't listening to me when I told you about the patient.... either way, not good).
Finally, the doctor figures out a treatment plan for (and hopefully with) the patient, or if they're feeling feisty they'll put you on the spot and say something like "So, student doctor, what do you think is going on here/ what would you like to do?" At which point you must fight your instinct to assume the fetal position/ turn beet red and stand there drooling on your shoes, and try to come up with something that sounds at least halfway intelligent/ correct, all the while (at least if you're me) thinking "Screw you Mister Doctor Man, hanging me out to dry like this!" I don't mind being pimped (ie grilled on medical knowledge) when not in front of a patient, but I don't feel like it serves much of a purpose when with patients (other than to make the med student look/ feel dumb), and I learn assessments and plans much better when I see how an experienced physician handles them (ie I like to act like a sponge and soak it all in). Any physicians out there want to shed some light on this in-room pimping? Is there some hidden agenda behind it all that I'm missing here?
You start out in third year fresh from taking Step 1 of the boards, so you are filled with all kinds of medical knowledge that, while good on paper, is for all intents and purposes useless in "real life" clinical medicine. So much of third year is spent learning how to actually interact with patients and realizing that patients and their diseases did not read your text books, so disease A might not always present the way you learned, and disorder U might not always respond to drug J the way you were taught. And just when you finally think you're getting the hang of things, third year is over, and it's time to take Step 2. Ugh.
Step 1 was heinous, and is still fresh in your memory (you may even still have night terrors in which Step 1 features heavily), but now you must study for and take Step 2. Oh, but just wait! The news gets even
Once you've survived Step 2 (and again waited weeks upon weeks for your scores), you can sail on through to graduation. Well, almost, there's still fourth year and the match to get through.
Fourth year consists of more rotations - 4 weeks in this case (which fly by after doing 6 week rotations for all of 3rd year). And, at least at my school, you get to choose what rotations you want to do, and where you want to do them. We had only a few required rotations: surgery (I did ophthalmology), ER, OMM, and internal medicine or pediatrics (I did pediatric intensive care). Beyond that you were on your own as long as you got to a total of 82 weeks of rotations (between 3rd and 4th year) prior to graduation. Other rotations I chose were: family medicine, radiology, and palliative care. The downside to all of this freedom is that you end up moving every four weeks, which is exhausting.
Since fourth year is the time when students are making final decisions on what specialty they want to go into, and where they'd like to do their residency, they typically do rotations in specialties and at hospitals that they would like to do their residency. Some call these "showcase" or "audition" rotations since you're basically trying to convince programs that you're a rockstar and should be selected to do your residency there. Just remember that in addition to working your butt off to make a good impression, you should also be assessing whether or not you'd be happy in that program/ hospital/ location for the next 3, 4, 5, or however many years the residency program is that you're interested in.
I was going to try to cover the match process in this post too, but it's already long enough, and the match is pretty complicated, so I'll spare you for now. Instead I'll fill you in on what I've been up to the last couple of days!
Yesterday, mercifully, we had no orientation activities, so I was able to tie up some loose ends and get some errands done. I finally got my Pennsylvania license plates, and I have to say (no offense PA), the NH license plates are nicer looking. I feel like the front of my car looks naked, since PA only requires a rear license plate. In the afternoon I baked a fruit pizza, and took it to a cookout at one of my fellow intern's house:
Soooooo delicious! Find the recipe here. I didn't do the glaze part with the jelly on top, because that just seemed weird to me, but there were no complaints from my fellow interns or their significant others, so I think it's OK to omit that part. Also at the cookout were hot buffalo wing Snyder's pretzels, which are pretty much fantasticness in a bag, and something I should never be allowed to purchase and bring into my house, because I'm fairly certain I'd eat an entire bag in one sitting and blow my calorie allotment for an entire week.
After dinner I went to trivia at a local restaurant - every week there is a group representing the residency made up of attendings, residents from all years, medical students, and significant others. This week there were a record number of us there and we actually had to form 4 teams, one of which came in first place.
It was a late night, so it made getting up this morning a little rough, but it was worth it since I won't be able to go to trivia for the next four weeks since I'll be working nights.... I think they'll survive without me though (actually, they'll probably be better off!).
Today we had our last EMR training session! Then an afternoon of learning all about how the OMM program works here, and a quick tutorial using plastic pelvises and babies on how to place your hands when delivering a baby so that the mom doesn't tear and the baby makes it out safely.... good to refresh my memory on that, it's been almost 2 years since I've been in on a delivery, and there's a very real chance I'll have to be in on one on Friday night!
After the orientation activities were over for the day I hit the gym, came home and ate leftover cabbage and ramen noodle salad for dinner, and then transferred my seedlings into larger pots. I'm growing tomatoes, scallions, green peppers, strawberries, and a sunflower (the damn birds ate all but one sunflower seed out of my pot). Once they get a but more impressive looking I'll post some pics.
And now you're all up to date (not to mention edumacated about 3rd and 4th year of medical school), and I'm off to bed before my final day of orientation tomorrow!
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