28 April 2013

At the threshold

Within days, I begin my third year of medical school. The start of third year marks a shift from the classroom to the hospital wards: I will be responsible for a panel of patients, arriving at their diagnoses and ordering treatments. Of course, I'll be closely supervised and constantly instructed.

I'm a bit uneasy, though, about the transition to third year:
  • The grades matter. Our school grades us either fail, pass, or honors on our rotations, although virtually no one fails. Usually no more than a fifth of students doing a rotation will net honors. But you need honors to get into a competitive residency. This means that I will be competing directly against my classmates. Much of our grades is based on our evaluations by our superiors. These evaluations can sometimes be subjective and variable.

  • The hours can be long. Students' clinical duties sometimes approach the school's 80-hours-a-week cap. In addition, we will need to devote extensive time to studying for our mandatory exams. There are only 168 hours in a week. If one works for 80 hours a week and sleeps for 8 hours a night, 7 days a week, that leaves only 32 hours for things like studying, driving to and from the hospital, cooking meals, doing laundry, and brushing one's teeth.

  • The responsibilities can be emotionally draining. I have yet to witness a birth or a death, but certainly will during third year. Comforting the dying and appeasing the furious are taxing ordeals, especially when there's so little time to relax. Medicine routinely involves life-and-death decisions, and mistakes that harm patients inevitably occur.

  • Medical students are at the bottom of the food chain. Although the practices are becoming less common, students are routinely quizzed on their medical knowledge ("pimped") in front of their team and put on mindless or unpleasant tasks ("scutwork"). Because medical students need good evaluations from their superiors, they have little recourse and little incentive to argue.

Although the older medical students I talk to confirm my picture of life as a third-year, most say that enjoyed their third year of medical school more than first year or second year. In particular, they loved that they were finally taking care of real patients.

I hope that by the end of third year I'll have adopted their view.