Thriving in Third Year

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Author: David Fine, Medical Student Council President
Originally published: Common Sense  September/October 2019

The beginning of the year brings new residents and medical students to the floors. A question that all new learners have on their minds is, “How can I succeed?” Personally, I can’t speak to the resident experience, but any medical student knows that there is not just a single way to do well. Over the course of the year you will be challenged with new concepts, different practicing styles, and inconsistent expectations. There is not just a single method that will be successful in your unique training environments, but I believe that there are a few key pieces of advice that will help you thrive and adapt throughout the year.

  1. Take a Stand: Coming up with a plan is more difficult early in the year and at the start of every new rotation, but it also makes the difference between being a scribe and an interpreter. Collecting patient information and sharing that in a clear presentation is without a doubt an important skill. Taking that information and suggesting a plan is what makes you a physician. It doesn’t have to be the best plan and it doesn’t even have to be the right plan. What matters is that you take a stand and hold opinions. Previously, your pre-clinical years may have resembled regurgitating information for exams. Now is your time to start flexing those physician muscles, and start synthesizing next steps. Without a doubt learning the art of medicine may take some getting used to, but your attendings will help push those plans in the right direction, and you will learn more than if you had been given the correct answer from the start.
  2. Prepare to be Challenged: Practice a phrase similar to, “I don’t know, but I will follow-up and get back to you.” There will be times when you collect a thorough history and physical, but forget to ask a key question. Other times you will be asked a clinical question and you won’t even be able to come up with an intelligent sounding guess. You want to be trustworthy and you want to take ownership of your education. Admitting that you don’t know something can be an uncomfortable sensation, and you may feel stressed or defensive. This is why practicing an expression and having it in your back pocket is important. Furthermore, it’s not just an expression because the theme of third year is recognizing deficits and working to improve. You don’t have to give a 5-minute presentation on each topic you research, but follow-up and let your team know what you are reading and learning. This tip also applies to receiving feedback. Be patient, be responsive, and even if you disagree with the feedback take it to heart and try to see where the suggestion is coming from.
  3.  Know Social Histories: What is your patient going home to? Is it a safe environment? Who are they going home to? How would they get home? Do they have a ride? Do they smoke/drink and how much? What do they do for work? What stressors are they dealing with? These are a few general questions that will help you establish a rapport with patients but this serves more than one purpose. It may affect their treatment plan and it will certainly affect their discharge planning. You are not solely training to be a diagnostician, so this information is vital to patient care. Your attendings will interpret this as you thinking ahead and being able to connect well with patients. You don’t have to present everything you gather, but you should know it and mention what you learn when it relevantly and inevitably is needed.

These are just a few tips that have been fundamental for me, and I hope they help you as well. Over the course of the year you will pick up evidence-based medicine practices and with practice you will become better at both obtaining information and presenting your patients. I want to send you the best of luck as well as the strongest assurances that your enthusiasm and willingness to improve will be more than enough to help you thrive during your clinical years.