Liking 3rd year

[gravitywave]

There are a couple of my classmates who disliked third year, but I think the vast majority really liked it (including me). It's just so great to finally be out of the classroom and doing what it is we came to med school to do - learn clinical medicine. Even the rotations in specialties that I had no interest in (i.e. surgery) were so much more enjoyable than sitting in class or studying for Step 1. Sure, there were individual bad days, and I definitely liked some rotations more than others, but 99% of the time 3rd year was a ton of fun and much better than the pre-clinical years.

that's awesome to hear

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[WellWornLad]

I could learn everything taught to me in 3rd year with about 4-5 weeks of moderate studying. It is perhaps the most inefficient system possible for learning medicine.

Don't get me wrong, it used to work back when med students actually did stuff 20-30 years ago - and not "did stuff" like put in one easy IV while the resident looked over your shoulder, but actually had real responsibilities and contributions to make. Now we've got the worst of both worlds: on the job training without the job.

Fine, you get to see and occasionally do some cool stuff, but I'm not trying to be a medical tourist. You're basically expendable/interchangeable at the hospital, yet keep hours like the place would fall apart without you. If being useless doesn't bother you, the utter waste of time should.

And yes, I know that you are an exception. You are down there on the wards making things happen and pulling for your "team." Well guess what, absolutely no one is impressed by the 3 seconds you saved grabbing the chart for the intern, because it'll never overcome the countless minutes consumed by your overly exacting H&P presentation during morning rounds, or the shameless desperation of the med student "independent presentation" on topic X no one cares about or will be paying attention to. You are in the way. And that is why 3rd year sucks.

 

[VoiceofReason]

Some of you are saying, with a straight face, that you enjoy writing endless notes, filling out orders, filling out imaging requests, writing in charts some more, making outpatient appointments for adults as if they were ******ed children, tracking down people who don't leave their pager numbers, writing in the chart some more, trying to read handwriting that could easily be hungarian and you wouldn't know it, writing transfer orders, writing discharge orders, writing more notes.

I have a theory that you people who like this were the same kids who obsessed over writing assignments in high school to please your teachers.

 

[CardiacIntensivist]

I could learn everything taught to me in 3rd year with about 4-5 weeks of moderate studying. It is perhaps the most inefficient system possible for learning medicine.

Bull. You are either the worse 3rd year alive or you simply do not understand that 3rd year is more about learning facts. The experience itself is part of the learning process.

 

[VoiceofReason]

I could learn everything taught to me in 3rd year with about 4-5 weeks of moderate studying.

Correct. But prepare to be inundated now with people who don't understand the difference between learning principles of medicine and learning paperwork idiosyncrasies

 

[VoiceofReason]

Bull. You are either the worse 3rd year alive or you simply do not understand that 3rd year is more about learning facts. The experience itself is part of the learning process.

Sorry man, what grand things you think you learned in your overactive imagination are actually just your hospital's filing system and prescribing preferences. You'll have to learn it again when you change locations.

 

[pingouin]

Some of you are saying, with a straight face, that you enjoy writing endless notes, filling out orders, filling out imaging requests, writing in charts some more, making outpatient appointments for adults as if they were ******ed children, tracking down people who don't leave their pager numbers, writing in the chart some more, trying to read handwriting that could easily be hungarian and you wouldn't know it, writing transfer orders, writing discharge orders, writing more notes.

I have a theory that you people who like this were the same kids who obsessed over writing assignments in high school to please your teachers.

Must suck to not have an EMR that can be pre-populated or progress notes copied over from the previous day or clinic visit then updated. Sure, we have to initiate some of them, but it really isn't that bad. And we have social workers and schedulers to arrange discharge appointments.

 

[WellWornLad]

Correct. But prepare to be inundated now with people who don't understand the difference between learning principles of medicine and learning paperwork idiosyncrasies

Called it.

Bull. You are either the worse 3rd year alive or you simply do not understand that 3rd year is more about learning facts. The experience itself is part of the learning process.

Yeah, we're all blossoming into little medical flowers, basking in the light of whatever medical fiction you've appropriated from TV dramas and pop culture.

Spare me. You talk as if 3rd year is the only chance we'll get to hug sick people.

 

[lockjaw]

Some of you are saying, with a straight face, that you enjoy writing endless notes, filling out orders, filling out imaging requests, writing in charts some more, making outpatient appointments for adults as if they were ******ed children, tracking down people who don't leave their pager numbers, writing in the chart some more, trying to read handwriting that could easily be hungarian and you wouldn't know it, writing transfer orders, writing discharge orders, writing more notes.

None of those things are specific to 3rd year - those are the same things that you'll be doing as a sub-I/intern/resident/attending (although probably to a lesser extent once you get to the attending level, but you'll still have to do a lot of those things). I'm not sure anyone enjoys all of those things, but they're a necessary part of medical training. It's the patient contact and on-the-job learning that I enjoyed about 3rd year - the rest of that mundane stuff I'm going to have to be doing to some extent for the rest of my life, so it's not worth getting frustrated over - it just comes with the job.

 

[KeyzerSoze]

Wow, this just gets better and better. So first we should get rid of pre-clinical medical school, replace it with a course where you cram First Aid, and now it turns out that the clinical part of medical school should really be done in 4 or 5 weeks. Awesome.

 

[CardiacIntensivist]

Sorry man, what grand things you think you learned in your overactive imagination are actually just your hospital's filing system and prescribing preferences. You'll have to learn it again when you change locations.

Give me a break. You seriously think you can learn Ob/Gyn, Peds, Surgery, Neuro, Psych, FM, and Internal medicine in 4-5 weeks?

The amount of facts alone would take longer than 4-5 weeks. That part is simply book learning. There is a tremendous amount of information that is absorbed throughout the year. The repetitive reinforcement is what solidifies it in our minds.

The experience I was talking about was not the "filing system" you are referring to. Guess what being a physician is a people-job. You have to learn to communicate on all levels. Part of that means writing effective notes. It also means calling consults, speaking with nurses, presenting on rounds and to residents and collecting information by reading consult notes, nursing notes, PT notes, finding labs etc. These skills take time to develop. You don't just write a couple of notes and you're ready to take care of patients. No, it takes weeks of speaking with patients, following up with daily information and presenting frequent to get really good at it.

How about learning to interpret labs and imaging? What, you read one CXR, one EKG and you think you're the expert? There are numerous permutations of what can occur and the exposure in third year allows improvement.

And lets not even mention procedures. For example, inserting an IV is relatively simple theoretically but given the variable anatomy in veins, one has to get a good feel of the needle and 3D visualization of insertion of the needle within the vein to get truly good at that procedure. There are subtle difference to how fast you insert the needle, what angle you insert it, how quickly and when you drop the angle, coupled with simultaneously holding the skin taught and using one finger to advance the catheter. The same idea will be the same for delivering babies, I&Ds, splinting, venipunctures, intubation and etc.

The surgeries that you scrub into are also an experience. Yeah, it f-ing sucks to be retracting for hours on end. However, there is a HUGE difference between reading about a surgery and actually experiencing it. Also, true that it sucks to be belittled and yelled at on the surgical rotation (and any rotation) but part of developing as a doctor is to grow a thicker skin so that when it is your turn to manage an emergency you will have to balls to do so.

Psych, probably one of my most disliked rotations, still taught me how to talk to crazy people, how to stay calm when some one is irrational and how to recognize psych patients so that I can refer accordingly.

All of this does not take 4-5 weeks. It takes time and dedication.

 

[xanthomondo]

I could learn everything taught to me in 3rd year with about 4-5 weeks of moderate studying. It is perhaps the most inefficient system possible for learning medicine.

Don't get me wrong, it used to work back when med students actually did stuff 20-30 years ago - and not "did stuff" like put in one easy IV while the resident looked over your shoulder, but actually had real responsibilities and contributions to make. Now we've got the worst of both worlds: on the job training without the job.

Fine, you get to see and occasionally do some cool stuff, but I'm not trying to be a medical tourist. You're basically expendable/interchangeable at the hospital, yet keep hours like the place would fall apart without you. If being useless doesn't bother you, the utter waste of time should.

And yes, I know that you are an exception. You are down there on the wards making things happen and pulling for your "team." Well guess what, absolutely no one is impressed by the 3 seconds you saved grabbing the chart for the intern, because it'll never overcome the countless minutes consumed by your overly exacting H&P presentation during morning rounds, or the shameless desperation of the med student "independent presentation" on topic X no one cares about or will be paying attention to. You are in the way. And that is why 3rd year sucks.

Post of the thread award winner

An old school attending said it the best (about the bolded)

Med school used to train doctors, residency used to train surgeons....now med school just trains students to get into residency. Residency just trains students to get into a fellowship.

It would be nice to be able to graduate medical school, and with 8 years of post-high school education not be an incompetent waste of space.

 

[VoiceofReason]

Give me a break. You seriously think you can learn Ob/Gyn, Peds, Surgery, Neuro, Psych, FM, and Internal medicine in 4-5 weeks?

The amount of facts alone would take longer than 4-5 weeks. That part is simply book learning. There is a tremendous amount of information that is absorbed throughout the year. The repetitive reinforcement is what solidifies it in our minds.

The experience I was talking about was not the "filing system" you are referring to. Guess what being a physician is a people-job. You have to learn to communicate on all levels. Part of that means writing effective notes. It also means calling consults, speaking with nurses, presenting on rounds and to residents and collecting information by reading consult notes, nursing notes, PT notes, finding labs etc. These skills take time to develop. You don't just write a couple of notes and you're ready to take care of patients. No, it takes weeks of speaking with patients, following up with daily information and presenting frequent to get really good at it.

How about learning to interpret labs and imaging? What, you read one CXR, one EKG and you think you're the expert? There are numerous permutations of what can occur and the exposure in third year allows improvement.

And lets not even mention procedures. For example, inserting an IV is relatively simple theoretically but given the variable anatomy in veins, one has to get a good feel of the needle and 3D visualization of insertion of the needle within the vein to get truly good at that procedure. There are subtle difference to how fast you insert the needle, what angle you insert it, how quickly and when you drop the angle, coupled with simultaneously holding the skin taught and using one finger to advance the catheter. The same idea will be the same for delivering babies, I&Ds, splinting, venipunctures, intubation and etc.

The surgeries that you scrub into are also an experience. Yeah, it f-ing sucks to be retracting for hours on end. However, there is a HUGE difference between reading about a surgery and actually experiencing it. Also, true that it sucks to be belittled and yelled at on the surgical rotation (and any rotation) but part of developing as a doctor is to grow a thicker skin so that when it is your turn to manage an emergency you will have to balls to do so.

Psych, probably one of my most disliked rotations, still taught me how to talk to crazy people, how to stay calm when some one is irrational and how to recognize psych patients so that I can refer accordingly.

All of this does not take 4-5 weeks. It takes time and dedication.

You're hopeless. I'm not going to dissect your post. I have news for you, you're still not good at any of those things you mentioned even though you've done most of your clerkships. It takes years of practice to actually be good at any given field of medicine.

Any foundational knowledge that you learned in a really inefficient manner could have been taught in a class or learned from a book.

 

[xanthomondo]

Give me a break. You seriously think you can learn Ob/Gyn, Peds, Surgery, Neuro, Psych, FM, and Internal medicine in 4-5 weeks?

Nope, but we also don't learn them in a year, either

The amount of facts alone would take longer than 4-5 weeks. That part is simply book learning. There is a tremendous amount of information that is absorbed throughout the year. The repetitive reinforcement is what solidifies it in our minds.

The experience I was talking about was not the "filing system" you are referring to. Guess what being a physician is a people-job. You have to learn to communicate on all levels. Part of that means writing effective notes. It also means calling consults, speaking with nurses, presenting on rounds and to residents and collecting information by reading consult notes, nursing notes, PT notes, finding labs etc. These skills take time to develop. You don't just write a couple of notes and you're ready to take care of patients. No, it takes weeks of speaking with patients, following up with daily information and presenting frequent to get really good at it.

How about learning to interpret labs and imaging? What, you read one CXR, one EKG and you think you're the expert? There are numerous permutations of what can occur and the exposure in third year allows improvement.

Honestly I was better at reading EKGs during MS2 when we had to learn how to read/interpret them. I haven't touched on it since.

And lets not even mention procedures.

I agree with you here, you need direct experience to get proficient at doing these. There is no substitution.

For example, inserting an IV is relatively simple theoretically but given the variable anatomy in veins, one has to get a good feel of the needle and 3D visualization of insertion of the needle within the vein to get truly good at that procedure. There are subtle difference to how fast you insert the needle, what angle you insert it, how quickly and when you drop the angle, coupled with simultaneously holding the skin taught and using one finger to advance the catheter.

Never got to do that.

The same idea will be the same for delivering babies,

Or that

I&Ds,

Or that

splinting,

Or that

venipunctures

Or that

, intubation and etc.

Or that...despire almost being through the entire MS3 and "needing" to work/stand around for countless hours.

The surgeries that you scrub into are also an experience. Yeah, it f-ing sucks to be retracting for hours on end. However, there is a HUGE difference between reading about a surgery and actually experiencing it.

Yeah, the feel of holding the retractor just makes the surgical info burned into my brain. It doesn't really matter that I can't see ANYTHING on the field or ANYTHING the surgeons are actually doing.

Also, true that it sucks to be belittled and yelled at on the surgical rotation (and any rotation) but part of developing as a doctor is to grow a thicker skin so that when it is your turn to manage an emergency you will have to balls to do so.

For some reason I don't equate being constantly chastised to being able to handle an emergent situation calmly.

Psych, probably one of my most disliked rotations, still taught me how to talk to crazy people, how to stay calm when some one is irrational and how to recognize psych patients so that I can refer accordingly.

All of this does not take 4-5 weeks. It takes time and dedication.

Again, the experience takes time, but not the amount of time that is consumed by MS3. You do not need 60-80 hours per week to get the experience that I've had so far.

 

[lockjaw]

You're hopeless. I'm not going to dissect your post. I have news for you, you're still not good at any of those things you mentioned. It takes years of practice - thats what residency is for, you say? Well then... what are clerkships for?

Sure, most if that is learned in residency, but you need a foundation of experience before starting residency - do you really think you'll be ready to start intern year after 4-5 weeks of clerkship, a couple of sub-Is, and then a bunch of cush electives/vacation time filling out the rest of 4th year? No, you won't be an expert at any of the things that SuperHiro mentioned by the time you start your internship, but at least you won't be doing all of those things for the very first time.

 

[MilkmanAl]

Must suck to not have an EMR that can be pre-populated or progress notes copied over from the previous day or clinic visit then updated. Sure, we have to initiate some of them, but it really isn't that bad. And we have social workers and schedulers to arrange discharge appointments.

Agreed. Even without a solid EMR system, I'd still like note writing better than anything the first two years have to offer. At least it's learning how to slap together a solid H&P in a reasonable amount of time.

 

[xanthomondo]

Wow, this just gets better and better. So first we should get rid of pre-clinical medical school, replace it with a course where you cram First Aid, and now it turns out that the clinical part of medical school should really be done in 4 or 5 weeks. Awesome.

No I think the truth is that medical school education/curriculum needs to be severely revamped.

 

[lockjaw]

Never got to do that.
Or that
Or that
Or that
Or that
Or that...despire almost being through the entire MS3 and "needing" to work/stand around for countless hours.

This is why I think pre-meds should really focus more on looking at the clinical curriculum of schools they're applying to, rather than focusing so much on how the school prepares you for Step 1 (since all schools do "average" on Step 1 anyways). I've done all those things mentioned by SuperHiro that you never got to do, and overall I feel like my school has given me an excellent clinical experience in my 3rd and 4th years that will hopefully allow me to be well prepared to start residency.

 

[xanthomondo]

This is why I think pre-meds should really focus more on looking at the clinical curriculum of schools they're applying to, rather than focusing so much on how the school prepares you for Step 1 (since all schools do "average" on Step 1 anyways). I've done all those things mentioned by SuperHiro that you never got to do, and overall I feel like my school has given me an excellent clinical experience in my 3rd and 4th years that will hopefully allow me to be well prepared to start residency.

How would it be possible to predict how much the students are allowed to do at their clinical sites? I'm willing to bet that people who are in my class were able to do some of those things. It all depends where you do your rotation at (which we got assigned by lottery...we didn't have 100% control over our fate).

 

[lockjaw]

How would it be possible to predict how much the students are allowed to do at their clinical sites? I'm willing to bet that people who are in my class were able to do some of those things. It all depends where you do your rotation at (which we got assigned by lottery...we didn't have 100% control over our fate).

I agree that finding out in advance exactly how much you'll get to do probably wouldn't happen - I just mean that it'll be helpful to know more about the structure and culture of 3rd year overall, rather than debating PBL vs lecture based curricula. Such as: are all rotations at one site? If not, is one site widely known to be better than the others? Community vs. university hopsital(s)? How are rotation sites determined? How is the teaching environment? Are students actively involved or more often just shadowing? Etc, etc. I just think there's too much focus on the first 2 years in the application process, when I think the clinical years are what actually vary the most between schools and make the most difference.

 

[VoiceofReason]

Sure, most if that is learned in residency, but you need a foundation of experience before starting residency - do you really think you'll be ready to start intern year after 4-5 weeks of clerkship, a couple of sub-Is, and then a bunch of cush electives/vacation time filling out the rest of 4th year? No, you won't be an expert at any of the things that SuperHiro mentioned by the time you start your internship, but at least you won't be doing all of those things for the very first time.

No, you won't be an expert on central venous access, or even peripheral, but those 6-10 IVs you placed.. Well, good thing you placed them then and not in your first 4-5 weeks of internship.

You greatly overestimate how much "experience" you've gotten.

 

[CardiacIntensivist]

How would it be possible to predict how much the students are allowed to do at their clinical sites? I'm willing to bet that people who are in my class were able to do some of those things. It all depends where you do your rotation at (which we got assigned by lottery...we didn't have 100% control over our fate).

It's why I advise pre-meds to focus their questions on third and fourth year rather than the first two years.

I get the feeling that the posters who are dissatisfied with their clinical years did not have a great experience (captain obvious is obvious). I do not claim to be an expert but after a couple of electives I realized that I learned quite a bit about all those procedures and imaging modalities. My communication skills, note writing, presentations, ability to remain calm with crazy patients/nurses/people have grown tremendously. I have certainly built the fundamentals that will allow me to be more efficient as an intern and I hope to further that knowledge then. I don't kid myself into thinking that I will change your mind. I only wrote my post in the hopes that others who read yours will also read mine and at least see that people's experiences are different. I absolutely disagree that the curriculum needs to be revamped but I wouldn't begrudge it some improvements. Perhaps it is in your OWN schools where you find the problems that you have. I continue to endorse the fact that I enjoyed medical school despite all the crap I've put up with and the pros certainly outweigh the (few) cons. It is certainly also true with the classmates that I am close to.

 

[CardiacIntensivist]

Never got to do that.
Or that
Or that
Or that
Or that
Or that...despire almost being through the entire MS3 and "needing" to work/stand around for countless hours.

Just saw this. No WONDER your years sucked. sheesh.... standing around for anyone is going to.

I'm sorry you were treated like that but do you think your opinion would be different if you got to do all that I listed and more?

 

[lockjaw]

No, you won't be an expert on central venous access, or even peripheral, but those 6-10 IVs you placed.. Well, good thing you placed them then and not in your first 4-5 weeks of internship.

You greatly overestimate how much "experience" you've gotten.

I'm not talking so much about procedural experience (I definitely still don't feel comfortable starting IVs yet, especially not on children) but the other things like doing H&Ps/writing notes/orders/admitting patients/calling consults/etc. A good intern caring for 8-12 patients needs to be efficient, and that's hard to do if you've never had practice doing the day-to-day things expected of you in the hospital. Would it be impossible to do if you only had 4-5 weeks of 3rd year? No; you'd just have a very, very steep learning curve. I'm not saying that you absolutely couldn't survive without 3rd year, but I don't feel like it was a wasted year in any sense.

 

[xanthomondo]

It's why I advise pre-meds to focus their questions on third and fourth year rather than the first two years.

I get the feeling that the posters who are dissatisfied with their clinical years did not have a great experience (captain obvious is obvious). I do not claim to be an expert but after a couple of electives I realized that I learned quite a bit about all those procedures and imaging modalities. My communication skills, note writing, presentations, ability to remain calm with crazy patients/nurses/people have grown tremendously. I have certainly built the fundamentals that will allow me to be more efficient as an intern and I hope to further that knowledge then. I don't kid myself into thinking that I will change your mind. I only wrote my post in the hopes that others who read yours will also read mine and at least see that people's experiences are different. I absolutely disagree that the curriculum needs to be revamped but I wouldn't begrudge it some improvements. Perhaps it is in your OWN schools where you find the problems that you have. I continue to endorse the fact that I enjoyed medical school despite all the crap I've put up with and the pros certainly outweigh the (few) cons. It is certainly also true with the classmates that I am close to.

I think I can peg you at which type of student you would be in my class

You'd be like the girl, who when assigned to give a presentation on carotid stenosis for 1pm on thursday to the group of 4 people, would be SO EXCITED all day long and wouldn't stop excitedly asking the residents "OMG did you see the SPACE trial and the BLAH trial and BLAH BLAH trial?!?!"

Even the surgery residents could have cared less.

 

[CardiacIntensivist]

I think I can peg you at which type of student you would be in my class

You'd be like the girl, who when assigned to give a presentation on carotid stenosis for 1pm on thursday to the group of 4 people, would be SO EXCITED all day long and wouldn't stop excitedly asking the residents "OMG did you see the SPACE trial and the BLAH trial and BLAH BLAH trial?!?!"

Even the surgery residents could have cared less.

I'm a dude, brah

Eh, I was enthusiastic but I also knew my place.

 

[xanthomondo]

I'm a dude, brah

Eh, I was enthusiastic but I also knew my place.

I know you're a dude but I was comparing you to a girl I know (sorry for the confusion )

Youre a 4th year, eeh? Of course life is going to be better for you!

Whatcha matchin into

 

[CardiacIntensivist]

I know you're a dude but I was comparing you to a girl I know (sorry for the confusion )

Youre a 4th year, eeh? Of course life is going to be better for you!

Whatcha matchin into

Yes indeedy. Fourth year...is...so...f-ing...win.

Anesthesia. And no it does NOT contradict all my previous posts in this thread

 

[nlax30]

Fourth year is bi-winning. Especially post match.

 

[CardiacIntensivist]

Fourth year is bi-winning. Especially post match.

Did you do the DO match. Why is it earlier? The wait is agonizing

 

[nlax30]

Did you do the DO match. Why is it earlier? The wait is agonizing

Yup, matched DO. Though I had a stressful few months leading up to that in deciding whether to do allo, osteo or both. Honestly, having a separate match is extremely annoying and just adds another layer of complexity to this whole process. Wish they'd just combine everything.

Definitely feel for my friends doing ACGME who are posting what seems like daily match day countdowns on facebook.

 

[CardiacIntensivist]

Yup, matched DO. Though I had a stressful few months leading up to that in deciding whether to do allo, osteo or both. Honestly, having a separate match is extremely annoying and just adds another layer of complexity to this whole process. Wish they'd just combine everything.

Definitely feel for my friends doing ACGME who are posting what seems like daily match day countdowns on facebook.

yeah time slows down as we approach the speed of match. Congrats for you!

 

[Jolie South]

It's why I advise pre-meds to focus their questions on third and fourth year rather than the first two years.

I get the feeling that the posters who are dissatisfied with their clinical years did not have a great experience (captain obvious is obvious). I do not claim to be an expert but after a couple of electives I realized that I learned quite a bit about all those procedures and imaging modalities. My communication skills, note writing, presentations, ability to remain calm with crazy patients/nurses/people have grown tremendously. I have certainly built the fundamentals that will allow me to be more efficient as an intern and I hope to further that knowledge then. I don't kid myself into thinking that I will change your mind. I only wrote my post in the hopes that others who read yours will also read mine and at least see that people's experiences are different. I absolutely disagree that the curriculum needs to be revamped but I wouldn't begrudge it some improvements. Perhaps it is in your OWN schools where you find the problems that you have. I continue to endorse the fact that I enjoyed medical school despite all the crap I've put up with and the pros certainly outweigh the (few) cons. It is certainly also true with the classmates that I am close to.

I couldn't agree with you more. I don't know why it has become "the cool thing" to complain about everything medical school related, especially 3rd and 4th years. Maybe, our schools are just awesome.

I feel 100X more competent than I did a year ago when I started rotations. I feel like we were given complete ownership over our patients, and I got a lot of great teaching from both residents and attendings.

While I agree that note-writing and order-writing can be a drag, how exactly do you plan on escaping that as a resident or attending? In all the core fields, it will be there in some shape or form. Not even radiologists and pathologists can escape writing reports and anesthesia requires documentation throughout their cases.

I guess I'm just happy to be one of the people that actually enjoys school, however uncool it makes me.

 

[apricotattack]

My theory: the 2 camps of medical students-

The first group worked hard and excelled during the first 2 years, having a ball memorizing everything that crossed their paths. They had the system down from college and aced exams without trouble.

The second group struggled and fought their way through the 1st 2 years, emerging at the other side with plenty of knowledge but feeling like they got kicked in the stomach for 2 years straight. They yearned for human contact whilst locked in the library trying to stuff clotting cascades and antimicrobial pharmacology into every gyrus they had.

The first group arrived at 3rd year and found very little structure, lots of residents and staff to impress or be embarrassed by, and (gasp) needy patients. Their anger over having to do scut work and trying to study in every free minute in order to honor made their lives worse than the first 2 years.

The second group emerged into 3rd year so eager to talk to patients and try out what they learned that they didn't really care that the hours were long and some staff and residents were mean. They were eager to help out the team in the name of helping out the patient, and they were glad to get some hands-on experience and one-on-one teaching about subjects that came up from patient care. They decided it was okay to learn about more than just the specialty they wanted to go into, and did their best to learn and get along with people.

THE END! Kind of corny, but I've seen it over and over again. You can probably tell that I'm in group 2. I really do think life is so, so much better in 3rd year. I would rather do any rotation I've done so far than do any part of 1st or 2nd year over - including surgery, urology, whatever!!

I also think it's really useful to be interested in a field like family medicine during 3rd year, because everything is applicable so you always feel your time is being well spent.

 

[Pansit]

Does anyone actually like 3rd year? or do people just say that to save face around non medical school personnel so that it doesn't seem like they hate their life choice. Is it different between big city hospitals and smaller hospitals?

i mean, how can you really like 3rd year? i understand not wanting to be in the classroom but 3rd year clinical experience is much different than 1st/2nd year experience.

If you like all that sucking up to attendings, all that pretending like every single rotation is the greatest one you have had so far, all that embarrassment of not knowing anything, all that anxiety of having to ask for a LOR or ask to get a good eval, that perpetual feeling that everyone thinks you are just wasting their time because you know that they know you really dont know anything, that perpetual feeling of never knowing how well you have done on a rotation compared to everyone else before...than you will love 3rd year!

 

[pingouin]

If you like all that sucking up to attendings, all that pretending like every single rotation is the greatest one you have had so far,

I've never done that and my grades this year are much better than in pre-clinical years. I've known what specialty I want to do since before I entered, and not once have I suggested to a resident or attending outside of that field that I was strongly considering their field. Interestingly, one of my OB/Gyn chiefs told me that it was refreshing that I told him I did NOT want to do OB, because he's sick of people pretending they do. So I would suggest- from my experience and that of some of my classmates- that genuineness gets you a lot further in your clinical years than BS.

all that embarrassment of not knowing anything,

Are you expected to know everything? I doubt it. Am I at the only school where malignant, nasty, verbally abusive attendings are the exception rather than the rule?

all that anxiety of having to ask for a LOR or ask to get a good eval,

See comment re: genuineness above. It's a lot less anxiety-producing to ask for those letters if you've been genuinely interested in what each rotation can offer you.

that perpetual feeling that everyone thinks you are just wasting their time because you know that they know you really dont know anything,

Really? Intelligent questions about patient or disease management is a waste of time? That's encouraged at my school. Using a rotation to learn, rather than to impress, seems to have a much more positive impact.

that perpetual feeling of never knowing how well you have done on a rotation compared to everyone else before...than you will love 3rd year!

Chances are you're not the worst student they've ever had, and you're not the best student they ever had.


Let's not pretend that every day is sunshine, rainbows, and cute puppy dogs where I am. But more days than not, I'm glad I'm in medical school, and EVERY day I'm glad I'm no longer a pre-clinical student.


As for apricotattack's proposal, I am solidly in the Type 2 camp. Maybe you're onto something...

 

[Pansit]

I've never done that and my grades this year are much better than in pre-clinical years. I've known what specialty I want to do since before I entered, and not once have I suggested to a resident or attending outside of that field that I was strongly considering their field. Interestingly, one of my OB/Gyn chiefs told me that it was refreshing that I told him I did NOT want to do OB, because he's sick of people pretending they do. So I would suggest- from my experience and that of some of my classmates- that genuineness gets you a lot further in your clinical years than BS.

By sucking up, I mean never being able to tell your attendings how I REALLY FEEL. Do i like being in the hospital at 4 am to pre-round on my surgery patients?...HELL NO...do I smile and say I would be happy to when they tell me to do it...YES. When the attending tells me to stay another 2 hours so I can watch a procedure I really dont give a crap about it, do I suck up and say YES I would?...Of course, because that attending is doing my evaluation.

 

[Jolie South]

By sucking up, I mean never being able to tell your attendings how I REALLY FEEL. Do i like being in the hospital at 4 am to pre-round on my surgery patients?...HELL NO...do I smile and say I would be happy to when they tell me to do it...YES. When the attending tells me to stay another 2 hours so I can watch a procedure I really dont give a crap about it, do I suck up and say YES I would?...Of course, because that attending is doing my evaluation.

In what job would you ever want to do the extra work that your boss is piling on? If there's a job out there where you feel like that would be different, I'd love to hear about it. Bosses will always give work to subordinates. That is the nature of the beast.

Work is work. Some work is more enjoyable, some less. In the grand scheme of things, I find medicine more enjoyable. Does that mean that you don't have to "pay your dues" to get the experience you need to be at the top of the hierarchy? I don't know why it would.

 

[CardiacIntensivist]

By sucking up, I mean never being able to tell your attendings how I REALLY FEEL. Do i like being in the hospital at 4 am to pre-round on my surgery patients?...HELL NO...do I smile and say I would be happy to when they tell me to do it...YES. When the attending tells me to stay another 2 hours so I can watch a procedure I really dont give a crap about it, do I suck up and say YES I would?...Of course, because that attending is doing my evaluation.

Have you ever had a job before? You will always have to do things you don't like in any job. Not making a fit about it is not "sucking up," it is being professional. This is no longer 1st or 2nd year where we are protected by academia. It's 3rd year, you are working with people now. Not only do you have to manage finding a way to get educated but to properly communicate and get others to work with you. No one is going to hand you anything. No one is going to go out of their way to make sure your life is the way you wish it to be. If you're not ready to make a few sacrifices....

 

[AmoryBlaine]

Speaking as a resident I want all of you students to remember this frustration with M3 year and when you are the resident/attending work actively to make it better.

That means you need patience, empathy, and you need to create the learning opportunities.

Example: I have a procedure in the ER, say an LP of which I have done approximate 6 million.

Easy way: do it myself and be out of the room in 10 min.

Better way: I will aggressively find someone who has not done one, be they an M2 shadowing or an intern and take the extra time to give the procedure up to them. If that means I stay 45 min after the end of my shift then so be it.

I saw a bunch of people by myself the other day so the intern could take an M1 who was shadowing through an incision and drainage.

I'm not bragging on myself, I'm telling you what I actually do.

If you don't like this system, then the people to change it are you. You have to go get these scared, nervous students, make opportunities for them, and then be like "dude it's ok if you screw up."



Easier to complain about not getting to do anything as a student then let med students do stuff as a resident.

 

[CardiacIntensivist]

Speaking as a resident I want all of you students to remember this frustration with M3 year and when you are the resident/attending work actively to make it better.

That means you need patience, empathy, and you need to create the learning opportunities.

Example: I have a procedure in the ER, say an LP of which I have done approximate 6 million.

Easy way: do it myself and be out of the room in 10 min.

Better way: I will aggressively find someone who has not done one, be they an M2 shadowing or an intern and take the extra time to give the procedure up to them. If that means I stay 45 min after the end of my shift then so be it.

I saw a bunch of people by myself the other day so the intern could take an M1 who was shadowing through an incision and drainage.

I'm not bragging on myself, I'm telling you what I actually do.

If you don't like this system, then the people to change it are you. You have to go get these scared, nervous students, make opportunities for them, and then be like "dude it's ok if you screw up."



Easier to complain about not getting to do anything as a student then let med students do stuff as a resident.

Outstanding! We need more residents like you. Bolded is especially hard given the pressure to finish things in a timely manner.

 

[Pansit]

Have you ever had a job before? You will always have to do things you don't like in any job. Not making a fit about it is not "sucking up," it is being professional. This is no longer 1st or 2nd year where we are protected by academia. It's 3rd year, you are working with people now. Not only do you have to manage finding a way to get educated but to properly communicate and get others to work with you. No one is going to hand you anything. No one is going to go out of their way to make sure your life is the way you wish it to be. If you're not ready to make a few sacrifices....

UH...Hello...in a job YOU GET PAID...in 3rd year, you are paying 30K to be there. All the sucking up is not to be professional. All the sucking up is so you dont get a bad eval, you can get a good LOR, and that attendings and residents and nurses, dont generally think your a *****. It's all part of the game.

 

[lockjaw]

My theory: the 2 camps of medical students-

The first group worked hard and excelled during the first 2 years, having a ball memorizing everything that crossed their paths. They had the system down from college and aced exams without trouble.

The second group emerged into 3rd year so eager to talk to patients and try out what they learned that they didn't really care that the hours were long and some staff and residents were mean. They were eager to help out the team in the name of helping out the patient, and they were glad to get some hands-on experience and one-on-one teaching about subjects that came up from patient care. They decided it was okay to learn about more than just the specialty they wanted to go into, and did their best to learn and get along with people.

I'm a combination of your two groups - I've liked all the years of med school so far. Maybe I'm just an abnormally happy, easy-going person? Or maybe it's because I've never really had a job (sure I've had little summer things, but not a real full-time job), so it's just exciting to me to finally have some responsibility and therefore all the things that Pansit mentioned don't bother me because I don't know any better. I don't know.

 

[Jolie South]

UH...Hello...in a job YOU GET PAID...in 3rd year, you are paying 30K to be there. All the sucking up is not to be professional. All the sucking up is so you dont get a bad eval, you can get a good LOR, and that attendings and residents and nurses, dont generally think your a *****. It's all part of the game.

Minus the pay situation, this actually is a job. Your job is to learn to be a resident and take care of patients. In a couple short years, it will be you that's required to do those things. Do you think as an intern you'll be able to just "say what you think" to attendings? Do you think that you don't get evaluated as a resident?

Do you think at any other job that you can just "say what you think"? Do you think you don't have to be nice to people or be professional?

And I don't know what you mean by "sucking up"? I treat everyone with respect and approach my job with enthusiasm. I try to learn from every situation and be as proactive as I can. If that's sucking up, then fine.

I don't know why everyone thinks that you need to pretend to want to go into a field to get good evals. I got my best evaluations from medicine, where I was honest from day 1 that I wanted to be a surgeon. Did the fact that I wanted to be a surgeon stop me from trying to learn on the medicine wards? No, because regardless of the fact that I'm going into surgery, my patients will also have medicine-type problems that I may have to manage while they're in house. Do I like being on medicine wards? No, I don't, but I have to be there so why complain about it.

 

[Pansit]

Minus the pay situation, this actually is a job. Your job is to learn to be a resident and take care of patients.

That is NOT a job...that is called being a student.

Do you think at any other job that you can just "say what you think"? Do you think you don't have to be nice to people or be professional?

In residency you will be at an institution for more than one month. So YES, you will be able to say what you think. You will know all the attendings personally, and can give opinions that people will actually listen to and do something about it. As a 3rd year medical student who will be at a service for only a month, you have NO say on anything and pretty are at the whim of whatever the residents or attendings want you to do.

And I don't know what you mean by "sucking up"? I treat everyone with respect and approach my job with enthusiasm. I try to learn from every situation and be as proactive as I can. If that's sucking up, then fine.

That is good but idealistic to treat every rotation with "enthusiasm". Try being at an FP clinic all day long, everyday, trying to treat every person that comes in for HTN or DM. If you are enthusiastic about that...than I tip my hat to you...because MOST medical students just want to come in, and then get the heck out.

I don't know why everyone thinks that you need to pretend to want to go into a field to get good evals. I got my best evaluations from medicine, where I was honest from day 1 that I wanted to be a surgeon. Did the fact that I wanted to be a surgeon stop me from trying to learn on the medicine wards? No, because regardless of the fact that I'm going into surgery, my patients will also have medicine-type problems that I may have to manage while they're in house. Do I like being on medicine wards? No, I don't, but I have to be there so why complain about it.

Nobody said to pretend like you are going into a certain field. BUT YOU HAVE TO PRETEND like you care. Which for many of the rotations, after maybe a week, you cant wait to get the hell out of there. Family practice...yeah...for me...no. Peds...yeah...after 3 days, I was waiting for the next rotation. I understand the educational value of experiencing all the rotations, but it doesnt change the fact that I am bored with most of it.

 

[smq123]

In residency you will be at an institution for more than one month. So YES, you will be able to say what you think. You will know all the attendings personally, and can give opinions that people will actually listen to and do something about it.

Wow, you think this is actually true? Wow, you are in for a rude surprise when you start residency.

Pretending to be enthusiastic? Doesn't end when you start residency. (You think I WANT to be there everyday? No. Do you think I WANT to rotate through everything that the ACGME says that I have to rotate you? No. Do I have to pretend like I kind of want to be there, at the very least? YES. )

Having to bite your tongue and be diplomatic? Doesn't end when you start residency.

Not being able to say what you think? Doesn't end when you start residency.

Knowing all your attendings personally? If you're LUCKY, that's how it is at your program. Yeah, you work with them more closely....doesn't mean that you're buddy-buddy.

Having your opinion listened to? Again, if you're lucky, that's how it will be at your program. So many stories, even at non-malignant programs, where things happen that you have no control over and your opinion is worth less than the janitor's opinion.

Having to literally lie about how many hours you actually work? Occurs VERY frequently at many residencies, especially in OB and surgery.

I'm glad that you have this fairytale vision of residency, but it's not the land of kumbaya, rainbows, and puppy dogs that you seem to think it is.

 

[smq123]

UH...Hello...in a job YOU GET PAID...in 3rd year, you are paying 30K to be there. All the sucking up is not to be professional. All the sucking up is so you dont get a bad eval, you can get a good LOR, and that attendings and residents and nurses, dont generally think your a *****. It's all part of the game.

And all the sucking up that you have to do as a resident (and yes, there is still PLENTY) is so that you don't get fired. And so that you can get a job when you graduate.

By sucking up, I mean never being able to tell your attendings how I REALLY FEEL. Do i like being in the hospital at 4 am to pre-round on my surgery patients?...HELL NO...do I smile and say I would be happy to when they tell me to do it...YES. When the attending tells me to stay another 2 hours so I can watch a procedure I really dont give a crap about it, do I suck up and say YES I would?...Of course, because that attending is doing my evaluation.

You honestly think that MS3 is the last time that you'll ever have to do stuff that you don't want to do? And you honestly think that, as a resident, you can just waltz in to your program director's office and say, "Yeah....I don't feel like getting up at 4 AM to come in and pre-round on this off-service rotation....that's not a problem, is it? K, THANKS." Or you can just waltz into the clinic and say, "Nah....don't feel like seeing another routine, bread-and-butter patient. I'm leaving. K, THANKS."

It doesn't work that way.

Never got to do that.
Or that
Or that
Or that
Or that
Or that...despire almost being through the entire MS3 and "needing" to work/stand around for countless hours.

This sounds like a problem with your med school, and not with third year. I did enjoy MS3, but I got to do a lot. Got to deliver a lot of babies. Got to suture a lot. Learned how to tie one-handed ties. Got to do a lot of pap smears. Did a few I&Ds. Had a lot of hands-on stuff. If your school doesn't let you do any of that, then I agree that your school's MS3 curriculum sucks. It doesn't mean that MS3 universally sucks, but that your school doesn't handle it well.

 

[xanthomondo]

In what job would you ever want to do the extra work that your boss is piling on? If there's a job out there where you feel like that would be different, I'd love to hear about it. Bosses will always give work to subordinates. That is the nature of the beast.

Work is work. Some work is more enjoyable, some less. In the grand scheme of things, I find medicine more enjoyable. Does that mean that you don't have to "pay your dues" to get the experience you need to be at the top of the hierarchy? I don't know why it would.

I worked before medical school and NEVER ONCE did my boss say "hey I want you to stay 2 hours late and stand there in the corner and watch me do paperwork." This is essentially what being forced to scrub into a late case is like. You're not going to do anything, chances are it will be of incredibly low yield (yay! the 15th lap appy I've seen!) for learning. It will serve nothing but to eat away at the little time you have.

If my attending/resident was like hey can you stay a few hours late and help with this trauma pt or with this transfer or something where I was actually doing something useful/education I really would have no problem with it. But when its 6pm and all surgeries/floor work is done and the residents say "ok, now lets go to the cafe" - that's when I get pissed. And of course I'm not going to ask if I go home - these SOBs are the ones grading me and they'll think I'm uninterested.

Not a single time during MS3 did I ever ask to go home or not do/accept something that was asked of me with enthusiasm. It has not been paying off.

 

[xanthomondo]

If I got the chance to do MS3 over again, I would ABSOLUTELY tell every single rotation that that was my career choice right upfront (and then act interested the rest of the rotation).

During surgery my collegue and I were asked what we wanted to go into by an attending. I said ophtho, the response I got was "isn't that really competitive?" My collegue said "surgery" (even though he meant orthopedic surgery) and her response was "I wish you told me that sooner! I would have taken you under my wing" - and then she then let him suture in her cases/close. I was never allowed to do anything in her case.

In OB/GYN I actually asked point-blank if I could have the chance to have my hands on a baby to catch it, because it was really interesting and I probably won't get another opportunity ever again. I was told no, we typically don't let students do that unless they indicate they're specifically interested in OB/GYN. I was told the same thing in clinic when I asked if I could see patients on my own to do a Hx and PE.

 

[xanthomondo]

My theory: the 2 camps of medical students-

The first group worked hard and excelled during the first 2 years, having a ball memorizing everything that crossed their paths. They had the system down from college and aced exams without trouble.

The second group struggled and fought their way through the 1st 2 years, emerging at the other side with plenty of knowledge but feeling like they got kicked in the stomach for 2 years straight. They yearned for human contact whilst locked in the library trying to stuff clotting cascades and antimicrobial pharmacology into every gyrus they had.

The first group arrived at 3rd year and found very little structure, lots of residents and staff to impress or be embarrassed by, and (gasp) needy patients. Their anger over having to do scut work and trying to study in every free minute in order to honor made their lives worse than the first 2 years.

The second group emerged into 3rd year so eager to talk to patients and try out what they learned that they didn't really care that the hours were long and some staff and residents were mean. They were eager to help out the team in the name of helping out the patient, and they were glad to get some hands-on experience and one-on-one teaching about subjects that came up from patient care. They decided it was okay to learn about more than just the specialty they wanted to go into, and did their best to learn and get along with people.

THE END! Kind of corny, but I've seen it over and over again. You can probably tell that I'm in group 2. I really do think life is so, so much better in 3rd year. I would rather do any rotation I've done so far than do any part of 1st or 2nd year over - including surgery, urology, whatever!!

I also think it's really useful to be interested in a field like family medicine during 3rd year, because everything is applicable so you always feel your time is being well spent.

I don't think it's that simple. I think a lot has to do where people set the bar for threshold of what they find interesting.

I personally could care less and InD's. The student rotating with me, if she heard the letters InD, would jump up, get all excited and beg if she could be the one to go into the room to watch. After the procedure (in which she did nothing but watch) she would run out and be like "OMG it just oozed so much!" If you did a few that would be cool, but how excited can you be after watching 10 or 20 of them? Seriously there has to be some acting involved.

People like that probably enjoy MS3 more than I do as well.