What made transitioning to clinical year difficult?

[MaxPlancker]

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Curious as to people's experiences transitioning from preclinical to clinical and what made it hard!

 

[jurisburger]

MAJOR transition: Having to actually get up and leave the house during clinical year vs. lounging at home all day watching lecture recording at my leisure

Other difficulties include...
-Not knowing how to navigate the hospital environment
-Not knowing how to use EMR
-Never had experience doing rounds and/or give formal patient presentations
-Not knowing any real medicine
-Subjective and often BS grading scheme
-Long hours with very little time to study for shelf exams (there is nothing more frustrating than wanting to study and not having the energy or time to do it because you're stuck in the damn hospital for unreasonably long hours)
-Tired all the time
-Very little time left for personal stuff (family, friends, etc.)
-Dealing with terrible patients
-Dealing with terrible residents/attendings/nursing staff
-Dealing with gunner class mates
-So much other BS

I don't know if you can tell but I'm biased because I hated 3rd year of medical school. It eases up a bit when you kind of get how things work after the first few rotations but at best it's still miserable for all of the above reasons.

 

[Money Moniker]

I'm still in Step I study mode so the transitioning hasn't happened yet, but I foresee the greatest nuisance being all the attention from the ladies. The preclinical years were primarily spent ensconced in the safety and security of the 'crib, far from the dangerous savagery of the sun's rays and the thots' machinations. Now I will have to venture out of my dank lair and subject myself once more to the furious onslaught of the opposite sex, protected only by the flimsiness of my all-too-short white coat. As in the immortal words of William Shakespeare:

Once more unto the breach, dear friends, once more;
Or close the wall up with our English dead.

 

[doyouhaveaflag]

There were two aspects of third year that made the transition difficult for me. The first was getting questions in a non-multiple choice format. I got really good at answering multiple choice questions in pre-clinical years, but suddenly I was being pimped with questions where I had to completely come up with a reasonable answer in my head, on the spot, rather than picking one from a lineup of five options. On my very first day of M3, my attending asked me to name some causes of hypoxia and I was like a deer in headlights and said "uhhhhh" for a few seconds. It took me a few weeks to get used to this different format of quizzing. I actually really like pimping now, I think it's the most effective way to learn if it's done correctly.

The other difficult transition was that suddenly my grades didn't necessarily correlate with how hard I worked. In preclinical years, I could see the result of my studying efforts reflected directly in my test scores. More hard work meant scores I was happy with. In M3, the subjectiveness of the evals and the inconsistency in how different people grade students meant that my eval grades were not always commensurate with my effort. Again on my very first rotation, one of my residents gave me all 4 of 4s on my eval while the attending gave me all 2 of 4s. I worked with them on the same team at the same time so there was no difference in my performance. A lot of the time, eval grades were just based on luck of the draw who I got paired with. Thank goodness there were shelf exams that were included in my clinical grades so I was still able to get the overall grades I was happy with.

 

[zipnogg]

work on presenting patients. nobody expects too much out of med students other than being present and giving a good effort. however, when it comes to seeing and presenting patients, be proactive about asking residents and/or attendings for feedback. it doesn't matter if your plan is not perfect, just getting in the habit of presenting a patient in a concise, organized manner will get you well-prepared for residency.

 

[tymont12]

Not knowing what exactly you are expected to do. Dedicated and preclinicals were easy in that way: your world was within lectures, textbooks, Pathoma or UWorld. In the hospital, you may be asked--or expected--to do things you have no clue about or can't even do because you're so ineffectual as a 3rd year.

 

[ndafife]

1. Pretty limited clinical experience before 3rd year so getting used to how things work (EMR, rounding, staff interactions, etc...)
2. Figuring out how to study and what resources work for me
3. Time commitment - Even outpatient work would have me committed to being in clinic 8-5 or so. Eat and workout after than and its 8pm which doesn't leave a whole lot of time to study, work on some BS class assignment, see friends
4. Its isolating. I see the 5-6 people in my class who are on the same schedule as me and that's about it.
5. Big transitions from rotation to rotation. Get done with surgery then switch to psych and it is a very different set of diseases, treatments, interactions with patients, interactions with preceptors. Even within the same rotation different preceptors have different expectations.
6. No personal days. Preclinical I could sit at home and watch lectures, or blow them off for a day if I wasn't feeling it. Can't really do that in 3rd year.
7. Figuring out how to always be present and available without being in the way.
8. Subjective grading can be stressful. Its about being likeable and getting along with people as much as it is about knowing things.
9. Your time isn't your own. "Can you come to bachelor party/wedding/baby shower/etc...?" Its impossible to plan too far ahead because until you get the schedule for the rotation you're going to be on you really have no idea what your availability is.
10. There is a difference between knowing things for multiple choice and knowing things when the attending pimps you.
11. Can't show up looking like a homeless person every day. Apparently people want you to look good or something.
12. It gets really hard to pretend you give a s*** about well-child exams your 3rd week of outpatient peds when all you want to do is study for the shelf exam of this specialty you came into rotation knowing you had no interest in going into

 

[Newyawk]

my resident has been pimping me all week. I got almost all of the questions right and then when I asked for feedback I hear "your knowledge isn't great". getting graded subjectively is just the most frustrating system. you constantly feel like you're being observed and any minor mistake can be perceived as a major flaw in your character. whether real or not, it is your perception of the event that makes the year very stressful.

 

[mistafab]

Hardest part for me in this first month is getting things wrong.

I hate getting things wrong - eats me alive.

Learning a lot though.

 

[Candidate2017]

MAJOR transition: Having to actually get up and leave the house during clinical year vs. lounging at home all day watching lecture recording at my leisure

Other difficulties include...
-Not knowing how to navigate the hospital environment
-Not knowing how to use EMR
-Never had experience doing rounds and/or give formal patient presentations
-Not knowing any real medicine
-Subjective and often BS grading scheme
-Long hours with very little time to study for shelf exams (there is nothing more frustrating than wanting to study and not having the energy or time to do it because you're stuck in the damn hospital for unreasonably long hours)
-Tired all the time
-Very little time left for personal stuff (family, friends, etc.)
-Dealing with terrible patients
-Dealing with terrible residents/attendings/nursing staff
-Dealing with gunner class mates
-So much other BS

I don't know if you can tell but I'm biased because I hated 3rd year of medical school. It eases up a bit when you kind of get how things work after the first few rotations but at best it's still miserable for all of the above reasons.

1. Pretty limited clinical experience before 3rd year so getting used to how things work (EMR, rounding, staff interactions, etc...)
2. Figuring out how to study and what resources work for me
3. Time commitment - Even outpatient work would have me committed to being in clinic 8-5 or so. Eat and workout after than and its 8pm which doesn't leave a whole lot of time to study, work on some BS class assignment, see friends
4. Its isolating. I see the 5-6 people in my class who are on the same schedule as me and that's about it.
5. Big transitions from rotation to rotation. Get done with surgery then switch to psych and it is a very different set of diseases, treatments, interactions with patients, interactions with preceptors. Even within the same rotation different preceptors have different expectations.
6. No personal days. Preclinical I could sit at home and watch lectures, or blow them off for a day if I wasn't feeling it. Can't really do that in 3rd year.
7. Figuring out how to always be present and available without being in the way.
8. Subjective grading can be stressful. Its about being likeable and getting along with people as much as it is about knowing things.
9. Your time isn't your own. "Can you come to bachelor party/wedding/baby shower/etc...?" Its impossible to plan too far ahead because until you get the schedule for the rotation you're going to be on you really have no idea what your availability is.
10. There is a difference between knowing things for multiple choice and knowing things when the attending pimps you.
11. Can't show up looking like a homeless person every day. Apparently people want you to look good or something.
12. It gets really hard to pretend you give a s*** about well-child exams your 3rd week of outpatient peds when all you want to do is study for the shelf exam of this specialty you came into rotation knowing you had no interest in going into

Good news: by the time residency rolls around you'll be familiar with EMR and know how to present. Bad news: most of this BS continues into residency on top of actual responsibility. Enjoy 4th year while you can.​

 

[Osteoth]

Other difficulties include...
-Not knowing how to navigate the hospital environment
-Not knowing how to use EMR
-Never had experience doing rounds and/or give formal patient presentations
-Not knowing any real medicine
-Subjective and often BS grading scheme
-Long hours with very little time to study for shelf exams (there is nothing more frustrating than wanting to study and not having the energy or time to do it because you're stuck in the damn hospital for unreasonably long hours)
-Tired all the time
-Very little time left for personal stuff (family, friends, etc.)
-Dealing with terrible patients
-Dealing with terrible residents/attendings/nursing staff
-Dealing with gunner class mates
-So much other BS

Def agree on a couple of your points, especially the grading & being unavoidably tired all the time.

 

[Oso]

the emergence of the gunners + constant testing/need for studying + me running out of f@cks to give = I did not enjoy 3rd year

 

[Redpancreas]

It’s the first time you really interact with people and it’s no longer objectively how much you know, but the impression you give off since your performance is really not affecting patient care, especially as a third year. I think it’s frustrating because certain people (type As or people who want to come back from a poor Step 1) feel the need to employ psychological warfare to get ahead by any means necessary. This makes it harder to focus on learning and you have to devote energy to making yourself stand out relative to others.

 

[Weirdy]

feel the need to employ psychological warfare to get ahead by any means necessary. This makes it harder to focus on learning and you have to devote energy to making yourself stand out relative to others.

Can attendings sniff this out most of the time?

I don't like sucking up. Get in, be useful, be quiet, take initiative, don't make more work for them, get out.
Others love to suck up and are very crafty with it.

How do I know whether I'm doing enough to stand out, or if I can just work like how I've worked before?

 

[NuttyEngDude]

Can attendings sniff this out most of the time?

I don't like sucking up. Get in, be useful, be quiet, take initiative, don't make more work for them, get out.
Others love to suck up and are very crafty with it.

How do I know whether I'm doing enough to stand out, or if I can just work like how I've worked before?

Generally attendings and residents can sniff it out. Whether you are aware of it is another matter. I've seen some cases where residents were so overwhelmed that they cant pay attention. These are the bad rotations.

 

[DBV]

Brutal schedule compared to M2. BS grading system. Cycling through a bunch of crappy specialties you dont care about. Having to look busy half the day on rotations where 90% of your work is done after rounds at ~9am. Swallowing your pride and taking beatings on evaluations just because nobody noticed you doing things.

Third year is the worst year so far but will report back on intern year

 

[Entadus]

The rotations (not all of them) where you have to wake up at 5AM day in, day out. Intern year should be fun...

 

[doyouhaveaflag]

The rotations (not all of them) where you have to wake up at 5AM day in, day out. Intern year should be fun...

Waking up at 5am? Man, I had to BE there at 5am for 3 or 4 months of M3. Then I chose a specialty where I have to be there at 5am most of intern year, lol.

 

[Cheekz]

Definitely agree with all previous comments on BS grading system. The subjectivity will eat you alive but there's nothing much you can do about it. Also hated the fact that you have to be "on" at all times. You always need to be proactive, and if you're too quiet it comes off as "uninterested" or "not engaged". Even if you're having the worst day of your life, you've gotta fake a smile and feign interest if you want to be a top clinical student.

 

[studentdocftw]

As mentioned ad nauseam, the subjectivity of evaluations...what's supposed to be an evaluation of your ability to carry out an encounter from presentation to plan somehow morphs into an evaluation of how well you get along with whoever is grading you.

 

[BigRedBeta]

9. Your time isn't your own. "Can you come to bachelor party/wedding/baby shower/etc...?" Its impossible to plan too far ahead because until you get the schedule for the rotation you're going to be on you really have no idea what your availability is.

This first part, for many students, is actually the root cause of much of the distress over clinical years. You have to be where they tell you to be, when they tell you to be there, and oftentimes when you get there, there's nothing for you to do. Compared to the freedom of undergrad and the pre-clinical years, this is a major paradigm shift and one that many people handle poorly. I think it was less of an issue for the people who didn't go straight from UG to med school, and if you were the sort of person who frequently felt that you got more done at home listening to lectures online (or worse, simply studying from entirely different resources) rather than showing up every day, then the change was even more dramatic. One year you're able to plan your day however you want - gym for 2 hours? Sure! Study at Starbucks instead of the library? No one cares! Meet up with old friends for a drink on Tuesday? Of course, it's your evening! and then the next it's: We round at 8am, you need to have seen your patients by 630am so you can go over your presentation with your intern before they finish pre-rounds, oh and by the way, except for this random day when you have a 2pm lecture, you can't go home without permission...

The scheduling aspect is also frustrating.

None of this gets better in residency, but 1) you get used to it, and 2) you actually have real work that matters, so it gets easier to tolerate.

 

[bananafish94]

I agree with many points above. The things that I've found to be particularly frustrating are:
-Of course, the grading. If you happen to be with an attending that gives straight 2s to pretty much everyone, you're completely out of luck.
-The scheduling thing can be frustrating. I can only plan things out < 1 month in advance, sometimes less than that if the clinic schedule is in flux for some reason. But I guess that's life now, you have to deal with it for the next few years.

However, besides that I do like 3rd year much more than preclinicals.

 

[Dro133]

As others have mentioned, the worst part to me is the sense that I am wasting my time. I would say that on average, 50% of my time in clinic 3rd year has been spent scrubbed into surgery doing nothing, shadowing, or sitting at a computer trying to look busy. This is time that could have spent doing countless actually useful things, such as doing practice questions (I can't really learn from reading review books or textbooks), sleeping, exercising, socializing, doing research, learning an actual marketable skill, etc. It can be extremely frustrating.

That being said, the 50% or so of the time that I actually am actually involved in doing something relevant to patient care (literally anything! I gave flu shots in clinic today and that was the highlight of my day) is better than pre-clinicals. That's why I'm holding out hope that I might actually find some enjoyment in this career path. We'll see.

 

[Black Coffee 24/7]

I'm currently on a night shift for this week right now. Ain't got jack to do except studying and ANKIng crap right now. So boring! Can I get some jacked up line of sick pts for once?