Medical school can be challenging for anyone, with high demands on time, the pressures of managing an ever-growing body of information, and the need to constantly juggle multiple responsibilities. The pre-clinical (first and second) years are spent in the classroom setting. Reading textbooks and sitting through lectures comprise the bulk of your workload. The clinical (third and fourth) years are spent in the hospital or clinic, where long amounts of time are spent with patients, and the skills you learned in the classroom are put to the test. Although “surviving medical school” may seem like an ominous task, there are numerous resources available to guide you toward your end goal – getting into a residency and, ultimately, starting practice.
Several handbooks and pocket survival guides are available in your medical school's library or online book retailer to help navigate the hazards of rotations, electives, specialty choice, residency selection and related issues. Many of these texts will help you better understand the counsel provided by residents, faculty and role models. To complement these resources, the AAFP Division of Medical Education has compiled a series of straightforward tips addressing common issues and challenges you will face in your clinical years of medical school. Many of these tips are also applicable to other aspects of your life and your future career.
The third year of medical school is generally comprised of six basic rotations:
Most rotations take place in the hospital, but some are community-based. Through these rotations, you are afforded the opportunity to develop procedural and cognitive skills, to practice your patient interaction skills, and to explore many aspects of medicine. These experiences will ultimately serve as your main point of reference for specialty choice.
What are these rotations like? The hours are often long, the expectations are high, and students’ roles vary by rotation and setting. Some rotations will allow you to see patients, take histories, perform physicals, take call and participate in procedures, while others are simply an opportunity to listen, learn and observe.
From the beginning of your first rotation in July to the end of your last rotation in June, you will experience many emotions. Emotional “highs” include performing a procedure for the first time, being able to successfully present a patient during rounds and, potentially, bringing a baby into the world. Lows may consist of such things as dealing with huge amounts of information, making mistakes, or coping with the death of a patient. Common emotions felt by students during the third year are anxiety, excitement, fear, frustration and exhilaration.
You will face many physical and cognitive challenges during your third year. Making the most of limited free time, being isolated from classmates, learning to deal with the hierarchy of the patient care team, knowing which resource to consult to find a quick answer, and handling post-call fatigue are just a few of the challenges you will overcome on a daily basis.
Overall, the third year in medical school is a very unique experience. It is a time like no other in the life of a medical student. When the year is over, you will have gained a better understanding of the art and science of medicine, tested your limits, identified some of your strengths and weaknesses, and, hopefully, you will have found your calling.
The beginning of fourth year is a time for reflection – a time to evaluate your experiences up to this point and to consider what lies ahead as you make key decisions about your medical career. The fourth year of medical school is comprised of several significant experiences: senior rotations (clerkships and sub-internships), applying for residency, interviewing for residency, the Match, and the Boards. And you will be challenged to manage several of these important projects at the same time!
The fourth year will afford you more flexibility to schedule rotations, time off and travel to interviews. Make the most of these opportunities. Emotions will run high this year and you can expect that a great deal of your emotional roller coaster will center on the Match, so remain positive, focused and optimistic.
As you begin your senior clerkships and subinternships, you are likely to have greater responsibility. You will no doubt have more frequent call, provide more complex care, and experience increasing clinical autonomy under the supervision of residents and attendings. Freedom to pursue focused experiences and rotations during the fourth year offers unique rewards and learning experiences that will give you a greater appreciation for what life after medical school is all about.
In the fall of your fourth year, you will begin to apply to residency programs. By researching various programs, you will start developing your own criteria to determine which programs are of most interest to you. Once you have applied to residency programs, the waiting game begins as you anticipate programs contacting you for interviews. Once this occurs, a whirlwind tour of residency programs and cities will take place. You will have the unique opportunity to experience several different programs – each with its own unique combination of characteristics, opportunities and challenges. Hopefully, you will find a program that is the right choice for you.
The winter and early spring of fourth year is time to finish interviews and meet your “Match.” Once you rank your programs, only Match Day awaits you. When your residency selection is finalized, you proceed into the final phase of the fourth year. You have rotations to finish. (And don’t forget about USMLE Step 2!) You begin making the necessary arrangements to join your program. For most, this means planning a move to a new location. You must cope with a myriad of emotions associated with leaving your support systems, saying goodbye to close friends, and transitioning from student to physician status. It’s also an exhilarating time – all of the pieces of the puzzle have come together and you’ve found your calling!