You’ve been dreaming of strutting down the hospital hallways in scrubs, standing next to an OR table under the bright lights, and shocking patients back to life in the emerg. Now you get your chance. The final two years of med school are the most exciting, interesting, challenging, and sleep-depriving of (likely) your entire life. While your role isn’t huge, you definitely have a place in the healthcare team now. You finally feel like you are contributing something, and you begin to realize how little you really know. You have now entered the roller-coaster ride that is clerkship. Seriously though, how many times do you get to hold a beating heart in open heart surgery or to walk in a room and have a complete stranger break down in tears and tell your their most intimate secrets? Not often! Until clerkship.
Welcome to the jungle.
Let me begin with a story. My first rotation in clerkship was general surgery (awesome!). Our first two days would be orientation, and then we would head out to our respective teams. But, as the schedule would have it, I was supposed to be “on call” the very first night. I didn’t even know what that meant, other than I would be staying at the hospital over-night. After all of our orientation lectures/sessions were finished on the first day, I reported to the resident at 5pm. She gave me a quick tour and some basic call tips – remember your cell phone charger and always bring new socks. It felt like the scene from Forest Gump when they get to Vietnam and are told to always have clean socks. There are more similarities between general surgery and ‘Nam than you would think! Since I knew nothing about being a clerk it was my job to follow the resident around. It was pretty awesome – we saw ward patients, did ER consults, and went to the operating room. It was fantastic to see everything in action, although I learned quickly that clerkship requires an entirely new, more pragmatic, knowledge-base than the first two years of med school. Before I knew it the sun was rising – we had been up ALL night without a minute of sleep. I admit I was on an adrenaline high and didn’t mind too much, but then I remembered I didn’t get a “post-call day” because I had my second day of orientation. Still wearing my clothes from the morning before, my fellow clerks stood in awe/disgust/fear as I sat through lecture after lecture that day nodding off and looking like a zombie. At the end of the second day of orientation I had been at work (and working) for about 33 hours. What had I gotten myself into…
My first two days of clerkship weren’t representative of my final two years of med school but there were certainly other times when I had been working 24+ hours in a row. After awhile it becomes less of a big deal than before. You also realize that no matter how much work you do, or how little sleep you get, the resident usually has it worse. That thought makes me nervous about my upcoming residency start date of July 1…
Be open.
One piece of advice I would have about clerkship is to be open to new areas of medicine. You might be gunning for psychiatry from day 1 but for many people this is the only chance they will ever get to be in an operating room or to participate in a dermatology clinic. It’s important to take advantage of these experiences because they may actually be your last training in a specific field of medicine…ever. I can tell you that I won’t be delivering babies any time soon but those few weeks on Obs/Gyn helping labouring mothers and catching my first baby are pretty memorable, and also essential to the medical experience.
That being said, if you’re not interested in a given field still make an effort while you are doing your rotation in it. There are many reasons. First, no one wants to work with someone who’s only putting in half an effort and making others pick up the slack. Second, you may have off-service residents on your rotation who are either in the program you want or know people in the program you want, so pissing them off is a bad idea. Third, you are there to learn and the best way to do that is to get involved. Finally, you never know if a specialty will surprise you. I had amazing times on both my psychiatry and emergency medicine rotations. Knowing that I was gunning for a surgical specialty, I was pretty surprised how much I enjoyed them. Even to this day I can see myself enjoying my life as a psychiatrist. No wait, who am I kidding, I need to operate.
Don’t be a dick.
One of the most important things that will impact your success in clerkship as well as residency matching is being a team player. I assume this carries over to residency as well but I’ll let you know. This doesn’t mean sucking up to your seniors, it means not complaining when the going gets tough. It means getting things done that you said you would do. It means looking around at everyone on your team and offering to help in any way you can to move things forward. Basically, be a nice person and be easy to get along with. Don’t throw people under the bus, don’t whine about work, etc. Your clerkship rotations can in a way act as job interviews. Programs want to choose candidates who they know will get along with their current residents. A poor attitude and unsavoury reputation can haunt you if you’re not careful.
Prepare early.
By the time 3rd year comes to a close you should have a pretty good idea of what you want to pursue as a career. Ideally though, it would be much better to figure this out earlier. That way you can schedule your 3rd year rotations and electives such that you get exposure in your chosen field. This is especially important for competitive surgical fields. Surgical programs tend to be much smaller than their medical counterparts. At my university there are over 30 internal medicine residents per year compared to 2 ENT residents. That being said, for surgical programs especially, it is important for you to get to know the residents and staff. Spending time with them on rotations and electives is an excellent way to do this (provided that you work hard and follow the “don’t be a dick rule”). Another way to do this is to start getting involved with research projects. Sometimes it’s hard to do full-on research, but you can at least offer to write a case report. Start getting your name out there and working on your reputation as a likeable person and a team player.
Coast to the finish.
Following your (hopefully) successful residency match in 4th year, you will have half of the year left to fill with electives. Some of my classmates chose to do “real electives” like internal medicine, ICU, or general surgery. While this is certainly an admirable approach I would not recommend it. Take that time to travel. But how can you do that if you still have electives? Do an international elective! Not only is it a fantastic way to see a new place, you get to spend a whole month there. Most international electives have pretty lax requirements and give you lots of time to explore and do touristy stuff. For example, a colleague of mine went overseas for a cardiology elective and had a long weekend every weekend and got off work at 11am every day. She ended up getting her diving certification and went scuba diving on the Great Barrier Reef. This is in comparison to another classmate who stayed home and did a general surgery elective with over-night call every third day.
From what I understand and what I’ve seen, the real work starts in residency. So, make the most of your remaining months in med school and do something fun. Travel! Train for a marathon. Do anything except work day and night, because there’s plenty of that to come.
Clerkship can be a grind sometimes, but you will also have some of the most memorable experiences of your entire life during these two years. And importantly, you get your first chance to experience what it’s really like to be a doctor.
Slice of Life 