Well worth the wait…

My transition to clinical training…

The first year and a half of medical school seemed like a series of boxes I needed to check off. Go to lecture; learn the material; regurgitate it on the weekly exam. Go to anatomy lab; memorize the structures; identify them on the anatomy practical. Review everything for final exams. Rinse and repeat with the next block.

That whole time everyone was studying as hard as we could, feeling perpetually behind but somehow managing to keep progressing through the curriculum. On the horizon our first national board exam loomed.

When I started medical school, Step 1 of the United States Medical Licensing Examination was hardly on my radar. I heard of it in passing, knew it was hard, but that was pretty much it. As the weeks went by, I started hearing more and more rumors about it from my more senior peers.

“Your score determines your future,” I remember someone saying to me. “If you want to do a competitive residency you have to score above a 250.” At that time I didn’t even know what the test was scored out of, but it turns out that’s about the 85th percentile.

It wasn’t long before Step 1 became a sort of mythical beast that I didn’t really understand but of which I lived in constant fear. Classmates were talking about their study schedules before they signed up for a testing day. Friends bought expensive study programs to begin their test prep months in advance. We talked about national averages, program averages, our dreams and our back up plans. In the months leading up to this exam we must have been insufferable to hang out with because it seemed like we couldn’t talk about anything else.

Then, all of a sudden, we finished our basic science curriculum and our dedicated test prep time started. I copied my schedule from a friend a year ahead of me and I was ready to begin. For the next six weeks I would be studying 6.5 days per week with an average of 12 hours per day. I studied on Christmas and New Year’s and tracked time only by how many practice exams I took.

On January 29th I showed up to the testing center at 6:50am and sat for the eight hour exam. I heard countless times that if you felt horrible at the end, you probably did fine. So when I finally finished and was left feeling like I studied for the wrong test, I tried not to think too much of it. I went home and put away my books, deleted all the pictures of random tables and diagrams off my phone, and tried to figure out what to do with my time now that there was nothing left to study.

For the next three weeks I did my best not to think about it. It was a taboo subject among friends: thou shall not speak of Step 1. And finally, the email showed up in my inbox telling me my score was ready. Sixteen months of class work and six weeks of grueling studying boiled down to clicking on a link in an email that took me to a score report that said: “PASS,” followed by a three digit number. What seemed like the biggest hurdle in my path towards my career was over for good. It felt sort of like coming home after a great vacation; the trip had been on the calendar for months, you spent hours researching things to do and making sure you had everything you needed. The actual trip was everything you wanted it to be, and then all of a sudden it’s over and you go back to your normal routine.

Except I wasn’t going back to the routine that had just become familiar, instead I was finally starting the clinical portion of medical school. I spent 18.5 years of my life in a classroom. I was comfortable there and good at it but now I had to figure out how to be a whole new type of student.

Instead of written exams, I am subjectively evaluated by my performance on the hospital wards. How well do I gather, synthesize and present information? Am I professional? Am I curious? Is my medical knowledge where it should be for my level of training? Besides studying for the knowledge component, there is very little you can actually do to prepare for this part of medical school. As type A/research-focused people, the unknown and subjective nature of clinical rotations is unsettling for all medical students.

On my first day in the hospital I was so nervous I barely managed to eat a piece of toast for breakfast. I showed up to the physician workroom eager to please and anxious about the idea of being responsible for any aspect of a real person’s health. There were three students, two residents and one intern on my team.

“Before we get too busy, let’s talk expectations,” the senior resident said to us students. “This is going to be one of your hardest rotations. We want to push you to your limits so that you know what you are capable of. We (motioning to the other resident) are here to make you look good to our attending physician, but you’re going to have to put in the work.”

Stay tuned, in my next blog, I’ll describe my experience in the Neurosciences Intensive Care Unit during my very first clinical rotation.

Here’s a teaser: Everyone has their own stories and has faced a certain amount of adversity but for the most part we are successful people. We are not used to constantly being wrong, to constantly failing. It is humbling and honestly a very necessary part of medical education. No one wants a doctor who is unaware of their own limitations. We want physicians who know what it feels like when it’s time to ask for help…