An update on how life is as a third year
So a lot of things are awesome about third year. You're finally out of the classroom, you get to interact with actual patients, and you start learning how to do the beginning of your medical career (note: you mostly learn how to be an intern, not a doctor. Becoming a real doctor is what residency is for.) When you ask, mostly people tell you that this year will be really hard, you'll work incredibly hard, but it will be rewarding and awesome in the end. In a lot of ways, they're right.
And yet...
They're not really truthful about why this year is hard. They fail to mention the things that, I'm convinced, are the reason so many medical students end up clinically depressed, burned out, on anti-depressants, taking time off, etc.
Grading can be so incredibly arbitrary, and it's really difficult to understand the kind of mental toll knowing you're being evaluated and graded *all the time* while you're at work takes, especially when workdays can be 14-30 hours long. (Yes, 30). You're constantly under the microscope, and the person looking through it changes. Frequently you're evaluated by people who have barely spent any time with you, and who are evaluating you on things they've never seen you do/you've never actually done. You get incredibly contradicting feedback, sometimes between people and sometimes from the same person. Sometimes your grade comes down to a single person who you just really, really don't get along with. A couple stories:
-I had an attending on anesthesia who, as far as I can tell, looked at my face and decided she hated me. I still don't know why. She was in charge of 40% of my grade on that rotation, gave me incredibly low marks, and then refused to elaborate to the rotation director why. I believe her impact on my grade ended up being reduced because it was so contradictory to the feedback given by everyone else on that rotation who had worked with me.
-I had an attending on plastic surgery say on an evaluation that I was "too forward and lacked self-awareness." This was literally the first time I had heard that on any evaluation or in any feedback, including from people in that department or other surgeons I had worked with. He marked me very low on my ability to interact with patients, despite having never seen me talk to a patient (in fact, no one on that rotation saw that.) This was someone I worked with for two afternoons total over the course of the month.
-I had a pediatrics attending then say I had excellent clinical demeanor and was appropriately forward and enthusiastic. He also said my write-ups were excellent. Another attending then said they were mediocre and needed work--no actual concrete feedback on later write-ups I handed to her with the changes she requested, but she told the rotation director they still needed work. Bzuh?
Again, grading: Very arbitrary, person-dependent, and often contradictory from the same person.
You go through a *lot* of different rotations on each clerkship. At most, you'll spend a month on a single service. Usually it's just a week or two. It takes a couple of days to a week to feel like you're getting your footing on a rotation and learning how things work, and about that long to feel like you're integrating into the team well. And once you've done that, it's off to a new rotation. That's very isolating, feeling like you aren't around enough to be part of a team, especially when they're together enough to have team dynamics and you're on the outside. In addition, your classmates (with whom you've spent most of your time over the past year) are suddenly just as busy as you, and often have wildly different schedules, so it can be difficult to find time to spend with them. And once you do, all people do is complain about the hospital and how much they hate it, despite trying to discuss other things. Your schedule is incredibly variable, to the point where you don't know if you can attend things outside of work with friends outside the hospital, or you just lack the time/money to go do things with them. You miss going-away parties for good friends because you had to work a 30 hour shift. You end up on a 2nd shift when everyone else is working days or nights, and so you literally don't see friends for a couple weeks at a time, and your only social interaction is the bartenders at the local bar you hit up after work. If you have a significant other, it's possible to go days or weeks without seeing them if your schedule is particularly fucked up.
And on top of that, there's other stressors: You're trying to figure out what you want your eventual career to be. You're working 10-16 hours a day for no pay. On some rotations, you do 30 hour shifts every 4 days, so you're constantly exhausted and your sleep schedule is fucked up. Life continues happening--you get married, people have kids, family members get sick or die, friends move away or do things and continually tell you "we haven't seen you for a month, when are you coming back out?" and you're on a rotation with night shifts. Every rotation has different rules and expectations, which are only sometimes clearly communicated, so you have to figure that out along with hospital/department politics. Most of us are accruing hundreds of thousands of dollars of debt during this. You spend most of your day feeling underinformed and like there's no way you can possibly learn enough to be a competent doctor (or at least I do).
Medical students are, by and large, very bright, motivated, and ambitious people. We've spent our entire lives being the smartest person in the room, knowing who we are and what we're doing, and exceeding expectations that have been pretty clearly communicated to us. Even in the beginning of med school, where for the first time you might be among mostly equally-sized fish in the pond, you can still excel doing the same things you've always been doing. And suddenly you get thrown into an entirely different world, where the skillset you've built to do well suddenly doesn't serve you nearly as well, and you need to flouder and get your feet under you quickly enough that you have enough time to excel, or convince someone you can. It's one hell of a system shock, and not one that anyone can adequately prepare you for, no matter how many warning talks they give you. Is it any wonder that a lot of students burn out?
And I think I've done fairly well. Maybe the therapy isn't working too well, maybe I sometimes drink too much, and maybe I don't sleep very well. Maybe when someone asks me what I do for fun and to de-stress, I don't really have an answer anymore besides "sit at home and watch TV by myself for an hour with a beer before I fall asleep while the episode's still playing." Maybe I can't really find the motivation or energy to work out anymore, or to make the effort to organize friend outings, or even to drive down to a weekly gathering on the rare chance I have that weeknight off. Maybe I still get so overwhelmed sometimes at all the things I need to learn and do that my brain spazzes and I end up on tumblr for two hours. Maybe some days I'm desperately grateful for someone being nice enough to buy me a coffee or a blizzard because I forgot my wallet and it's been a shitty-ass day where six patients yelled at me because I was the first person in the room.
However, I can still get myself out of bed in the morning and get through my day without medications, and that's not something everyone can say anymore.
In the end, I'm told it's worth it, especially if you pick your career and specialty deliberately. And it's true--even now it can be worth it, when you run into a patient in the grocery store, they recognize you, and tell you they're doing well. Sometimes patients sincerely thank you for listening, or for helping them, or just for being present. It's a hell of a grind until then, though, and it's hard even when you ostensibly know what you're getting into before it starts. And no, I don't tell bright-eyed applicants this stuff, either. They wouldn't understand it even if I did.
Further reading that better conveys what I'm trying to say:
http://www.kevinmd.com/blog/2011/06/reasons-medical-students-burn-depressed.html
http://forums.studentdoctor.net/showthread.php?t=521175
http://www.biomedcentral.com.beckerproxy.wustl.edu/1472-6920/7/6
http://www.nytimes.com/2010/10/07/health/views/07chen.html?pagewanted=all&_r=0
http://jama.jamanetwork.com/article.aspx?articleid=186586
And yet...
They're not really truthful about why this year is hard. They fail to mention the things that, I'm convinced, are the reason so many medical students end up clinically depressed, burned out, on anti-depressants, taking time off, etc.
Grading can be so incredibly arbitrary, and it's really difficult to understand the kind of mental toll knowing you're being evaluated and graded *all the time* while you're at work takes, especially when workdays can be 14-30 hours long. (Yes, 30). You're constantly under the microscope, and the person looking through it changes. Frequently you're evaluated by people who have barely spent any time with you, and who are evaluating you on things they've never seen you do/you've never actually done. You get incredibly contradicting feedback, sometimes between people and sometimes from the same person. Sometimes your grade comes down to a single person who you just really, really don't get along with. A couple stories:
-I had an attending on anesthesia who, as far as I can tell, looked at my face and decided she hated me. I still don't know why. She was in charge of 40% of my grade on that rotation, gave me incredibly low marks, and then refused to elaborate to the rotation director why. I believe her impact on my grade ended up being reduced because it was so contradictory to the feedback given by everyone else on that rotation who had worked with me.
-I had an attending on plastic surgery say on an evaluation that I was "too forward and lacked self-awareness." This was literally the first time I had heard that on any evaluation or in any feedback, including from people in that department or other surgeons I had worked with. He marked me very low on my ability to interact with patients, despite having never seen me talk to a patient (in fact, no one on that rotation saw that.) This was someone I worked with for two afternoons total over the course of the month.
-I had a pediatrics attending then say I had excellent clinical demeanor and was appropriately forward and enthusiastic. He also said my write-ups were excellent. Another attending then said they were mediocre and needed work--no actual concrete feedback on later write-ups I handed to her with the changes she requested, but she told the rotation director they still needed work. Bzuh?
Again, grading: Very arbitrary, person-dependent, and often contradictory from the same person.
You go through a *lot* of different rotations on each clerkship. At most, you'll spend a month on a single service. Usually it's just a week or two. It takes a couple of days to a week to feel like you're getting your footing on a rotation and learning how things work, and about that long to feel like you're integrating into the team well. And once you've done that, it's off to a new rotation. That's very isolating, feeling like you aren't around enough to be part of a team, especially when they're together enough to have team dynamics and you're on the outside. In addition, your classmates (with whom you've spent most of your time over the past year) are suddenly just as busy as you, and often have wildly different schedules, so it can be difficult to find time to spend with them. And once you do, all people do is complain about the hospital and how much they hate it, despite trying to discuss other things. Your schedule is incredibly variable, to the point where you don't know if you can attend things outside of work with friends outside the hospital, or you just lack the time/money to go do things with them. You miss going-away parties for good friends because you had to work a 30 hour shift. You end up on a 2nd shift when everyone else is working days or nights, and so you literally don't see friends for a couple weeks at a time, and your only social interaction is the bartenders at the local bar you hit up after work. If you have a significant other, it's possible to go days or weeks without seeing them if your schedule is particularly fucked up.
And on top of that, there's other stressors: You're trying to figure out what you want your eventual career to be. You're working 10-16 hours a day for no pay. On some rotations, you do 30 hour shifts every 4 days, so you're constantly exhausted and your sleep schedule is fucked up. Life continues happening--you get married, people have kids, family members get sick or die, friends move away or do things and continually tell you "we haven't seen you for a month, when are you coming back out?" and you're on a rotation with night shifts. Every rotation has different rules and expectations, which are only sometimes clearly communicated, so you have to figure that out along with hospital/department politics. Most of us are accruing hundreds of thousands of dollars of debt during this. You spend most of your day feeling underinformed and like there's no way you can possibly learn enough to be a competent doctor (or at least I do).
Medical students are, by and large, very bright, motivated, and ambitious people. We've spent our entire lives being the smartest person in the room, knowing who we are and what we're doing, and exceeding expectations that have been pretty clearly communicated to us. Even in the beginning of med school, where for the first time you might be among mostly equally-sized fish in the pond, you can still excel doing the same things you've always been doing. And suddenly you get thrown into an entirely different world, where the skillset you've built to do well suddenly doesn't serve you nearly as well, and you need to flouder and get your feet under you quickly enough that you have enough time to excel, or convince someone you can. It's one hell of a system shock, and not one that anyone can adequately prepare you for, no matter how many warning talks they give you. Is it any wonder that a lot of students burn out?
And I think I've done fairly well. Maybe the therapy isn't working too well, maybe I sometimes drink too much, and maybe I don't sleep very well. Maybe when someone asks me what I do for fun and to de-stress, I don't really have an answer anymore besides "sit at home and watch TV by myself for an hour with a beer before I fall asleep while the episode's still playing." Maybe I can't really find the motivation or energy to work out anymore, or to make the effort to organize friend outings, or even to drive down to a weekly gathering on the rare chance I have that weeknight off. Maybe I still get so overwhelmed sometimes at all the things I need to learn and do that my brain spazzes and I end up on tumblr for two hours. Maybe some days I'm desperately grateful for someone being nice enough to buy me a coffee or a blizzard because I forgot my wallet and it's been a shitty-ass day where six patients yelled at me because I was the first person in the room.
However, I can still get myself out of bed in the morning and get through my day without medications, and that's not something everyone can say anymore.
In the end, I'm told it's worth it, especially if you pick your career and specialty deliberately. And it's true--even now it can be worth it, when you run into a patient in the grocery store, they recognize you, and tell you they're doing well. Sometimes patients sincerely thank you for listening, or for helping them, or just for being present. It's a hell of a grind until then, though, and it's hard even when you ostensibly know what you're getting into before it starts. And no, I don't tell bright-eyed applicants this stuff, either. They wouldn't understand it even if I did.
Further reading that better conveys what I'm trying to say:
http://www.kevinmd.com/blog/2011/06/reasons-medical-students-burn-depressed.html
http://forums.studentdoctor.net/showthread.php?t=521175
http://www.biomedcentral.com.beckerproxy.wustl.edu/1472-6920/7/6
http://www.nytimes.com/2010/10/07/health/views/07chen.html?pagewanted=all&_r=0
http://jama.jamanetwork.com/article.aspx?articleid=186586