I hate third year already ...

[Paws]

I have only just started and I am already bummed big time. Does this all get better? My intern is no help and I am completely lost. The residents seem completely miserable and constantly complain to me about how unhappy they are. I wander around like I have no idea what I am doing, and that's because I have no idea what I am doing. And then, my face hurts now from having to keep this weird frozen semi-smile. I spend so much energy trying to figure out: should I say something? am I being to quiet? or if I do ask a question or make a comment, then I wonder, maybe I shouldn't have said that. I have no idea how to do this medical culture thing and I am struggling to figure out how do I fit into this scenario.

Then, worst of all, sometimes I see classmates in the distance reciting perfect patient presentations, asking intelligent and deeply perceptive questions and chatting amiably with their residents who seem to think they are the most awesome medical student they have every had, blah blah and I can't help but feel stupid and depressed. I can't even write a stinking progress note, and my consult notes look ******ed. And my feet hurt all the time. Sometimes, I don't even know what floor I am on or where the ICU is, all the hallways look the same.

Does this get better and do you really start to figure things out? I don't want to even think about evaluations and grades, because I am grateful I can just still be standing after 14 hours in the hospital and 10 in the OR, without food or drink. I'll probably get marked down for "appearing disinterested" when I am about to really just pass out from hunger.

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[sophiejane]

I have only just started and I am already bummed big time. Does this all get better? My intern is no help and I am completely lost. The residents seem completely miserable and constantly complain to me about how unhappy they are. I wander around like I have no idea what I am doing, and that's because I have no idea what I am doing. And then, my face hurts now from having to keep this weird frozen semi-smile. I spend so much energy trying to figure out: should I say something? am I being to quiet? or if I do ask a question or make a comment, then I wonder, maybe I shouldn't have said that. I have no idea how to do this medical culture thing and I am struggling to figure out how do I fit into this scenario.

Then, worst of all, sometimes I see classmates in the distance reciting perfect patient presentations, asking intelligent and deeply perceptive questions and chatting amiably with their residents who seem to think they are the most awesome medical student they have every had, blah blah and I can't help but feel stupid and depressed. I can't even write a stinking progress note, and my consult notes look ******ed. And my feet hurt all the time. Sometimes, I don't even know what floor I am on or where the ICU is, all the hallways look the same.

Does this get better and do you really start to figure things out? I don't want to even think about evaluations and grades, because I am grateful I can just still be standing after 14 hours in the hospital and 10 in the OR, without food or drink. I'll probably get marked down for "appearing disinterested" when I am about to really just pass out from hunger.

Paws,

It does get better. You express what a lot of people are feeling. Just remember that you are not SUPPOSED to know how to do this stuff yet. You are a student, and a student's job is to learn. I think a lot of people get really hung up on being useful, or fitting in to the culture--and there is a measure of that--but the absolutely most important thing you can do is learn. You have to examine a lot of patients and make a lot of mistakes--that's your job this year.

It is really hard for us perfectionist med students to be thrown into third year and to feel so freaking incompetent for the first time in a really long time. For some who sailed easily through undergrad and the first two years of medical school, it may be the first time they have EVER felt so incompetent.

A lot of this year is about humility. You will feel like an idiot a LOT. But just remember that your classmates who to you look so cool and confident are also freaking out inside and feeling like idiots.

Hang in there. 4th year is a dream.

SJ

ps: Carry snacks! You can't be productive or learn when you are starving. Protein bars are quiet, neat, and inconspicuous. Get the little half-pint water bottles--they fit nicely in your pocket.

Also, find little landmarks--a poster, a sign, a picture on the wall, and commit it to memory--you'll be surprised how much this helps when you are lost.

 

[seansoutherland]

Dude, I was in the same boat. I didn't pick up on what was to be expected of me until 2 weeks into my first rotation.

There were practical things that no one ever told me:

1. Don't bring up something about a patient in front of the attending physician/resident during rounds that you know that they didn't. It makes them and you look bad.
2. Get your soap notes filled out before the resident sees the patient in the morning and before rounds. They might read it and find out something new and important, plus it keeps them and you in a communication loop, which is, by far, what I have found to be most important in interacting with the residents.
3. COMMUNICATION WITH THE RESIDENTS IS KEY. One time, I was asked to go see a patient before the resident in another department I had never heard of, but it was my first rotation and the first week at that, so I couldn't find the room for the life of me. There were no signs and no maps, so I did what I knew I could do and went to the resident's room to look on the internet to find the location. Just in case, I called the chief resident to ask what the attending resident's pager number so that I could tell her that I got lost. I decided to just go down there, but the attending was already there. Word got out later about the ordeal, and the residents had assumed that I went to the resident's room to study instead of seeing the patient promptly as directed. (They had the correct notion that I am a book nerd). I had, in fact, not studied and merely spent a good amount of time trying to find the blasted place. I cleared this up with another resident, only to find that the others had also assumed the same thing, so I felt compelled to explain the whole story to each one. I was amazed at how one little incident could completely alter their perception of me and be based on a total misunderstanding. Since then, I have realized that I needed to be more proactive about what I was doing by anticipating what would make their lives more convenient and by clearly indicating what was on my mind that would make my job easier right when the situation necessititated it.
4. Go to conferences when they call it "required." I had a patient that asked a ton of questions about a potentially devastating diagnosis. I had spent hours before the conference reading her chart and researching the current methodologies for diagnosis, prognosis, and treatment. I was well versed on the subject, and I opted to spend more time with the patient during the conference instead of attending. I felt extreme empathy for my patient and didn't want to be another non-chalant medical person that never took the time to listen to their patients. Unfortunately, word got back that I didn't go to the conference, and apparently it might have affected my grade. I don't know yet. I don't, however, regret spending time with the patient. Her life may have changed dramatically for the worst, and sitting in a conference seemed a little trivial to me at the time. I should have gone and read up and spent time with her even earlier to avoid the backlash, but I have assured the residents that my intent was pure. It was just really hard to leave her at the time.

So, this is just a tidbit of my experiences on my first rotation. I am, by no means, a seasoned professional, but I did feel out of my element for awhile. I am starting my 2nd rotation tomorrow.

I feel that everything is coming together, however, just as it should.

I am not giving advice, but just expressing one of my unfortunate experiences from which I have become more wise.

 

[manta]

you're totally not the only one! i can't seem to find a happy place between total leech and looking totally disinterested (not that i am! i'm usually thinking through some embarrassing moment that happened earlier in the day.) i get lost almost every day, more than a month after starting. i have major problems with linear thinking (i can't tell jokes or stories at all!), which is basically what presenting and writing notes are all about. i'm the only person who can't open this one stupid locked door with a number pad, despite punching in the right combination. i've only cried twice at school, ever - and one of those times was last week in the staff bathroom. this experience seems to be highlighting my worst flaws, and this was after having such high hopes that this is when i was truly going to shine.

but, it's still early. i think i've figured out the hungry thing though. i started carrying around ziploc bags of dried fruit and nut mix, which seems to be doing the trick! if you're into power bars or whatever, there are little 100 calorie ones on sale at target. and alton brown makes a pretty good one - recipe is a foodtv.com - they are really dense, and keep me full for hours. which is a major accomplishment.

and i really appreciated your post, sj. i think a lot of people do a really good job at looking like they know what they are doing, but are just as scared and clueless as the rest of us. well, almost as clueless. my cluelessness would be hard to top.

good luck paws! thanks for sharing what i didn't have the guts to.

 

[ambientbaby]

Hi Paws,

I remember that we were both impatiently waiting to get our AMCAS application verified. Ahh those were the days. When you get frustrated, just think about those times and how many people would pay big $$ to be where you are.

Enjoy it!!

 

[orientedtoself]

This pocket book has templates of how your notes should look in Medicine, Surgery, and OB. Also, are you carrying around all of the right stuff? Definitely get Maxwell cards if you don't already have them. Hang in there!

 

[johankriek]

Does this all get better?

umm i can assure you that it will get easier.... but it wont get better.. i wish i could lie..


Just whatever you do... dont get into it with any body.. If someone engages you in a heated discusiion.. just walk away..... walk away and say you really have to go to the bathroom.. and dont come back....

 

[nabeya]

paws will soon see that it gets better over time and paws will be able to write good soap notes and h&ps after lots of practice.

I have only just started and I am already bummed big time. Does this all get better? My intern is no help and I am completely lost. The residents seem completely miserable and constantly complain to me about how unhappy they are. I wander around like I have no idea what I am doing, and that's because I have no idea what I am doing. And then, my face hurts now from having to keep this weird frozen semi-smile. I spend so much energy trying to figure out: should I say something? am I being to quiet? or if I do ask a question or make a comment, then I wonder, maybe I shouldn't have said that. I have no idea how to do this medical culture thing and I am struggling to figure out how do I fit into this scenario.

Then, worst of all, sometimes I see classmates in the distance reciting perfect patient presentations, asking intelligent and deeply perceptive questions and chatting amiably with their residents who seem to think they are the most awesome medical student they have every had, blah blah and I can't help but feel stupid and depressed. I can't even write a stinking progress note, and my consult notes look ******ed. And my feet hurt all the time. Sometimes, I don't even know what floor I am on or where the ICU is, all the hallways look the same.

Does this get better and do you really start to figure things out? I don't want to even think about evaluations and grades, because I am grateful I can just still be standing after 14 hours in the hospital and 10 in the OR, without food or drink. I'll probably get marked down for "appearing disinterested" when I am about to really just pass out from hunger.

 

[efex101]

Paws, hang in there....I can tell you that there is a difference if you are a female and are with a female resident versus with a male...sad but true. Just learn as much as you can and it will be over before you realize it. Third year is a lot of politics, subjectivity, and sometimes plain BS that has nothing to do with patient care. We are all in this together and we will get through it. I just take it one week at a time and always think about what lies ahead....my third year three week elective overseas...agh now that will be good. Hang in there.

 

[chintu]

Paws, I felt the same way you did in my first two weeks of very first rotation. Took me a whole week to get my schedule together and get in the cycle of waking early and going for prerounds and then rounds and then finally squeezing some time here and there to study for shelf. My first week in neurology during rounds my attending asked me to do a sensory exam on a patient in front of the whole team, I looked like a total idiot doing it incorrectly and then my chief lectured me on what I am supposed to do as a 3rd year student and asked me to come in even earlier and observe the residents do the exam. As far as writing notes I am still learning how to write assessment/plan stuff and was bashed upon crappy notes by the residents many times. Finally, during my last 2 wks on rotation I just let it go w/o applying myself too much and I was pleasantly surprised how I felt like I had fit in the flow with smoother presentations and quicker progress notes. Not to mention my physical exam skills improved a lot and I was commended by my residents towards the end on a good improvement. I think sometimes we try just too hard to learn everything at once and that's just not going to happen, just realize that you don't know much at this point and you are bound to make a few mistakes and that its okay to do so, just relax w/o worrying too much about grades/evals and try to enjoy the learning process and you will see that 3rd year could also be somewhat exciting and fun.

 

[oudoc08]

My meager experience as a 3rd year so far has been great, but I'm a bit older and I think I'm less willing to play the politics. My advice, step back, take a deep breath, chill out, and keep things in perspective. You don't have to put up w/ abuse. You're there to learn, not to play BS games, and be some resident's punching bag. I've found that people who spend too much time trying to impress the residents in fact, do poorly. Don't act interested, be interested. It always amazes me that people continually pass on the BS advice to plaster on a fake smile. It hasn't been that long ago that the residents were students also. They're not stupid, and when you try to goomba your way along, you look like an immature fool. Grow up, be a contributing member of the team and you'll be healthier, happier and a better student, and your evaluation will be stellar.

 

[loveumms]

I hated almost every second of third year - I hated following around my residents/interns trying to be helpful but feeling like a doofus. I hated getting there at 4:30 am to gather vital signs for surgery ... and then being told that the vital signs are not being used until rounds at 7:00. I hated getting to the hospital for IM at 6:00 to write all my notes, none of which were read by anyone.

I hated watching some of my classmates kiss a** so hard that you wanted to puke in the basins located next to the patient (getting there 20 minutes before students were expected to arrive, looking up stuff on other students patients not to learn but to look good during rounds, babbling and falling all over themselves when the attending was around). Or those who tried so hard to make “friends” with the residents, that the residents snickered when said med student walked out of the room and probably made fun of that person while they were out drinking on Friday nights.

I hated peds and OB/GYN (no offense to those who want to go into those specialties) - both nestled at the end of my third year so those four months were excruciatingly painful. Most days I wanted to rip my hair out and scream at the top of my lungs.

I could go on and on but, I’m sure you get the point. Of course there were times during third year that I thought to myself … wow, this is amazing – I’m so lucky to be doing this. Believe me, those thoughts occurred but unfortunately there were so many other annoying times when I was either trying to pretend I liked what I was doing or was wasting my time doing nothing at all (you do A LOT of waiting around in third year).

There was two wonderful things about third year that I keep repeating to myself over and over – Step I is over and you never have to take it again, second year is over and you will never have to repeat it again.

Now, there is light at the end of the tunnel. You will find something you truly enjoy during third year – and that is really the point. I tried to keep the fact that I was never going to see/do some of the stuff I got to see/do during third year. I tried to learn as much as I could. Then at the end of third year you will be welcomed into the graces of fourth year – which ROCKS (no one is lying to you when they tell you this).

Best of luck and just try to grin and bear it

 

[pillowhead]

Now, there is light at the end of the tunnel. You will find something you truly enjoy during third year – and that is really the point. I tried to keep the fact that I was never going to see/do some of the stuff I got to see/do during third year. I tried to learn as much as I could. Then at the end of third year you will be welcomed into the graces of fourth year – which ROCKS (no one is lying to you when they tell you this).

Best of luck and just try to grin and bear it

I think this is really good advice. Paws--it sounds like you're on a surgery rotation right now which is brutal introduction to third year (I know, it happened to me!) If you have no intention of entering surgical field, try to take it for what it is and realize this is the last time (well except ob/gyn) that you'll ever see surgery up close ever again. It can be really hard to maintain that attitude when you're hungry and tired and your feet just ache, but it's helps if you can.

Try not to worry so much about the little stuff. I remember at the beginning of 3rd year when the resident would ask for a penlight, all us 3rd years would be scrambling over ourselves to be the first one whipping out their penlight. After a few months, the vast majority of people lose that attitude because 1) you can't keep it up and 2) no one is impressed by it anyway.

It will get better! A year from now, you'll be amazed by how far you've come.

 

[shaggybill]

Keep in mind that some of us would give anything to trade places with you. I'm just an undergrad. Where you're at right now seems like it might as well be a billion years away to me.

 

[ocean11]

I have only just started and I am already bummed big time. Does this all get better? My intern is no help and I am completely lost. The residents seem completely miserable and constantly complain to me about how unhappy they are. I wander around like I have no idea what I am doing, and that's because I have no idea what I am doing. And then, my face hurts now from having to keep this weird frozen semi-smile. I spend so much energy trying to figure out: should I say something? am I being to quiet? or if I do ask a question or make a comment, then I wonder, maybe I shouldn't have said that. I have no idea how to do this medical culture thing and I am struggling to figure out how do I fit into this scenario.

Then, worst of all, sometimes I see classmates in the distance reciting perfect patient presentations, asking intelligent and deeply perceptive questions and chatting amiably with their residents who seem to think they are the most awesome medical student they have every had, blah blah and I can't help but feel stupid and depressed. I can't even write a stinking progress note, and my consult notes look ******ed. And my feet hurt all the time. Sometimes, I don't even know what floor I am on or where the ICU is, all the hallways look the same.

Does this get better and do you really start to figure things out? I don't want to even think about evaluations and grades, because I am grateful I can just still be standing after 14 hours in the hospital and 10 in the OR, without food or drink. I'll probably get marked down for "appearing disinterested" when I am about to really just pass out from hunger.

Hey Paws,

I KNOW how you feel TRUST ME! I liked my first rotation BUT my second one in OB/GYN sucks.... MAINLY, actually ALL b/c of the politics, attending (one in particular) and residents (bickering among each other mostly), plus one person on my team WHOM I can't stand!!!!! My attending is a racist prick! and I can't stand him! but I'm turning things into positive.. I"M FEEDING the stray cats around the hospital and making their day happier... and honestly that keeps me going (although some of my other teammates and friends think I'm nuts......). My advice to you... feed the stray cats around the hospital and spread some good karma around! I just bought a new bag of cat food for my darlings

 

[nerfherder]

It gets better...next year. Third year sucks!! (sorry). But for how sucky third year is, 4th year is the best year there ever was. Hang in there and you're not alone in feeling this way, at all.

 

[Paws]

I hated almost every second of third year - I hated following around my residents/interns trying to be helpful but feeling like a doofus.

Most days I wanted to rip my hair out and scream at the top of my lungs.

Ahhh .... once again SDN peeps come through when the medschool chips are down. How many times have people on this forum saved my sorry little butt? only about a million times, either because I posted a thread like this one or someone else posted one that I found great comfort in.

Thanks guys - all your comments are so awesome. It really makes me feel so much better. It is so amazing to me that we are all over the country and yet we are all going through the same stuff.

And you know, I DO remember waiting to be verified by AMCAS and now does that seem like a million years ago? and do I feel grateful to be here? I totally do! Do I also hate surgery? yes, probably. (I'm sure ob will be next on that list for similar reasons.)

I like Ocean's idea about feeding the kitties around the hospital. What bliss, and how rejuvenating to your soul. And Efex, girl I know the rigors they put you through at your school, and you are also right about the gender issues, and weird junior high bitchiness among some female professionals. Sad but true. I'm a little older so I do try to step back and just take in the scene with an objective eye. I sort of feel sorry for people who run around like nuts and have such harsh lives. If I was a surgeon I would want to be a decent and professional one. They exist, one of my attendings is pretty good to me.

Talking to my classmates, we are most of us struggling with these same issues or similar. It is so hard psychologically and emotionally to stay balanced and not want to walk out screaming - or crying.

I am trying to figure out ways to be extra nice to myself, pamper where I can and to really work hard to stay connected with my classmates. We are mostly all trying to help each other. Well, not everyone I guess but still most of us do. I realize that I have more friends than I thought, and we are supporting each other pretty well.

I am so pooped, but I have to get up again early tomorrow. Where do you find the time to study?

I am glad that my thread hit a cord with so many other people. It is really great to hear other people's comments and share these feelings. Tonight I did a really good patient history in the ER and I was told it was very good and so that made me feel like there was a little light at the end of the tunnel, and maybe it wasn't just the train coming at me.

 

[efex101]

for studying...in surgery amazingly what is working with me is getting up at 4:00 and reading for an hour our so....I just cannot come home (late) and then read/study so I figured....get in bed get a good sleep and then read.

 

[MeowMix]

Wow, I am so sorry to hear that your early rotations are sucking so bad. I have faith in all of you! We have made it through MCAT, AMCAS, interviews, acceptances, MS1, anatomy, MS2, and Step 1 together - I know you will come out of that tunnel eventually. (And I love the idea of feeding the cats outside the hospital...I hope you are using Meow Mix!!).

Not to discount your experiences, but to let others know that rotations can vary hugely from place to place: I also started with surgery. I did it in a small town where I was the only student on the rotation, and although my attendings were truly of the Surgical Personality Type, they were generally good to me and I learned a lot. They told me that it was OK that I didn't know anything at first, since it was my first rotation, and I only got told off once (on my last day). At the beginning I felt frustrated because they did not formally teach me much at all, but when I did jump in and experiment with writing notes, etc. they let me go with it and corrected me as necessary; I worked up to writing some sort of A&P by the end of the rotation (admittedly, very novice-level).

After that I did neuro, which was extremely benign; although there were 3 of us students at the site, we had no backstabbing competition or other nastiness. The attendings and residents were very nice, positive, and also didn't expect us to know anything at the start; the residents never criticized us in front of the others (although they did correct us where necessary).

I think that one thing that really helped me was having had a very rigorous experience in grad school, and being used to being under pressure. For example, I would stand up and give a talk on my research in front of the research group, my advisor would rake me over the coals for an hour (to the point where I was almost in tears), and then at the end he would tell me it was a pretty good talk and I would restrain myself from wanting to kill him. Five years of that helped me get used to that style of interaction; I notice that our more academically-oriented attendings have that same style. All I can say is it's a part of their training, and don't take it personally; they seem to view it as some sort of hardening process that you must go through (like a pot being fired in a kiln).

I hope that all of you who have had less than optimal experiences will get something better next time!

 

[Medical123]

Hi Paws,

It sounds like you may have just wound up on a really crummy team. It really makes a difference in who your residents/attendings are. I started out having a wonderful experience on general surgery my first week. After that, the residents switched out for the month, and I wound up on a team with really low morale, an attending who was known for cursing and throwing charts, and a chief resident that didn't teach. I felt like I went from Heaven to Hell! Even residents on other teams would advise me to stay as far away from my attending and chief that I could! It was that bad! If I hadn't have had the good week, I think that I would have been soured on surgery forever. However that good week made me realize that WHO you work with can really change your perspective on a particular specialty.

Hang in there! Hopefully, your next rotation will be much better! At least you will have one of the most difficult rotations of the year out of the way!

 

[DebDynamite]

Paws,
I am at the end (two more effing days!) of my surgery rotation, which is my first also. Believe me you are NOT alone. I NEVER have time to read when I'm there, I'm either scrubbed in, seeing my patients, following my attendings/residents around- who teach barely a morsel's worth for the amount of time I put in chasing them around (no I do not particularly wanna round, my resident wants me to go with)- or worse yet - getting scutted. It is probably the most ridiculous experience I have ever had. The good things: 1. It is almost over. 2. I have gotten to see/close on some pretty cool cases & traumas 3. I now know for sure that surgery is not in my future, and- 4. It is almost over.

If I have to hold retraction one more time my arm will literally fall off. If I see another lap chole I shall vomit. If I have to inhale bovie smoke another second of the day I'll quit eating anything remotely barbequed. But now I know for sure that surgery is not in my future. And I expect that by the end of the year I will feel this way many times over. But one of these dang rotations will get me goin'---or, I shall sell myself to Merk & Pfizer and push Viagra all the livelong day.

Hang in there. It must get better than this.

PS---Yo Yo Manta! We miss you!

 

[Doc Ivy]

If I have to hold retraction one more time my arm will literally fall off. If I see another lap chole I shall vomit. If I have to inhale bovie smoke another second of the day I'll quit eating anything remotely barbequed.

Really? I can't get my day started without the smell of Duraprep and Bovie smoke. But then again I'm one of those surgiphiles

It's true that 4th year does get a whole lot better, but just when you think you've arrived and you get to do more than retract as a Sub-I, you've got some hot shot fellow telling you to close faster this idiot actually reprimanded me in the OR for not being an expert on some obscure matress suture technique that he showed me once 3 weeks ago. I swear it's like residents forget that we're not born knowing this stuff, that is what residency training is for.

 

[DebDynamite]

This is what it is all about I suppose- for if I must manifest enthusiasm for another appy, gallbladder, colon resection ect, I will cry. It's not that I don't have respect for it, or even the awareness that actually doing it would be really cool. I just hate being somebody's beehotch on a procedure that if I am lucky, and I mean really lucky I 'll get to stitch up- and I have seen the dang thing numerous times. I just wanna stitch, I don't want to see another slipped nissen repair-whahhh!!! And some of the residents I swear want the med students to scrub in just so THEY get pimped less by the attendings. At least I have no attachment whatsoever to being piimped now- surgery takes that outta you fast.

 

[Shodddy18]

I'm just finnishing up my 2 week rehab medicine rotation... a welcomed vacation!

 

[Adcadet]

I'm a fourth year on a pretty easy rotation in my chosen specialty that I honestly think I'm pretty good at for my level, and I frequently have moments or hours and sometimes a full day where I just feel like a *****. Just keep learning what you can, and soon enough people will start telling you that you're doing a pretty good job, even if you still feel like a *****.

 

[wakemewhenit'so]

There were parts of third year that I honestly liked, but it was hard and painful daily. Most of the other students seemed to act like it was just dandy showing up with that dumb smile all the time and deal with all the uncertainty, awkwardness, stress and low-man-on-totem pole politics-- that made it harder because I felt like there was something wrong with me, personally.
I hoped fourth year would be instantly better, but I actually so far have found it the most painful yet, because we're treated as sub-I's without really being taught how to be a sub-I and none of the respect/friendliness that actually attend the residents... as if miracously, in the change to 3rd year to fourth year we are ready for patient management but are still lackeys.
I guess my point is that, for at least some of us, these years are really difficult to swallow, but there is no quick light at the end of the tunnel, so to survive them, it's better to dig in your heels and keep your chin up and try to realize that you're not alone (even if it seems that way sometimes) and do the best you can and then put it out of your head at the end of the day, so you save a piece of yourself.

 

[tupac_don]

There were parts of third year that I honestly liked, but it was hard and painful daily. Most of the other students seemed to act like it was just dandy showing up with that dumb smile all the time and deal with all the uncertainty, awkwardness, stress and low-man-on-totem pole politics-- that made it harder because I felt like there was something wrong with me, personally.
I hoped fourth year would be instantly better, but I actually so far have found it the most painful yet, because we're treated as sub-I's without really being taught how to be a sub-I and none of the respect/friendliness that actually attend the residents... as if miracously, in the change to 3rd year to fourth year we are ready for patient management but are still lackeys.
I guess my point is that, for at least some of us, these years are really difficult to swallow, but there is no quick light at the end of the tunnel, so to survive them, it's better to dig in your heels and keep your chin up and try to realize that you're not alone (even if it seems that way sometimes) and do the best you can and then put it out of your head at the end of the day, so you save a piece of yourself.

Oh there is a light at the end of the tunnel. The light emanating from a train coming towards you, just like your avatar

 

[loveumms]

There were parts of third year that I honestly liked, but it was hard and painful daily. Most of the other students seemed to act like it was just dandy showing up with that dumb smile all the time and deal with all the uncertainty, awkwardness, stress and low-man-on-totem pole politics-- that made it harder because I felt like there was something wrong with me, personally.
I hoped fourth year would be instantly better, but I actually so far have found it the most painful yet, because we're treated as sub-I's without really being taught how to be a sub-I and none of the respect/friendliness that actually attend the residents... as if miracously, in the change to 3rd year to fourth year we are ready for patient management but are still lackeys.
I guess my point is that, for at least some of us, these years are really difficult to swallow, but there is no quick light at the end of the tunnel, so to survive them, it's better to dig in your heels and keep your chin up and try to realize that you're not alone (even if it seems that way sometimes) and do the best you can and then put it out of your head at the end of the day, so you save a piece of yourself.

So this post brings up an important thing to do during third year misery - learn how to manage your patients (from start to finish). Learn all the stuff (most of it BS) that you need to do as an intern, and ask as many questions as you can. Since you’re a ‘newbie’ you will not be seen as an idiot asking the “simple” questions.

If you are very lucky and have a sub-I on your team, learn all that you can from them. I had a fourth year sub-I while I was on surgery (during my first rotation as a third year) and on one of my medicine rotations. All I can say is, as a third year the sub-I is one of the most valuable people on the team for you to get along with and learn from. They will answer the questions you might be afraid to ask the resident and they will be able to point you in the right direction. Also, they will be a little closer with the team since they are contributing a little more so they will likely be able to get inside info on you (and if they are super cool, they will tell you what the team thinks so you can either keep doing what your doing, or make changes so you can get a good eval). Of course, this is a give take relationship. During surgery, I knew the sub-I wanted to scrub in with a certain attending (the chief of surgery) and since I didn’t want to do surgery, I let her scrub on most of those cases. In return she helped me with everything I needed and even lent me some of her books. What I’m trying to say is it’s a you scratch my back, I’ll scratch yours relationship.

During my third year medicine rotation I did everything from putting in admission orders to writing discharge instructions and medication orders. Some of my classmates wouldn't do this stuff b/c it wasn't a requirement of third year (mostly third year is learn to do a succinct H&P and write PNs). I'm telling you, do all the other stuff while you can. I would even do all the discharge summaries for my patients then have the intern look it over. Believe me, the interns were so grateful I was doing the D/C summaries that they didn’t mind taking the time to read it over and tell me what was wrong (since I was saving them the pain of having to do that D/C summary).

I did a sub-I right at the start of fourth year - and I knew how to do all the stuff that was expected of me without having to ask a lot of questions (which got me a good eval and LOR from the attending – b/c the residents will speak very highly of you if you know what you’re doing).

So, here is my advice, during your third year rotations:
1. Take initiative to do the stuff that you really don't want to do (some would consider it scut work, I considered it a investment in the future).
2. Learn how to do admission orders, how to put in lab/diet/consult/PT/OT/social work orders
3. Learn how to discharge a patient (and then do it over and over again b/c they are all not the same)
4. Learn how to quickly work up all the common admissions (chest pain, SOB, abdominal pain) – get a good pocket book that will go through these things in case you forget.
5. Read as much as you can. I like to use emedicine or up to date since they both hit the highlights of diseases and then quickly outline management and treatment. When anyone on your team gets something you don't know, read about it (but whatever you do, don't show off your knowledge on rounds and make the other students look bad - this is a BIG no no ... makes you look like a douche and most residents/attendings think it’s tasteless).
6. Make sure you follow the interns around periodically b/c you need to learn their job inside out (since you will be expected to do it during your sub-I and your only two years away from being an intern yourself)

 

[johankriek]

Oh there is a light at the end of the tunnel. The light emanating from a train coming towards you, just like your avatar

true true

i cannot believe they change drastically the way 3rd year is.. Most of the stuff you will pick up as you become experienced.. but its time thing.. I think most of the hardship of third year is clearly hazing ( rite o fpassage ) bull. and if you have at all a backbone and dignity.. its very very very hard to swallow.. the disrespect shown to you by everyone is phenomenal.. Once in a while you will be treated like a person by a decent human being.. and its usually someone you dont expect..(such as a senior member of the team). or someone totally not even on the team.. it may have been worth tolerating this in the past because once you graduated and finished and you were a consultant I dont think its worth tolerating anymore..

 

[Paws]

I agree with the recent posts about trying to figure out ways to take the horse by the reins, or whatever the metaphor might be. I am sort of bouncing babck to my old self and also figuring out how to do things, where things are, what floor the ICU is on, etc. Basic stuff like that. I am also using my pocket Maxwell's plus the Tarascom Book OrientedtoSelf mentioned above like crazy!! Plus, now I seem to have all these really friendly people around me who smile at me and ask me how I am doing because in my first few days I just wandered around like I was totally lost - which I really was. Lots of scrub nurses, or techs, unit clerks and nurses helped me out and so now I kind of already know them and we're friendly to each other. That makes me feel better, and more oriented to what I am doing. And, like I fit in I guess!

I agree that alot of third year is dodging the politcal stuff that you're not always even aware of. The other day in the OR this nice older guy was chatting to me and telling me jokes in front of my team. He made me laugh and was super. Wow! that felt great! I had been feeling starved for some decent, normal attention. Turns out he's a Divsion Chief and everyone else knew that but me. Afterwards, I felt confused and sort of mad because I had relaxed and been more casual. I didn't know who he was, or I would have been more respectful. Stuff like that makes me nuts. So many minefields I just give up and try and just be myself. I am not Svengali for Pete's sake.

It's getting better but I think it will be a long hard year as people say. I just try and be really gentle with myself and give myself a break. Let the weirdness go and do my best. I am also trying to learn how to do as much as possible so that I can be prepared for my next rotation, as well for next year. Plus, I will be an intern (I hope) in two years and so I want to be thinking about all that now. I don't mind doing scut work like stinky bandages, foleys, all kinds of chart stuff or whatever. I don't care, it's all part of the bigger picture and I want to be a good intern and be comfortable doing everything. I hope I never feel "above" doing any of that stuff.

Thanks for the early am tip, Efex! I think I will do my studying then as well. And Wakeme, yep I was totally thinking: is there something wrong with me that no one has ever mentioned in all these years? some horrible flaw that is awful, and yet has never been mentioned to me before?

 

[TheAyatollah]

Dude, I was in the same boat. I didn't pick up on what was to be expected of me until 2 weeks into my first rotation.

There were practical things that no one ever told me:

1. Don't bring up something about a patient in front of the attending physician/resident during rounds that you know that they didn't. It makes them and you look bad.

Screw it if it's important to the patients care to hell with the resident. Some advice to keep you from turning into darth vader so you can still be an actual person when you are done with the medschool sideshow. Like for example if a patient could potentially benefit from a cholecystectomy but has such bad coronary artery disease that they couldn't possibly survive the surgery and the attending doesn't know about it.

 

[Adcadet]

I got a bit of a negative review for educating a patient about her COPD and the role of her steroid medication and smoking. The mistake I made: the attending had never explained to the patient that her "asthma" was more than just asthma. Ooops, I should have known and ignored the giant pink puffer elephant in the room and acted like the patient was in a perfect state of health thanks to her wonderful doctor. Blah!

 

[dynx]

I want to reiterate some advice above. Third year is NOT hard if you come at it with the right attitude. You're there to learn. Some people are there to pretend they know it all and get good evals...f*ck them. Ask questions, do what you need to do to learn, if you have a bad resident that scuts you out, f*ck them too, leave them, take the bad eval, grades are NOT everything. Go find opportunities to learn, search for people willing to teach you. This is your chance and you will be far more qualified as an intern if you forget about ego and appearances now and do what it takes to know your stuff cold rather than playing the game to get honors (Ive done both, honored what I wanted to, used the other rotations to actually learn). A good intern told me "you're gonna be a doctor soon, and people will not tolerate your f*ck ups." Thats the real world, get ready to enter it any way you can.

 

[tupac_don]

I want to reiterate some advice above. Third year is NOT hard if you come at it with the right attitude. You're there to learn. Some people are there to pretend they know it all and get good evals...f*ck them. Ask questions, do what you need to do to learn, if you have a bad resident that scuts you out, f*ck them too, leave them, take the bad eval, grades are NOT everything. Go find opportunities to learn, search for people willing to teach you. This is your chance and you will be far more qualified as an intern if you forget about ego and appearances now and do what it takes to know your stuff cold rather than playing the game to get honors (Ive done both, honored what I wanted to, used the other rotations to actually learn). A good intern told me "you're gonna be a doctor soon, and people will not tolerate your f*ck ups." Thats the real world, get ready to enter it any way you can.

What do you consider scut work. Could you or anyone else post it. I think I have a pretty good idea, like taking labs, getting X-Ray, Blood cxs results, pt discharge, writing the initial H and P, writing orders is that it?

 

[dynx]

What do you consider scut work. Could you or anyone else post it. I think I have a pretty good idea, like taking labs, getting X-Ray, Blood cxs results, pt discharge, writing the initial H and P, writing orders is that it?

ummm...no. Thats work, you need to learn how to do that. Anything they tell you to do that a monkey could do: (examples Ive seen):
1. Get the patient list and add all lab values to all the patients daily notes...no thinking just copy.
2. "heres a stack of notes, put them in all the patients charts"
3. "Hold the phone to my ear" when the dude was trying to write and talk on the phone at the same time...he wasn't scrubed in or anything. Happened to a friend of mine, id have hit the dude in the head with the phone.

Anything you think a trained monkey could do (really) is scut.

 

[Doc Ivy]

Work is reading up on the cases for the upcoming week and educating the team--Scut is stuff like going to the OR desk and updating all of the cases on the census for the upcoming week--- work is going to radiology to get a wet read on a film before rounds, Scut is going to radiology and picking up all of the films for OR cases the next week.

But the way I look at it, scut is stuff that has to get done yeah it's busy work, but until I'm an official MD and can actually sign orders, and make independent decisions scut-work is a pretty big part of what I contribute to the team.

 

[E.A. Poe]

My first rotation, surgery, has been challenging. I realize it could be much worse. First service/month was wildly busy. We were prerounding at 4:45-5:00 d/t the large number of patients and early cases and they would keep us until 7:30. That left little time to study unless you wanted to cut into sleeping time which would affect performance the next day. I had little time to read as the sliver of free time that I did have I spent with my wife and kid. Attendings were extremely busy.

Second month I think we have great attendings who take time to teach us, but I perform poorly under pressure/crowds as I'm more of a shy type. The only way I can get around fumbling with presentations is if I over-study and memorize everything which is something I don't have time to do since I'm catching up on studying for the final d/t all of the reading I missed last month. I also "don't do" pimping questions, or rather do poorly with them partly due to a subpar fund of working knowledge being new to the wards. I am also a novice with inter-party interactions and am improving.

Even though I am bitching right now when I think about the situation I couldn't care less as long as I don't get a straight pass on the rotation. But even if I do I don't think I'm going to care. I may just steer fully clear of clinical medicine and work in a more science-based field. If I do want to do clinical medicine I did well enough on my step 1 that I shouldn't have to worry too much and will just do well on my sub-I.

 

[efex101]

A very wise upperclassmen once told me that third year is full of PC issues and folks that only care about grades. He told me to keep my eye on the prize. The prize is taking care of patient needs and if you *know* that you are giving your patients 200% then do not worry about "grades". Life is so much more than honoring X or Y rotation. I am here to learn *and* to take care of the needs of my patients and all else will somehow fall into place.

 

[Mr. McDuck]

Yeah, except if you don't get the grades, you might not get the specialty/residency of your choice and not be able to focus on the prize at all.

 

[efex101]

Sure, you do your *best* but sometimes your best will not translate into better grades. There is just way too much subjectivity in the evaluations. Also, I think that although grades/usmle *is* important ...there is also something to be said to applying broadly and heavily. Many times folks do not get into the specialty of their choice due to just not applying and ranking enough programs.

 

[mamadoc]

I agree that alot of third year is dodging the politcal stuff that you're not always even aware of. The other day in the OR this nice older guy was chatting to me and telling me jokes in front of my team. He made me laugh and was super. Wow! that felt great! I had been feeling starved for some decent, normal attention. Turns out he's a Divsion Chief and everyone else knew that but me. Afterwards, I felt confused and sort of mad because I had relaxed and been more casual. I didn't know who he was, or I would have been more respectful. Stuff like that makes me nuts. So many minefields I just give up and try and just be myself. I am not Svengali for Pete's sake.

Paws, you did just fine in this interaction and maybe it was better that you didn't know who the guy was. BE YOURSELF. Start to think of yourself as a member of the team, a colleague - OK, you are a **junior** member, admittedly, but that does not mean that you don't count or that you don't have insights that can be useful. And just as if you were sitting around a table at a business meeting, you can talk to people and be normal. You are doing fine.

 

[Paws]

Hey thanks Mamadoc for the positive feedback. I guess I was feeling aware of how much my team ignores me and leaves me dangling in space. Maybe my problem is that I am looking at them from my own persepctive. I mean, I would treat my students and my team differently. I would speak to them, number one, and I would look out for them as well. How my team does is a reflection on how I am doing. So if my student or team is floundering that is my responsibility.

I also know that when you don't give clear instructions (or any instructions) you shouldn't then criticise someone for not doing something. There's alot of abuse in this system and yes! I see my neglectful intern kissing a$$ all over the place and meanwhile I am left out of the loop. I have had to talk to other people to figure out what I am supposed to do and learn. Word among my friends is that this is the worst service to be on, and that if I am struggling it is just the normal way things go there.

I am just hoping I can learn enough now to be useful and productive on my next rotation. But the sucking up and brown-nosing **** is hard to watch. I am so much more likely to jsut say: I don't know, and be honest. Sadly, I also watch people treat me differently now that I have a white coat on. I keep wanting to say (and I often do), I am a student, please just be yourself around me. These dynamics are so weird, I am glad we have a few years to figure them out.

I also agree with Efex, grades, schmades. What can I do? I work my butt off and they say I am so-so. I do nothing and they love me. It's all bull-doody. In the end, am I a competent clinician? Do I feel I can take good care of my patients? those are the questions that are important to me. And Dynx, I am totally going after what I want to learn and ignoring the lack of training from my team. It's a shame that they aren't interested in teaching or whatever, but I can still learn and move on.

 

[Mr. McDuck]

Sure, you do your *best* but sometimes your best will not translate into better grades. There is just way too much subjectivity in the evaluations. Also, I think that although grades/usmle *is* important ...there is also something to be said to applying broadly and heavily. Many times folks do not get into the specialty of their choice due to just not applying and ranking enough programs.

That's true. I'll probably apply to every program in the country.

 

[TheCat]

haha where to begin about how 3rd year was the worst year of my 25 years of life-It is everything everybody else said and more-in a worse way. Yes you will meet those few odd ducks who rave about how they loved third year but I really feel the concencus is 3rd year blows (I have been to 2 med schools for personal reasons and both 3rd year classes hate it) The stories are really endless.

I remember one of many memorable reasons why I hated 3rd year was surgery-no matter what I did I was yelled at and told i basically sucked.-One of my first days on surgery-and this mind you was about half way through the year already-I was asked to go surgically evaluate this 90 year old patient with terminal bladder cancer who was obstructed from it. So I go down there-this guy is in his last week of life most likely, he is balling and crying and has no family/friends/support whatsover-so after about 5 minutes and finding out what the obstructive problem was and how that was effecting him-I thanked him for his time and left-well I presented to my resident and she totally reemed me out for not getting an entire, full history, including smoking history, other family history, all past medical problems, social history---etc-she siad it didnt matter that he was dying and couldnt bare to talk anymore-STUPID!

Or probably the kicker for me-my mom had lung cancer about 6months prior to surgery rotation and she underwent a thoracotomy and was in just the worst pain for months after and the experience was anightmare-however i was not there to witness it in person. So on my surgery rotation-in my last week after seeing about 100 appys-There was a CT surgeon doing a thoracotomy in the next suite and I asked him if I could scrub in and asked my intern if it was ok-she said sure-so I scrub in to get an idea of what my dying mother had gone through-and half way through the surgery, my chief resident pulls me out of the room and reems me out in front of my attending for not being present to witness appy #101 "your JOB is general surgery-you need to see certain procedures blah blah" even after I explained why I wanted to witness this surgery-they had no care in the world-and thes people are doctor? needless to say surgery was quickly off my list of fields I considered!

The last point I want to say-is you really have to choose between maintaining your sanity v. taking **** and ass kissing to MAYBE get a better grade. I chose not to take **** from my residents-I was not argumenetive and worked hard but if I had a resident who was being mean or unfair for no reason-or making me look stupid in front of an attending-then I would make her look stupid in front of an attending-or I would argue and reem her out if I felt I was justified. I called a few residents bitches over the year, I arguged with many more-I got some crumby evals for it but in the end of the year I passed and honored all my classes-and always kept my sanity and integrity-and surprisingly after putting a resident in their place-you earn a hell of a lot of respect most of the time and they dont bother you for the remainder of the rotation-I dont recomend calling them a bitch-but hey-sometimes its warrented!

basically third year blows-and I am in 4th year and it is just HEAVENLY-NOTHING to study-no more tests, step 2 is over, and I have ever night free! woo!

 

[Paws]

Hmmm ... I am going to have to think about this calling your intern/resident a b*tch. My intern has been horrible, as well as one of the residents. I was constantly told that everything I did was wrong, even when it was actually right. Lab values, patient evals, other services' notes, whatever. Also, I was often told conflicting information so I ended up going to the wrong place or doing the wrong thing, and then I would get reamed for that. One of the residents seems to like showing off my incredible stupidity to senior people. You get the picture. I think I am a decent judge of character and so I have had to quickly figure out who was able or willing to help me and which attendings seemed to be pretty normal and sane.

In the end, it is sad to me that this is how some people choose to go through life. What does it get you? Hassling your underlings can cause greater problems in the long run. Things don't get done, no one will help you, chaos abounds! I try to be decent to people because it just seems like the easier thing to do. Treat everyone the same, how easy is that.

I hope all my rotations aren't like this, and that I have some friendlier interns and residents. But what's with these b*tchy women docs? I am a woman but I don't try to stab other women in the back. That seems sort of insane and pointless to me. If I don't like someone I just act professional and let it go. I don't understand why women do this - It's exhausting and painful to deal with.

I have to agree with TheCat, I am sure my grades will suffer in some roations because I value my emotional well-being more than the faint possibility of maybe doing "better" and having to totally compromise my integrity by kissing a$$. When people in my group make off-color or racial jokes or they make fun of a patient, I just look away. I don't want to participate in any of that. It's painful sometimes.

 

[efex101]

You would be surprised just how many folks act this way. The bottom line is that the people do NOT care about patient care and act this way to make themselves feel more important by belittling someone else. I just ignore these arses and do my best. There are some folks that will never change no matter what and medicine is full of them.

 

[ocean11]

haha where to begin about how 3rd year was the worst year of my 25 years of life-It is everything everybody else said and more-in a worse way. Yes you will meet those few odd ducks who rave about how they loved third year but I really feel the concencus is 3rd year blows (I have been to 2 med schools for personal reasons and both 3rd year classes hate it) The stories are really endless.

I remember one of many memorable reasons why I hated 3rd year was surgery-no matter what I did I was yelled at and told i basically sucked.-One of my first days on surgery-and this mind you was about half way through the year already-I was asked to go surgically evaluate this 90 year old patient with terminal bladder cancer who was obstructed from it. So I go down there-this guy is in his last week of life most likely, he is balling and crying and has no family/friends/support whatsover-so after about 5 minutes and finding out what the obstructive problem was and how that was effecting him-I thanked him for his time and left-well I presented to my resident and she totally reemed me out for not getting an entire, full history, including smoking history, other family history, all past medical problems, social history---etc-she siad it didnt matter that he was dying and couldnt bare to talk anymore-STUPID!

Or probably the kicker for me-my mom had lung cancer about 6months prior to surgery rotation and she underwent a thoracotomy and was in just the worst pain for months after and the experience was anightmare-however i was not there to witness it in person. So on my surgery rotation-in my last week after seeing about 100 appys-There was a CT surgeon doing a thoracotomy in the next suite and I asked him if I could scrub in and asked my intern if it was ok-she said sure-so I scrub in to get an idea of what my dying mother had gone through-and half way through the surgery, my chief resident pulls me out of the room and reems me out in front of my attending for not being present to witness appy #101 "your JOB is general surgery-you need to see certain procedures blah blah" even after I explained why I wanted to witness this surgery-they had no care in the world-and thes people are doctor? needless to say surgery was quickly off my list of fields I considered!

The last point I want to say-is you really have to choose between maintaining your sanity v. taking **** and ass kissing to MAYBE get a better grade. I chose not to take **** from my residents-I was not argumenetive and worked hard but if I had a resident who was being mean or unfair for no reason-or making me look stupid in front of an attending-then I would make her look stupid in front of an attending-or I would argue and reem her out if I felt I was justified. I called a few residents bitches over the year, I arguged with many more-I got some crumby evals for it but in the end of the year I passed and honored all my classes-and always kept my sanity and integrity-and surprisingly after putting a resident in their place-you earn a hell of a lot of respect most of the time and they dont bother you for the remainder of the rotation-I dont recomend calling them a bitch-but hey-sometimes its warrented!

basically third year blows-and I am in 4th year and it is just HEAVENLY-NOTHING to study-no more tests, step 2 is over, and I have ever night free! woo!

Hey sorry to hear about your mom, is she better now?

I'm glad you're in forth year and have all this *(&* behind you.

Take Care and good luck! I hope you match into your first choice

 

[Paws]

I know, that's a terrible story about your resident.

You did the right thing to go see that surgery, how insane was their response! Hope your mom is doing better ...

 

[raptor5]

i think i've figured out the hungry thing though. i started carrying around ziploc bags of dried fruit and nut mix, which seems to be doing the trick!

The last thing I need is more crap to carry around. If you need a drink of water, soda, or need some crackers, hit up the nourishment/nursing station. Some interns/teams are hungrier than others. Some are still extremely psychotic and are now traumatized by the new experience they are having. I had one intern who was pregnant and another that was an athlete/cyclist. Needless to say they eat often. If your good you can convince the nurses to bring you coffee. I SH$T you not.

 

[manta]

The last thing I need is more crap to carry around.

No, that's the beauty of it - nuts are concentrated fat and protein. A little goes a long way. I do know what you're saying though. Considering all the crap I carry around in my pockets, however, a snack is the one thing that I use absolutely everyday.

Thanks for a supportive thread guys. My rotation started hectically, but ended up being a really great experience. Like many of you here, I'm a little older, and the weird hospital hierarchyculture doesn't bother me - I was just getting really frustrated with my own weaknesses. Organization is one thing I never quite figured out, so I was definitely frazzled. Hopefully, things will continue to get smoother as I figure out a system that works. Surgery's next!

Good luck on rotations!