Even a whole month of transitions cannot prepare one for the onslaught of information and experience that is gained when the medical student finally enters clerkship. It was my third year in medical school but my first time feeling the weight of medicine. It was the first time I watched a patient bleed to death on the OR table and the first time I may have saved a patient’s life when they were considering ending their own. It was my first goodbye to a patient leaving the hospital for hospice, and my first hello to a newborn I had just delivered with my own two hands. These are the highlights of third year: we romanticize the rollercoaster of experience to keep pushing through long hours of standing, studying, and persevering under the relentless gaze of our evaluators.
But much of third year is not spent in these moments. Much of my time was spent on social calculation and reading microexpressions. Does this resident seem like they would write me kind words on a MyTip evaluation or only a sentence of words that distinguishes me as little as a drop of blue dye in the ocean? When the attending laughed at something I said, was it with endearment or derision? Does the surgeon want me to anticipate their movement, predict their next move, show that I memorized every step of this AV fistula construction or is it too arrogant for me to grab the mayo scissors from the scrub tech’s tray? Classmates and I would discuss how it did not matter if five hours were spent in-person or fifteen. The exhaustion at the end of a day felt identical. On my surgery clerkship, I found myself making extra efforts to ensure I saw patients on my own, because when it was just me and the patient in the room, there was no evaluation taking place, and I felt I could finally breathe.
This is not to say that my preceptors were not golden beacons of knowledge and guidance. Overall, I felt that the majority of my attendings and residents were wonderful and engaging educators. But the pressure was still on. I’ll never forget when my chief pulled me aside on my very first rotation and said, “You told me you might want to do internal medicine, right? You want honors?” You can imagine me nodding my head in desperation like a bench player getting asked by the coach if they wanted to sub in for their first real game. “Then you’re going to need to act more engaged on rounds, even with patients you don’t know. I know you’re preparing your own patient and making sure to be thorough, but our attending might think you’re just distracted on the computer.” The statement was fully in my best interest, but dually shot up my cortisol for the rest of the rotation. It was the same resident at the VA who taught me to grab the nurse habitually on bedside rounds, to bring the Is and Os chart in case it was relevant information, and to dig decades into the past of patient charts so that I was the foremost expert on the patients I would be presenting. How much of this was being useful and how much of it was about looking useful? Sometimes the rotations I did the best on were not the ones I scored highest on with evaluations. The rotations that were the hardest for me mentally were the ones where my role was the most passive, and I heard many of my classmates say the same.
One of my surgery attendings once told me that the job of a third year medical student is to present and to do it right. He was one of the few who routinely interrupted me every other word during a presentation. But at least, he would explain exactly why he did so. Because of him, I felt like I could do oral presentations in my sleep by the end of the rotation. For a long time, this felt like some strange hazing process to put the medical student on display, since there was no real designated role outside this soliloquy. It was not until I got to my last rotation on OBGYN, where I attended nearly every sign out for L&D, that I saw the power of presenting. And it was not about rounds, but about handoffs. In five minutes, how were you supposed to communicate the most vital information–not all the information one could possibly know–but the most crucial clinical updates? The organization of your presentation was near proof of how long you had spent organizing your own thoughts about the patient and what needed to happen next. Now on my sub-I, I find myself mentally thanking that IM chief resident and surgery attending nearly every day.
The most magical moments of your third year, unsurprisingly, are not during rounds or handoffs. They will occur when you are selfishly taking the extra five to ten minutes chatting with patients, maybe about why they’re in the hospital or what they’ll do when they get discharged. In these small moments, patients would ask me, “are you going to be there during my surgery? Will I get to see you again?” Or when they thanked me after I asked about how they were feeling emotionally, or if there was some way we could aid in circumstances beyond medicine. There is real power in the “social visit.” In these moments, I saw the anxiety of a patient wanting someone who knew and saw them beyond their pathology. But isn’t that also the anxiety of the medical student? Are we not just begging our residents and attending to know us, our good intentions, and to see the efforts we make to ensure we do right in our studies and by our patients? We tire on rotations where we feel out of control of the outcomes of our scores, perhaps similar to the way patients feel out of control of the outcomes of their health. The preoccupation with performance in third year is a sentiment that will be shared by all of your cohort. Your exhaustion will inevitably occur somewhere within the year. On reflection, my advice is this, when the day is long and the weight of being watched becomes heavy, go “hide” in your patient’s room. The both of you can help each other feel more human again.
Natalie Nabaty is a medical student from the class of 2025 at UACOMP with so many passions she struggles to juggle them all. Between playing guitar, dancing traditional Assyrian line dances, and studying global health, writing is a skill she is happy to refine while in medical school. She graduated from ASU with a Bachelors in Biology and a minor in Psychology. Her special interests include migrant health, global neurology, and medical humanism.