How Do We Get "There"

I remember observing fourth year medical students during my first rotation of clerkship as a newly minted member of the internal medicine team. They worked efficiently, exuded confidence, and seemed so comfortable in their roles.  I felt a little overwhelmed, a bit lost, and quite unsure of what I was supposed to be doing.  I wondered how I would ever hope to be close to their level in a year’s time.

Fast-forward a year later, and I found myself on the opposite side of the equation. I had the opportunity to work with third year clerks on a couple of electives, and I would sometimes hear them articulate those same thoughts that I used to have.  I would tell them the same thing that those fourth years would tell me as a CC3: that they would get “there” before they knew it.

I wish I could have told them exactly what to do to get “there”, but it was hard given I am not so sure what “there” is. Sure, I felt a little more confident as a fourth year student than I did as a third year on my first or second rotation, but there was no clear difference in my mind (as opposed to say, observing a staff physician and a clinical clerk). There were no clear steps that I could say led to this minor boost in confidence, there were no “aha” moments, and no one area that I could recommend focusing on.  In fact, I found myself in the same boat again, observing the PGY-1s and wondering how I was supposed to be like them come July 1^st.

Our third year clerkship is an immersive yet somewhat disjointed experience. We are thrown into different hospitals, different teams, and different disciplines. We are exposed to a variety of teaching styles depending on our rotations, residents and staff.  However, all of these experiences invariably seem to add up and spit us out on the opposite end of the core clerkship as students who can function reasonably well in a hospital or clinic setting.  What happened in that year that changed us? That got us “there”?

I have talked about this with my peers, and it usually comes to the consensus that the only things we know are that it requires time and experience in the mysterious contraption that is clerkship to develop more confidence in the clinical setting and that there are always greater levels to strive and work towards (i.e. developing into a PGY-1). 

“There” is a moving target, and what “there” is will always change.

What I am looking forward to doing during this selective is looking inside that contraption and seeing how it works. What components of it work to help us along our path, and which parts could be improved. I am excited to learn a little about how we learn (though I am certain I’ll only scratch the surface in three weeks), and to see what I can do to be an effective part of the clerkship experience for medical students as a resident in the (very near) future.