Transitioning from Transitions

Exactly one week ago I was sitting in a classroom, listening to a series of lectures and seminars meant to prepare us cohort of fourth year medical students for residency. The information presented was, for the most part, non-clinical, and addressed instead the social issues of medicine that we may face in the years ahead. For me, the week of classroom discussions, groupwork and clinical reflection was rather different from the weeks prior, which consisted of a rigorous CTU rotation followed by interviews, and would be just as different as the upcoming selective, which I have now since commenced. Over the four years of medical school, there are numerous transition periods, both formal (eg. Transition to Clerkship and Transition to Residency) and informal ones (eg. pre-rotation "crash course" weeks). I found that there were two main domains of difference that existed during these transition periods: the pace of daily activities, and the type of thought processes required to succeed in each working environment.

What I experienced during my most recent transition from classroom activity to clinical activity was difficulty in adapting to both of these domains. The change in pace of daily activities would be considered more of a physical change, though there certainly exists a mental adaptation as well. When you're not faced with rigid timelines for responsibilities on a daily basis for a significant number of days, the physical body may adapt to this new standard and become "sluggish". Simultaneously the thought processes involved in classroom learning is also different from the clinical setting, as one must switch from passive to active participation, which involves the addition of situational communication, idea synthesis, and problem interpretation and solving to the basic foundational components of listening and observing. When the first set of these skills become inactive for an extended period of time, you often require a period of time for them to get "turned on" again and regain your competency in them. For us learners, this period of time where we are "transitioning from a formal transition week" may last anywhere from a few hours to a few days (or perhaps even weeks) depending on what you're transitioning from/into, how long the formal transition period was, and your established level of competency in the required skills prior to the transition. Unfortunately, there is ongoing fluctuation of skill competency in junior medical learners since we are constantly learning to adapt to new rotations with each rotation often requiring different skills.  Having interspersed week-long classroom periods seem to fragment the continuous flow of competency training even more, at least perceived based on my clerkship experience.

So how can a clerkship curriculum address the fragmentation of working pace and thought process perceived by students? Or rather, is there even a way? Or is it more up to the student to learn to adapt his/her learning and working styles efficiently during these transitional periods to accommodate the curriculum requirements. I think a healthy balance is necessary in this case, achieved through feedback-guided curriculum changes as well as student motivation to take ownership of their learning. Take for the example a pre-rotation “crash week”, when students are bombarded with a wealth of information, often presented in extraordinary clinical detail. The basis of scheduling the teaching this way, in a way, still makes sense since we need at least some knowledge before seeing patients. However, not having seen any patients with the presented conditions yet, it’s rather challenging to apply the classroom knowledge to actual clinical cases in a meaningful manner. What some rotations do, is have the teaching spread out over the entire rotation allowing students to revisit and synthesize the information after having the opportunity to see patients with those concerns, thus eliminating the concept of the “crash week”. I understand that this may be more feasible in certain services over others; nevertheless after speaking to several colleagues most still feel the same way –that their learning tends to progress more continuously when education is delivered simultaneously rather than clustered together. The fragmentation seen here is but a morsel compared to the overarching challenge of continuity in medical education which has been the subject of debate for a long time. While certain changes have already been implemented, it’s highly necessary for us medical students to continue offering feedback on our current experiences and frustrations and how they’re contributing to our learning success.

-JJ