Tuesday, May 10, 2011

I’m back!

From AMSA On Call

Post #8 of the "Back to the Wards" series focusing on the transition from research years back to the medical school and clinical rotations.

Yesterday marked the start of my outpatient pediatrics rotation, the first of my third year of medical school, and the end of this series of posts on my transition from doctoral work in the School of Public Health to my third year clerkships. As I interacted with my M3 colleagues during general orientation last week, and pediatrics orientation yesterday morning, I was struck by the overall high level of anxiety. In spite of my perception that everyone (except maybe the other returning MD/PhD students) should be calmer than me because of their more recent completion of things like clinical competency assessments and Step 1 of the USMLE, all of us were talking nervously about seeing real patients, presenting histories and physicals in the inpatient and outpatient setting. Many of us noted with some trepidation that we don’t do any pediatric exams during our first two years of medical school. While I still believe that many of my colleagues were much more prepared than they believed themselves to be, orientation was nonetheless an important reminder that no matter how large or small the period of time between the pre-clinical and the clinical years of medical school, the jump in expectations (both self-imposed and outlined in the ever present learning objectives for each rotation) is daunting. None of us felt truly ready for the challenges that Monday afternoon would bring.

Despite all this, Monday afternoon was great. I can only speak for myself, as I haven’t had much time to debrief with other students, but although I didn’t have all of the answers at my patients’ well-child exams, or ask all of the questions I needed to at sick visits, I made it through and presented what I did know to an understanding and friendly attending. I tried not to hesitate to ask questions and highlight the gaps in my own knowledge. In some ways, I think that doctoral work was great preparation for the wards. Who better, after all, than a PhD student to give a succinct outline of what is known, highlight the gaps, and attempt to make a conclusion anyway? At the same time, I felt myself struggling as I dusted off my medical vocabulary, only to find it a little rusty and perhaps a bit smaller than last time I trotted it out, and I often came up blank as I tried to expand my differential diagnosis.

Looking forward, I see a lot of reading and asking of clarifying questions as my rotation progresses. Just in the past few days I have absorbed a great deal in clinic, and am recognizing the value of applied and practical learning structured around the patients I see. I think my time away will ultimately make me a better doctor, but first, I’ve got to get to studying!

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