Wisdom from clinical year on the wards

Clinical year clerkships are the crux of the medical student experience. Scurrying from place to place, adapting to new environments, adjusting roles and personas amid ever-changing team dynamics — these all become part of the daily routine. 

In a traditional medical school model, students rotate through hospitals and clinics after spending two years in the classroom brushing up on biochemistry, anatomy, physiology and other subjects that are quickly learned and mostly forgotten about by the time the next test rolls around. Duke, in a trend that’s become increasingly embraced by other medical schools, condenses that learning into one year and releases students to the wards at the beginning of their second year. This initially might sound a bit premature but is really rather prudent when you realize that most learning in medicine follows a pattern of learning something, forgetting it, seeing it in another context and relearning it, forgetting slightly less of it this time, seeing it again and relearning it, forgetting even less of it on the third pass—you get the idea.

I began my year of rotations last August and finished around a month ago, flitting between hospitals and clinics for week- or month-long blocks in a variety of fields. There’s a jack-of-all-trades aspect to clinical year that’s necessarily uncomfortable — in this environment requiring frequent shifts from specialty to specialty, change is the only constant. You go from seeing a patient presenting to clinic with a yearslong history of debilitating migraines to hearing a baby’s first cries during a delivery to craning over a resident’s shoulder in the operating room for a peek at a beating heart. You go from speaking with a patient in the emergency department who just intentionally overdosed on a medication to seeing a patient who just received a devastating cancer diagnosis to interviewing a patient who just hit five years cancer-free. There are moments where you see humanity at its most raw and its most polished, its worst and its best. 

When every day features memorable moments, losing perspective of the pressure and privilege that comes with these interactions becomes all too easy; it’s often said that an average day for a healthcare provider may very well be the worst day in a patient’s life. Working in this setting day in and day out really does change you as a person, and having had a period of separation from that routine in the first month of my third year, I’ve gotten a better grasp of how this year has changed me.

For instance, I’ve always been the type of person to pull up Google Street View before traveling anywhere I haven’t been before. What’s the street parking situation? Where’s a backup garage if the street parking is all taken? If there are multiple, which garage costs more? Why isn’t there a public transportation option so I wouldn’t have to go through this mind-numbing exercise? Writing this out makes it all seem horribly neurotic, but I assure you there’s a method behind the madness. Unfortunately, there’s no such thing as Google Street View for random workrooms in the hospital, only vague “text or call if you get lost” offers that stirred up the same fear in me as asking for help finding something at Walmart (another thing I do not like to do). 

But over the course of the year, I grew more comfortable with discomfort. Showing up at a clinic and asking receptionists and nurses to point me in the right direction — oftentimes more than once — became practically a weekly ritual, and soon I didn’t think anything of going to bed with a less-than-precise idea of where I would report the next morning. This translated into growing more at ease in other situations too, as I didn’t have to thoroughly read everything in a patient’s chart before going into the room. I realized I could familiarize myself with the important points and embrace greater trust in my ability to guide a conversation more naturally depending on what the patient wanted to discuss as opposed to having a rote script.

Going hand-in-hand with embracing this discomfort was a realization of the power of saying “yes” to offers. Medical students are offered a lot of opportunities: “Do you want to see this patient on your own?” “Would you like to help deliver the baby?” “Do you feel comfortable calling the consult?” Of course, none of these tasks are beyond our level of training, and all are done with appropriate supervision, but rising to the occasion often felt intimidating at the beginning of the year. I’d sometimes defer, explaining that I felt more comfortable watching and learning so that I had a stronger foundation to perform whatever was asked of me later that week. 

Yet I began noticing that declining these opportunities put me in a stagnant mindset, making me less engaged in the task at hand. When I started saying yes, however, I felt so much more empowered and involved, even if I fell short. Phrasing a question poorly during an interview or taking a few extra minutes to refine my suturing technique in the operating room are hiccups that inevitably come with learning. My supervisors were always able to give me advice along the way so that patients still received the best possible care while I learned far more from the experience and had a stake in the process. And thus I learned how rising to the occasion is often a self-fulfilling prophecy in building competence.