The transition from preclinical to clinical training in medical school is frenetic, to put it lightly. You’ve spent so much time focusing on memorizing drug names, side effects and acronyms for clinical presentations of Lupus over the last two years, and now you’re given the chance to flex all that knowledge! Except that you soon realize much of the information you’ve learned is either outdated or so rare that you have to remind your preceptor what the pathophysiology is behind the disease(s) in question.
You’re thrown into the clinical environment with very little experience and, as you’re surely used to now, you must learn fast and adjust even faster. Depending on your clinical team and rotation schedule, this can be quite a feat. But let’s be clear: if you got into medicine to take care of sick patients and play an active role in the diagnosis, treatment or management of disease, your third year of medical school will be an incredibly rewarding experience.
I have just completed my first rotation as an MS3 in Family Medicine here at the University of Utah School of Medicine. I worked at a small Family Medicine and Rehabilitation clinic just north of Salt Lake City, staffed by one MD, two APRNs and a handful of MAs and Laboratory Technicians with just 6 exam rooms. On my first afternoon I saw a young boy with otitis media, a man in his 50’s with refractory hypertension, conducted a well child check on a 9 month old and assessed a sprained ankle. From then on I was given an increasing amount of autonomy when it came to seeing patients and coming up with a concrete plan for management.
By the end of the rotation I was seeing 8-12 patients a day, putting in orders, and acting as an intern. But in this type of intimate clinical environment, I had to learn fast so as not to keep the staff behind schedule. This meant learning to navigate the EMR to write multiple notes every day, gathering a detailed history and conducting a target physical exam in less than 20 minutes, a tall task for those patients with several chronic conditions who need multiple services per visit. It became even more difficult when these patients were seeking opioids for pain management, couldn’t afford the best treatment for their conditions or couldn’t adhere to our treatment plan because of a lack of social support at home. In this first rotation I began to appreciate that patients are not just the chief complaint they present with – each presentation results from an amalgam of socioeconomic, cultural and genetic factors that play unique roles in the patient’s health status. Having the capacity to understand this and tailor your care accordingly is both the beauty and the challenge of Family Medicine.
Each rotation brings about its own personal and professional challenges for medical students. Coming face to face with the opioid epidemic, witnessing socioeconomic disparities in healthcare delivery, learning to triage patient complaints and fitting a full visit into 15-20 minutes were some of the more difficult aspects of my 6 weeks in Family Medicine. While there are a number of resources that provide tips and advice for surviving your MS3 rotations, I believe the best advice is to not prepare for rotations the way you have prepared for exams throughout medical school.
So much of your success during rotations will be based on your adaptability, resilience and ability to work within the care team you’re assigned to. Yes, you will be pimped on anatomy/physiology/pharmacology, but whether you get pimping questions wrong will not make or break your assessment; rather, how you were able to adjust to working with your preceptor in a useful and beneficial way is how you will be remembered. Much of this will be based on your EQ, which will improve with each and every new scenario you find yourself in and are required to adjust to. As I continue rotating I will provide updates for each specialty, but for now I can say that I am thankful for having started with Family Medicine, a broad specialty that requires a large volume of knowledge and that will give you an invaluable perspective into healthcare delivery in the primary care setting.