Year 2 in review and Now What?

Well, I guess that I am now officially a third year medical student. How the time flies when your head is buried in Robbins for a year. I really mean that it flew by. It feels like just yesterday that I was hanging out in the ER and looking back on first year and getting geared up for second year.

It was a struggle for me at times. Sitting around reading a book, memorizing minutiae of diseases for the sole purpose of regurgitating it on an exam felt like an exercise in futility most of the time. That passive style of learning about as far outside of the context where the knowledge will be used as you can get. I think it's a pretty big oversight in the curriculum design, I'd say 90% of us just memgurgitated through the year without trying to integrate the knowledge into something that is applicable to the wards. But then again, it was better than the integrated Problem-Based format that several schools have initiated. I could see sitting around a conference table with a bunch of unprepared students getting on my nerves pretty quickly. From the rather limited small group stuff that we did do, I can say that the majority of my classmates are F'd when it comes to rounds and pimping. Sure they can regurgitate the 25 different translocations for each type of leukemia, but can they form a differential for someone who has abdominal pain??? NO! I feel completely unprepared for what is coming...thanks over-priced medical education. Way to set me up to be useless next year!

Don't even get me started on Step 1 and the debacle that is. While it was somewhat nice to review everything that I've learned so far in a fairly coherent manner, do you really need to charge me 400 dollars and pin my hopes and dreams and future income on it???
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So now that Step 1 is on the books, I keep asking myself "now what?"

There is a ton of information and misinformation floating around about third year clerkships. We had a few forth years come talk about the clinical sites and they weren't able to come up with any clearly discernible differences between them. Our dean of student affairs talked about the sites as well, and without mincing words said that they are all the same. I even took some initiative and talked to older students to try to get a taste of what's expected at my clinical sites and to be honest, they've given me very little to go on in terms of what the expectations are/who the better attendings are to work with, etc. Thanks guys. I guess I'll just have to figure it out as I go.

I hopped on SDN's clinical forum....which is always a huge mistake. Between the posts talking about shoes, PDA's, resident horror stories, pissing matches and generalized gunner behavior, I decided it was a warped perspective that was better to ignore. So I bought myself a copy of the 250 Biggest Mistakes that 3rd Year Medical Students Make to try to get my head wrapped around what I'm in for in two weeks. The overarching theme of the book is to be a neurotic pain in the ass to everyone in the hospital from housekeeping up to the department chairs!!! It instructs me to make sure that I chase down every evaluator and have them clearly define how they'll be evaluating me, how they want write ups, notes, oral presentations, their coffee and their ass kissing. My complaint is that for every helpful nugget in the book (how to write up a new admission/progress notes, how to present a patient), I had to wade through the waste deep gunner advice ("Here's every question to ask your resident on the day you start") and stupidly obvious advice for those medical students with an IQ of 36 or below (Read your orientation packet before orientation). It came with a free Maxwell's (a $15 value), so I can't complain too much.

Anyway, here's my major concern:
In the span of about a week, I'm going to be tossed in way over my head (during the second week of July no less) onto what is rumored to be one of the more malignant Surgery services in the country. There's a bit of a nagging feeling that the preparation that I've received thus far may have been inadequate for what's expected. While that seems the norm for most medical students...so at least I'm not alone.

But in all seriousness: I've never presented a patient orally, I've done 2 complete physicals, I've written up half a dozen patients, I've stabbed a couple veins and I've spent maybe a total of 6 weeks working in a hospital setting...this is going to be a rough transition.

Oh well, the dude abides I guess...