Third Year Advice
One thing we can all do during these unknown crazy times due to the COVID virus is try to support each other. With this post I’d like to offer some advice to the next class for when they start their clinical rotations at UNLV, and to new third year medical students in general.
The Longitudinal Integrated Clerkship (LIC)
Our third year follows the LIC format rather than the “traditional” block rotations. Traditional curriculum has students rotate through all of the core specialties (OBGYN, Pediatrics, Family Medicine, Internal Medicine, Surgery, Psychiatry, and sometimes Neurology) one at a time in approximately 5-8 week blocks. Our LIC curriculum has us do shorter rotations, usually 2 weeks in length, and we go back and forth amongst the core specialties throughout our third year. The idea behind this is for us students to have longitudinal relationships with our attendings and patients, and for us to develop a working knowledge of all the core specialties at the same time / throughout the entire third year rather than just a few weeks.
Being part of the charter class was a unique challenge when it came to facing our third year of medical school without upperclassmen to ask for advice and tips for rotations. It was also a challenge to navigate through the LIC curriculum while our attendings and residents were also adjusting to the changes. But, it’s definitely a decision I would make again and I’m still incredibly grateful for the opportunity to be part of the first class at my school. Studies about the LIC curriculum show many positive outcomes, and I know the founding faculty at my school put a lot of thought and work into it for which I am nothing but grateful.
One of the positive things that really stood out to me doing this LIC format was the opportunity we had to form longitudinal relationships with the residents we worked with. Our faculty would often talk about trying to form longitudinal relationships with attendings, but honestly that didn’t happen for many of us. However, the guidance, friendship, and camaraderie we developed with residents from all of the specialties was really special and made possible by our curriculum design. The residents acted as our surrogate upperclassmen in many ways, and I will never forget the kindness and patience they showed me, and I’ll be sure to continue that tradition when I become a resident.
Reflecting on my third year journey
I was re-reading what I wrote after the first five months of third year were complete, and a lot of the same themes definitely continued for the second half. There was still a continued sense of pressure that I placed on myself, and medicine related to patient care still feels like learning a new language which at many times can be overwhelming. The moments when the foreign language “clicked” definitely became more common which was really exciting and validating.
I still strive to give my best self to my patient interactions and medical school work, and I think I have gotten more forgiving of myself when I’m not my best self at home. I am so grateful for my support system being so patient with me throughout my third year of medical school, and I think I’ve also gotten at least a little more patient with myself.
Overall if I had to pick one takeaway about third year it definitely is that talking to patients is my favorite thing I’ve ever gotten to do and I’m so excited for the future that is centered around that. To any new third year students reading this, some good news is that I think most people like third year better; but, even if you’re not one of them it will at least be a very different and new adventure!
Studying during rotations: What I did & what I wish I had done
With our LIC curriculum, it was extremely overwhelming to try and approach studying all seven core specialties at the same time, in preparation to take all 7 shelf exams in one week. We do get two attempts at the exams, one in September and one in March, so that helps. At the same time, trying to keep up and learn things on each rotation was also a challenge. My advice for studying and some summary of what I did:
- Try to focus first on your actual rotation. It can be surprisingly difficult to stay fully present during rounds with so many other things on your to-do list and your mind. Don’t forget that so much of your learning, and arguably the most memorable learning, happens when it’s related to patient care.
- Keep a list of terms or things you don’t understand throughout each day and look them up between patients or whenever you can. I would honestly use UpToDate a lot to look things up, and at times it was exactly what I was looking for, but other times it went into much more detail than I needed at that point in time. Try looking around at your study resources and the resources your school library offers when it comes to reading up on new topics.
- Take notes on all the patients your team is rounding on, even if you’re not assigned to that patient. Try to learn something new from each patient, from each interaction. For me this included jotting down diagnosis, treatment plan, or new terms on the patient list.
- Don’t be afraid to ask questions, especially from your resident team.
- I completed the Step 2 Anki Deck before the first round of shelf exams. This plus the learning I was doing on my rotations resulted in a range of passing to honors grades on all 7 shelf exams. I was honestly happily surprised at my scores on the first round, because I had done only minimal UWorld questions up to that point.
- I would try to be doing flashcards related either to my current rotation or to an upcoming one, and this helped a lot with questions my attendings and residents asked, and helped me understand the rotations better.
- This was my first time using Anki, and I was really reluctant and nervous about it, but I’m converted to a flash card user now for the first time in my life. The flash cards were great to be able to do during down time during rotations (after I had looked up the things on my list), and I was surprised that the knowledge and spaced repetition really worked and I was able to recall the information in “real-life” and on test questions.
- I wish that I had done random UWorld questions throughout all of third year, not just during the second half.
- My hesitation in doing UWorld during the first half of third year stemmed from how I used it during Step 1 studying. During Step 1 studying, UWorld took up most of my day, and I took extensive notes on each question that I got wrong. I was feeling that I really needed to be able to sit down at my desk in the quiet in order to give UWorld the attention that it needed. However, the questions for step 2 are different, and just in general being a third year medical student kind of demands a new approach. I have found that the UWorld step 2 questions are faster to get through, even if the stems are longer, and faster to take notes on.
- It’s not impossible to save UWorld questions for the end of your day when you are at home in silence, but it’s definitely worth trying to fit in a few questions here and there throughout your long days.
- I used Online MedEd videos as a supplement and would do random videos on topics I was interested in, felt I needed a better understanding of, and to prepare for specific rotations.
- This is just what worked for me, but I know lots of classmates who watched all of the videos and used their other study tools, and they really enjoyed it.
For any UNLV students reading, we’ve also put together a student-only survival guide with tips that are specific to our hospital and our rotations, so I’ll leave this studying advice at that.
Some difficult aspects I wish someone had told me about
I’m really grateful to be part of PhiDE through which I have access to so many supportive upperclassmen and residents, and I definitely leaned on them for advice and comfort. That being said, I’d like to be honest about some of the difficult aspects of third year that we don’t always talk openly about.
I was really tired, really exhausted, in a new way throughout a lot of my rotations. Part of this definitely stemmed from not always making enough time for workouts, and others are definitely better at that than I was. I think a large part of the exhaustion is a mental one though, which isn’t surprising given the path we are on. I didn’t realize at first how draining it was to be constantly trying to learn, always trying to put my best efforts forward, and honestly always being at least a little anxious about being judged by those above me and even by my peers. Your residents and attendings will submit evaluations about your performance, and at our school those make up a majority of our clerkship grades. That plus the pressure of being the first class and wanting to leave a good impression of our school definitely led to some anxiety. I finally reached out to one of my best friends who’s one year ahead of me at a different school and asked if it was normal to feel so tired all of the time, and I was so comforted when he said “oh absolutely that’s just part of third year.” So, I wanted to share this thought hoping it brings some comfort, and I hope we can continue normalizing the difficulties we’re all facing on this journey.
The other most difficult aspect has definitely been not knowing what time I’ll be heading home each day. It sounds kind of trivial, and it took a few months for me to really start noticing the toll it does take on your ability to plan things outside of your rotations. But, it is difficult to make plans with family and loved ones, to plan to catch an evening gym class, to plan your walk with your dog, when you won’t know until the time comes when you’ll get to be finished on your rotation for the day. That being said, the residents and attendings at our hospital are really understanding when you have appointments, or if you have set times you need to get your kids, or when things come up, so I’m just referring to the day-to-day. It’s just part of the journey, and I’m not trying to complain nor would I change being on this path for anything, but again I just being honest and sharing some thoughts I would have liked to hear at the beginning of my third year.
My last piece of advice for this post: Support your fellow classmates.
I would not have made it through some of the most difficult and exhausting days without the support of my peers, and I hope I was able to support others along the way too. We are all in this journey together, and I am so grateful for the people I’m on this journey alongside.
Check in with each other. A simple, “hey how’s life outside of medical school” can go such a long way when we’re all getting that tunnel vision of focusing on our rotations. Don’t try to outcompete each other or make the other students on the rotation look bad. Let each other know what you’re doing. For example, if you’re writing a patient note without being asked or for practice, let the other students know so they can do the same. Make group texts with the residents so you’re sure all your peers rotating with you know the same information you do. Also, when you’re seeing a patient that’s assigned to another student, make sure your classmate goes in the room first and that you let them take ownership of their patient. Don’t accidentally take away valuable educational opportunities from your peers. These things sound simple, but can be forgotten by anyone in the hustle of third year.
Even when you’re on rotations with people you don’t know very well yet, just be kind to one another always. The stress of third year is absolutely guaranteed to make all of us not be our best selves at all times, so try to be forgiving and give people the benefit of the doubt.
For me I had some of the highest levels of anxiety on my surgery rotations, just because I always feel that my anatomy knowledge needs improvement and the OR itself just makes me uncomfortable. I am so grateful for every classmate I had those rotations with. Thank you for sharing your protein bars from your pockets with me, for sitting on the floor in the halls with me while we waited, for being cognizant of everyone on the team seeing equal amounts of surgeries and procedures, and for helping me with pimping questions I didn’t know while also allowing me to answer the ones I do. Thank you to my friends for normalizing how exhausted we were and how gross we felt sometimes. Thank you to my friends who I didn’t rotate with but still supported me. And on my last rotation, thank you to my classmate who became a closer friend who supported me in such genuine ways as I struggled through after the loss of my Cocoa. Something as simple yet so significant as offering to help with dinner, to wash my white coat for me, seriously reminded me that I wasn’t alone in this journey at a time when my grief was making me feel isolated.