This is is part of a series of reflections on medical school that I’m writing, with each new post being a reflection on each year. I’ve previously written an overview of what this series will entail.
All year, I’ve been facilitating a small group of first year medical students once a week as part of Case Western’s “Foundations of Clinical Medicine” program (FCM). Affectionately known as “touchy-feely Tuesdays,” it’s the component of our curriculum that deals with the doctor-patient relationship, and professionalism. During first and second year, Case students stick with the same FCM small group and discuss various issues each week. When I look at the classmates that were in my FCM group and what they’re going to do for residency, I’m not at all surprised by any of them. They are a fantastic fit for what they’re going into, based on what I saw those first two years.
More interesting than my peers, however, is looking at the small group that I’ve facilitated this year. They’re just the same as we were, and as I imagine most of the groups are. As almost-graduates, my peers and I regularly talk about little we feel like we know. Nothing, in fact. But looking back at the first years I’m with every Tuesday, it helps put into perspective how far we’ve come since then.
It’s hard to put to words what my thoughts are when I think about the time I’ve spent with the first year students, especially in comparison to second, third, and fourth year students. In first year, you’re barely get an amuse-bouche of clinical experience. Hardly enough to really truly feel comfortable, or that one is able to contribute to the care of a patient. It’s hard to feel like more than an observer at that point, even if you are actually doing something like writing a patient note. And I can see that lack of familiarity, that lack of comfort that most people I know felt.
I didn’t feel like a medical student until the last block of the first year, which is what the current students are in the middle of right now. Before then, i felt like a science graduate student. But block four focuses on cardiology, pulmonology, nephrology, and pharmacology (aka, heart, lungs, kidneys, and drugs). You know, important doctor stuff. It’s several complex systems studied during the same block. Not randomly, but because of the significant interplay they have - it’s difficult, possibly impossible, to teach one of these systems without involving the others. It’s the block where the majority of our class took all of the allotted time for the final exam (which was six hours, already an hour longer than the other blocks). Not to say the prior blocks were easy, but this one was certainly the gauntlet of the pre-clinical medical school exams.
I remember taking that final exam and just being done. Done with the first year of medical school. Done with nearly eleven straight months of classes. Done with a fantastic hurdle, that while only 25% of completion, felt like an incredible milestone. And it was. And it will be for the current students.
The four years of doctor school are often likened to attempting to sip water from a fire hose. The sheer volume of information we’re expected to master is astounding. It is often said that the average English speaker has a vocabulary of 15,000 words, and that medical professionals have an additional 15,000-18,000 words, for a total of 30,000 - 33,000 words. In other words, after completing a sixteen-year college education, we must then proceed to double our vocabularies. In four years. This number is commonly thrown about, however I have not seen an actual study to confirm or refute this. Only something posted on Kevin MD. So it could actually be 1,000. Or it could be 20,000.
First year doesn’t make you feel any more like a doctor. Heck, I’m about to graduate and officially have that title, and I sure as heck don’t feel like a doctor yet. During some of the Tuesday morning sessions, whenever a discussion ensues about some medical detail, the students' heads often all turn to me. And I pray that I actually know what they’re talking about. Sometimes I do, and sometimes I don’t. In the cases where I do, it’s a fantastic feeling. Hey, I actually learned something! In the cases where I don’t, it makes me petrified that in just two months, I’ll have actual patients looking at me in the same fashion, waiting for me to speak. It is both awesome, and terrifying. And I believe anyone who doesn’t admit approaching internship with a mixture of those feelings is either lying to you, or to themselves. Of course, that’s only my opinion.
So no, first year doesn’t make you feel any more like a doctor. But completing first year certainly makes you feel like a medical student. It makes you realize you’re actually on your way to becoming a doctor. During one of my first-year lectures, our prof said, “You guys can relax. You’re all in medical school now. You’re all going to be doctors.”
We all smiled and breathed a sigh of relief.