Surviving medical school was certainly a challenge. The first two years were tortuous in both the amount of information that was thrown at us and that we were expected to learn in a short amount of time. The entire process it to prepare the students to take Part I of the Medical Board exam. THE BOARDS are always on a first and second year medical student's mind. At the end the first two years all medical students are given three weeks to study for this exam which is ultimately the first part of the three stage process that must be completed to become a licensed physician. Learning a specialty is a separate process. Immediately after we took our boards, we were to begin our third year which was the start of our clinical rotations.
During the six week wait until we heard the results of our board exams, we not only had to go on the with the stress of learning how to actually practice medicine in a hospital setting, but worry about if we passed our boards, as if we did not, we were not allowed to continue our third year further and would have to go into remedial classes. Each year there is a specific date when every medical school in the country is notified who did and did not pass. The official scores are sent later. I recall the day that the pass/fail list was to be announced running into the registrars office (she knew us all by name) and had apparently stopped breathing out of sheer anxiety. She looked up at me and said "You can breathe now, you passed." That was when I realized that I was standing in the door holding my breath. I really did not care that much about the actual scores. I just knew I passed and did not need to worry anymore. I thanked her and left. THE BOARDS PART I had been put behind me. Now I could focus on earning that long coat. The one that if you have read my earlier posts, I refuse to wear.
The long coat meaning that I was a physician, not a medical student. Medical students were relegated to short white coats. Not that any of the medical students on the show ER ever wore short coats. There is a reason doctors do not watch ER. We get so irritated with all the gross inaccuracies that occur on that, and all other "doctor" shows that it just makes for a miserable viewing experience. So we watch the Colbert Report.
But back to the crusade for the white coat. The last two years of medical school largely involve following a resident around and slowing learning the ropes of working in a hospital. It is pretty much a junior residency without the same level of responsibility. Oh, and instead of getting paid a moderate salary, we paid out about the same amount in tuition plus room, board and textbooks. Initially we would just follow a resident and play a largely passive role. We were usually assigned some menial tasks to take care of, giving rise to the term "scut monkey" as a common one used to describe the medical student's role on the treatment team. With time, our skills would grow and we would do more of the tasks that we would need to be doing in the "real world" - writing progress notes, orders, physical exams, helping with procedures. We did have some outpatient exposure, but much like a standard residency, most of the work was based on hospital work. This has been a flaw in the training of medical students and residents for some time now as the system has for decades become reliant on the services of residents to care for inpatients. This leaves little time for preparation for what will become the final endpoint for most trainees which is office based work.
Those years did include taking call along with the residents so medical students too, suffered the 36 hour long work days. The frequency of call varied depending on specialty, surgery generally 1:3 and psychiatry 1:6. Most specialties were 1:4. Most work weeks were seven day work weeks, perhaps 6 days a week or we would get one or two days off a month, but the schedules were grueling. It was not just clinical work we were expected to do. Once we got home, we were expected to go home and study up on the various maladies our patients suffered from and review notes from the various lectures we had to attend during each rotation. Attendings varied in their personalities from very inspiring to humorous to verbally abusive and threatening. One had a bad reputation for behaviors that were on the edge of sexual harassment, but woe to the medical student that tried to do anything about it, as his power in the hospital was too great to be overcome.
It was a very trying time. Not just for the crushing workload but from the human aspect. On the first call night I ever took, I saw a severely premature infant nearly die. He had been at a higher level NICU elsewhere because his case was so unstable, while his two triplet brothers were stable enough to remain at the one I was assigned to. He had just been sent back from the other hospital to be with his triplet brothers - so he could be with them when he died. He had heart deformities and was simply too small to survive an operation to correct them. That night he destabilized and I stood there with the whole family, the mother in hysterics, holding her son who was just barely over one pound in size telling him how much she loved him and how she prayed she would see him in Heaven. He made it through that night, and I am not sure how much longer but he was not going to survive. Hard way to start one's clinical rotations in medical school, huh?
Those NICU memories hung heavy on me when I stared down at my much more stable premature son in that heating bed 4 1/2 years ago. But my son now asks me how to operate the gear shift on my car and scares the hell out of me. I think he's fine.
I survived the third year of medical school, and the forth year was not nearly as bad. There was a great deal of time for electives and not the rigid rotations of the third year. There were two months of required "acting internships" in internal medicine where the medical students were expected to take on the role of an intern with the same responsibilities of an intern and those two months were hell but most of my fourth year was much more relaxed and had more of a focus on outpatient areas and more diverse areas of psychiatry. I was even able to arrange to spend a month at another highly respected university in another state doing a rotation on the psychiatric unit there. This was one of the top psychiatric residencies in the country and was an experience I would not have missed for the world. We also had to tackle Part II of the Medical Boards during the 4th year of medical school. This one was not nearly as terrifying as Part I and passing this was not as essential as it could be retaken during residency if need be. I passed Part II without difficulty and was 2/3 of the way towards being licensened as a physician.
I had nearly reached a dream that I had had for some time and never thought I would ever see come true.
To be continued.
No comments:
Post a Comment