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“There are some things you learn best in calm, and some in storm.”
― Willa Cather, The Song of the Lark
Over the past year I have been blogging for The Lancet Student. As luck would have it, I ended up writing during my 3rd year of medical school, American Style. This is my “clinical clerkship” year. In a way, my posts on The Lancet Student have been a record of my journey during that year. As a new academic year begins, it seems right to reflect on how to get the most out of that year of clinical learning. One of the great gifts I have been given with my work with The Lancet is the ability to interact with medical students literally around the world, from the established medical schools on the East coast of the United States, to younger students in older medical schools in Europe, and finally medical students from the Middle East and Far East. However, one of the disadvantages of this is that I often have to translate what American medical education means in the context of world medical education. I now realize one of the gifts of translation is not seeing our differences, but instead the large number of things we have in common. Translating medical education is no different.
Despite the differences in the structure of medical education around the world, one thing that all medical education has in common is that point in time when you move out of the classroom equipped with some basic medical knowledge, and venture out into the clinical world. It may be called an externship, practical experience, clerkship or just a rotation…but the experience is the same. You head in slightly unprepared, despite all your previous work, and start to learn how to be a physician. Sometimes you get hints or guidance on what to do, but most of the time the learning is through observation and osmosis. It is tedious and at times frustrating, and you begin to realize that it sometimes called a “Clerkship” for good reason.
After hours, days, weeks, and then months, you will begin to see the pattern and purpose behind your work. Regardless of the amount of the time you spend in the classroom, and all the learning you will do, it will not give you one bit of information about how to be a physician. You can learn how to think like a physician, but without observation, practice and mentorship, you will not learn how to be one. This is harder for some than others.
Although many students see this as an extension of the competition for grades that pervades the basic science components of the medical curriculum, it is not a continuation of that race. It is a whole new race. It is, in the end, a personal struggle to understand what medicine means to you, the student, and the place you see for yourself in it. Some will get better marks, but so much is dependent on the situation you find yourself in with a particular supervisor, how busy the placement is, or even the time of year that you perform the rotation. Do not focus on grades, focus on your footing in medicine, where you will make your mark, and the grades will come, because you will be following your heart, and when your heart is in full engagement with your path in life, your hands will follow beautifully.
Just like in a storm, your footing is best learned during the trials you will experience during your clinical years. In particular, a universal I have found among medical students is the storm you will experience during your Surgery and Critical Care experiences. Even if you do not intend to find your place in medicine within those specialties, they are places you will find and test your footing. Embrace the storm, and learn all you can about yourself there. Good luck.