It has been a regrettably long time since my initial post. While my last reflections seem like a lifetime ago, I am still resonating with a similar topic. The ideas of initiation, hazing, and cyclical feelings of inadequacy have again reared their ugly head as I am a few months into my third year. The transition from the pre-clinical to clinical years is a notoriously difficult time in medical education, yet the challenges were not what I had anticipated.

As a “premed” I spent many hours volunteering in the Emergency Department, I knew the hospital inside and out, had the rooms clean before the nurses were aware the patient was discharged, was intimately familiar with the contents of every cart in the ED, and felt completely comfortable generating casual conversations with patients. If you needed any flavor of Jell-o I could find it. If you needed a specimen run to the lab, I had already done it. This was my job as a volunteer, I knew what I was supposed to do, and I did it well. The year before I began medical school I worked as an Emergency Department scribe. As the right hand to the physician I could listen to a history and generate a patient chart in 5 minutes, I was organized on their behalf, I anticipated needs,  I tracked study results. Most importantly, I felt I was part of the patient care team. This was my job as a scribe, I knew what I was supposed to do, and I did it well.

Fast forward to the present day, after two years of medical education and a half day of orientation, my colleagues and I prayed we would swim as we were unceremoniously hurled into the deep end of clinical education. In my head I begged to be asked a question about the pathogenesis of disease, something to show for the grueling past few years. Instead I felt relentlessly inadequate for not knowing basic ways in which I could be part of the patient care team; I didn’t know where the wound cart was, I didn’t know what was in it, I didn’t know the hospital. This was my job as a medical student, I didn’t know what I was supposed to do, and I wasn’t doing it well. Throughout the course of those first few weeks I constantly would flash back to my premed days, having moments where I would give anything to feel as confident as I did as a volunteer or a scribe. After an arduous application process, a cross country move, and two years of sacrifice for my medical education, there I was wishing to be half as competent as I was as a premed? There are few moments in my life where I have had a realization so utterly devastating. What did I have to show for my years of hard work? But, with every perceived struggle in life, I searched for the bigger picture, the everything happens for a reason. 

In my last post I described Gross Anatomy as a process of hazing. It served a purpose to introduce enthusiastic first years to the complexities of the field of medicine, to instill the idea that the journey ahead would be extraordinarily rigorous, and to ensure that students would walk out of their last day of cadaver lab with a sense of humility and eagerness to learn. We were at the top of our classes in college, we were recently gifted with a bright new white coat, yet it was imperative that we begin this new experience grounded and humble.  After two years of book work students face what seems like a mountain of an obstacle, USMLE Step 1. This exam is the culmination of years of work, focus, and dedication and pushes students beyond limits they had previously held insurmountable. We are released from other side of this exam as  kings and queens of the multiple choice question, master study marathoners, professional learners. Perhaps this was the time for the unwelcomed reality check. The abrupt dive into clinical years was a painful reminder that we have so much to learn. It has been a reminder that our transition into becoming physicians must be a culmination of everything we have invested so far. For me, I must be that premed volunteer finding anyway to help the patient care team from Jell-o to friendly conversation with patients. I must be that scribe who knows the study results as soon as they are available. I must recall the knowledge I have accumulated over the past two years in order to understand disease and treat patients. I must continue to stay humble, hungry and helpful.  In May of 2018 I hope to be a ‘pro’ medical student, feeling on top of the world as I rush around the hospital I am so intimately familiar with, fulfilling the role that I will have come to better understand. And, in July of 2018,  I know that will all come crashing down. There a few individuals in a hospital more terrified than a new intern, and so repeats this processes of endless initiation. The cyclical rise and fall in confidence and adequacy serves to remind us of the bigger picture. As we transition through our career and gain new responsibility, it must not be taken lightly. Every stage in training serves a purpose as a reminder that there is no field more humbling than medicine. Feeling inadequate is part of the job, doing something about it part of the odyssey. 

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