The fourth year of medical school is sometimes referred to as the “victory lap,” because historically it has been an easier year where you take some chill rotations, interview for residency, and mostly relax before starting intern year.
Fourth year is, obviously, the greatest year for medical school. It’s the last year when you can focus simply on your own learning without yet having to deal with all the horribleness involved in actually working in the hospital – writing the notes, checking the administrative boxes, following decision rules and spending seemingly 90% of your time in front of a computer. There is also significant time built in for important rotations such as “Let’s Go Skiing” and “I’d Like to Drink Some Beer Now,” both of which are courses known for giving out high grades. It’s fantastic.
Fourth year is also a strange, sometimes frustrating in-between limbo. As medical students, we are (thank god) still not doctors, which means we cannot write our own orders, administer medications, write official notes, perform unsupervised procedures, or discharge patients. In short, we can’t do anything that actually moves things forward and helps with what is colloquially called “the work of the day.” This is a good thing for patient safety, but a bad thing for efficiency.
To illustrate: in the famous book “The House of God” by Samuel Shem, one of the thirteen RULES – always written in all caps – is Rule #11: “SHOW ME A BMS* WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET.”
*A BMS is a Best Medical Student from the Best Medical School, which is obviously all students at all medical schools since according to our Dean’s Letters, we are all the best.
Anyway. For us, this Generally Unhelpful State is acceptable in second year when we do our clerkship rotations, a necessary evil during our third year, and flat-out frustrating during fourth year. We are here to learn, but for many of us 3rd and 4th year is when we start feeling ready to contribute to the team and feel capable of doing things independently without physically burning down the entire ward.
Alas, because of (probably good) legal and (probably not as good) institutional reasons, we still can’t help all that much. As a 4th year I am acutely aware that at the absolute best, I am a forty thousand-dollar piece of gum stuck on the bottom of the resident’s shoe – attached enough to know what’s going on but not so overly sticky as to impair their walking about the hospital. At worst, I am the accidentally-left-on-handbrake while you’re trying to merge onto the highway. A huge drag.
(That’s $40,000 per year. Just in case you were confused.)
Being the generally conscientious and well-meaning human that I am (hahaha!), this general uselessness has lately begun to grate on me. I’m finishing up another away rotation this month, this time at a glossy tertiary care center on the East Coast. The emergency department has all of the bells and whistles you can imagine, including a brand-new set of ultrasound machines that cost considerably more than a small airplane – a brand-new set of ultrasound machines that I happen to be both good at using and excited to try out.
Just kidding it turns out that residents have to do all the scans themselves, and anything I do has to be repeated by them anyway for ‘documentation purposes?’ So me performing any ultrasound is about as useful as a surgeon without thumbs. Great.
As a millennial I am supposed to put this in now:
I am not alone in this feeling. Part of this frustration is normal and an indicator that we are set for the next stage of our training. Note the use of the word “set” instead of “ready;” there is nothing that can prepare you for the onslaught of actually being an intern – covering night float, knowing pain medication doses down pat, responding to the pages of the nurses. To say otherwise is the height of arrogance. There is no ready. There is only “possesses sufficient knowledge of his own idiocy to avoid catastrophic mistakes for long enough to involve more senior team members.”
“Awareness of own stupidity” works too, a sentence which more or less defines this blog.
My ERAS application, as covered before, has been submitted. The realization that I’m applying for a residency – a job – is beginning to sink in, and I am thoroughly terrified of what comes next. I am ready, though, to stop being gum on the bottom of someone’s shoe.