Having a Positive Experience in Clerkship (Part 1)

Clerkship. For the 1st and 2nd year medical students reading this, chances are that word produces a range of emotions. Excitement. Confusion. Nervousness. Perhaps a bit of fear. For those of you that don’t know, clerkship is the third year of a medical undergraduate degree in Canada. After spending the first two years of medical school learning the basics of medicine and diseases in a primarily lecture-based curriculum, clerkship provides the student with their first opportunity to truly be immersed in the world of medicine. In other words, rather than going to lectures, the third years spend a majority of their time on rotations in hospitals and medical clinics, learning from their supervisors and assisting in patient care.

Over the first two years of medical school, UBC medical students are provided with little tidbits of information about what clerkship is going to be like. At first, the information is pretty general, like what kind of rotations you’ll have (for example, everything from general surgery to rural family medicine), then it slowly becomes more specific (such as how many days we spend “on call” in certain rotations). I am a second-year student now, and over these past couple of years, assuming I’m reading my class correctly, it seemed like the closer we got to clerkship, the more excited my class became. After all, clerkship was going to give us a chance to get out of the classroom and actually practice medicine, something many of us had been dreaming about for years. Then, the program threw us an unexpected twist.

A couple of weeks before the end of our second year, the school decided that it was time for them to go all out on clerkship information and lectures, supposedly to “prepare” us. Prefaced as lectures that were intended to give us information on how to succeed in clerkship or take care of ourselves mentally and physically during this difficult part of our education, we received messages that would have more accurately been titled “things to worry about regarding clerkship.” Over and over we were bombarded with warnings about how often we would be embarrassed in front of supervisors and colleagues for not having all the answers, cautionary tales about how if were overwhelmed and lacked mindfulness we might make mistakes that could jeopardize our or the patient’s health (for example, accidentally sticking yourself with a needle), and, of course, reminders of how tired we are going to be. If I had a dollar for every time I was told how exhausted I would be during clerkship, I would have my medical school tuition paid off. I’m kidding, but being serious, there are only so many negative stories one can endure before it takes its toll, and slowly I saw the excitement for clerkship in some of my colleagues turn to dread.

I’ve decided that I’ve had enough. I’m done listening to stories that make third year sound so horrible that it makes me wonder why I’ve chosen medicine as my career path. I’m through waiting for someone to come speak to my class about what makes clerkship a memorable and valuable, even if difficult, part of our education. That’s why I’m writing this piece today. I have taken it upon myself to get the other side of the clerkship story. Mainly, I asked a few people that have gone through clerkship to tell me about things they enjoyed about their third year, including valuable moments they had with patients, interesting learning opportunities they experienced, etc. Let these stories be a reminder to all future clerks that we’re going to be ok, and we are here for a reason. This piece will be a three-part series, where we hear the stories from one current or former clerk per part. With that, let’s hear from our first colleague.

Quick note: all of the participants in this piece are from the UBC Southern Medical Program in Kelowna, so different clerkship programs may have experiences that differ from those stated on this blog.

Sidney, Class of 2018:

“Dear class of 2020,

I remember so clearly back to the week before I started my first rotation of clerkship.

I was a mess.

I was visibly having trouble functioning. I was so stressed I couldn’t concentrate on anything other than prepping for being on the wards: I was food prepping like a madwoman, furiously practicing my suturing and devouring surgery facts. On the first day of my first rotation, I was so nervous that when trying to introduce myself to the surgeon I couldn’t pronounce the word thoracics. It kept coming out thorax..thoraxes…thorr..thorax. What I discovered that day however, is that Kelowna is a wonderful place to study. I spent that entire day one on one with the surgeon who taught me to put in a chest tube on my own, let me suture up the chest, and even did a quick teaching session and a practice oral. He was respectful and patient and completely understood that as it was my first week on the wards I had no idea what a chart was, never mind where the orders go and oh horror what you might actually want to order. I walked home on air, so excited about the day.

Here’s the thing. Ok well there’s a couple things:

  1. Short term stress, just like short term glucocorticoids make you feel like you can do anything. So don’t fight it, channel it! Use that energy to go for a run, or make food and squirrel it away in the freezer, or do a bit of studying. It’s ok! But really though do channel it towards some self-care things, because that investment pays off big time. And honestly there is so much to know that the sweet point of studying is where you feel like you know a bit of the bread and butter of the specialty, but you’ve still managed to enjoy some of your last days before clerkship starts. Coming in rested is another investment that should be prioritized, don’t let studying take priority over self-care!
  2. The doctors and nurses at the hospital expect very little of you coming into third year. They will push you to do your best, but they understand that it’s a unique environment that you have very little experience of to date. They are there and willing to support you as long as you are respectful and polite. It will happen that you forget something very basic, or get lost, or make mistakes. And that’s ok. You learn the most when you’re operating in areas of discomfort. Which brings me to my next point
  3. Discomfort vs mistreatment. Our school, especially in Kelowna is so dedicated to minimizing mistreatment, that they are educating you on what it looks like. Which may make you feel like every day on the wards is like dodging shrapnel in the trenches. But IT IS NOT! It will happen often that you feel uncomfortable because you’re being pushed into areas of medicine or being supported to perform skills that are outside your current knowledge base. And that is good! It takes an attentive teacher to take the time to support you through advancing your knowledge. What is not good however is if you are being made to feel worthless, or disrespected or humiliated. Because this happens quite rarely, but does still exist as part of the culture of medicine, our program wants to educate you on what it looks like, so that if you are in that position you are able to see it for what it is, and report it back to the faculty so that they can change that culture, and confront that issue to improve it for the students following you.
  4. And finally, clerkship was one of the most amazing times in my life. I got to speak with patients and provide comfort on some of the worst days of their lives. I was able to prove to myself that the past two years were actually worth it, and that I have learned things. I met so many doctors, nurses and staff that love their job, and love teaching. I was inspired by how much some doctors truly cared for their patients and went above and beyond. I was also blown away by how much our program is behind us. They want you to succeed. And they are so ready to help in any way. Every success you have, they are like proud parents beaming at you. But also, they don’t want that at the cost of your sanity, they want you to take care of yourself and be taken care of on the wards. Sometimes self care just means eating your lunch outside once a week, or meeting a friend for coffee one evening. But you can also make time for hikes, trips to visit family, ski days, sparkling hills, soccer, church, whatever it is that makes you feel connected to the outside world.

I’m so excited for all of you. Third year is a time of accelerated growth: personal growth and growth of knowledge. You will not be the same person at the end of it, and you will be challenged in many areas, and it will be a struggle at times, but I know that in the SMP the status quo is an amazing experience.”

Stay tuned for the second and third parts in this series!

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