101 Things
In honor of the fact that second years all over the country have completed the year (or at least they have over here) and are now beginning to study for Step 1, I thought I would provide some light reading in the form of my list of "101 Things I Wish I Had Known Before I Started Third Year"
Third years/fourth years/residents/etc. please feel free to add to the list.
101 Things I Wish I Had Known Before I Started Third Year
1. If there’s anything else in life you want to do, take a year off
2. In theory, the MS3 year is significantly more exciting than it is in practice
3. Nothing you learn in the hospital/clinic will help you on the shelf exam. Nothing you learned in first or second year will help you in the hospital/clinic
4. Real patients are much easier to talk to than standardized patients
5. You start off the year thinking “holy crap, this is so cool that I get to talk to patients on my own!” and you end the year thinking “what the hell does this stupid patient want from me now?”
6. At least once a day something a patient says will make you want to roll your eyes. Resist!
7. From now on, instead of complaining about classes or classmates, you complain about your attending or your resident.
8. 9-5 is awesome hours. Truly incredible.
9. Sleeping with residents is a bad idea. Sleeping with fellow med students is a worse idea. When in doubt, go for the resident
10. At some point, you will get covered in a disgusting body fluid
11. No one will ever page you when you’re on overnight call. But you’ll lie awake worrying that you’re gonna miss something so you’re not gonna get good sleep anyway
12. After surgery, you will not have any problems standing for long periods of time. Until then, however, your feet, knees, and lower back are going to kill you
13. You will forget 90% of what you learned for Step 1 during the month after Step 1
14. You start to refer to drugs by their trade name instead of their generic name
15. You absolutely love patients who have a list of medications on their person. Bonus points if they include dosages
16. At some point during the year someone will be out to get you and make your life miserable
17. At some point during the year you will cry. If you’re lucky, it won’t be in public.
18. Waking up at 6AM is known as “sleeping in”
19. Saturday call is the worst because then you’re at the hospital every. Single. Day. Sunday call is slightly better because at least you get half of Monday off.
20. Most of your psych patients will be offended when you tell them that you’re from the department of psychiatry. Think about it, how would you feel if your doctor decided you’d benefit from talking to some stranger and possibly getting drugged?
21. You will get sick during your peds rotation. Because no one can fight 6 weeks of preschoolers coughing in their face.
22. How much patients like you is directly related to how much they know about the medical training process. If they know that as a student you can’t do much, they’re gonna be annoyed that you’re wasting their time by talking to them
23. You’ll have to hug a patient at some point during the year. Try not to make it awkward.
24. How nice you think a resident is is directly related to how early he/she lets you go
25. How much you enjoy getting pimped by your attending is directly related to the number of hours of sleep you got the night before. If you were on call, you’re going to be miserable as hell and you won’t remember anything after that exchange anyway.
26. Someone will probably throw something at you. If you’re lucky, it won’t be a scalpel.
27. There is still a disturbing amount of mindless busywork
28. Thanks to all the ethics education in first and second year, if you see someone doing something unethical, you feel guilty about it. You won’t actually stop him/her but at least you’ll feel bad about it
29. 1 year check-up for well-controlled hypertension is never an exciting office visit. Especially when you have 20 of them in the same day, in a row.
30. You’ll probably worry about killing someone but you will never even get close to having the opportunity, so don’t sweat it.
31. Anything the attending can do with you, he/she can do faster without you. Trust me, you’re not really an integral part of the healthcare team
32. A lot of time is spent waiting for someone to tell you what to do. Then you usually get told to go study until it’s time to round again
33. Teaching rounds can go on for over 6 hours. Pee beforehand and wear comfortable shoes
34. You start to look forward to shelf exams because you get to see your friends and wear jeans
35. Most people lose weight during their surgery rotation. But there are a few lucky people like me who don’t because they go home and eat 2500 calories every night because they’re so hungry from not eating all day
36. White coats do not stay white for very long. And it’s impossible to get the gray off the cuffs.
37. Wearing scrubs saves a lot of time in the morning. But you can only get away with that during surgery and parts of OB
38. Long hair gets in the way of everything. Cut it or pull it back.
39. Dangly earrings also get in the way. Stick to studs, especially in the OR
40. Ties get in the way. Consider investing in a tiepin
41. Make sure you clean out the pockets of your white coat every few weeks because a lot of crap can accumulate. Most of it will need to go in the shredder.
42. Whenever you go to use your penlight, the battery will be dead. This is especially annoying since you only use it once or twice the whole year.
43. Almost every patient you have in OB will be younger than you and have many more kids
44. Away rotations can be awesome because you don’t have to do weekends and usually they start later. Downside is, if you don’t like your attending, you’re staring down the face of 4-6 long weeks together.
45. If someone does something inappropriate to you, report it. It’s ok. Seriously.
46. You get really sick of your wardrobe really quickly. And you have to stop buying t-shirts and instead buy button downs. It gets expensive
47. You develop the ability to go for long hours without peeing
48. You will discover that you hate a lot of things you didn’t think you would hate
49. If you’re lucky, you’ll also discover that you like a few things you didn’t think you would like. If not, well, that’s OK too. There’s always 4th year electives
50. You start to pray that nothing happens that can only be taken care of during business hours.
51. You also start to pray that your car won’t break down.
52. You stop being good at sitting through class and all of a sudden, class 9AM-noon becomes a big deal
53. Be nice to nurses. Really, really, really, really nice. Because holy crap, if they don’t like you, they’ll make your life miserable.
54. That being said, nurses tend to be much nicer to male med students.
55. You don’t study as much. There’s not as much incentive when you have an exam every 6-12 weeks.
56. A lot of days it is perfectly acceptable to answer “how are you?” with “I’m in hell”
57. Patients don’t like being woken up at 6AM when you’re prerounding. It’s hard to feel all that sympathetic when you’ve been up since 4:30AM
58. You start to get really pissed at trauma victims for being dumb enough to have some sort of trauma in the first place
59. Most attendings/residents do not put all that much thought into your evaluation. This usually means you get mostly “excellents” and their secretary writes you a nice comment (if they don’t have a secretary, you don’t get a comment)
60. At some point during the year you start to flip out about the fact that you’ve hated everything thus far
61. You get massively burnt out after winter break. And then you sit at your computer when you should be studying and write lists of things you wish you had known before starting third year
62. The housing at most away rotations is terrible. But you usually get free food.
63. If you get an hour off in the middle of the day, use it to go work out. Because you never know when you’re going to get to leave and at least that way you’ve worked it in.
64. The proper way to greet other MS3s is to say “what are you on now?” This is different from the proper way to greet other MS2s, which is to say “what’s your rotation schedule like next year?”
65. There will be a few people who will be in everything with you. Ideally you get along with them, if not, well, you probably will by the end of the year
66. If someone is not in a rotation with you, you will not see him/her for the duration of that rotation
67. You get good at writing SOAP notes while walking or standing up
68. It will take you over an hour to do a good H&P your first few times. Then you’ll hand it off to the resident and he’ll say “I’m not going to read all this crap” and sign the bottom
69. You get tired of signing your name on all your notes. Just using your initials followed by “MS-3” is OK
70. All of your attendings and residents will have some sort of weird quirk. My attending now disappears into the bathroom with a book every day for half an hour, one of my residents would only wash one of his hands, a different one used to chew up his Styrofoam cups and spit out the pieces…you get the idea
71. Carry gum on you. Then you look like a stud when the resident asks if anyone has a piece of gum. This will help your evaluation more than knowing the correct dose of calcium gluconate given in acute hyperkalemia
72. Drug company lunches are awesome. Free food and you don’t have to make awkward small talk with your attending/nurses/residents because the drug rep does all the talking
73. Never, ever, ever, ever disturb a nurse while he/she is eating. They will kill you. Or they’ll spread nasty rumors about you.
74. The nurses in the MICU are vicious. The only nurses worse than that are the ones in the SICU who come up with nasty nicknames for all the med students.
75. Your pen will die when you need it most. Carry around a few of them.
76. Your last patient of every day will always have several chronic problems and several acute problems and the whole situation will take over an hour. Guaranteed.
77. You start to pick review books based on whether or not they’ll fit in your pocket. If they don’t, don’t use them!
78. You start to realize how scary the prospect of old age really is
79. You realize that you never ever ever ever ever want to go to the hospital for any reason
80. If you need to see a doctor for any reason, you’ll probably wind up seeing one of your attendings. Don’t have a urologic/gynecologic problem.
81. Despite the fact that you spent most of second year memorizing drug side effects and contraindications, no one really pays attention to them in the real world.
82. Same with CYP450 inducers/inhibitors. No one actually adjusts the dose to account for that.
83. All you talk about is your patients. Non-med students only find it interesting for 10 minutes or so. Med students are just waiting for you to stop talking so they can talk about their patients.
84. There are a lot of things you didn’t realize people actually got. Like DVTs, esophageal adenocarcinoma, hemorrhagic cystitis, and all that other stuff that you assumed was just an empty threat.
85. Clicky pens save a lot of time
86. But don’t put them in your mouth. Think about where they’ve been
87. You can only use hand sanitizer three times in a row before you develop a sticky layer of goo on top of your hands
88. The correct answer to “would you like to do this?” is always “wow, can I?” regardless of what exactly “it” is. Get excited about doing rectals, honey
89. Eat when you can
90. Drink when you can
91. Sit when you can
92. Pee when you can
93. If there is only one chair in the vicinity, the attending gets it
94. When things get really bad, shut your eyes for a second and try to breathe through it
95. Clean your stethoscope off in between patients or stick it in a rubber glove. And if the patient’s in isolation and they have scopes in there, just use those instead of yucking up yours
96. Every now and then you start to feel kind of competent. It doesn’t last, but it’s nice to just enjoy the moment sometimes
97. Compliments are few and far between
98. You start to realize that all those other med students were not just crazy and whiny when they said third year was long and hard. You’re probably not going to be any better at it than they are
99. You realize that interns are the most miserable people on earth and you become slightly scared of graduating because you don’t want to be that unhappy
100. At the same time, man, are you ready to get the heck outta dodge
101. Toward the end you kind of hit your stride. Either that or you care less that you didn’t. Maybe a combination of the two, it’s hard to tell the difference.
My absolute best wishes to everyone studying for the USMLE and have a great night, everyone!
-jess
Third years/fourth years/residents/etc. please feel free to add to the list.
101 Things I Wish I Had Known Before I Started Third Year
1. If there’s anything else in life you want to do, take a year off
2. In theory, the MS3 year is significantly more exciting than it is in practice
3. Nothing you learn in the hospital/clinic will help you on the shelf exam. Nothing you learned in first or second year will help you in the hospital/clinic
4. Real patients are much easier to talk to than standardized patients
5. You start off the year thinking “holy crap, this is so cool that I get to talk to patients on my own!” and you end the year thinking “what the hell does this stupid patient want from me now?”
6. At least once a day something a patient says will make you want to roll your eyes. Resist!
7. From now on, instead of complaining about classes or classmates, you complain about your attending or your resident.
8. 9-5 is awesome hours. Truly incredible.
9. Sleeping with residents is a bad idea. Sleeping with fellow med students is a worse idea. When in doubt, go for the resident
10. At some point, you will get covered in a disgusting body fluid
11. No one will ever page you when you’re on overnight call. But you’ll lie awake worrying that you’re gonna miss something so you’re not gonna get good sleep anyway
12. After surgery, you will not have any problems standing for long periods of time. Until then, however, your feet, knees, and lower back are going to kill you
13. You will forget 90% of what you learned for Step 1 during the month after Step 1
14. You start to refer to drugs by their trade name instead of their generic name
15. You absolutely love patients who have a list of medications on their person. Bonus points if they include dosages
16. At some point during the year someone will be out to get you and make your life miserable
17. At some point during the year you will cry. If you’re lucky, it won’t be in public.
18. Waking up at 6AM is known as “sleeping in”
19. Saturday call is the worst because then you’re at the hospital every. Single. Day. Sunday call is slightly better because at least you get half of Monday off.
20. Most of your psych patients will be offended when you tell them that you’re from the department of psychiatry. Think about it, how would you feel if your doctor decided you’d benefit from talking to some stranger and possibly getting drugged?
21. You will get sick during your peds rotation. Because no one can fight 6 weeks of preschoolers coughing in their face.
22. How much patients like you is directly related to how much they know about the medical training process. If they know that as a student you can’t do much, they’re gonna be annoyed that you’re wasting their time by talking to them
23. You’ll have to hug a patient at some point during the year. Try not to make it awkward.
24. How nice you think a resident is is directly related to how early he/she lets you go
25. How much you enjoy getting pimped by your attending is directly related to the number of hours of sleep you got the night before. If you were on call, you’re going to be miserable as hell and you won’t remember anything after that exchange anyway.
26. Someone will probably throw something at you. If you’re lucky, it won’t be a scalpel.
27. There is still a disturbing amount of mindless busywork
28. Thanks to all the ethics education in first and second year, if you see someone doing something unethical, you feel guilty about it. You won’t actually stop him/her but at least you’ll feel bad about it
29. 1 year check-up for well-controlled hypertension is never an exciting office visit. Especially when you have 20 of them in the same day, in a row.
30. You’ll probably worry about killing someone but you will never even get close to having the opportunity, so don’t sweat it.
31. Anything the attending can do with you, he/she can do faster without you. Trust me, you’re not really an integral part of the healthcare team
32. A lot of time is spent waiting for someone to tell you what to do. Then you usually get told to go study until it’s time to round again
33. Teaching rounds can go on for over 6 hours. Pee beforehand and wear comfortable shoes
34. You start to look forward to shelf exams because you get to see your friends and wear jeans
35. Most people lose weight during their surgery rotation. But there are a few lucky people like me who don’t because they go home and eat 2500 calories every night because they’re so hungry from not eating all day
36. White coats do not stay white for very long. And it’s impossible to get the gray off the cuffs.
37. Wearing scrubs saves a lot of time in the morning. But you can only get away with that during surgery and parts of OB
38. Long hair gets in the way of everything. Cut it or pull it back.
39. Dangly earrings also get in the way. Stick to studs, especially in the OR
40. Ties get in the way. Consider investing in a tiepin
41. Make sure you clean out the pockets of your white coat every few weeks because a lot of crap can accumulate. Most of it will need to go in the shredder.
42. Whenever you go to use your penlight, the battery will be dead. This is especially annoying since you only use it once or twice the whole year.
43. Almost every patient you have in OB will be younger than you and have many more kids
44. Away rotations can be awesome because you don’t have to do weekends and usually they start later. Downside is, if you don’t like your attending, you’re staring down the face of 4-6 long weeks together.
45. If someone does something inappropriate to you, report it. It’s ok. Seriously.
46. You get really sick of your wardrobe really quickly. And you have to stop buying t-shirts and instead buy button downs. It gets expensive
47. You develop the ability to go for long hours without peeing
48. You will discover that you hate a lot of things you didn’t think you would hate
49. If you’re lucky, you’ll also discover that you like a few things you didn’t think you would like. If not, well, that’s OK too. There’s always 4th year electives
50. You start to pray that nothing happens that can only be taken care of during business hours.
51. You also start to pray that your car won’t break down.
52. You stop being good at sitting through class and all of a sudden, class 9AM-noon becomes a big deal
53. Be nice to nurses. Really, really, really, really nice. Because holy crap, if they don’t like you, they’ll make your life miserable.
54. That being said, nurses tend to be much nicer to male med students.
55. You don’t study as much. There’s not as much incentive when you have an exam every 6-12 weeks.
56. A lot of days it is perfectly acceptable to answer “how are you?” with “I’m in hell”
57. Patients don’t like being woken up at 6AM when you’re prerounding. It’s hard to feel all that sympathetic when you’ve been up since 4:30AM
58. You start to get really pissed at trauma victims for being dumb enough to have some sort of trauma in the first place
59. Most attendings/residents do not put all that much thought into your evaluation. This usually means you get mostly “excellents” and their secretary writes you a nice comment (if they don’t have a secretary, you don’t get a comment)
60. At some point during the year you start to flip out about the fact that you’ve hated everything thus far
61. You get massively burnt out after winter break. And then you sit at your computer when you should be studying and write lists of things you wish you had known before starting third year
62. The housing at most away rotations is terrible. But you usually get free food.
63. If you get an hour off in the middle of the day, use it to go work out. Because you never know when you’re going to get to leave and at least that way you’ve worked it in.
64. The proper way to greet other MS3s is to say “what are you on now?” This is different from the proper way to greet other MS2s, which is to say “what’s your rotation schedule like next year?”
65. There will be a few people who will be in everything with you. Ideally you get along with them, if not, well, you probably will by the end of the year
66. If someone is not in a rotation with you, you will not see him/her for the duration of that rotation
67. You get good at writing SOAP notes while walking or standing up
68. It will take you over an hour to do a good H&P your first few times. Then you’ll hand it off to the resident and he’ll say “I’m not going to read all this crap” and sign the bottom
69. You get tired of signing your name on all your notes. Just using your initials followed by “MS-3” is OK
70. All of your attendings and residents will have some sort of weird quirk. My attending now disappears into the bathroom with a book every day for half an hour, one of my residents would only wash one of his hands, a different one used to chew up his Styrofoam cups and spit out the pieces…you get the idea
71. Carry gum on you. Then you look like a stud when the resident asks if anyone has a piece of gum. This will help your evaluation more than knowing the correct dose of calcium gluconate given in acute hyperkalemia
72. Drug company lunches are awesome. Free food and you don’t have to make awkward small talk with your attending/nurses/residents because the drug rep does all the talking
73. Never, ever, ever, ever disturb a nurse while he/she is eating. They will kill you. Or they’ll spread nasty rumors about you.
74. The nurses in the MICU are vicious. The only nurses worse than that are the ones in the SICU who come up with nasty nicknames for all the med students.
75. Your pen will die when you need it most. Carry around a few of them.
76. Your last patient of every day will always have several chronic problems and several acute problems and the whole situation will take over an hour. Guaranteed.
77. You start to pick review books based on whether or not they’ll fit in your pocket. If they don’t, don’t use them!
78. You start to realize how scary the prospect of old age really is
79. You realize that you never ever ever ever ever want to go to the hospital for any reason
80. If you need to see a doctor for any reason, you’ll probably wind up seeing one of your attendings. Don’t have a urologic/gynecologic problem.
81. Despite the fact that you spent most of second year memorizing drug side effects and contraindications, no one really pays attention to them in the real world.
82. Same with CYP450 inducers/inhibitors. No one actually adjusts the dose to account for that.
83. All you talk about is your patients. Non-med students only find it interesting for 10 minutes or so. Med students are just waiting for you to stop talking so they can talk about their patients.
84. There are a lot of things you didn’t realize people actually got. Like DVTs, esophageal adenocarcinoma, hemorrhagic cystitis, and all that other stuff that you assumed was just an empty threat.
85. Clicky pens save a lot of time
86. But don’t put them in your mouth. Think about where they’ve been
87. You can only use hand sanitizer three times in a row before you develop a sticky layer of goo on top of your hands
88. The correct answer to “would you like to do this?” is always “wow, can I?” regardless of what exactly “it” is. Get excited about doing rectals, honey
89. Eat when you can
90. Drink when you can
91. Sit when you can
92. Pee when you can
93. If there is only one chair in the vicinity, the attending gets it
94. When things get really bad, shut your eyes for a second and try to breathe through it
95. Clean your stethoscope off in between patients or stick it in a rubber glove. And if the patient’s in isolation and they have scopes in there, just use those instead of yucking up yours
96. Every now and then you start to feel kind of competent. It doesn’t last, but it’s nice to just enjoy the moment sometimes
97. Compliments are few and far between
98. You start to realize that all those other med students were not just crazy and whiny when they said third year was long and hard. You’re probably not going to be any better at it than they are
99. You realize that interns are the most miserable people on earth and you become slightly scared of graduating because you don’t want to be that unhappy
100. At the same time, man, are you ready to get the heck outta dodge
101. Toward the end you kind of hit your stride. Either that or you care less that you didn’t. Maybe a combination of the two, it’s hard to tell the difference.
My absolute best wishes to everyone studying for the USMLE and have a great night, everyone!
-jess