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April 18, 2014

Ten Things A Medical Student Should Expect In Clerkship

There are many things a 4th year or 3rd year medical student should look forward to during his or her clerkship. Ah, clerkship! It's that moment in a medical student's life that, well, he would either want to remember forever or just plain forget. Whatever it is, it is a process that no medical student gets exempted from. In order to survive the tumultuous clerkship phase, a medical student must get himself psyched for this experience.

No. 1: Ready to Embrace Stress. Yes, nothing can be more stressful than clerkship. Not only is it physically stressful but also mentally stressful as well. One must learn how to roll with the stress in order for a medical student to see the end of what appears to be an endless tunnel of clerkship. From dealing with patients to dealing with residents and consultants and sometimes menopausal nurses, a clerk can find less stress inside a pressure cooker than being inside the hospital. And it doesn't seem to go away, maybe except when you sleep. Well, maybe not for some. 

No, 2: You are now a Doctor! Or so they think. And your residents as well as your patients will expect that you already know every diagnosis there is in the book. Your consultants will expect you to answer their questions like you are one of their residents. And while you squeeze your brain trying to dig the answer that is probably not there, nearby residents would look at you with facial expressions of "how stupid can you get." So be prepared. Patients will ask you questions and they won't even bother to read your nameplate which clearly tags you as clerk. They will still look up to you as if you are their doctor. And with this misplaced expectation comes the pressure to be able to provide them the answer  they might be searching for. It pays to read ahead, learn the case and stick with the friendlier resident to learn about the science and art of diagnosing and treating patients. 

No. 3: You don't have a Clinical Instructor. Unlike your friends from the college of nursing you are on your own buddy. No C.I. to teach you on site. Need to insert an NGT? Well, you have to learn it by yourself. It is really largely learning by doing during clerkship. Your best teacher can be a friendly nurse, resident, your fellow clerk who already learned how to do those stuff and maybe even your patient. 

No. 4: You will rather sleep than eat. Priorities are priorities. Between sleeping and eating, a clerk, when he or she has spare time, will choose to sleep rather than eat. It's really physiological rather than a conscious choice. Working straight for more than 24 hours every 3 days can be exhausting and the body will definitely search for those missed opportunities. Some clerks have mastered the art of sleepwalking. Others pretend to be wide awake but the brain is actually asleep. It's like having the lights turned on but no one's in the house. This is dangerous. Not only because you might get yourself into an accident but you might get caught by a resident or consultant. 

No. 5: Haggard Is The New Look. Un-brushed hair, unpressed white uniform, droopy eyes, chin-leveled eyebags. You should start getting used to this look. The more haggard you look, the more chances of you getting proclaimed as the outstanding clerk for the year. This does not give you an excuse though to not smelling good. So just because you look like a zombie doesn't mean you should start smelling like a decaying walking dead. 

No. 6: You will start talking like you're charting. When with fellow clerks, you will tend to "talk chart" q 15 mins or PRN, especially when you have been NPO x 5 days. Must start full DAT stat. 

No. 7: Losing your stethoscope can feel like losing a relative. It has become an extension of yourself that you feel that you are not complete without it. Take care of your stethoscope. It is your best instrument next to your brain. Some clerks would start "decorating" their stets with hospital "name tags" or ribbons or other stuff that would make their stet unique. Stets can be expensive so don't misplace your stets. Doing your rounds without your stet can feel like going around the hospital butt naked. 

No. 8: You will write and write and write and....: As clerks, it is your duty to write the patient's history, the patient's progress notes, the patient's discharge summary, the patient's OR tech, the patient's lab request, maybe even the patient's lab and radiological findings. You will write notes and lectures. You will write censuses and endorsements. You will write whatever your resident or consultant would want you to write. Oh, didn't I tell you that you will need to write? 

No. 9: True Friends, Reveal Yourselves. Because of all the stress and pressure, this is the phase in your med school life where you will discover who your real friends are. And the friendships you will forge during clerkship will be the strongest that you will ever have. 

No. 10: You are definitely the lowest animal in the hospital kingdom. This might be already a cliche to you but you will definitely feel this one at the start of day 1 of clerkship. You will lose the comfort of holidays and free time in exchange for the tough love you will get from your residents, interns and nurses. You will have a nameplate but no name. You are what planktons feed upon. You are a speck of dust. 

Fortunately, you won't remain a speck for long. So take this clerkship as a road of transformation, the painful process of a caterpillar growing into a butterfly, the melting of steel inside the hot forge. Clerkship can be harsh but once you survive it, and I know you will, you will look back at this moment of your life this time with an M.D, right after your name. 

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