Three Tips for Thriving in the Third Year of Medical School

Show up. While the days of attendance sheets are behind you, you are no longer one in a sea of 185 other students. Now you are one in a group of four to 12 other students. You may be the only third-year student on a team. No attendance sheet necessary—if you are late, it will be noticed. Furthermore, being “there” is not the same as being “present.” A clerk is expected to participate in rounds by asking questions, helping the team with all patient-related tasks and eagerly seeking to work up more patients in an effort to learn and help. Being present also means staying late. A good rule of thumb: give yourself fifteen minutes more than you think you need each morning, and plan to stay late into the evening. Be the first one to arrive at the hospital or clinic each day, and plan to leave with your intern when the work is done.

"...For the sake of your patients, always brush your teeth."

Be prepared.During the first two years of medical school, a student needs only to be prepared for “game day” (also known as exam day), because the entire grade is based on the performance on that day, in those two hours. By contrast, on clerkships, every day is “game day.” Each and every day, students are working with interns, residents and attendings who have a direct influence on the students’ final grades.

The good news is that one bad day will be offset by the 29 other good days you have with the same team. The bad news is that you need many more good days than bad. How does one ensure “good days”?

• For starters, try to rest when you can, eat regularly, drink water (but make sure you know where the bathrooms are) and exercise.

• Read, read, read. Start reading on the first day of the clerkship. See patients and read up on their conditions to lend context to your learning. Write down your questions and make every attempt to answer them on your own. Keep 4×6 index cards in your pocket; when a question comes up on rounds, write it down. Make it your business to look it up that evening, fit your answer on the front and back of the card (tired house staff will be able to pay attention only for a few minutes) and be ready to present it the next day in rounds.

• Stay on top of your patient logs and patient write-ups. Procrastinators do not succeed on the wards. It is not only unprofessional to hand in your assignments late, it is also an important missed learning opportunity, as you will not get feedback in time to apply it to the next assignment due.

• Finally, it’s never a bad idea to keep your most interesting patient’s information on an index card so that when you have a session with, say, the chair and he or she says “Who has an interesting case?” you’re ready to go.

Dress the part. First impressions matter both to the patients and to your teams. Look clean and professional at all times. Jeans and T-shirts are never appropriate when seeing patients. Your white coat should be clean; your slacks should be pressed. If you smoke, this is the perfect time to quit. Brush your hair, and please please please, for the sake of your patients, brush your teeth.

The third year is tough. The third year is physically, emotionally and mentally exhausting. It is also one of the most rewarding and formative years of your life. I know you will all make it, though, and succeed—if you follow Ludwig’s three simple rules.

What are your rules for getting through the third year of medical school? Share them in the comments below. 

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