I recently headed off to a reception for students from the new Pacific Northwest University of Health Sciences in Yakima, WA who are spending their third year of osteopathic medical school in Puyallup, WA doing rotations with the physicians in our community. I’ve had a student with me recently, and it brings back memories of my third year in med school, and how things have changed. It also leads me to mull over why I’m choosing to take on this uncompensated work.
In my third year of med school at Tuft’s University School of Medicine in Boston I opted to spend my whole third year at Maine Medical Center in Portland, ME. Looking back this was one of the defining decisions I made.
It let me see how medicine was practiced in a smaller community than Boston, and in a far more progressive environment. In Boston third year students were first and foremost unpaid labor, pushing patients to and from procedures on gurneys and in wheelchairs, drawing blood, starting IVs. They stood on the fringe of large groups of student, resident, and attending physicians hoping to be noticed when they knew something and not noticed when they didn’t. In Portland there were no 4th year students, so we got to do many of the things the fourth year students did in Boston, and because there were relatively few students, there was staff hired to do the simple tasks like getting patients to places and drawing blood each morning. I came back to Boston to start my fourth year far ahead of my fellow students who spent their third year in the mecca in many ways, but far behind in understanding the politics and pecking order that existed in the city hospitals. I felt I had a far better ability to make diagnoses, decisions, and do procedures. I often was chastised for overstepping my unwritten boundaries finding that students “don’t do that” here.
I have a third year student with me in the office now. She’ll stay for 4 weeks studying family medicine. It seems odd to have a student so green working in an outpatient setting. In my third year I really never left the hospital for any training. I met my first outpatients in the few electives of the fourth year. The experience for my student will be vastly different. She will have spent most of her time under my direct observation, watching me, presenting cases to me, and hopefully learning from me. I spent the majority of my time independently seeing patients, checking back with interns and residents, only occasionally with attending physicians, and feeling primarily overwhelmed. She is protected from this type of learning by immersion, and has far closer supervision than I experienced.
The experience for me was so overwhelming that then I lost about 15% or my not overweight body mass in the first 2 months of my third year, until I realized I’d need to make time to eat and sleep to survive. The work was simply never done, and there seemed so much to learn that the days and rotations seemed too short. My student comes to the office at 8 AM, and leaves by 6 PM. I rarely showed up after 6 AM, and never left before 6 PM. I was on call every 3-4th night, and so far I don’t see that she will be on call at all, at least on the FP rotation. Was my experience more intense? Definitely. Will her experience give her a better idea of what primary outpatient care is all about? Definitely.
She will get to see a practicing family physician at work, and hopefully leave respecting that we can do a good job, see lots of patients, and play a valuable role in the medical care of our patients. I chose family medicine really on faith and a gut feeling that it was the best career for me. I had never really seen a civilian, non-hospital based FP work. She will have seen family medicine up close and for real.
Edward Pullen is a family physician who blogs at DrPullen.com.
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