Medical students: Welcome to the wards

Dear third-year medical students,

Welcome to the wards.

I remember this stage — basking in the glory of completing pre-clinicals, in the excitement of finally switching heavy textbooks for living, breathing people, in the realization that medical education now lies in the hands of those I wanted to heal. I would be sleeping less, but living more, because this was my purpose.

Remember this moment because this will be the most difficult year yet. Your humanity, empathy, and purpose will be challenged. You’ll experience exhaustion like never before. You’ll be broken down, time and time again. But still, find the resilience to stand. Never forget why you’re here.

Depending on where you start you might have an easier transition. You might find people willing to guide, teach you, take you from classroom to wards. You might be shoved in the operating room the first day and the scrub nurse will stare with eyes of fury as she protects her sterile field. You might be scolded over how you don’t know how to navigate the EMR, drilled on questions you don’t know, over, over, until you feel like you have learned nothing over the past years. This is luck, of who you are paired with, what rotation you begin and what team you’re joining. Some have forgotten they once were where you are now. Don’t let them get to you. You are meant to be here. Look in the mirror every morning with those dark eye bags of courage and bury that imposter syndrome. Every stumble is a lesson learned. Every failure will make you a stronger clinician. Practice, exposure, and experience brings competence. Hang in there.

If you haven’t noticed yet, you’ll begin to see medicine’s imperfections. This will be emotionally draining. You’ll see how overworked we are, the unbelievable patient load we carry, how hard we strive, the countless hours thrown into the closet and how we are fighting an impossible system. You’ll witness social injustices, racial disparities, and it will frustrate you. You’ll try your hardest to help a patient, then learn the hard lesson that you can’t help a person who doesn’t wish to help themselves. Don’t carry their burdens as your own. You’ll see people react differently to stress, the power dynamics in play and witness the medical hierarchy in full force. You must be self-reflective, constantly. You must never take things personally. This is the year budding physician start losing their empathy, remember to chase the silver lining.

Recognize the people you work with are human, show them the compassion, patience you show your patients. Recognize you’re human too, show yourself the compassion, patience and you show everyone else. Know your enthusiasm should never be taken advantage of. If you’re being singled out, treated differently and belittled in a way that doesn’t foster learning, don’t question twice. Reach out, report.

No matter the rotation, know everything about your patient — admission date, vital signs on admit, medications, the images and the findings done. Write lab values. Read all the notes. Never trust the chart entirely, ask the patient. As the student, you’ll be scrutinized, expected to know every detail. But you’ll also know your patient the best and will spend the most time with them. You, the simple medical student, will become their greatest advocate. Talk to the nurses.

Reach out to residents and let them know you’re following a patient, go over assessments and plans before presenting to the attending. Research your patient’s disease process, know it well. This is your patient. Own it. Take the responsibilities of caring for them as if you’re the only one. Your shoulders will learn to carry the weight.

Medicine is a team sport. Your classmates are your colleagues, all that collaborative effort in pre-clinicals should never disappear. Work together. Teach each other. Be on the same page. Arrive around the same time, when a question is directed at your classmate let them answer first, don’t steal patients, work together to carry an equal load and don’t aimlessly stay if your classmate has left. Your colleagues aren’t your competition. They’ll be your fiercest allies, support each other. Navigate through these lessons of humility with comradery. Their bad days will be yours, their missed questions will find you. Your only competition has always been yourself.

Ask for feedback consistently. Take criticism constructively. Enjoy every rotation you are on regardless if you will pursue it; this will be the most exposure you’ll ever get to the variety of medical specialties. Cherish it. When else will you usher a baby into this world, suture a surgical battle scar, witness miracles at the stroke of midnight? Allow yourself to marvel at this privilege.

Last, but not least, no matter how hectic the day is, how busy you are, how drained you feel, sit and talk with your patients. Listen to them. Hold their hand, wipe their tears, create space. You’re the only one with the luxury. Recognize you’re acquiring a massive amount of medical knowledge, but that means nothing if you don’t see the person before you for the human they are if you don’t acknowledge their suffering, if you don’t admire the art in medicine. Allow your patients to teach you and you’ll learn things you can’t even fathom.

Looking back, I see I wear a year of stories and lessons, of joys and heartbreak. They’ve found homes in shadows under my eyes, in valleys of my smiles, in the smile breaking through exhaustion. Stories speaking lifetimes will find you, and encounters settling in your memories will carry you forward. You’ll go through the ringer, as we all must do, but it will make you stronger. You already know the reward is far greater so enjoy this year. You’ll leave it a conqueror, and you’ll become a better physician for it.

I’m excited because I know what this year holds. See you on the wards, show me that bright, enthusiastic smile, those eyes sparking with unyielding passion. Let me see you wear that short white coat so well.