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Dear Medical Student

Dear Medical Student,

I remember what it was like.

I remember what it was like the week before your clerkships begin, when you spend thirty minutes writing an email to the resident about how you’re excited to work with them, about how you’ve done cardiac stem-cell research and are interested in pursuing cardiology, and what can you do in advance, and oh, where should you meet the team on Monday morning? And they respond, “Great see you Monday 7 – Jack.”

It’s Monday, and you’re not sure if you’re meeting at seven or on floor seven or both, and you’re roaming around the hospital floors, starting to panic. You finally stumble upon the workroom to find Jack, who looks shocked to see you, and then he apologizes because they’re actually starting at eight today and so why don’t you go hang out somewhere for a bit, and you’ll reconvene in an hour. One whole hour? Where will you go? You roam around the floor and find a break room, but when you walk in, you meet the glare of six nurses eating breakfast. You sit in the bathroom for awhile, aimlessly checking your phone, before you finally go to the cafeteria and order food that you don’t eat, because you had breakfast three hours ago when you woke up in a panic and couldn’t fall back asleep.

I remember what it was like to be in the workroom and there are not enough chairs. You can’t tell if it’s better to sit on the garbage bin, which is comfortable but unsanitary, or to stand slightly too close behind the resident who’s nicest to you. The resident looks around and laments the lack of seating before telling you to feel free to work elsewhere, and he’ll give you a call later when they afternoon round, which he forgets to do.

I remember how it feels at 4 pm when you ask the resident if there’s anything you can help with and she says, “No don’t worry, thanks though,” and keeps furiously typing. You scroll through the UpToDate article on hyponatremia for another hour before she exclaims, “How is it 5 pm already? You should go home!”

You get home at six, make and eat dinner, and the next thing you know, it’s 7:30. You open your question bank to study for the end-of-rotation exam and force yourself to do four questions before your eyes are physically closing from exhaustion. You check the list of the 762 questions you have left to do this month with a sick feeling in your stomach before falling asleep.

I remember what it was like when your first attending says, definitively, “Always start your overnight events from morning rounds the day before,” and a week later your second attending scolds you, “They’re called overnight events for a reason: You should only report what happened overnight.”

I remember not knowing what to wear, what to say, what not to say, where to stand, what to do with my hands, when to arrive, or when to leave. I remember not knowing, in certain moments, why I had decided on this utterly insane path for myself.

I remember my expectations for the clerkship year, for what the Dean had called “the magic of taking care of real patients.” I remember crying to my roommate about how simultaneously overwhelming and underwhelming this year was, and what was wrong with me that I didn’t love it? Was I going to be a good doctor? Did I deserve to be?

To you, dear medical student, I say:

I remember.

It gets better.

There is nothing wrong with you.

I am now a resident doctor. I now realize that it’s stress, insecurity and being stretched unsustainably thin that drives us as residents to have bad days, to not teach as much as we should and to not appreciate you sufficiently. You are wonderful—forgive us.

Now that I am part of “the system,” I don’t pretend to have the solutions to these problems, but at least I can be honest about them. I can’t conjure up a chair or summon an extra hour in the day to devote to teaching. Instead, I try to acknowledge the system’s imperfections and my own. I curse the lack of chairs. I laugh at the way that medicine is at least 60 percent style and 40 percent data, even though we pretend otherwise. I tell you “I don’t know” when I don’t. I cram my thirty-minute acid-base talk into the miraculous seven extra minutes we have before lunch. When patient care is crazy and overwhelming, I try to find meaningful ways for you to pitch in. If there are none, I tell you to open up your question bank—or, better yet, to go home.

Don’t get me wrong: The clerkship year contains magic, but it’s buried in a lot of garbage. I think that if we acknowledge the garbage—and thank our medical students for wading through it—we can help them to be genuinely excited about becoming doctors, rather than feeling duped by a system that makes them feel forgotten.

Bear with us, dear medical student—it’s worth it, and there’s magic on the other side.

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Jessie Stuart is a third-year resident in internal medicine at the Brigham and Women’s Hospital in Boston. She is an aspiring oncologist and physician-writer. Her works have been published in the New England Journal of Medicine , the Wall Street Journal, STAT news and Pulse. “This story was inspired by my passion for medical education, my own embarrassing memories as a medical student and my optimism for a future in which clerkship students are meaningfully integrated into care teams and empowered with control over their schedules and lives.”

Comments

12 thoughts on “Dear Medical Student”

  1. J RUSH PIERCE MD

    Very nice Dr. Stuart. I thought the letter motif was very effective. Your descriptions of the anxious uncertainties of a third year medical student are accurate and engaging, and the evolution to the wisdom and insightfulness by residency is nicely done. I very much enjoyed this essay, as I did your NEJM piece, “Making the Call.” I hope you’ll continue to write about your doctoring journey.

  2. Lisa Sieczkowski

    This is amazing. Exactly what I felt 20+ years ago as a medical student and still exactly pertinent. Now, as a residency program director, I want all of my residents to read this.

  3. Dr. Stuart, loved your recollections, thoughtful analysis, and how you used these experiences to improve things going forward. Absurd comments abound in healthcare. I remember years ago being taught how to do urine dipsticks by an instructor who told me, “You ask too many questions” when it was the first and only time I had spoken up in her class. It stunned me but also hit home the importance of not blowing off students’ questions.

  4. Wonderful, supremely evocative essay! Also I remember: the terror, the mix of profound apology and gratitude toward one’s subjects, of learning any procedure that involves piercing a patient’s skin…

  5. David Coulter, M.D.

    Dr. Stuart, please do not ever lose that sense of insecurity and awkwardness, so that you will always be trying to learn and improve. And be sure to find a way to manage the inevitable stress so that you will avoid burnout. And keep writing.

  6. Dr. Louis Verardo

    Dr. Stuart, this was a terrific piece. I am 71 years old, retired, but all my recollections of that time in my training came rushing back. What I remember is a combination of excitement, terror, awkwardness, and the thrill of learning how to actually treat patients.

    Thank you for those memories.

  7. Dana Cook Grossman

    What a touching and powerful piece, Jessie. Kudos to you for coming clean about the process’s shortcomings.

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