Tips for Transitioning to Third Year

Clinic years of medical school are vastly different than the preclinical years and require new study habits, work styles, and a lot more people skills. This blog post will acknowledge the big shock that is third year, identify some tips and tricks, and remind students that they are not alone on this crazy med school journey.

Welcome to third year: Expect changes

Congrats! You’ve made it through your preclinical years and knocked out your USMLE® Step 1 exam! Now for the new frontier—clinic work (read more about Clinical Rotations: Expectations vs Reality).

The two biggest changes you’re likely to notice are:

1. Your schedule is no longer your own.

2. You’re expected to work with people all day.

Most programs assign you a new rotation every month, and it is likely that you will work with 2-4 attendings on that rotation. Each rotation, and even each attending, has its own schedule and own set of clinical responsibilities for you to learn and adapt to. For about 8-10 hours a day, you will be on your feet, moving with your team from one patient to the next, and there will be a lot of talking and note writing. It may be helpful to view your new clinical life as a fluid schedule, moving through things as they come, just going with the flow.

New study habits: Osmosis is still your friend

Given that all of your at-home study time is now replaced with clinical work, you’ll need to learn new ways to study.

Much of what you learn during clinicals will be from the clinical experience itself—reading about your patients, listening to your attendings and residents, and watching how medical care happens in real life. A big tip is to find out what your learning style is: listening, watching, hands-on, or reading/writing. When you’re in the clinic, do you learn best by listening to the attending talk through the problem? Or are you the kind of person who needs to read an UpToDate article? Is it more helpful to watch someone deliver a baby, or do you need to be the one doing it with your own hands? Understanding how you learn best, and being able to communicate that to your team, is going to help you learn more, better, and faster.

The phrase “learn from your patients” is going to be a guiding light through your clinical rotations, and I highly recommend it as a learning approach. Each day, pick a patient you are caring for and learn more about their condition. Read the UpToDate article, watch the Osmosis Clinical Reasoning video, and then write down a few notes about what you’ve learned to share with your team tomorrow (use a screenshot from the Osmosis video as a visual for brownie points!). Learning about your patients will better enable you to engage with their care, and over time, you’ll learn most of the big topics you’ll need for your Shelf exam.

To further round out your learning, use UWorld and the Osmosis USMLE® Step 2 question bank to keep your test-taking skills sharp. Many students will work through questions or flashcards during their 5-10 minutes breaks between patients, and over the course of the day will be able to finish a 40-set of questions or make it through their flashcard deck. The key here is making the most of the fragments of time you have- your dedication adds up, I promise.

Common challenges: tips and tricks

The biggest hurdle to starting any new rotation is—where’s my team, and what’s my job? As best as you can, try to contact someone on your new team a few days before you start, and find out when and where to meet them. Once you meet your team, find a resident you like and claim them as your buddy. Having a single person on your team to refer to will help you feel more secure and directed, and will give your clinical experience more continuity (just do everything they do and you won’t miss anything). They can help explain your clinical responsibilities, answer questions, provide help, and give meaningful feedback. As you become more familiar with your team and your role, feel free to branch out and follow other residents, but at the beginning, it is helpful to attach to a single person.

Another challenge is learning how to take care of yourself now that you’re working 60 hrs a week. Because your workday is so fluid and long, it can be helpful to increase the structure of your at-home time. Big things that help are…

Plan to pick up groceries and meal prep on your day off
1. There is not always a protected lunchtime for you to go get food, so having your lunch on hand will save you time, money, and many hungry days
2. Also, snacks are lifesavers!
Commit to an exercise habit before or after work
1. This can be a moving target, as most rotations start very early in the morning, and it’s hard to guess when you’ll get off in the afternoon
2. Some students get up extra early to have their scheduled 30 minute run before they shower and head into the clinic
3. Some students schedule evening exercise classes at the gym
4. I personally try to exercise at whatever time I get home, so the routine is there but the timing isn’t as important
Set alarms to keep a consistent sleep schedule (aim for 7-9 hours)
1. Each rotation starts at a different time, so your sleep schedule will likely move around many times during the year, but as much as possible, go to bed and get up at consistent times
2. Having an established circadian rhythm and sleeping enough hours will keep your energy and mood up, even on hard rotations
Make time for a mindfulness practice
1. Being in the clinic or the hospital all day, surrounded by people, constantly addressing different needs and concerns can be very draining- and it’s important to check in with yourself
2. Adopt a mindfulness practice that helps you check-in with yourself and relax
3. Some options include journaling, deep breathing and meditation, slow walks or yoga
4. These do not need to be long, but even 5-10 minutes at the end of the day can significantly reduce stress and help you rest up and reset for tomorrow

A final note is this: Transitioning to clinical work can be both exciting and overwhelming. Embrace the change and the challenge, and hopefully, you learn fast and grow into your new role quickly. However, if you find yourself struggling, know that you’re not alone and that you can ask for help. You’re going to be stressed and tired, maybe even a little worried, but when it turns into anxiety, depression, or burnout- reach out. Taking care of your mental health is always important, at every stage of your med school journey and beyond.

About Ashley Kennon

Ashley Kennon is a 4th-year medical student at UT McGovern in Houston, TX. She is planning to apply to Pediatrics this year, and eventually hopes to work as a Hospitalist and volunteer as a community health teacher. Outside of medical school, Ashley enjoys dancing, and is even part of an Israeli line dance team!

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