During my first year of medical school, I looked forward to writing blog posts. Back then, everything was new so I had a lot to say about what I was experiencing—the clinical exposure, the white coats, the late hours in the library, even the studying itself. The amount of information was overwhelming and the hours slowly melted from day to night, but being a medical student was a new adventure I was just beginning, and I enjoyed it immensely. As a second year medical student, I am still very happy. However, the studying, in my mind, has changed. It’s not new anymore, and as a result the volume of material is starting to feel laborious, the hours a little long, my back a little sore.
The transition from winter to spring as a second year medical student is not a cup of tea. The USMLE Step 1 board exam is fast approaching (we take it in June), so while most people are getting ready to grab a blanket and Frisbee and hit the park, we’re scoping out which local libraries stay open the latest. Just a couple of weeks ago, we took our “mock boards,” pretty much your standard practice test in order to find out how we’d score if we were to take the Step 1 exam right now. The experience helps to clarify the amount of work that will be necessary to successfully prepare for this single 8-hour exam, and while certainly eye opening and even a little scary, it actually feels exciting, too.
As the process of sitting in a chair and learning syllabi grows stale, the scope of medicine is beginning to clarify. My friend Sean likes to say, “you have to know what you don’t know.” That might not make much sense to everyone, but to most medical students it does. During the majority of first year, we didn’t know what we didn’t know, meaning there was so much we didn’t know, the scope of what we eventually needed to know was unclear; medicine was endless, and the knowledge felt infinite. Well, it doesn’t feel that way anymore. Now it’s starting to feel like we know the breadth of what we’re dealing with; when someone says a sentence about heart disease causing liver failure, for example, I can usually understand it. I know some things, and I know what I don’t know, so I know what I still have to learn. The difference is that now I know that I am able to learn it.
A few weeks ago on a Friday night, after eating a delicious calzone from Mellow Mushroom, I, along with a small group of friends went to the World Trade Center here in Portland to watch Code Black, a medical documentary by a resident physician in the Emergency Department in Los Angeles County Hospital. The film was exceptional, largely because it doesn’t have a specific thesis or mission. Instead, it simply documents working residents with a front row seat into their everyday lives at the busiest public-run Emergency Department in the country.
It was a funny experience, watching this documentary. Here I was, thinking I’m really starting to understand this whole medicine thing—cardio, renal, pulmonology, bacteria, viruses—I get it. But sitting in that theatre watching actual doctors work reminded me that I still know very little about the actual career I’m entering. One of the major themes of the film was that these young doctors have to learn to deal with the paperwork and bureaucracy of modern medicine. The hardest aspect of their job is not retaining medical knowledge, but the other intricacies of providing care – the documenting, the social issues, and the number of patients who need attention always outnumbering the number of people there to help. None of this was a total surprise to me, but it was a timely reminder. Right now, I’m becoming a master of the medical knowledge, but Code Black was a reminder that studying has very little to do with the job itself, and instead is simply a prerequisite.
For the next few months, I am an expert at what I do. I am an expert at learning, at studying for long hours at a time, at retaining information in order to answer tricky multiple-choice questions that test my knowledge on every topic of modern medicine. Put me in a hospital and it feels confusing and chaotic, but if you were to put me in front of a graph depicting pressure-volume curves of the human heart, I am home. I look forward to testing the extent of my knowledge this June; people often say the day of your Step 1 Exam is the day you know the absolute maximum amount of facts about medicine. After that, we’ll just have to learn how to apply them.