Medical Maturity

Mid-April is an interesting time for us second years. There is a realization that the end is almost upon us. We are just weeks away from actually putting on the white coat and stepping into the hospital. There will be no more hiding behind security of textbooks and multiple choice tests. The patient won't present with easy answers or straight forward diagnoses. The people we meet won't be actors, and the write-ups and SOAP notes won't be fake. As third years, we will be part of a care team, and our knowledge and ability to learn hands-on are important. Gone are the days of being graded on our biweekly electronic efforts. The only grade that matters is the health of the patient.

But we're not there yet. As we start our final block of course work, the Boards loom in the background. There is a ton of studying to do before July 1 and before putting on that white coat. Now I assume that most of us can't wait for this test to be over (I'm counting the days). But again, there is some security in sense that the classroom is what we are used to, it's what is comfortable. For as long as I can remember, performance has been judged on being able to pick the right answer out of A, B, C, D, and E. For years, a mistake on an exam has only meant a few points on a test score. But after June 8th, my actions and decisions no longer affect just me. Sure, there are SHELFs and plenty more computer-based examinations down the road. But mistakes in the real world have different consequences.

Don't get me wrong; I welcome this change. I also realize that the reason I have 2 more years of medical school, 3+ years of residency, and then fellowship, etc. is because ultimately it takes years and years to be ready to take on this responsibility. There is a lot to learn in the process though. There is a big difference between correctly knowing to do a lumbar puncture between L3/L4 or L4/L5, and actually tapping a patient. This past Introduction to Clinical Medicine session, we started learning how to write admission notes and present patients on hospital rounds. I looked around at my fellow classmates and we all looked anxious and unsure. We probably will be walking around the hospital dazed and confused for quite a while. Yet every year thousands of medical students do it, and we are just the next in line. The mistakes we make have been made time and time again, year after year. So I guess I find comfort in the follies of my forebears...

These next few weeks are the calm before the storm. I was waxing philosophical with Ronnie the other day about what a difference a year makes. It is something that I like to call "medical maturity," and a year ago, I didn't have it. For a long time I've known that medical school is where I want to be, but the focus and drive to really own that responsibility has been lacking. The thirst for knowledge was there, but I've never committed to it. College was about scraping by and always doing the absolute minimum to succeed. Perhaps that was important at the time; it was about figuring out who I am (even though I still need a few more years for that one), and balancing commitments to athletics, school, friends, family, etc. And that was tough. I truly believe if I didn't care about school, I would have been a better swimmer. And if I didn't swim, I probably would have been a better student. Now that excuse is out the window. However, even a year ago, I wasn't ready for that challenge. I was still okay with skating though, doing a million things at once, and pushing responsibilities to that last minute. Medical maturity is the focus and realization that this stuff is kind of important, and that we'd all like to be good at what we do. I think many people enter med school with that level of commitment. For others like myself, that maturation process takes longer. I'm further along this road than August 2009, but I still struggle to find balance.

And as I worry about what third year will bring, the 7 of us heading off to Asheville received an introduction to the program from our Director. There are a few "unwritten rules" about next year that he shared with us. I read down the list and realized that none of them had anything to do with medicine. It reminded me of one of my favorite posters: "Everything I Ever Learned, I Learned in Kindergarten." But these rules are often forgotten:

1. Be on time.
2. Do what you say you are going to do.
3. Work hard.
4. Dress professionally.
5. Be nice to people.
6. Be positive.
7. Admit when you are wrong.
8. Say you don’t know when you don’t know.

Keeping these in mind makes the transition easier, but I won't be surprised when we lose track of some of these unwritten rules. Maybe it wouldn't be a bad idea to throw these up on the mirror to see before work every day. Can't hurt.

Someone once told me that if you should up 5 minutes early and smile, you're 95% there.

I think I can do that.