For the students who have survived their foray into clerkship, congratulations for making it this far. You are only a year away from finishing your medical schooling. Here are some words of wisdom as you draw closer to the end as an undifferentiated stem cell and down the new path as a resident.
It still shocks me that I am only a few days away from beginning my residency. Four years have come and gone. I now have a degree and letters behind my name to show for it. This last year has presented with its own unique challenges and a lot has changed in four years. Let’s have a look back.
It was here that I first learned how to correctly use my stethoscope, how to speak with patients, and how to act like a doctor. These were my baby steps. I studied a whole host of topics, covering the broadest and biggest organ systems. It was also here that I learned anatomy and had the privilege to work with cadavers.
In many respects this was the most stressful year. While clinical work is taxing in its own right, nothing came close to the mental toll this year had on me. Studying was both a necessity and a compulsion. Easily I spent entire days sitting a library, reading, memorizing, understanding. I had never studied that much in my entire life.
This time, the stresses of clinical work were balanced between the mental and the physical. By far the most challenging year of all but also the most enjoyable. Having sat in class for the better part of my life, now I would have to do.
It was an adjustment to work in a hospital, to see volumes of patients, to do call shifts. But I adjusted and grew used to the pace of the ward. Gradually, I learned to move from knowing how, to showing how, to doing.
On top of the clinical work, I had a number of additional challenges this year. I had an all encompassing OSCE, residency applications and touring, and a licensing exam to complete. By this point, clinical rotations were not quite as overwhelming or scary as they used to be, but I still had many hard days.
The brunt of the stress this year came from the latter additions. Those three things were for all the marbles, and the consequences of missing any one of those were a constant worry. The OSCE wound up showing some of my weaknesses that I would need to improve on. The CaRMS tour would take me across the country from colder to coldest winters in Canada. The licensing exam ended up being a two-week mad dash to the finish line. For six months, the pressures mounted through these three main events.
But I eventually reached the end of my four year journey. I graduated, I was admitted to a residency program, and I passed my exam.
It has been a roller coaster ride through four years of medical school. I am happy I could document it all here in these posts. Now I start a different journey through residency and look forward to reflecting more on this new adventure.
For the third and last time, we walked across the stage to receive our medical diplomas from the dean of medicine, conferred to us by the president of the university. Convocation was the final chapter of our graduation.
Finally after eight years of university schooling, I was an alumni. It took tremendous amount of academic fortitude to reach this point. But it also would not have been possible without the support and understanding of my family and friends. These are the unsung heroes, the honorary MDs who were there when I took my first blood pressure reading, who volunteered for my abdominal exam, who learned and taught me about being a patient and being a physician.
The graduation festivities continued today with valediction speeches and some key words of wisdom from classmates and physicians respectively. Instead of donning the white coat today, I received my graduation gown for the hooding process. This is the act of conferring an academic hood to signify the completion of my degree in medicine. In addition, we all swore our Hippocratic oath for the first time while preceptors and physicians present for the event reaffirmed theirs.
"Nelson Mandela once said: ‘It always seems impossible until it is done.’"
That was how our graduation ceremony began. We were ushered into a hall where our friends and family were gathered; some of our preceptors were also able to take the day off to watch us make the transition into residents. It would be the first of three parts to my graduation.
A number of speeches were planned for the event. Some recounted the establishment of the school, its goals and its aspirations; others offered words of wisdom, advice from one generation of doctors to the next; each had a special place in the ceremony.
The main event for the day however was the donning of our white coats. Gone are the days of short white coats that separated us from our attendings. As the roll call came out, establishing where we had matched to for residency, we each received a long white coat, embroidered with the coveted title we had worked four years to achieve:
Sir Winston Churchill once said: "If you are going through hell, keep going."
Today, I finished writing the MCCQE part one, a seven-and-a-half hour endurance test that could procedurally scale its own difficulty as I wrote it. Just when I thought I had a good handle on the material, the questions of the next section would get harder. The more worrisome trend was when the questions seemed to get easier: did I make a lot of mistakes?
It was an exam that prevented me from resting on your laurels, generating questions that were matched to my very own ability to answer. And yes, this did happen on multiple occasions.
But no more.
While I still need to wait for the results of the exam (and I hope I passed), I have slogged through hell and survived.
Now, the real celebrations can begin.
I expect I will not be posting very much over the course of the coming week as the MCCQE part 1 is fast approaching. I thank you all for your patience and understanding.
I hope to see you all on the other side.
Tom of the Medical State of Mind