In one week, M2 year will officially end. As I am spending most of my time making a color-coded Excel schedule for boards studying and trying to understand what exactly is a molar pregnancy in Reproduction—our last sequence of the year, I haven’t let the whirlwind of fast endings and boards studying and the beginning M3 year on May 7th sink in. And I’m not sure that it will until I’m hiking in Moab during the few days of decompression time between boards and rotations.
In the midst of the constant studying during M2 year, I haven’t been sure of what I’m actually learning and retaining. But through a new M2 elective in Clinical Reasoning in the Emergency Department, I recently realized how much I’ve learned of this new language, how certain things have come together (and just how many more things need to come together during M3 year—fingers crossed). In this pilot elective, second-year medical students “become” third-year medical students for three hours: the attending physician assigns you and your M2 partner to patients with problems rooted in issues that have emerged in the M2 sequences you have studied, and both of you conduct a history, physical exam, and present your findings and differential diagnosis to the attending. It’s exciting to wear scrubs or professional clothes and a white coat and dash off from my house to the ER on a random Sunday, jamming my stethoscope into my pocket (I’m not sure when I’ll become jaded and this feeling will disappear).
I’ve learned that I will look and feel awkward when waiting to present or discuss findings with my attending–I’ll put my hands in the pockets of my white coat, only to take them out and reach for my smart phone and try to read something pertinent in UpToDate, only to place the phone back in my pocket. I’ve learned what pitting edema feels like: how deeply I can press the skin near the ankle of a patient with congestive heart failure and how slowly the skin normalizes due to the volume of fluid. I’ve learned how to elicit a patient’s reflexes without a hammer and just with the side of my hand. When interviewing a patient whose legs were covered with thick, purple scars, I realized in connecting his answers with my mental images of the clotting cascade from our Hematology-Oncology sequence, that what I was seeing was warfarin skin necrosis. As I walked back from the Emergency Department on a Sunday in February, I realized that a year or two ago, I would not have had those mental images or understood most of the discussion (words or content) that I had with the attending after seeing this patient. So perhaps this is part of the transformation—and it’s comforting to realize that perhaps I have learned some things these past 1.5 years. But learning becomes much more tangible when associated with stories and emotions and people, and I’m excited to leave the lecture hall for the clinical world.