The major challenge of the second year is to
balance all its demands, namely multi-
ple-coursework, patient responsibilities, and
preparation for tests and Step 1 of USMLE
in June. The second year thus has all the
components to generate a great deal of physical
and emotional stress, and it usually does. The
advice given as to stress management in
the preceding section is obviously applicable
for preventing and/or meeting this year's
challenges. The survival skills developed during
the first year should help ensure satis-
factory completion of the second.
Third-year Guidelines
The beginning of the third year marks a major
turning point in professional medical
education. It represents the onset of a
lifelong involvement with the realities of clinical
medicine.
The initial impact is reflected by the need to
learn how to develop a relationship
with patients. In this regard, medical students
should clarify to the patient and/or the
patient's family their position as being on the
first rung in the medical hierarchy. This
may preferably be reinforced by referring to
oneself as "student Doctor Smith." This
will limit the student's responsibilities to
their appropriate level and permit unanswer-
able patient questions to be referred to the
appropriate authority without embarrassment.
Concomitant with the introduction to patient
care is the impact it has on the attitude
of the medical student toward patients. There
generally (and unfortunately) is a change
in attitude from being service oriented to
being self-education oriented. The goal that
should be sought is the ability to view the
patient simultaneously as a human being and
as a source of biomedical
knowledge.
Another special feature of the junior year is
the development of a relationship with
the house staff. There will be substantial
learning opportunities as well as exposure to
menial routine or "scut" work. Thus the results
can be both exhilarating and rewarding,
and frustrating and depressing. The key to a
meaningful experience is to determine what
the patient's diagnostic or therapeutic plan is
so that you can interact as intelligently as
possible with the other members of the medical
team.
During this year the opportunity to view the
bedside manners of different attending
physicians will be available, perhaps for the
first time. Each will be found to have a dis-
tinctive style that can be instructive to the
doctor-in-training.
Learning to chart, that is, to prepare a
current, clear, concise, and complete record of
the patient's progress, is a significant part
of the educational experience. Finally, a cen-
tral element of medical school experience,
namely the "workup," taking a history and
performing a physical examination, will be
introduced during the junior year.
Developing a positive attitude toward hospital
work routine and critical skills in achiev-
ing a differential diagnosis is the key to
professional success. To master the art of diag-
nosis, one must work out the rationale for
every question and organize questions into
logical groups. Leads should be followed up by
additional questions and a search for
specific physical findings. Thoroughness in
working up the patient will prove most
rewarding for both the practitioner and the
patient.
In summary, the junior year represents a
relearning of the basic sciences in a clinical
setting. Learning the biochemical and
physiological bases of disease mechanisms in the
context of living patients will facilitate
developing the skills to provide therapeutic relief.
The onset of the clinical years is the
appropriate time to learn how to avoid making
mistakes. The three basic rules in this regard
are:
1. Recognize your own limitations. Be prepared
to admit when you feel unquali-
fied to undertake an assigned task. Do not try
to bluff your way through a chal-
lenge or develop an air of bravado that you can
do anything.
2. Don't be afraid of new challenges, so long
as you feel assured you are being
adequately supervised during the course of
carrying them out.
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