Maximizing Your Second Student Year To Prepare For Clinic

Less than a year ago, during my last semester of the second year, I was taking a course called Fundamentals of Podiatric Practice II. The course was a great primer for soon-to-be third-year student doctors preparing to enter the clinical setting. In order to complete the course, one of the requirements was to shadow upperclassmen down at Temple’s Foot and Ankle Institute, and learn how to write a SOAP (subjective, objective, assessment, plan) note.

This was very exciting to me. It was an opportunity to get a glimpse of what I will be doing for the remaining half of my podiatric medical education. However, as I entered the patient room, that excitement was quickly accompanied by a lingering anxiety. As I watched my colleague, who was a third-year student at the time, confidently interview his patient and deduce medical diagnoses from findings, I pondered over my preparedness for such a day when I will walk in his moccasins and a second-year student will be shadowing me.

That experience revitalized my efforts to make the best of the second year. For the remainder of the semester and as I began to study for part one of the American Podiatric Medical Licensing Examination (APMLE), I would approach the material I was learning with a concluding thought: “How will this apply to me next year in clinic?”

As a third-year student today, I can say with credence that such an approach is not only helpful but necessary for the incoming third-year student. The difference between merely learning that fluoroquinolones can cause the adverse effect of Achilles tendinopathy and, for example, correlating such a fact with the need to ask your first patient with Achilles pain if he or she is on any antibiotics, is a missed diagnosis.

Metaphorically, clinical practice utilizes a completely different part of the brain. Often, you are working backward to connect a sign or symptom to a pathology, and a pathology to an etiology. Imagine being told to recite the alphabet backwards when you have done it the other way around your whole life. Sure, you might eventually do it but it will take longer to accomplish. That is why it is important to adjust the way we process medical knowledge in our pre-clinical years. Constantly creating hypothetical clinical scenarios based on the material you are learning serves the purpose of fine-tuning all your didactic knowledge and repackaging it for the white-coated student doctor. It is no coincidence that there is an emphasis on clinical vignette-style questions in medical school.  

Tackling your studies from that angle will serve you greatly on the road ahead but in fairness, no preparation will spare you the intimidating experience of your first plunge. However, just like when you first learn to swim or ride a bike, that day will mark the beginning of an enriching trajectory. Before you know it, interviewing patients and presenting to clinicians will become a natural and routine part of your day. Even only a few weeks into clinic, you will look back at your second year self and chuckle at the thought of how uncomfortable you once were with performing the simplest of tasks.

That day will come sooner than you think and you will be very proud of how far you and your colleagues have come along.

Follow the author on Twitter at @RamiBasatneh.