From The Lecture Hall To The Hospital: The Pre-Clinical To Clinical Transition

What does it mean when someone is BIBEMS? Wait, so that wasn’t the attending? When does the cafeteria open? Why do I feel so lost?

I vividly remember the excitement, anticipation and fear that set in on my first day of clinical rotations in medical school. In hindsight, I realize it was normal to feel anxious about entering a new, unfamiliar setting. The aim of this article is to provide general principles to help guide you through your transition to uncharted territory as a clinician student.

Professional Experience and Clinical Knowledge: The Two Halves of Your Clinical Year
As you transition from your pre-clinical years of medical school to your clinical ones, it is important to keep in mind that in addition to classroom learning, medical education requires practicing clinical experience. Communication, workflow efficiency and logistics are not emphasized in pre-clinical education. These skills are not tested with multiple-choice examinations, but instead obtained through professional experience. Bridging the gap between these two halves will be a primary challenge of your clinical year.

As a first step, it will be important to acknowledge this gap and proactively develop strategies to overcome it. Make phone calls, read all the notes in your patient’s chart from the social worker and try to understand what your residents are doing when entering admission order sets. Along these lines, be sure to ask questions when time allows – it’s a lot easier to familiarize yourself with workflow when a resident is involving and guiding you through it. Once you feel more comfortable in a practicing medical environment, you will feel more confident and allow yourself to focus on your patients’ medical issues.
In contrast to practicing clinical experience, the study of clinical medicine will be more familiar to you. By this point, you are virtually an expert at studying for exams. Answering practice questions and sifting through flashcards will feel far less foreign than placing consults and following up on discharge disposition. The exam content in your clerkships directly builds upon the basics you have honed during your pre-clinical years, albeit more nuanced and application-based. With some adjustments and continued focus, the skills that have helped you succeed thus far will continue to serve you well.

Medical information may seem foreign to you again. It isn’t.
When you begin your clinical year, you will feel overwhelmed by the speed and volume of information being conveyed – acronyms, brand names and abbreviations are ubiquitous. Although these may seem foreign, it is important to recognize that you are already familiar with the underlying principles behind your patient’s care. I would encourage you to find a way to simplify each patient’s disease into concepts that you are already familiar with, and only then begin filling in the details. This may make you feel like you are not focusing on the important, “upper-level” details that you ought to be – I assure you this isn’t the case. I have found that many attending physicians truly appreciate students’ questions about the underlying pathophysiology behind clinical decisions being made.
Embrace the Socratic method.
For many, the Socratic method is considered the cornerstone of clinical, or bedside, teaching. By the end of your pre-clinical years of medical school, you are accustomed to being presented a large volume of information neatly and concisely. In most of your early curriculums, teaching is primarily done through large lectures where there is not much room for individual engagement. Bedside teaching is quite the opposite. Attending physicians and residents will ask questions to you, individually, about patients. You will not know the answers to some of these questions, and you are not expected to. Not knowing the answer is part of the growth process in your career in medicine. Treat each question not as a test, but a learning opportunity.
For most, the start of clerkships will mark your entry into patient care. Don’t be shy about feeling excited – this is why you wanted to become a physician in the first place. While extremely rewarding, the transition to clinician student can be a challenge. Sticking with your study habits, embracing the Socratic method and becoming comfortable with workflow will help make this transition an easier one.

I would like to give a huge thanks to Dr. Eric Barna, assistant professor of Internal Medicine at Icahn School of Medicine at Mount Sinai, for his guidance and help with this article.
Posted by Ara Vartanyan on Jul 25, 2019 7:12 PM America/New_York