Medical School - 3rd Year

​The Third Year of Medical School: Tips for Successful Clerkships

Before beginning your third year, find a few trusted senior students and discuss their thoughts on how to succeed at your medical school during your clinical rotations. They will likely focus on the importance of professionalism, medical knowledge, and communication.  

Professionalism

Professionalism is key to your success during your third year. Arrive early, dress appropriately, work hard, and act professionally at all times.

  • Treat every member of the health care team with kindness and respect. You can learn something valuable from every member of the healthcare team, including nursing, the respiratory therapist, etc.

  • Be compassionate. Empathize with your patients and their families. Try to think about things from their perspective. You don't have to be a parent to imagine how frightening it can be to have a sick child. Spending a few extra minutes actively listening can provide an enormous amount of comfort to an anxious family.

  • Be enthusiastic. Go above and beyond! Residents and attendings can identify disinterest and negativity, as well as genuine enthusiasm. Their observations will be reflected in the final evaluations. Those who invest time and effort to learn more find that their residents and attendings invest more time to teach and mentor in return.

  • Be a team player. Offer to help others.

  • If people around you make inappropriate comments, jokes, or gestures, do not follow their example. Be a model of humanism and respect for others.

Medical Knowledge and Patient Care

  • Take ownership of your patients' care and show initiative. Go beyond reporting facts: become an investigator, interpreter of data, and an advocate. Make an active effort to anticipate and solve problems. Research possible management plans and present them to the team.

  • Read about your patients and their conditions, come up with a differential diagnosis, follow up on consults and labs, and check in on patients during your downtime. Use each patient encounter as a learning opportunity. What would be your next step if you were solely responsible for their care?

  • Speak up and show what you know! Don't be afraid to answer questions confidently and contribute. At the same time, be careful not to think – or act – like a "know-it-all," always remain open to other's ideas and open to learning new things.

  • Document precisely, thoroughly, and accurately. If you did not check it, don't write it in your note. It is better to omit information than to include false information.

  • Study! Use resources recommended by your clerkship directors and be proactive about studying. Do not wait until the last week of the rotation to begin reading. Set aside time every day to cover core curriculum topics and review practice questions.

  • Challenge yourself. Third year students often have more free time than fourth year students, interns or senior residents during the day. This is your chance to shine! Find the answer to a clinical question raised on rounds, look up an evidence-based guideline that addresses optimal management of a condition you are facing, help expand a complex differential. You can directly impact patient care, even as a novel clinician, if you put in the extra effort.

  • You may be a student, but you can also be a teacher. Incorporate what you're reading and learning into your presentations on rounds. You will elevate your own performance, as well as the performance of your entire team.

Communication and Feedback

  • Know the expectations of your clerkship director, attendings, and residents. Ask for guidance at the beginning and midway through the rotation. Knowing expectations at the outset of your rotation will ensure a smooth transition. By checking in at the midpoint, you will show that you're genuinely interested in meeting and exceeding their expectations. It will also allow you time to proactively remedy your performance prior to your final evaluation being submitted.

  • When asking for feedback from your team, ask for tangible examples of your perceived strengths as well as areas for improvement. The best way to learn is to get constructive advice and to challenge yourself to integrate what you've learned into your repertoire. This is how you will become a better clinician. Communicate openly and honestly with patients and their families. Explain your role and offer to help them. However, do not answer questions if you are not certain of the answer. If you do not know something, simply state that you will help them find the answer. Always circle back with the family to close the communication loop once you have identified their concerns.

  • Communicate proactively. Check in with the supervising resident before rounds in the morning, throughout your shift, and again before you leave at the end of the day to exchange information and ensure that all outstanding issues are addressed.

  • Don't be shy to ask for help. Residents and attendings are often distracted with their own clinical responsibilities. They may take for granted that your silence equates to self-reliance. You're a third-year student; you're not expected to know everything!  Even a few minutes of coaching may prove tremendously helpful with workflow efficiency, documentation, presentations, or even core concepts you're struggling with.

  • Make your rotation what you want it to be. If there are certain experiences you're interested in– whether it's watching a lumbar puncture, going to the OR to follow your patient, or mastering certain curriculum – make it happen! Discuss your objectives with your supervising residents and attending to ensure they can help you achieve your goals.

Research in Pediatrics During Medical School

Pediatrics offers many exciting opportunities in research, including basic science research, epidemiology, translational research, clinical research, quality improvement, and pediatric health services research. Pediatric clinician scientists are growing in numbers and funding, with the National Institutes of Health (NIH) funding for research in pediatrics totaling about $4.4 billion in 2018. If you are considering a career in academic pediatrics, you may have questions about doing research, such as the following:

How Might Research During Medical School Help Me Excel in a Career in Pediatrics?

While pediatric residencies do not require applicants to have research experience, such experience in medical school can be very valuable to the student considering a career as a clinician scientist or as an academic pediatrician.

You may have the opportunity or even be expected to do some research in residency, thus having the experience as a student can give you a head start on a clear idea for a pediatric research project, or at least provide insight toward a general research topic of interest. Furthermore, it may even position you to be competitive for research funding. If you are interested in a career in subspecialty pediatrics, most fellowships require their trainees to complete a research requirement to become board certified in that subspecialty. For those interested in general academic pediatrics, there are fellowships available that will further assist medicine and ability to critically evaluate current healthcare practices. While a meaningful research experience can certainly enhance a student's application for residency in pediatrics, it is not essential, and you should only pursue a research opportunity that sincerely interests you.

When During Medical School Could I Participate in Research?

Many medical schools have time in the curriculum for students to pursue research during the summer between the first and second year. While it can be challenging to start a new research project during the academic year, many students who start a project during the summer between first and second year are able to continue into their second year and beyond. Opportunities for research electives are generally provided in the third or fourth years. Some medical schools provide the option for an additional fifth year, with opportunities (and sometimes an expectation) that students will get involved in research in some way. Some medical schools have support available for student-led community-based research or a student research day for you to present your findings. Other schools have complete research tracks in which you can focus your study.

How Can I Find Research Opportunities?

The best way to begin your search for research opportunities is to think about questions that interest you. Have you always been intrigued by new lab techniques and questions about biology, chemistry, or physiology? Then basic science research holds opportunities for you. Do you want to explore how health policy affects the provision of care for large numbers of children and families? Health services research may hold the key. Do you wonder about the connections between science and clinical practice? The growing field of translational research may help you build this bridge. Once you have an area of curiosity, or even when you're trying to decide what intrigues you most, you may want to seek out a mentor or advisor in the department of pediatrics, network about research opportunities at a pediatric interest group at your school, visit your school's department of research, or make an appointment with an advisor in the office of student affairs.

During the fourth year of medical school, students complete senior clerkships and sub internships while taking electives in areas of interest. Some pursue experiences in research, work with underserved cultural groups, and international child health. Most US schools require that students successfully complete parts 1 and 2 of the United States Medical Licensing Exam (USMLE) to graduate.

What Sources of Funding Are Available to Support Medical Students Who Do Research?

Some professional groups offer small grants or funding for students to present research at professional meetings. For example, the American Pediatric Society and the Society for Pediatric Research offer a medical student research program that provides 8 to 12 weeks of funding for medical students who want to extend their education by working in research laboratories. Some medical schools offer small intramural grants for medical student research, available through a research office. The AAP provides grant support for community-based research for residents through the Community Access to Child Health (CATCH) grant program, and students may be able to collaborate with a resident on a project funded through this program or obtain research experience that will position them well to apply for their own grant support when they are residents. The Society for Teachers of Family Medicine also provides some support for medical students to attend meetings to present their work, and students interested in pediatrics may find rewarding collaborations with students interested in family medicine. Finally, faculty who have research funding for their own work often seek students to assist, and the faculty grants sometimes provide some funding support for students' participation in the research.

What About Other Extramural Funded Programs?

Most offices of student affairs or research at medical schools provide lists of extramural grant funded initiatives that aim to increase student participation and careers in research. The Centers for Disease Control and Prevention and the National Institutes of Health have summer fellowships available, for example. These are competitive programs, so you should investigate early and give yourself plenty of time to complete the application and obtain letters of support from your faculty, offices of student affairs, or past research mentors.

What If I Didn't Do Any Research and Now I Am a Third- or Fourth-Year Student?

Don't panic! Many candidates for residency training have not done significant research. Many other relevant extracurricular activities, such as participation in community service projects, student government or medical school committee service, will support and enhance your application to residency training in pediatrics.

Bottom Lines

Research during medical school is a highly valuable but optional part of the overall education of a physician. Pediatricians that have experience with research gain skills that can help them critically analyze and apply the medical literature. Research skills offer one important way to express a commitment to medicine and to improving the health of the children we serve. Finally, experience obtained through meaningful research in medical school may spark a passion for a career as a clinician scientist or academic pediatrician, laying an important foundation for residency and fellowship training and beyond.

Choosing a Medical Specialty

After successful completion of a 4-year medical school program, students choose a specialty area and enter residency training. The length of residency varies by specialty; primary care residency in pediatrics is three years.

Choosing a specialty is a big decision, but fortunately, resources abound!  Abundant facts and figures for the major specialties are available online: training duration, starting salaries, practice settings, income ranges and such. Not all considerations, however, have equal weight. As one pediatric infectious disease specialist pointed out, specialty choice is a big-picture judgment.

"My belief is that you have to do what will make you happy," he said. "It's hard to know what the job market is going to be ten years out, and even if it's going to be tight, you've got to do what you're most interested in." Students are sometimes overwhelmed by medical school debt, and make a specialty choice based primarily on income, he added. "Debt drives a lot of decisions, but I think a choice that is based on economics alone has the wrong motivation," he said. "Some specialties pay more than others, but all provide a good living. Students need to ask themselves, 'Am I going to be intellectually stimulated enough with whatever choice I'm contemplating? Am I going to be happy two or three years down the road? Or am I doing this for the wrong reasons?'"

Faculty and attending physicians can offer guidance, and many medical schools sponsor interest groups for the various medical specialties. Interest groups are ordinarily open to all students; participating is a fine way to narrow choices and does not represent a commitment. If there is no interest group at your school for a specialty that you would like to explore, speak to the clerkship director, department chair, or residency director about starting one. There are no limits to attending these interest groups, so join more than one as your interests dictate.

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