Dear MS3s,

Welcome to the wards.

I remember when I was at your stage — basking in the glory that is completing pre-clinicals, in the excitement of finally switching my heavy textbooks for living, breathing people, in the realization, and apprehension, that everything is now becoming real. That my education now belongs in the hands of those I wanted to heal, in colleagues, in the team sport that is medicine: doctors, nurses, physician assistants, pharmacists. That I would be sleeping less, but living more, because this was my purpose. This is why I came to medical school.

Remember this moment because this will be the most difficult year yet. Your humanity, empathy, purpose will be challenged and you will walk a fine line. You will experience exhaustion like you never have before. You will be broken down and crushed, time, and time, again, and you must still find a way to stand. You must stand. You must never forget why it is you are here.

Depending on the rotation you start on you might have an easier time. You might find people who are willing to guide you, teach you, transition you from the classroom to the wards and clinics. You might be shoved in the operating room the first day and the scrub nurse may stare at you with the eyes of fury as she protects her sterile field, as if she were Gandalf and you were Balrog. You may be scolded over how you don’t know quite yet how to use the electronic medical record, shoved aside, and made to feel like wallpaper. You may be drilled on questions you do not know, over, over, over, until you feel like you have learned nothing over the past years. This is luck, a matter of the draw, of who you were paired with and what rotation you began and who is meant to teach you and what team you’re trying to be a part of. Some people in this field have forgotten that they once were where you are now. Please do not let them get to you. You are meant to be here. Look in the mirror every morning with those dark bags of courage under your eyes and bury that imposter syndrome. Every stumble is a lesson to be learned. Every failure will make you a stronger clinician. Practice, exposure, and experience brings competence, hang in there.

If you haven’t noticed yet, you will start to see how imperfect medicine is. This will be the most shocking, the most emotionally draining. You will see how overworked we all are, the unbelievable patient load we carry, how hard we strive, the countless hours thrown into the closet, how we are fighting an impossible system: see your patient, write your notes, chase labs, fill out paperwork, call for collateral, call consults, wait, wait, wait, fill out more paperwork, write more notes, follow-up on consults. You will witness social injustices, racial disparities, and it will frustrate you to the point of tears in an empty stairwell. You may try your hardest to help a patient, and learn the hard lesson that you can not help a person who does not wish to help themselves. Do not carry their burdens as your own, this has nothing to do with you or your abilities. You will see that different people react differently to stress. You will see power dynamics in play, witness the medical hierarchy in full force. You must be self-reflective, constantly. You must never take things personally. This is the year budding physician start to lose their empathy, their compassion, their humanity. Continuously chase the silver lining that is becoming harder to see. You must never forget why it is you are here, you must continue to try to find your purpose.

Remember that the people you work with are human, show them as much compassion, patience as you show your patients. Remember that you are human too, show yourself as much compassion, patience, as you show everyone else. Know your kindness, your enthusiasm, should never be taken advantage of. If you are being singled out, treated differently than your colleagues, belittled in a way that does not foster your learning, for whatever reason it may be, do not question twice. Reach out, report.

No matter what rotation you are on, memorize your patient’s chart. Know everything by memory-the date they were admitted, their vital signs when they were admitted, who saw them, the medications they are on, the images and the findings that were done. Write all the lab values. Read all the notes. Never trust the chart entirely — always ask the patient yourself. Unfortunately because you are the student, you will be scrutinized. You will be expected to know every detail. But you will also know your patient the best, will spend the most time with them. You, the simple medical student, will become their greatest advocate. Talk to the nurse in the morning for overnight events. Reach out to your resident and let them know you are following a patient and offer to present to them in the morning and go over assessments and plans before presenting to the attending. Research your patient’s entire disease process, know it well. This is your patient. Own it. Take the responsibilities of caring for them as if you were the only one. Your shoulders will learn to carry the weight.

Medicine is a team-sport. I cannot stress this enough. Your classmates are your friends, your future colleagues, and all that collaborative effort in your pre-clinical years should never disappear. Work together. Teach each other. Be on the same page. Tell one other the correct time of when you’re coming in the morning, if you know the answer to a question directed at your classmate let them answer first (it was directed at them), please don’t steal patients-seriously, that’s not cool, try to work together so you’re each carrying an equal load, let one other know if you want to do a learning topic/bring in a research paper, and don’t stay behind for absolutely no reason if your classmate has left. They are your colleagues, not your competition. They will be your fiercest allies, so learn to support each other. Navigate through these lessons of humility. Their bad days will be yours too, their missed questions will find you too. Remember, your only competition has always been yourself.

Ask for feedback, consistently. Take criticism, constructively. Enjoy every rotation you are on, you won’t realize how incredible it is to witness a field this in depth until you have moved on. This will be the most exposure you will ever get to the variety of medical specialties, embrace and cherish it. This may be the last time you usher a baby into this world, suture a surgical battle scar, witness miracles as the clock strikes midnight. Allow yourself to marvel at this immense privilege.

Last, but not least, no matter how hectic the day is, how busy you may be, how drained you may feel, sit down and talk with your patient. Listen to them. Hold their hand, wipe their tears, give them space. You are the only one with the luxury. Recognize you are acquiring a massive amount of medical knowledge but that means nothing if you do not see the person before you for the human they are, if you do not acknowledge their suffering, if you do not admire the art that is medicine. Allow your patients to teach you and you will learn things you can’t even fathom.

I look back and see myself significantly younger and naive. I wear a year of stories and lessons, of joys and heartbreak. They have found homes in the shadows under my eyes, in the valleys of my smiles, and in the occasional spark that shines through this exhaustion. Stories that speak of lifetimes will find you, encounters that find a home in your memories will carry you forward. You will go through the ringer, as we all must do, but it will make you stronger. You already know the reward will be far greater. Enjoy this year, unapologetically stroll the hospital halls. You will leave it a conqueror, and you will become a better physician for it.

I’m so excited because I know what this year has in store for you. See you on the wards, let me see that bright, enthusiastic smile, those eyes sparking with unyielding passion. Let me see you wear that short white coat so well.

With open arms,

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