“CRASH” was the name of my medical school's clerkship orientation week for third-year students, which couldn’t have been a better word for the experience. From the manuals simulating Epic EHR, to the daily tutorials on attendance policies, I was convinced this week-long crash course had covered every possible logistical topic relevant to my upcoming rotations. However, as my clerkships unfolded, I found a gap in my user manual library. While “self-care” and “resilience” were mentioned, I never received a holistic handout adequately preparing me for the emotional journey ahead. I knew how to page, but I didn't know the protocol for impostor syndrome. I knew the clerkship directors, but I couldn't look up how to mentally recharge for a new rotation within two days of finishing another. To provide myself with spiritual guidance during this chapter, I created a personalized manual, called How to Do ‘Enough.' I valued the comfort and insight it provided in addition to what “CRASH” taught me and was moved to share it. I hope it can serve as a navigational tool to inform and strengthen fellow third-year travelers.
Lesson 1: Enough studying is putting in 8/10 effort.
The third year of medical school requires studying in preparation for the shelf exams at the conclusion of each rotation. This is difficult given students must do this while working 8-12 hours daily, typically six days weekly. It is tempting to put in 10/10 effort for your rotations during the day and 10/10 effort for studying when not working. You gave studying your all during your pre-clerkship years, so why should this be different? The truth is putting in 10/10 effort for studying during rotations is neither possible nor productive. Showing up for your clerkship responsibilities requires 10/10 effort, but overextending yourself with studying will burn you out. Instead, 8/10 studying will allow you to study daily, to study productively, and to give yourself enough buffer energy for tomorrow. You don’t have to go all out for studying, as long as you’re all in for the long game.
Lesson 2: Determine what you need for enough wellness so you can withstand your third-year constraints.
We’ve all attended wellness workshops discussing behaviors that help you thrive. Every wellness program is a customized recipe, with each person requiring different ingredients in different ratios to achieve wellness. To thrive during my pre-clerkship years, I required three nights weekly of socializing, six mornings weekly of exercising, and eight hours of sleep nightly. That was my ideal ratio with my ideal ingredients. However, in my third year of medical school, I didn’t have enough time or energy to maintain my ideal wellness recipe. I had to establish the bare minimum of social time, exercise, and sleep to make it through a week. At bare minimum, I needed social time once weekly, 30 minutes of exercise daily, and 6.5 hours of sleep nightly. Anything less in these areas and I wouldn’t be able to fully recharge my social and physical battery to recover from the week.
Lesson #3: School has taught you enough to be in the room, but the rest is up to you.
The first time I participated in medicine rounds, I was shocked by my ability to keep up with the conversation and understand on a superficial level what was being discussed. I shared this observation with my attending, whose response was, “You are taught to understand the battle, but now you need to understand the war.” I knew enough to be there, but I needed to engage in rapid learning to stay there. School had prepared me well, but it was my turn now to keep learning at lightning speed. To rise to the occasion, I took any chance I could to use UpToDate, AMBOSS, or StatPearls to learn about the bigger picture and clinical implications beyond the textbook details. You know more than you think, but you must self-direct your learning in order to excel in the room, not just be in it.
Lesson #4: Being your best is enough, so keep moving forward.
All third-year medical students are united in a feeling that the things they do are never enough. You convince yourself that you’re not involved in enough research, or your test scores are disproportionate to your hours of studying, or your student organization hasn’t built up enough momentum. However, this is both a normal response and an intended effect. Part of your training is to ensure your intellectual and mental foundation is strong enough to withstand the stress of residency and beyond. It’s a test of technical skill, but also of emotional fortitude. I was one of the many students who tried to fight this stress by working harder and longer. I took on more research projects, created a study plan with no days off, and overwhelmed myself with side projects. But this strategy will leave you feeling worse, like you’re coming up short in every area, no matter the magnitude of effort or good intentions. The key is to accept that you will never feel sufficient in all areas of your work, and to instead focus on moving forward regardless. As a medical student, you aren’t being trained to excel in every area, but to focus on what is most important. Be kind to yourself, be kind to others, and do the best you can.
While these four lessons can serve as a launching point, there will be others you will learn along the way that will be unique to the physician you are becoming. This is part of the beauty of the process, and one of the reasons why your third year of medical school will be intellectually, emotionally, and mentally impactful. Remember to celebrate all you have done and will continue to accomplish along this path — it's already enough.
Fae Kayarian is a third-year medical student at Rush Medical College of Rush University Medical Center in Chicago, IL. As a future physician, she aims to combine clinical medicine, medical device research, and the medical humanities to address the changing physical and social landscapes of our world. In her free time, she enjoys long bike rides, lifting heavy things at the gym, and spending time with loved ones.
Illustration by Jennifer Bogartz
