Developing clinical judgment is a process that takes years of learning and experience. I am approaching the 4 month mark in my clerkship year and things are starting to make a lot more sense. As more and more of the knowledge I learned in the first two years is translated into clinical decision making at the bedside, I appreciating more than ever the process of learning.
In preclinical years, you build your foundation of medical knowledge, often times the boring stuff. The medical terminology, gross anatomy, physiology, pathophysiology, and other basic science knowledge. I thought most of this knowledge was irrelevant when I learned it, but as I see more patients and cases, the trivial knowledge becomes useful information.
As you learn how to manage diseases, you also learn the clockworks of how to do things. Writing notes, prescriptions, trade names, dosages, prices, side effects, and other nit picky information that you didn’t bother in the first few years. It’s not hard work. After a while, things get memorized. The treatment of a UTI becomes just like a formula you learn in physics class. Not hard, but necessary so things can be done.
And finally you learn about evidence based medicine (EBM). I’ll be honest, the first two years, it was hard to grasp what EBM meant and how you could use that knowledge. But as you start reading guidelines and review articles, you realize that there is an awful lot of things that we just don’t know. Is one drug better than the other? How do you know that? Which symptoms should you ask about, which one has a strong predictive value? Which test should be ordered, what do you expect to find, and how much can you rely on the result to be true?
I used to find EBM stuff pretty boring but now it’s probably one of the most stimulating things to learn about. It’s the frontier of medicine, it’s NEW knowledge.
And finally to become an effective physician, you must master the history and physical. It’s a skill they teach you on the first day of medical school that will be relevant in all your future patient encounter. Learning how to listen to answers and communicate effectively. Knowing which questions to ask, when to ask and how to ask them.
Overall, third year has been great so far. It’s intellectually stimulating and I’m having lots of fun on the wards and in the clinics. I’m reading more than ever on my own time, from old and new texts. I am updating my knowledge every day and sharpening my history and physical. Motivation is at an all time high.
Now… if I could only find some time to eat, sleep and exercise… =p