Finding their Future
An intense third year is comprised of clinical rotations — and decisions that form students’ future
It’s two degrees below zero late in February, and Fasika Aberra, shivering in spite of a hooded parka and heavy scarf, makes her way to the U-M C.S. Mott Children’s Hospital, floor 5 West, for a 6:30 a.m. arrival. Having volunteered at Mott as an undergraduate, she navigates the place with ease. She pre-rounds with each of the three patients under her charge to see how they did overnight, checking vital signs, completing brief physical exams, reviewing lab reports and charting treatment plans for the day.
It’s the second month of her two-month pediatrics rotation, the first having been spent in outpatient specialty and subspecialty pediatrics clinics. Sounding far less like a medical student and more like the budding physician she is, Aberra admits that she thought working with such young patients was going to be a very sad experience. “But the wonderful thing is that many of these patients get better quickly, and it’s inspiring to see that happen and to be part of it. And you can always do something to make them smile — maybe it’s the gleam on your stethoscope, or a funny face you make …”
Later in the morning, rounding with a team that includes her attending physician, senior resident, a second medical student and an intern, Aberra presents her assessment of each of her patients, as does the other medical student on the team. At Mott, rounds are “family centered,” taking place with family members present at the patient’s bedside, giving them the chance to ask questions and contribute information about the patient, and to have input in planning subsequent steps in their child’s care.
The group places a silver flag high on the doorway of the patient room to identify their team and signal that rounds are taking place. Medical staff on the floor seeing the color-coded flags — nurses, for instance — can listen in on rounds if they choose. The rounding team enters the room in hierarchical array: attending physician first, then senior resident, resident, intern and students. Discussion ensues briefly in the hallway after the patient visit — questions are asked and answered — and the group moves on to the next. Halfway there, Aberra dashes back to retrieve the silver flag and places it on the next patient’s doorway.
After rounds, Aberra and the rest of the team discuss each case in a small staff room on 5 West. Black and white photos of past pediatrics house officers line the walls, along with a child’s colored picture of a princess, charts indicating the prednisone tapering regimen for IBD patients, the electrolyte composition of various body fluids, and a day-prior-to-discharge to-do list. The team reviews and confirms the courses of patient treatment, medications, and plans for the day. Then, at a small work station, Aberra and her student teammate enter notes on a computer.
“In general,” Aberra says of her pediatrics rotation, “I saw quite a few cases of bronchiolitis from respiratory syncytial virus, which is very common in winter months. There were also several cases of failure to thrive — kids falling off their growth curve — skin infections, inflammatory bowel disease, type 1 diabetes, and rare cases too, like Kawasaki’s disease and Duchenne muscular dystrophy.”
Though she gave serious thought to a combined internal medicine and pediatrics specialty, Aberra now plans to pursue residency in internal medicine, working mostly with hospitalized adult patients. “I just feel I can do more good with adults,” she says, “and I like the inpatient practice of medicine — caring for patients with multiple medical problems, utilizing evidence-based guidelines, team discussion, bedside and teaching rounds.”
The third year of medical school — from May to May — is almost exclusively about clinical rotations, punctuated weekly with Friday afternoon all-class seminars. There are seven rotations: pediatrics, surgery, neurology, family medicine, internal medicine, psychiatry, and obstetrics and gynecology. Inpatient rotations include on-call duty — 30 hours at a stretch spent in the hospital. While the frequency of being on call varies with the rotation (internal medicine has the most frequent, at every four days), and there’s no on-call activity with the outpatient specialties, it’s readily apparent that with the early morning starts and long days, year three couldn’t be much more different from the first two years.