Playing With The Big Kids

Medicine is very hierarchical, especially during medical training. At the top are the attendings, then come the fellows, the upper level residents, the interns, and finally the medical students. The structure is more rigorously followed in some specialties and locations (ie Surgery, the East Coast) than in others. I have been lucky to train at places where things are a bit more relaxed in general, so as a medical student I could talk to an attending without going up the chain of command if needed.

However one feels about the structure and its nuances, it can be rather comforting to have in place. It starts from Day 1 of medical school. We were assigned a "big sib" from the 2nd year class who was there to answer our questions about what books to buy and how to study for tests. In those days the 3rd and 4th years seemed far removed and intimidating because they had "real clinical experience." Of course, the fact that they were on another campus most of the time probably added that perception.

Our "sibling" networks continued throughout medical school, and soon we were those "intimidating" students giving advice on how to schedule rotations to those below us, and asking our current interns about the different residency programs they had seen. There is something comforting about having someone who is essentially your peer available to answer all of your "dumb" questions and to calm your nerves about the next step when needed.

Then residency started and things changed. Don't get me wrong--I have great colleagues ahead of me in the program who have provided great guidance when needed. But one thing that is different about my field is that I have a lot of contact with attendings and fellows. They come to me to give them the answers on their patients. Let me tell you, it can be quite intimidating. Usually it starts okay because I have some idea of the case or the question at hand and can give them a basic answer. If I cannot, I will tell them upfront that I do not know, but will find out, and get back to them.

It gets harder when my basic answer is not enough and they begin the questioning, especially if it delves into more esoteric clinical realms. Let's think about this for a minute. I am not doing a traditional intern year, so my clinical knowledge is that of someone who graduated medical school. Actually, at this point some of that base has left my memory in favor of new knowledge, so I am on a decline. At that point of awkwardness someone higher on the totem pole than I will usually take over. It always amazes me how much my fellows and attendings know, and it seems impossible that I will ever be there also.

The whole experience reminds me a bit of being in kindergarten and riding the bus home with the 5th graders while I clutched my Care Bears lunch box and sat very quietly. I never thought I would ever be that big and that cool. But then one day I was, well maybe a bit shorter than they had been, but still I was there laughing and having fun on the bus home. So perhaps one day at the end of this I will make it to the top of the hierarchy and be able to show cases and answer esoteric questions with ease. Then it will be fun to play with the big kids. For now I think I'll just sit quietly, get my work done, learn via osmosis, and bide my time at the bottom of the trainee hierarchy.