Newsletter article by Education Chair, Marbree
It is stressful, scary, and there is nothing any of us who have already been through it can say or do to fully eliminate those feelings. (Honestly, a little bit of fear is healthy to keep you from making rash decisions). My goal with this article is to help you get a little better grip on the situation and to give you some confidence in your decision making process. And remind you that there is hope on the other side.
Before we go any further, I want to define the terms I am going to use, so we are all on the same page. “Clerkship” refers to 3rd - & 4th-year clinical training while “internship” and “residency” refer to post-graduate training. They are all comprised of “rotations.”
The first thing that you need to realize is that – as you have already experienced in this journey of medical school – you and your student have differing perspectives and priorities because the lives you are experiencing are different. This does not change as you consider which clerkship sites you are going to put and in what order on your rank list for the match in October.
Both you advocates as well your students need to keep in mind that communication between the two of you in this process is at the heart of the success of your relationship, their success in their chosen profession, your success in your life, and the success of your family. What I write here is based on the certainty that the successes stated above will fail if the two of you do not, or cannot, communicate each step of the way.
We need to keep in mind long-term as well as short-term happiness. When we first arrived at KCOM, the Financial Aid office gave the advice, “You can live like students now, or you can live like students later.” They were warning against taking out excessive loans to pay for pizza delivery or a bigger house or a brand new car instead of making more frugal, but adequate, choices. The same is true of your lives over the next few years: where your student goes for rotations and/or residency. Your family may live in a small apartment, a big city or rural community, drive a long commute, live far from friends and family, and sacrifice your student to very long work hours or multiple out-rotations away from home. Your family may move several times now to get the best training site in each phase or move multiple times in the future because your doctor-partner is dissatisfied with their job or location.
This is not just because your doctor-to-be is probably going to be the primary breadwinner for your family. They will also likely be the primary debt-owner and will have to continue to work until that debt is paid off. This is true even if they quit being a physician and start a new career afterwards – sad but not uncommon, especially as it is becoming harder and harder to work in health care. But if you can find situations that help him/her get a quality education that is appropriate for them in an environment that you can at least tolerate, you will both have a much better opportunity to end up in an equally-satisfying place. Rest assured that KCOM makes sure that all of the sites you have to choose from for the clerkship match are high-quality options, no matter what their individual attributes. You will be fine wherever you match, as long as your student chooses to be dedicated and you choose to be flexible.
Here is a contrast of how medical students and their advocates prioritize factors choosing a clerkship site:
Student
Geographic location – return to Utah, East Coast, the mountains, AZ/FL/CO are “fun places”
Long-term medical training/career goals – what residency programs will be available directly through that rotation site (i.e. OPTI programs) – important if pursuing a highly-competitive residency field, if they don’t “have the numbers;” getting their foot in the door and getting face time.
Training-style emphasis – “book learning” didactics vs. “hands on” experience. This often lines up with the hospital-based vs. preceptor-based division, but not exclusively. For example, whether you will learn by heart everything on a differential diagnosis or be the “first assist” to the surgeon or perform a colonoscopy as a medical student.
Presence or lack of “house staff” (i.e. interns and residents in addition to the students)
Family considerations –job opportunities for their advocate, school systems for children, general community environment, social opportunities, etc.
Advocate
Family considerations – job and social opportunities for yourself and your children
Geographic location – relative to family, friends, home or places you want to live in or visit
Time with their student –commuting hours, work hours required, months to be spent on out-rotations, etc. NOTE: Almost everyone will have to do some out-rotating to search for residency programs, no matter where you are based. NOTE: Students are not protected by the “80-Hour Rule” that limits the number of hours interns and residents can legally work.
Long-term medical training/career goals – i.e. final position/salary for their doctor-to-be
Cost – cost of living, housing, expense of travel required to get to family
As different as these perspectives can make you feel, you are a family, a team with your student. (Otherwise, you probably wouldn’t be signed up for the SAA newsletter.) This cannot be a decision made by only one person. Unattached, single people have that luxury – you and your student do not. You, the advocate, have either been around long enough to have been a part of the original decision to pursue becoming a doctor, or you decided you liked your student enough to take that future as a part of the package deal.
There will be compromises – and most likely should be – on both sides. For example, a friend of ours paid for undergraduate and med school through the Army scholarship program, so he owes the military 9 years of service after the completion of his residency. His wife worked out the compromise that she would go far away from family to a 5-year residency in Hawaii and travel wherever the Army sent them afterwards if, after his commitment was up, she got to choose where they settled down (and she gets to open a bed and breakfast).
Medical students’ families do put up with inconveniences and discomfort in the short term, often putting their own dreams on-hold, to get their student through training. The students themselves do choose training sites for the impact it will have on their personal life as well as their education. Neither of you can allow yourself to become a wholly “sacrificial partner” nor should you expect your partner to become one. Delaying ones’ personal preferences is one thing, but wholly squelching them, especially unacknowledged, isn’t healthy or wise. Both you and your student need to always keep in mind that the job is not more important than the relationship.
Dr. Kent Blanke, Director of Medical Education for the residency program in Kirksville, gives a speech every year to the incoming intern/residents’ spouses. He wants us to know that our resident really would prefer to be home with us, but sometimes that is a sacrifice they have to make for the sake of their training. Medical training—from MCAT preparation to retirement—is stressful enough without adding family discord too. You cannot have long-term goals for your career and not have long-term goals for your family. The relationship has to emerge healthy and strong on the other side of this next phase, not just the education. Our doctors-to-be are going to need us.
Another hard part of the match will be the temptation to feel that you have to write in stone the path for the rest of your lives now, almost a year before the next phase even starts. Yes, for some, they will make (or have already made) a plan that they will stick to – completely as planned – without any hiccups or detours. And they will be completely happy with the results. But most of us will not.
Your student may match to their “perfect” training site and end up hating it. You may match to a “so-so” site that you plan to just use as a transitional point, then end up falling in love with the hospital and community and decide you want to settle down there. An unexpected rotation may totally catch your student off guard as either loving or hating the subject, totally changing the specialty they were convinced they wanted to pursue. Births, deaths, illnesses and financial crises happen. So do awards, fellowships, research opportunities and terrific mentor relationships. Rotation sites can open and close. And who knows what the future will look like as government health care reform takes effect. A concept that totally blew me away as we prepared for clerkship is that physicians do relocate during their careers for totally normal reasons, just like other professionals.
Read about Marbree's Personal Experience & advice.
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