What I Wish I Knew Before Starting Third Year Clinical Rotations

Kellyanne Murphy, MSIII
Albany Medical College
EMRA MSC Mentorship Coordinator

Let me guess— it’s 2 AM and you’re reading this because you can’t sleep. You just passed Step 1 (Congratulations, by the way, that’s huge). Now you’re about to embark on an entirely new and unfamiliar adventure: your third-year clinical rotations.

After months spent buried in books, notes, and question banks, you’re about to step onto the hospital floors. You’re nervous. Excited. Anxious. Overwhelmed. You’re on Reddit, reading post after post of third year clinical rotation advice (you should probably stop). Instead of spiralling further into late-night Reddit, let me share a few truths I wish someone had told me before my first day of third year.

There is no better or worse rotation track. I remember when my third-year rotation tracks were released. I stared at my computer in disbelief. I got my 18th choice. I went through all five stages of grief that night.

Let’s clear one thing up right off the bat…

1. Denial: This has to be a glitch. Maybe they uploaded the wrong file. I’ll refresh my email one more time.
2. Anger: How did everyone else magically get one of their top three tracks?
3. Bargaining: If I email the administration, offer to switch, or promise never to complain again, this could be fixed.
4. Depression: I will never emotionally recover from this. Third year is ruined. I should’ve ranked differently. I knew it.
5. Acceptance: Alright. This is my track. I’ll survive, I’ll learn a lot, and in a few months I’ll wonder why I was ever this dramatic.

Now, at the end of my third year, I do wonder why I stressed so much about my rotation track. I can confidently say that I loved my track! There’s no other one I would have rather had. From talking to classmates, it seems they feel the same way; no matter where their track fell in their ranking, they’ve grown to love it too. At the end of the day, you will have to complete all of the core rotations, and the order in which you accomplish that is not that important in the grand scheme of things. No rotation track is inherently better or worse than another.

What’s important is that you use this year to study hard and absorb as much information as you can, which brings me to my next point…

Everyone studies differently. “All you have to do is watch Emma Holliday.” “Listen to Divine Intervention every time you get in the car.” “Complete all UWorld questions and repeat your incorrects.” “Anki every day.” Just like during preclinical, you’ll get a lot of advice on how to study and what resources to use. If you ask 100 medical students who completed every shelf exam how they studied, you will get 100 answers, and all 100 would be correct. Time is hard to come by during third year, and there are many great resources out there. You don’t need to use them all. Find what works for you and stick to it.

With that being said…

You will learn the most from patients, not from online study materials. You know that one Anki card you press again on every time you see it? Yeah, for me, that was a card on Kawasaki Disease. After seeing a patient with Kawasaki on my pediatrics rotation, I never got that card wrong again. Third year is when medicine finally clicks. A single patient you follow for a few days will teach you more than any question bank ever could. When you see the disease, talk to the patient, and watch their treatment plan unfold in real time, the information sticks. Don’t underestimate how powerful that learning is, even when it doesn’t feel “high yield” in the moment.

And no matter how much you study…

You will not know the answer to every pimp question. Honestly, that scared me the most about starting third year. What if an attending asks me a question I don't know the answer to? Well, guess what, it happened on my very first day. And it’s happened what feels like a million times since then. In these situations, there are two approaches I’ve found helpful:

1. Talk through my thought process. Even if you don’t know the exact answer, this is a great way to identify gaps in your knowledge, allowing your attending to fill in the blanks.
2. If you have absolutely no idea, be honest. Say, “I don’t know, but I’ll look that up and get back to you after rounds.” (After all, if you already knew everything, you wouldn’t need third-year rotations in the first place).

And sometimes, much to my own surprise, I nail the answer! Proof that I know more than I think. Third year is full of highs and lows. There will be moments when you make the correct diagnosis, impress an attending, and feel on top of the world. And there will be days when you leave the hospital feeling completely useless, questioning whether medicine is the right path for you.

And that’s okay because…

Feeling useless at times is completely normal. Third year feels like being the new hire at a job where everyone else has been there for years. Except it’s not just a feeling. That’s precisely what it is. As soon as you get comfortable, it will be time to start the next rotation. Every rotation has a learning curve and the first few days can feel awkward. You may not know where to stand on rounds or how to present efficiently. That’s okay. Remember— you can’t compare your first day, or even your first few weeks, to someone who’s been doing this for months or years.

It can be tough to come to terms with this, especially when evaluations make up a significant portion of your grade, but remember…

Your evaluations are about more than medical knowledge. Showing up on time, being engaged, helping the team, and having a good attitude go a long way. You don’t need to be the most intelligent person on the team; you need to be reliable, teachable, and kind. Those things are noticed.

Evaluations. Shelfs. OSCEs. They are important, and yes, they can be stressful. But despite it all…

You are allowed to enjoy this year. Third year is challenging, exhausting, and at times overwhelming, but it’s also incredibly meaningful. You’ll meet patients who you’ll never forget, nurses who will have your back, attendings who will inspire you, and residents who will believe in you before you believe in yourself. You’ll watch your classmates geek out over things that don’t personally excite you. It’s so fun to see everyone find their niche and truly come alive in their element, and honestly, a powerful reminder of how differently we’re all drawn to medicine. I have loved absolutely every moment of third year. These are the moments you’ve been working toward. Let yourself enjoy them.

It may not feel like it just yet, but you are ready to trade Boards and Beyond and Bootcamp lectures for resident pearls in between patients on rounds, Bose headphones for your stethoscope, sweatpants in the library for a short white coat on the wards, and the controlled environment of preclinical learning for the dynamic and sometimes chaotic reality of practicing medicine. It’s going to be great. You’re going to be great! I promise.