You never quite appreciate a time in your life until it’s years behind you and you’re faced with a whole new set of challenges. I remember I thought some of my classes in high school were SO HARD until I failed organic chemistry in undergrad (after trying pretty hard).

I always fantasized in college about working and making money and being an adult  until I had to deal with office politics. When I was working for a very successful Japanese company, I always thought to myself, “I wish I had gone to medical school.” Then, when I was sitting in a cubicle on campus for 12 hours a day studying in MS1 I wished I was doing the exact same thing, only getting paid like I used to.

Here’s the funny thing, though: Now, as I sit here finishing up fourth year, third year is LITERALLY the only time in my life I don’t look back fondly on. I would NEVER go back, not even if I could make a deal with the Devil and relive third year in exchange for a 260 on my Step 1. Nope. No Deal. Why? I know I have a flare for the dramatic, but in my humble opinion, here are the top 5 reasons why third year is the WORST.

#5: You have NO idea what you are doing.

I remember after getting my Step 1 score, I felt so damn good. I was like, “The rest of this is going to be so easy.” HA! I started on a Family Medicine rotation and I literally had NO idea what I was doing. Sure, I knew facts, and I was theoretically good with patients, but I had never used an EMR, had never done any procedures, didn’t know how to present a patient, I didn’t know any principles of management, I didn’t know ANY acronyms, trade names for drugs, evidence based medicine or where the supply closet was (let alone the code). Nothing like feeling completely incompetent to knock you down a couple of pegs!

What was really frustrating to me was the fact that in third year you just get thrown into things, and you are expected to know what a resident knows, but you usually don’t even understand the language they are using on the wards! Furthermore, I don’t know why, but all of a sudden you start messing up even simple things like using a fax machine or dropping blood off at the lab. It doesn’t just feel like everything you are doing is wrong, you really and truly are doing everything wrong. I hated that about third year.

#4:  Studying just isn’t happening.

If you are still in MS1/2, you are blissfully unaware of a whole knew realm of knowledge you will have to know Day 1 of MS3. You will now be expected to know treatment of choice, next best step in management, statistics on patient mortality reduction using various treatments, and the entire concept of Evidence Based Medicine. You have SO much to learn in third year, but for some reason, your brain just isn’t having it. You come home from the hospital and collapse on the couch. The thought of busting out UWorld or a textbook is just laughable. Remember when you could do, like, 120 UWorld questions in a row AND review them for Step 1? During third year, if you do 10 questions in a night or read 2 pages in a book, you are like “I’m the shit look at me go!”. It’s actually ridiculous. I think that’s why people say Step 2 CK is easier than Step 1 (it isn’t, btw), but the fact of the matter is, if you studied in MS1/2 like you do in third year, you would fail out really quickly. But third year, you can pretty much slack a lot, and get by you won’t do WELL on that impossible shelf if you slack, but most people do pass. It’s a miracle, actually.

#3: You feel guilty all the time.

There is a lot less direction in third year in the Hospital, so a lot of the time, it’s up to you to seek out work to do. But obviously, many days you really just don’t want to. You would love to just leave the hospital. Your resident doesn’t acknowledge your existence, lecture was cancelled and you haven’t done a single UWorld question during the entire rotation.

“Should I just leave?” If you don’t ask yourself this question at least once a day in your head as an MS3, you are a robot. You want to leave, and you probably will leave, but not before feeling super guilty and worried that someone is going to see you leaving or notice you are gone. You actually find creative incognito ways of leaving the hospital. You take the stairs so you don’t see anyone in the elevator. When you are finally out the door, you run for it : “FREE!! I’M FREE!” It’s like you got away with breaking out of prison or something. But make no mistake, even with the afternoon off, you won’t do anything productive. You won’t do any studying, so you feel guilty about that. And you won’t work out, so you feel guilty about that. You won’t clean your apartment, call your mom, cook dinner, or do laundry: Guilty. Guilty. Guilty. In fourth year, you’ll probably continue to behave this way, but the awesome thing is: the guilt is gone.

#2:  You realize medicine isn’t what you imagined it would be.

From Day 1 of medical school, you can’t wait to be with patients and “save lives.” When you get your first patient, you feel such amazing ownership. You do a 1hr patient history and a ridiculously thorough physical exam. Then you write up your note, in excruciating detail only for the resident to be like, “This is way too much,” delete it all, and replace it with a few lines. You don’t understand why the resident does this at the time until you see how much they are responsible for!

In third year, you see that your idealism about “helping people” is misguided. There are so many barriers in the hospital to great patient care; there are inefficiencies, bureaucratic nightmares, politics, and patients that just don’t adhere to your treatment recommendations. In third year, this loss of idealism in medicine made me question whether or not this was what I wanted to do.

But surprisingly, this fog does lift at some point, and you realize that all of these things are opportunities for you to make a difference in your medical career. You may be inspired to get involved in Healthcare Policy, or you may just gain a greater appreciation for all of the people keeping this machine working. It’s okay to lose some idealism; it’s a big part of growing up. If you stay positive, and keep working, you will get through this (without losing your humanity in the process) and come out the other end a well rounded, pragmatic future physician.

#1:  Short. White. Coat.

Have you noticed that literally anyone in the hospital can wear a long white coat except a medical student? This is not an attack on the people wearing the long white coat that aren’t doctors; it’s just a commentary of how low your status is in the Hospital as a Medical Student. You feel so goofy wearing that short white coat and constantly are saying things like “I’m just the medical student.” You have those moments where you lean over and everything falls out of your little white coat front pocket. You just sort of feel like a loser in that little white coat. And make no mistake, the short white coat really does give almost anyone a license to reprimand you for being in the way. You may be thinking, “But Leila, you wear a short white coat in 4th year.” Yep, you sure do. And during fourth year, you still have days of feeling like that, but most of the time, you don’t really care anymore. In fact, many times, I wasn’t required to wear a white coat in fourth year, but I still did. Why? Because where else am I going to keep my cell phone and candy?

You are not alone

Don’t worry, it gets better, third years. You are not alone in feeling this incredible insecurity of knowing nothing, feeling really low on the totem pole and just looking generally goofy. If you are waiting for me to tell you how to get through it, that’s not what this article is about. The whole point is to let you know that yep, third year is awful for everyone, but it won’t stay that way forever! Thousands of people have been in your shoes, and they got through it, and you will too! IT GETS BETTER! Just hang in there and keep your chin up.