Transitioning to the Wards

Every year, second-year medical students at the school of medicine wrap up their preclinical curriculum in February and take a capstone course called Transition to the Wards (TTW). This course teaches students how to work together in health care teams to care for patients during the next phase of their education, which occurs almost exclusively in inpatient or outpatient medical settings. TTW trains students how to apply the science and principles they learned from their preclinical curriculum to work in a hospital environment. This year, students took TTW concurrently with another course called Pre-Clerkship Education Exercises (PRECEDE), which trains students on the specific clinical decision-making skills they will need for particular clerkships including internal medicine, emergency medicine, women’s health, surgery, pediatrics, neurology and psychiatry.

As with most courses this year, perhaps the greatest challenge for students and faculty was the adaptation of these vital courses to a virtual, Zoom-based format. Historically, the in-person educational experience was particularly valuable for TTW/PRECEDE, given the nature of these courses, which taught skills such as delivering bad news to patients, ethics discussions, EKG interpretations, and case-based clinical reasoning. The impact of these exercises would be difficult to replicate in a virtual format.

Being among one of the first cohorts of medical students in the history of the school of medicine to participate in virtual TTW/PRECEDE, I completed the courses with some important action items that will guide me during the intimidating but exciting months ahead.

Strategically push through Zoom fatigue.

Many of my classmates and I were already “Zoom-ed out” by the end of our preclinical curriculum, only to find ourselves confronting a TTW/PRECEDE course incorporating four to eight hours of Zoom activities daily, with additional online preparatory work required for the next day’s virtual sessions. The days were long and exhausting, jumping with few breaks from one Zoom session to the next, which was often on a very different topic that required a different degree of engagement compared with the prior session. We made it, but the Zoom fatigue made it difficult for many of us to remain undistracted and fully attentive.

I realized early on that if I wanted to get the most out of the ensuing month, I needed to figure out how to push through days of mental lethargy, of which there would be many. I also reminded myself that Zoom would not be going away any time soon, and that adopting the right mindset and tools now would serve me well down the line — especially on the wards, where meetings and even patient rounding would at times be done virtually.

Everyone has their own methods to overcome Zoom fatigue, and I personally employed the helpful tips covered in an article by the Harvard Business Review. Reminding myself every morning that what we were learning would be immediately relevant to patient care in just a couple of months allowed me to push through the resistance and absorb as many pearls of clinical wisdom as I could from virtual TTW/PRECEDE.

Embrace the discomfort of failure.

After 554 days (as my classmate Sara pointed out) of preclinical education, I understood basically how the body worked and what could go wrong with it. I could contrast the pathophysiology behind nephrotic and nephritic syndromes, explain the biopsy findings in lichen sclerosis, or recite the many clinical manifestations of syphilis. I had become adept at factual recall, and could potentially piece together signs and symptoms to formulate a presumptive diagnosis.

But none of this prepared me for my first practice oral presentation. In one of our TTW sessions, we went to the hospital to interview and examine a patient, read their chart, and present their case and a management plan to our faculty preceptor. This was to give us an introduction to ‘pre-rounding’ and ‘rounding,’ important activities we would be doing regularly as medical students on the wards.

I had felt inadequate and clueless many times in medical school, but up to that point I had not had a “deer in the headlights” experience quite like this. Despite having visited the patient just a minute ago, I had no idea what to say or how to say it. I had the baseline knowledge, but was wholly unprepared to piece together what I knew into a cohesive, succinct and intelligent case presentation. In short, I completely froze. It was the most humbled I had been in medical school, worse than trying to drink from the firehose of information we had to learn during our first semester.

I was very hard on myself after this experience, and had to intentionally and repeatedly remind myself that this was my first attempt, that many more failures lay ahead, and that this was all a normal and expected part of training to become a physician. I had placed an unreasonable expectation upon myself to be decent on my first try in executing a new skill, which was utterly unfair to me. Having the right perspective regarding failure, growth and maturity will be indispensable throughout the rest of my training. The courage to take (reasonable) risks, accept my failures, and grow from them without weaponizing them as an indictment against my competency as a learner or person will be crucial in the months ahead.

Lean on others, and allow them to lean on you.

One of the most wonderful aspects of TTW/PRECEDE was the depth and frequency with which we could learn and engage with our classmates in various-sized groups. The course was heavily predicated upon student involvement; the more actively we were willing to participate in the activities, the more we would all get from the course.

This may surprise some people, but TTW/PRECEDE was the closest I had ever felt to my classmates. Although the virtual format could have given us the license to zone out, I found myself and my classmates engaging in some of the most interesting, lively and helpful discussions in my entire medical school experience. From struggling through lab, EKG, and X-ray interpretations and working through differential diagnoses for tough patient cases together, to executing proper management of a cardiac arrest simulation and lending our arms to each other for acquisition of venous access, I was able to bond with my peers at times even more than I had in person.

What TTW/PRECEDE emphasized to me more than ever before was the importance of doing this journey together. I was moved by how many times I witnessed my classmates supporting each other through words and gestures when someone struggled through a particular skill or gap in knowledge. Everyone brought a unique set of strengths to the table, which allowed them to edify others who had weaknesses in those areas, and their own weaknesses were likewise covered by the strengths of others.

Although TTW/PRECEDE was the last course in which our entire class would be all together, it served to build a camaraderie that I hope will connect and sustain us even as we go our separate ways on the wards. If and when I find myself lost as a deer in headlights again, I can look around and know that I am not alone, and as we lean on one another, we will be able to brave whatever lies ahead.

Related content

• Lessons from Pre-clinical Medical Education
• Resuming Medical Training in the Era of COVID-19: A Medical Student’s Thoughts
• Transition to the Wards: A Pivotal Point in Medical School Training

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