The benefits of early clinical exposure in medical education

Medical schools are increasingly emphasizing early clinical exposure for their medical students. While the traditional medical education format — in which the basic sciences are taught during the first two years, and clinical rotations are stressed during the latter two — are still generally followed, many schools provide their students with exposures to the hospital or clinical settings much earlier in their medical education.  For example, just two months into my first year, I have already spent two weeks in the university hospital rotating through various core specialties.

Is so early a clinical exposure really worth it? After all, I have barely begun to learn any of the basic sciences expected of a future physician.  Oftentimes I found myself not knowing what the doctors were talking about or only making sense of some parts of a diagnosis. Without having taken anatomy, I spent a half-day on the OB/GYN floor looking at ultrasound images and another half day in the operating room watching a surgeon performing a partial nephrectomy; I couldn’t orient myself to where in the body he was cutting. After all, this early into my medical education, I hardly knew what side of the body the spleen was on.

However, even though I was lost most of the time, those dizzying two weeks I spent in the hospital was an experience I would not want to trade for any other. To me, the benefit of early clinical exposure was not so much about measurable knowledge gained; it’s more psychological, harder to pin down, but just as important.  Perhaps the best way to illustrate this is through an anecdote from my childhood. On my sixth birthday, I was given a piggy bank as a present. Periodically, I would put some change into it. For a six year old, this was not a particularly interesting task. I did it because the piggy bank was a more logical place to store the pennies, nickels, dimes, and quarters than on my table. It took a year to fill up the piggy bank.  But when I counted the money inside, I had over 40 dollars — enough to buy the latest edition of Need for Speed all by myself! This eye-opening experience gave me a newfound purpose: to fill up the piggy bank as quickly as possible. I started looking for change everywhere: under the couch cushions, inside my father’s desk drawers, and in my mother’s purse. After I swept all the change from my house, I decided I had to make money some other way. I built a lemonade stand and overcharged my parents for the lemonade I made using their ingredients. As a result, I was filling up the piggy bank with far greater frequency — because I now had a clear purpose.

For the same reason, early clinical exposure provided a larger perspective to my medical education. It not only gave me a visceral view of my career as a future physician, the experience also gave me an overarching purpose that organized and propelled my learning. I have come to see that sitting through a lecture is no longer a tedious necessity of my medical education but an essential building block that lays the foundation of my medical career. Whereas I once questioned the need to memorize the location of the renal artery during an undergraduate anatomy lecture, I now have a newfound appreciation for the absolute necessity of such knowledge — especially after I witnessed a urologist using a Da Vinci machine cutting through layers of fatty tissue and then clamp down the renal artery in order, as he explained to me later, to prevent excessive bleeding when he excised the tumor. At that moment, I realized that each fact I learn in medical school is another “nickel” added to the metaphorical piggy bank that will one day be filled up and allow me to don the long white coat and live up to the ideals of the Hippocratic Oath.

For these reasons, I cannot overstress the importance of those two weeks of early clinical exposure to my overall medical school education.  In Stephen Covey’s The 7 Habits of Highly Effective People, the second habit is to “begin with the end in mind.” Having been exposed so early in medical school to the rigors, demands, and breadth of knowledge required of physicians in a hospital setting, I, too, have begun my medical training with the end in mind.

Karan Patel is a medical student.

Image credit: Shutterstock.com

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