The middle school of medicine: a reflection on the first year of medical school, by Alexis Bailey

Alexis Bailey is a medical student at the

UA College of Medicine-Phoenix.

Her piece was originally published by KevinMD

There is a picture of me kneeling in front of the Azure Window, once off the coast of Malta, eating a chocolate ice-cream cone. I am 12 years old, having just finished the sixth grade, wearing high-top “Bathroom Wall” Converse and not-at-all-grungy cargo pants in my attempt to emulate the 2008 aesthetic of Avril Lavigne. On top, I’m wearing a plaid button-down and a straw cowboy hat, which my mom had bought me the previous day at a tourist shop because it reminded me of barrel racing and Shania Twain. My face looks content, but beneath my ridiculous outfit, I was wondering if people liked me or who my teachers would be in seventh grade and if I was doing well enough in school. Would my mom be mad at me for kissing a boy on the soccer field or using swear words?

I distinctly remember feeling extremely cool, much cooler than my parents seemed to acknowledge, and yet utterly insecure. A striking dichotomy of both child and adult formed the conflict of adolescence. Every day my understanding of “self” unfolded a little more. I was blissfully unaware of my misguided attempts to be grown-up and yet all too aware of my awkwardness, never connecting the two might be related.

Fast-forward, and I am in the middle school of medical education. The simple, naïve pre-med years are behind me, and ahead of me lies a more competent resident and attending physician. My undergraduate years are elementary school: My meals provided to me by a cafeteria, more naps than I ever deserved, and plenty of time to spend with friends (and horses). As an undergraduate student studying biology, I was aspirational about my future, but still basking in the glow of higher education with no realistic concept of what the future held. Now a newly-minted second-year medical student, I am once again struggling to find my place, yet this time within medicine and not the schoolyard. I feel grown-up enough to be a respected member of the medical team and yet too young to make any meaningful contributions, buckled into the Dunning-Kruger roller coaster of I got this! and Wow, I do not got this. Every new concept, experience, and physical exam skill affirms my love for medicine as it simultaneously terrifies me. Will I ever be good at this?

During my fourth session shadowing a community family-medicine preceptor, I was tasked with taking a patient history (histor-ies, really, as it was a couple). Panicked, I told the doctor I was not ready, but he assured me the task was not that bad and also not optional. I knocked on the door of exam room 2 to find a sweet woman and her husband next to her, staring a bit blankly. I nervously introduced myself and began to work through the OPQRST I had learned in my doctoring course, scribbling down medications I hadn’t yet heard of, and details I figured would be important.

Despite my obvious discomfort, the couple was very willing to answer my questions and indulge a young stranger about their medical history. I attempted to follow up on their answers to the health screening packets the clinic provided for their yearly physicals, but it soon became clear to me I wasn’t prepared for that task. I had no idea how often women should get mammograms or when they aged out of Pap smears. Nevertheless, a few minutes into the encounter, it suddenly didn’t feel so scary. My friendly yet frightened face seemed to discourage them from asking too many questions: they’d wait for the doctor.

“I’ll be back in with the doctor soon,” and out the door I went, clammy and relieved. As exhilarating as medicine is, real patients are terrifying—with real problems and no script. I feel guilty admitting to my anxiety and hesitancy given how badly I’ve wanted to practice medicine for the last many years, but my excitement is not yet a match for the colossal amount of information I’ve yet to learn. Yet as I left the room unscathed, I felt confident in my history taking, and reported back to the doctor with the information I found. I rattled off prescriptions needed, new symptoms, gone symptoms, life updates—

“Great! Did you ask about Cologuard for them?” Well, no …

“Her last mammogram?” Um, no …

“How are we going to keep them from dying of cancer?” he said with a light-hearted smile, his medical assistants looking a little too satisfied at my incompetence. So much for my stellar history taking skills and the small amount of security I just had in myself. There is a lot of learning ahead of me.

In the end, there is something reassuring about the middle school of medicine: I already survived once. Maybe not the medicine part. But the middle school part, yes—despite every awkward encounter, wrong answer, embarrassing moment, and weird change, I survived middle school to reach high school, then college, then medical school. I sometimes find myself wishing I could fast-forward, to be an attending now without any of the pain that comes with learning and growing. But I know that these in-between, adolescent times are crucial to the development of my own values, resilience, and viewpoints, as if I am nestled in a cocoon of experiences, protected by the institution of medical school but awaiting to emerge a full-blown physician.

Sitting in Malta eating my ice cream cone, I had no idea I would someday be a 12-years-older version of that same girl in medical school: excited for the future but worried about who I am and who I am becoming. Fortunately for everyone, I ditched the high-top Converse and straw hat for a short white coat and a stethoscope.