Yesterday, I received the notice that I’ve officially withdrawn from medical school.

If there’s a more drastic way to “fail” at clerkship, I don’t know what it is.

But I don’t feel like I’ve failed. I feel like I’ve adjusted course. I feel like I made a mistake and have learned from it. I feel hopeful for the future for the first time in two years. And I hope that anyone who needs to hear this today knows: it’s okay if medicine is not for you.

I’m not sure exactly what my motivation is for writing this today. Part of it is cathartic, to get my experience off my chest. But the other part comes from how alone I felt while going through this process. I desperately needed someone else who had felt as I did, and it felt like everyone I knew in medical school was flourishing, like they’d found their calling in life. I know everyone has struggles and that there are others who felt as I do, but I couldn’t see them. And I don’t want anyone else going through this to feel alone. So here’s my story.

I began medical school with the intention of becoming a psychiatrist. It had been my dream since I was in the tenth grade, and every decision I made up until my acceptance letter had been to help get me here, to medical school. I turned down social events and dedicated all my free time to volunteering and researching. I remember in second year of undergrad working so hard that my only breaks came when I was eating dinner each night (incidentally, that was also the year when I got my first ‘B’). But May 12th 2015, it all paid off when I got my acceptance letter to U of T med. I cried so hard reading that letter that when I called my mom she assumed I had gotten rejected because I was so distraught. In reality, it was relief and happiness. I had worked so hard, but I had made it. I was going to accomplish my dream.

Then I began preclerkship. I struggled a little here – the hours had somehow gotten even longer than in undergrad (something I didn’t know I could physically do) and as psychiatry was my passion, I didn’t have a lot of interest in most of the material, but I persevered. I failed one exam when we had three exams in one week, and this shook me. I had never failed an exam in my life. But I was able to retake it and I got a 95% the second time. I learned that it was the hours that I was struggling with, not the material, and that gave me hope. I helped spearhead the Monologues in Medicine committee and the Resiliency curriculum. I was open about my struggles and advocated for medical student wellness. I tried to implement the teachings in my own life: I tried to make time for social interaction, to enforce breaks in my schedule, to make sure I was eating and drinking well. It was hard, but I made it. And I was looking forward to clerkship, to a time when I would be out of the classroom and into the hospital, really working.

Then clerkship hit.

On paper, clerkship doesn’t sound that bad. It’s a series of internships with exams at the end on the material you learned that rotation. But reality is different. In clerkship, you work a physician’s hours (or longer, since often my preceptors would go home and leave the notes and paperwork to me and the residents). I was working 12-13 hour days, and when you add in transit time, time for eating and showering in the morning, and sleeping a few hours each night, that does not leave a whole lot of time for anything else.

But I had to be aware of the little time I had, because it had to be carefully rationed out. In theory, you should be learning the exam material on the job, so most of your studying should come during your working hours. But in reality it doesn’t always work that way. Sometimes you’re assigned to a specific subspecialty and you only see one type of illness or one type of patient. Sometimes the things you learn day to day don’t translate to the sorts of questions they’ll ask on an exam. And sometimes there’s just so much material that you cannot hope to learn it all on rotation (I’m looking at you, internal medicine, where we were given no textbook or material to study, but instead were given a several pages long list of topics to know that ended with a statement along the lines of ‘and any other relevant topic in medicine’. Umm thanks?). So instead of my free time going to the self-care I so desperately needed, it instead went to studying. I stopped spending time with friends and family. I didn’t exercise. Most of my meals came from Uber Eats. My apartment was constantly a disaster. My life was medicine, and only medicine. And still I struggled on my exams. One I had to do remedial work. One I straight up failed (cough internal medicine cough).

Then there are the hours you spend on the ward. In theory, it should help fuel your passion for medicine. It should give you a sense of community. It should make you feel like you’re putting in all this work and all this time for a purpose. But again, reality is not so simple. The truth is that most medical students are abused in the work place. Maybe not always abuse as we tend to imagine it (though I have heard stories from other medical students who have experienced physical and sexual abuse in the work place, those are not my stories to share) but verbal abuse and humiliation run rampant in our workplace. It’s hidden under the thin veneer that it helps to be afraid when learning – that you’ll remember the information better if it comes with an emotion attached. Theoretically, that’s true, but only to a point. For me, I was so stressed that when I was abused and humiliated I heard nothing, learned nothing. I would just nod my head, apologize, and try desperately not to cry until I was alone. And I suspect that this veneer hides the truth, that medical school is simply a hazing culture. The mentality that “we went through this to be a doctor, so now you have to as well”. I also think that my supervisors were stressed and struggling themselves, and that leads to a lack of compassion that gets transferred down the pecking order to those beneath them.

And so I woke each morning, struggled to get out of bed while exhausted and depressed, put on a smile, went to work and tried to hold that smile for patients while getting verbally abused, and came home even more exhausted only to have to study even more material. Then I would stagger to bed, sleep five hours, wake up, and repeat. I couldn’t take care of myself beyond ensuring I had enough calories to continue on. And there was nothing more to my life than this. I missed my family and friends. I missed eating non-pre-packaged meals and living in a clean apartment. I missed my hobbies. And I missed feeling well – both physically and mentally. I became more and more anxious and depressed.

For two years, I did my best to try and be resilient. I went to OHPSA and got accommodations to my clerkship schedule. I was on medication and in therapy for my mental health. I tried to tell myself this was only temporary, I only had to keep holding on and it would get better. But then I looked ahead. Fourth year may not have the same exams as third year, but you’re transitioning and moving from city to city every two weeks. You need to impress your supervisors for reference letters. And in your free time, you need to be preparing for CaRMS and the LMCC. Then comes residency which is a whole other beast, with struggles and stresses of its own. And finally I realized that I simply wasn’t happy, and if I continued on this path, I wasn’t going to be happy. So I took a leave of absence to figure out where I wanted to go from here.

During that leave of absence I did career counselling. For the first time in my life, I looked beyond medicine at other options. And I realized there were other education and career paths that I could be on where I could be happier, both in the short and long term.

I won’t say that my decision to withdraw from medicine was easy. It took me two months to come to the decision. There were (and still are) a lot of factors I had to consider, not the least of which was the debt I had incurred in medical school. Even now, when I’m certain I’m making the right decision for me, I still cried when I got the email that I’ve been withdrawn. This was my dream for so long, and I put in so much time and effort, and worked so hard to achieve it. And, despite all the negatives, there are lots of things I will miss about medicine. But I can no longer put one dream ahead of my health and happiness. And leaving is the right decision for me.

I know there are people out there who love medicine, and thrive in medical school. I may not understand, but I am so happy for you. This post, however, is for those out there who are silently struggling. I just want you to know that you are not alone. Maybe medicine is the right path for you, and the struggle will be worth it. In that case, just know that you are not alone in struggling, that this is a hard path and it absolutely makes sense that you’re having a hard time. Please take care of yourself first. And maybe there are people out there reading this for whom medicine is not the right decision. I’m here to tell you that that’s okay too, because I know that’s not something you’re going to hear from many other people. But it’s okay. It’s okay to put yourself first and do what you have to do to take care of yourself. And if you have to leave, you’re still going to be okay. I know it feels like the end of the world, but it isn’t. There is life on the other side, and you will be happy again. Medicine is just a career, and you are so much more than just a medical student. Be happy.

– CC4

As a CC4 on an elective surgical rotation I was in an OR for a very large abdominal aneurysm. Naturally the surgery was very complicated and I stood on the sidelines watching until the very end, at which point my staff asked me how my suturing skills were. Having been told previously that they were exemplary, and trying to appear confident, I replied “excellent” and he invited me to scrub in and close the skin. It was a big moment and I was feeling proud, diligently performing a running subcuticular suture the full length of the incision. Unfortunately my sutures were not “excellent” and when I had almost finished, the surgeon inspected and told me I needed to take it all out and start again. I was mortified. It was after midnight and the scrub nurse, the anesthesiologist and a fellow elective clerk all groaned. I was mortified. By the time I was done, the patient’s skin was bruised, the closure looked terrible and all I wanted to do was hide under the drapes. Takeaway point, always be humble. I should have instead said “I’ve been told they’re good, but I’m always looking to improve, will you give me some feedback as I go?” Humility is not weakness.

– PGY3

My first rotation of clerkship was pediatrics wards and the staff, whom I knew to be quite harsh from a series of mandatory workshops in my preclinical years, had really high expectations for first-time clerks. My second day on the wards, he asked me to write an admission note for a PICU transfer in under an hour—it took me 3 and he was really unimpressed. Nevertheless, I tried my best to keep up with the pace and manage multiple patients at once. After the first week, he gave me feedback saying I was doing “just fine” and just needed to be more confident and less nervous.

Then I worked all weekend. We were understaffed so I had to manage five patients at once. I’ll admit I’m not the most organized person and struggled to keep up with my tasks and finish my to-do list by the end of each day. Like my other classmates on the floor, I let a few things slip through the cracks in the middle of all the chaos.

On Monday, my staff and senior resident took me aside to tell me I was failing my rotation with 4 days to go. They said I was clearly overwhelmed and couldn’t even manage two patients at once and was too slow and didn’t understand what was going on with my patients. I basically needed to make drastic changes and speak with my site director to pass. I was not given any concrete suggestions to improve.

I was floored. I had truly been doing my best and did not see this coming at all. I burst into tears right then and there. But with the help of my site director, I eventually came up with different strategies to be more efficient, like keeping lists with colored pens and carrying a notebook and minimizing distractions during the day.

On the last day of my rotation, I was told I was still completely inadequate and would struggle through the rest of clerkship and that other attendings would be even more harsh in the future. Again, I sobbed throughout the whole session. I was so proud of the changes I’d made! This was basically my worst nightmare happening—would I even make it to graduation without failing clerkship?

Well, the next rotation was obstetrics and I fell in love with the field. I was told I was sharper and faster and more confident than the average medical student—basically the complete opposite of the feedback I’d gotten during peds wards!

This goes to show feedback really depends on the observer and the context—don’t let a few bad weeks during your training get to you and discourage you from pursuing medicine.

You got this!

– CC4

I was really looking forward to my anesthesia rotation, mostly the opportunity to learn procedural skills. By the end of the first week I hadn’t had a chance to practice IVs. The resident I was working with offered for me to practice on him – he told me it wasn’t a big deal, so I took the learning opportunity, and succeeded!

The next week I was with an anesthesia fellow for a shift. I introduced myself at the beginning of the shift. He said, “oh, you’re the med student who goes around stabbing residents!” I thought it was a bit of a strange comment, but I shrugged it off.

The next day I ran into one of my clerkship group-mates. She had been working with the same fellow I had worked with the previous day. At the start of her shift she mentioned to him that she hadn’t had much practice with IVs and was hoping to learn. He responded to her that he didn’t let med students stab him, unlike his resident colleague. He then mentioned me to her and said that the only reason that my resident had let me practice IVs on him was because he had a crush on me, and that they (the anesthesia residents and fellows) had been making fun of him for it at rounds that morning. The fellow then made a joke to my group mate along the lines of, “next, she’s going to tell him she’s never put a Foley in!”

I was absolutely mortified. I burst into tears. For the rest of the rotation I felt like I had a neon sign on my forehead “flirtatious clerk that ______ resident has a crush on.” I spent the next few weeks so self conscious about how I communicated with my male superiors, worrying that they might interpret my eagerness to learn as flirtation.

I now realize that I wasn’t in the wrong, and I have since regained my excitement to learn. Talking to my classmates and clerkship group helped me get through the experience. Clerkship has a fair amount of both ups and downs, I found that talking through the tough times with people I trusted really helped.

– CC4

Long story here, but I hope meaningful.
One of my hardest experiences in clerkship happened at the end of my Internal medicine rotation. On call one night, I admitted a 25-year-old woman. She had been declining for a while and was now fairly ill. And yet despite a battery of tests for the rest of that week, no clear diagnosis was made. The entire time I followed her personally, and tried my best to help with the diagnostic process, as well as communicate with her family the difficulties we were having.
One week later, we still had no diagnosis, and without warning, the patient went into status epilepticus. Our new CTU staff was paged – but because she was new that week, she had not even met the patient or the family. I found myself beside her, among all the staff from the ICU team who were busy with intubating. I realized that I was the only one present who knew the patient well; but found myself struggling to mount the courage to present myself as such to this team of professionals. In the end, I meekly accepted helping to bag mask, all the while feeling distressed that my patient was declining, that I could do nothing helpful, and shocked by how nonchalant the team was about the situation.
The patient was eventually moved to the ICU. A kind resident brought me with them, and I helped her put in a central line. To my continued amazement, she quizzed me on drugs for status. At the time I couldn’t understand how she could ask that, when it seemed a life or death situation.

I left that evening to study for my iOSCE the next day. The day after that was our Internal medicine OSCE. By the end I was completely fried, but I arrived back at the hospital for an evening call that night, and ran into one of the senior clerks – Who flatly informed me that the patient had died Tuesday morning, from a disease I had never heard of before (HLH, for the record). Her passing, and the entire debrief with family and staff had occurred over the two days that I was away. I had not been included, due to being away for exams, as well as, honestly, being just a clerk – apparently.
For the rest of the week, no one talked about the case. Because our staff was new that week, she didn’t have much connection to the patient, and never mentioned her again. Our senior resident also left that week, so there was no one to help me sort out the feelings I was having. I felt shame, that I hadn’t figured out what her illness was, or been able to help in her care at the end. I felt rejected by the staff who hadn’t included me in any debriefing process; and I felt anger at the establishment, who didn’t seem to care that a 25 year old girl had just died, and more about the “interesting” disease she had had.

For weeks after the rotation ended, I struggled with deep discouragement. I was crying often, and missed some days of the next rotation. I felt extremely tired of everything related to medicine. Eventually, I reached out to an OPHSA counsellor who started chatting with me weekly. We worked out many of the feelings that come with “your first death”, as well as the difficult experience of internal medicine in general. She felt that I was showing symptoms of burnout, and in retrospect I agree. It took a bit of time and self-compassion, but eventually the darker feelings improved.
The lessons I think I’ve learned that I’d like to share – You may be “only” a clerk, but never sell yourself short; You have a huge impact on a patient’s/their families experience. All the same, don’t get down on yourself when you are out of your league (and this will happen). 2) Your patients will die, and it may be okay for you, or it may really, really suck. Many doctors see that happen everyday, and their reactions are normal; Just like your reactions and feelings are at your stage. Please talk to someone about them. OPHSA is great for that. 3) Burnout happens in medical school; its not a sign of weakness, but often of caring very much. Talk to people about that too 😊

 

– CC4

One day on internal medicine CTU, I was sent to talk to a patient who was admitted for heart failure. I skimmed the admission note, and gathered some facts about his history; then set off to talk with him. I arrived in his room, and saw two beds with elderly men in each. I announced the patient’s name loudly, and the gentleman in the far bed waved to me. I sat down, and began my interview. I asked all my questions, and got a good sense of his story, however found that some details were slightly off from the consult note: his age by two years, the length of time he had been widowed by 8, his pack per year smoking history by about 5 years. I didn’t think much of it. I returned to my team and presented the case, suggesting some adjustments to the management plan. My staff said he has spoken to the patient too that day, and disagreed with some of my points; so he suggested we go to see the patient together. To my horror, as we entered the room, I waved to the patient with whom I had spoken, but my staff turned to the OTHER patient in the room, and began talking to him. Only then did I check his ID bracelet, and realize that I had interviewed the WRONG patient entirely. Somehow, their stories were both extremely similar!! I was immensely flustered, and ended up waiting until after my staff was done talking to the patient to admit what I had done. Honestly, I felt like the biggest tool ever. My staff initially looked unimpressed, but after I explained that the other patient had actually ANSWERED to his roommate’s name, he started laughing. He admitted that something in my story had seemed a bit off. He encouraged me to always check the ID bracelets – Which believe me, I always do now! Take away – Admit to mistakes, and check IDs!!!

 

– CC4

I was on general surgery and was eager to do hands-on stuff when possible. The opportunity came to put in an NG for a patient with a query bowel obstruction. I had done two before, so I had gotten falsely cocky. The patient’s nurse had just gone on a break but I asked another nurse for help and went to it. The NG insertion went smoothly, but unfortunately, when I aspirated, nothing came up. Luckily the nurse realized the syringe I was trying to aspirate with still had a lid on it, whoops. We hooked it up to suction and I walked away. But that’s not all folks! Little did I realize she had just ingested all the contrast for the CT she was about to get, and I unintentionally suctioned almost all of it back up. The CT wasn’t the most convincing due to the lack of contrast. My residents were a little frustrated by ultimately understood and just mocked me for it a little. My bad!

– CC4

The dreaded intubation skill.

I always told myself that I was good at procedural skills. When we were practicing on models intubation seemed easy, and everyone even told me “it is way easier on a surgical patient”, “the models make it seem difficult”. I was confident going into my anesthesia clerkship rotation, but I didn’t get a single one. The staff had to step in every time. This was super disappointing, and hurt my confidence going into residency whenever I was in situations where an intubation might arise.

But then, during a PGY1 emergency block an elderly lady came in who needed to be intubated and my staff turned to me and offered me the procedure. It was tough to visualize the chords at first, but then the RT put a bit of magical pressure on the cricoid cartilage, the chords popped into view and I nailed it. I went home feeling like a hero, the med student who was with us thought I was a boss, and I learned that sometimes you just have bad luck with procedures. Sometimes the patient has difficult anatomy, sometimes the positioning isn’t right, or the staff is too hands-on or too hands-off and it just doesn’t go your way. There is usually another chance to get the skill later in your training.

– PGY3

I started my first clerkship rotation in the emergency room. When I showed up, my preceptor didn’t arrive yet and another staff told me that I could get started with seeing a patient. My first patient was a middle-aged woman with a longstanding history of anxiety. She described having acute-onset palpitations and story that sounded exactly like a panic attack. I found her ecg and, having next to no actual experience interpreting one, glimpsed at the top corner and saw that the computer interpreted it as normal. I then met my ER staff for the first time ever, reviewed, and insisted that my patient can go home. He flipped to her ECG, took a 2 second glance, and pointed out that our patient actually had obvious atrial fibrillation (which was missed by the computer) and was in no condition to be discharged. Definitely not a great first impression and I remember feeling like a total idiot. My staff however was super understanding when I told him that it was my first shift and didn’t make a big deal out of it at all. Looking back, I realized that I often catastrophized my mistakes when in reality, majority of staff and residents expect us to learn by making wrong management plans and incorrect diagnoses when reviewing. I’ve learned that being kind to yourself and realizing that you are there to learn will make cc3 a much more enjoyable time!

– CC4

There were several weeks in my Family Medicine rotation in which I drove home silently in tears at the end of every day. Everyone had told me it would be a fun rotation where everyone was nice. And everyone was nice. Except I wasn’t having fun because I constantly felt like I wasn’t meeting expectations. I couldn’t recall screening guidelines or the immunization schedule. I missed some crucial history questions in a back pain encounter, even with the help of the Core Back Tool questionnaire. I was taking too long for each encounter but wasn’t able to gather enough of the relevant history. My preceptors often had to step in to quickly redo the history and physical, completing in 5 minutes what I had failed to complete in 30. At midterm evaluation, my core preceptor made it clear that I was failing to meet expectations many aspects, but would give me all “3 – meets expectations” because they were kind. I had spent the first half of my rotation working harder each day to study and memorize the content. Yet I still couldn’t seem to answer any of the questions my preceptors or patients asked. But despite all my hard work and determination to improve clinical skills, I was failing to meet expectations. The next three weeks were difficult in many ways. I didn’t feel motivated. Yet I felt obliged to smile and say “I’m fine thanks!”, and “yeah, I’m really enjoying this rotation” whenever residents, preceptors, or classmates asked. All of my colleagues seemed to be enjoying their rotation and exceeding expectations while I was struggling. I constantly felt lonely in the busy clinic, surrounded by people. I wish I could tell you I somehow did a 180 and after an all-nighter (like the Mulan training scene) I finally came to feel competent. To this day, I shudder when I hear “Family Medicine clinics”. But that’s okay. Medicine is such a varied field that it might take time for you to find your niche. You don’t need to excel in everything and you don’t need to like what every else seems to like. Just keep an open mind throughout the rotations, you never know where you find you fit best. Wishing you all the best throughout your clerkship adventures! 🙂

– CC4