Massachusett's heartland

Decisions, decisions. It's about that time of year, the rite of passage: picking medical clerkship schedule. The clerkship is our first real exposure on the wards as clinicians in training, learning trial-by-fire. The school keeps telling us this is the light at the end of the tunnel--only we don't know which end we're about to get. In the midst of cramming for pathophysiology, studying for the USMLE, deciding on clerkship, I am now presented with an additional choice of spending my *entire* third year in Western Massachusetts. The only obvious drawback: it's in Western Massachusetts. Rolling hills of snow. Amber waves of nothingness. Medicine 24/7.

I'm a cityboy, always have been. I like my cafes around the corner, my local grocery pretentious and pricey, and my company queer. This is a big decision. Of course the school knows; that's why it is trying so hard to make the site attractive, promising a dedicated staff to care for the 30 odd medical students all from my school (without the added competition with students from other medical schools that would happen if I were to complete my clerkship in Boston), and brand spanking new facilities with state-of-the-art technology and dedicated teachers. I could pursue 1 uninterrupted year of research on top of my medical clerkship, have a mentor of my choosing, and potentially, get some really nice recommendations out of the experience. To a 'gunner', as we'd like to call those in the medschool class who are always willing to go one step beyond to best the competition, this sounds like a heavenly opportunity. It probably is.

I cannot deny the fact that I can personally benefit from this arrangement. Third year of medical school really boils down to 2 things: getting honors on all clinical rotations and really good recommendations. Since many medical schools stopped recording grades for the first two year of training, residencies can only use three markers to gage candidates: board scores, third year clerkship grades, and letters of recommendations. If I go, I will have a good chance of maximizing my return on 2 of the above criteria, and the one year of research can do nothing but add to my chances of landing a better residency. Somehow, a place at MGH seems more possible, and an eventual life in Boston more certain.

Many of my friends are not considering this option. They say that the 30 that end up at this hospital will be the gunners of the class, thus distilling the competition and raising stress for everyone involved. We are largely stuck with each other the entire year, although everyone will have his own rotation schedule. Relationships will be strained because of the distance. Medicine 24/7 is never healthy. Life sucks out there.

For now, I have not made up my mind. I do like the reduced stress of having everything at one site within 5-10 minutes of where I will live, and having clinicians who will know my name, know my needs, and see me not as another lowly medical student groveling for grades, but one who might actually want to learn something. The site visit next week should give me a better gut feeling for the place. So many of life's major decisions are really based on instinct anyway, why should this be any different? Additionally, I'll see who is actually interested, and if indeed this distillation effect everyone fears is actually happening. Whatever. Bring it on.