Medical Training Hierarchy: Your Role as a 3rd or 4th Year Student

Last Updated on June 24, 2022 by Laura Turner

I’ve just started my fourth year, and while it’s a relief to be done with all of my medical school exams, I’m finding that there are plenty of new responsibilities to take on! I’m no longer the lowest member of the medical food chain, which also means that I partially have the responsibility of taking care of my M3 classmates. I am currently rotating on a surgical service where this dynamic is especially prevalent. It comes into play when scrubbing in to surgeries or doing other “higher level” tasks. I think this hierarchy is important to discuss for those M3s just beginning their first clinical year.

I recently read a post in which a fresh third year medical student discussed a negative comment he had received on an evaluation, saying that he had been a bit brazen on the service. The student went on to describe an instance where he asked to scrub in to a surgery over a general surgery resident physician. As a third year, I did not have any idea how the surgical food chain worked, or that there even was one. By food chain, I mean the hierarchy of each member of the medical team. There is an unspoken understanding that the attending physician is highest in that chain, followed by the residents, and lastly the medical students. All of the other members of the tea—including nursing staff—are also incredibly important, but I’ll just focus on the chain of command in the steps of a physician’s training. The aforementioned student had clearly broken that chain, and it reflected in his evaluation. This order exists for a reason: the resident and attending physicians both have significantly more experience, and therefore are the ones directing the case. As a medical student with very little clinical experience, it can be best to wait for direction instead of usurping a learning opportunity from the resident physician. Residents and even attending physicians are aware that students are there to learn and will present valuable opportunities when appropriate. The key is to know when it is appropriate to ask to participate.

It’s pearls like these that help M3s shine on their services. I know as an M3 last year, I learned much more than I expected from people who were just one year my senior. They have just been through everything I am about to go through, and the experience is therefore fresh in their minds. They gave me valuable insight into how to balance studying for shelf exams and being on service, as well as general advice on when to be seen and not heard and how to know what to do and when on each service. On many services, I felt as though medical students were oft-neglected and though this is just the nature of the beast, I was left wondering what I was supposed to do and where my place was. Thankfully a 4th year medical student guided me and taught me how to be helpful—from getting warm blankets to helping the attending gather supplies for a skin excision. I know how valuable that was to me, so I’m hoping to pay it forward. I’m currently on a service with a third-year medical student, and I try to help her out and teach her some clinical pearls as well. It’s amazing to look back and realize how much I learned during my third year, both in and out of the hospital. I know that my M3 counterparts would benefit from at least some of that knowledge. Through each step of the training process to becoming an attending physician, there come many opportunities to help those who are not as far along, and I am so excited to embrace them.