Editor's Note: The second quarter of Penicillin For Your Thoughts continues to explore the transition from pre-med to medical student to practicing doctor, not only in terms of schooling and physical obstacles, but also how ones identity and relationship with their passion is constantly being redefined.

The third and fourth years of medical school are not some Greys Anatomy prequel, the race to residency. Yes, you have dramatic things like surgery, impressing attendings, and 24-hour shifts, but this time, there are real people going through it. For those who have never spoken to medical students (me before sophomore year), you cant help that fiction dictates your reality, and thats okay. Just listen up.

Third and fourth years move the student out of the classroom into clinical rotations through the various specialties. The School of Medicine holds clerkship rotations in all five WWAMI states, sending its students all around the region to study under professionals. Sometimes, youre the only one in your rural Idaho town, stripped of the support of school.

Third year was jarring, and youre not really prepared for it until you do it, fourth-year student Liz Reed said. When your time is limited, you have to figure out how to soak up all that knowledge when you dont get the chance to see it over and over again.

The vast majority of students are accustomed to textbooks and lectures, to sitting down and having time to process. Labs and field experience have always been an elective. Once you get to rotations, though, youre learning from your hands.

You have those moments, Oh shoot I didnt ask that question, I didn't think of that, Reed said. I struggled a lot. I hated being wrong and I was wrong a lot.

The physical demands of rotations are about as crazy as youd expect. Reed commented that she got an average of three hours of sleep during her internal medicine rotation, which was apparently pretty good.

Youre adjusting to a new sleep schedule every six weeks, Reed said. My first was OB-GYN. The first two weeks was getting up at 4:30 to get to the hospital, then I had nights, then a regular 9-5 schedule I dont know if you ever get used to it, its just something you do.

Its always in retrospect that you realize you werent prepared for a big life adjustment. Reed advises not to beat yourself up and be gentle.

Fourth years been a huge relief, Reed said. Being able to talk to your classmates, your mentors, your partner, your friends [it is] that little piece of solidarity of We know, were there too.

For all the ways it grinds your soul to bits, rotations give you the first opportunity to see the same patient over and over again. During her internal medicine rotation, Reed got to tell a woman she had been moved to number one on the priority list for liver transplants. Saying goodbye to this patient after six weeks was one of the moments that validated Reeds decision to do medicine.

When I got up there, she was having a rough day, Reed said. When she realized it was me, she let me into the room and kind of broke down. Im feeling overwhelmed, all these doctors, I need a break. Shed kicked out every doctor, resident, person, but she let me in. It was really special.

What we can get out of medical school rotations as pre-meds is the attitude to just take things as they come without being bitter. If people can emerge from rotations with a positive attitude and a reinvigorated love for their passion, its probably the course to take.

What makes all the studying worth it, all that hard work worth it, is those relationships with patients, Reed said. Its been my absolute favorite part of school.

Reach columnist Theresa Li at science@dailyuw.com. Twitter: @lithere_sa

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Medical school rotations: What to expect from the hardest years of medical school - Dailyuw