Med school is no picnic, everyone knows that. What is especially hard about medical school is that it is filled with ~120 very intelligent, very driven people. Everybody in the room is used to being at the top of their class in undergraduate, used to being the smartest in the room, and many of them are in for a rude awakening. 30 of them will find themselves in a very unfamiliar situation, being at the bottom of the class.
Attrition rates: Med school isn’t like other professional or graduate programs which are plagued by high attrition rates. Graduate school for example has an average of 20-40% attrition rate depending on the program. Medical school has around a 4-6% attrition rate total which means that when you’re accepted to medical school you have a 95% chance of becoming a doctor.
Sounds easy right?
Medical school has a saying, P=MD. Meaning as long as you pass you’ll become a doctor.
Another popular phrase is, “What do you call a person who graduates at the bottom of their medical school class? A doctor”
Both of these statements are true but this notion can be somewhat misleading. Simply passing medical school is not necessarily as easy as it sounds. In addition, scraping by is likely to make the USMLE examinations quite a bit more difficult and then applying to residency with subpar numbers is not desirable. In addition to just barely passing, you CAN fail out of medical school.
How Failure works
Many people ask me about failing medical school. They might ask because they’re afraid of failure or they might ask because they want to know whether it’s worth it to wager 4 years and upwards of $300,000 on something that is not guaranteed. These are reasonable inquiries, so what do you have to do to fail?
Medical schools don’t want to kick you out, so you’ll get many chances if you fail. These policies vary school to school but are generally quite similar. Most schools will assign you a tutor (typically at no extra charge) if they see you are performing subpar, even if you’re not failing. One failed test is usually harmless if you end up passing the class as a whole, but it will likely trigger some sort of observation to make sure you’re not falling behind. Remediation exams are offered after a failed course and may replace one test or may be an assessment of the entire course. If you pass you will usually get the lowest passing score possible for that course but you continue on your way. If you fail again or fail another course in the future you may have to go in front of the promotions committee. Here they will assess whether you’re doing so poorly that you’d benefit from doing the entire year again or if a remediation exam is appropriate. They typically don’t “recommend withdrawal” after failing one year, but failing the same year twice is going to put you in hot water. Some states have a requirement for you to pass in a certain amount of time so this may change how lenient they are with you. Students who fail a year generally try to use the time to either study or do research in their off time because they’re aware their transcript won’t look as good with a failed year.
Why do people fail?
By far the biggest reason people fail medical school is for lack of trying. This isn’t to say that these people are lazy, but they weren’t able to muster the mental effort to perform for 4 years. Some of them ARE lazy, some of them lose motivation, and some realize that medicine isn’t the right fit for them. There are plenty of other reasons someone might have difficulty in medical school but here’s a list of things that I feel students did wrong and how to correct it.
The problem: Poor test taking strategies
Many of them just didn’t test well; they took the MCAT 5 times to get a good score and convinced themselves that med school tests wouldn’t be so bad. They then go on to suffer from some of the same test taking problems they had during the MCAT. They may get anxiety, move too quickly or too slowly, change answers, not understand the big picture, fall for traps/distractors, or get hung up on details.
How to avoid it:
Practice practice practice. Med school is all about practice problems. Putting yourself in the testing environment early and often will help you work through questions faster and hone your skills. You should learn to pick apart a question and understand what the question writer is really asking, and learn to identify distractors and sift through fluff. Many students think they have to master the material before they can do practice questions on it, but this isn’t the case. Most question banks have thorough explanation of why each answer was wrong and why the correct answer was correct, and then the good ones will also have a couple paragraphs of high-yield information. A great strategy is to get the baseline knowledge by watching lecture or reading a review book and then expand that knowledge by doing questions. You hone your test taking skills and you learn as you go.
The problem: Trying to do everything the professor assigns
This is more rare but I’ve seen it happen, the professor assigns 200 pages of reading and journal articles and such and they think they have to read every word in order to pass. Sometimes in med school you need to know what to ignore. The professors are often putting up supplemental reading for the people who are interested in that topic. Learning how to discern what is important and what isn’t will save a TON of time.
How to avoid it:
Pretty simple. Think about what they’re assigning and compare it to other textbooks and review material. Talk to your classmates and talk to students above you. If all else fails you can talk to the professor as well.
The problem: Not evaluating their efforts
Self-Assessment is pivotal, and sometimes students don’t understand this. They will study a certain way and do poorly and not re-evaluate exactly what they’re doing wrong and how they can change it. They often get into the trap of “I just need to study harder” without thinking about how to study better.
How to Avoid it:
Ask yourself “Am I retaining this information” and “Am I studying efficiently.” These are two questions that should be asked during and after courses, regardless of how well you’ve been doing up until this point. Different classes will require drastically different study strategies and relying on prior successful strategies may be your undoing. Evaluate the amount of time you spent studying, did you become distracted, were you too uncomfortable, were you too comfortable, did you need to stop to get food too often, did you have trouble staying motivated, did your friends talk too much, etc.
Sometimes you just need a change of scenery; certain classes I studied in the library, others at a starbucks, sometimes in the designated group study rooms and even occasionally at home. Studying in a group worked for some classes where you needed to talk things out and quiz each other like anatomy, we’d go and look at the cadavers and the models repeatedly asking each other what everything was and what it did. Some classes were more about straight memorization like pharm and I made concept maps to keep it straight. This isn’t necessarily what you should do but you should keep your techniques fluid and never be afraid to shake up your routine based on perceived and quantifiable efficacy (scores).
The Problem: Burnout
This one gets everybody, but everybody seems to think it wont affect them. Medical school is long and arduous, with little time off. My school gave one summer vacation in between 1st and 2nd year but after that it’s straight through until mid-late 4th year. This can get real exhausting real fast. Burnout is a more than being exhausted, because sometimes you’ll feel exhausted but be able to keep going, but when you’re really burnt out you just cant go any more. You’ll sit and stare at your screen but nothing clicks. You’ll dream of the outside world and wish that you just had a break, and start envying people out there enjoying . Depending on how long you stay “burnt out” you may just end up a little behind or it could ruin your performance in a class.
How to avoid it:
Avoiding burnout should be a very top priority, because all of what I’ve said before will crumble if you don’t have the will to go through with it. Sometimes burnout avoidance is as simple as scheduling breaks, which help prevent you from getting “sick” of studying. Attending to your wellbeing is an important factor in avoiding burnout as well, activities with friends and a few minutes here and there on old hobbies can work wonders in the long run. Staying in shape or playing sports help keep you from blimping up and also keep you sane as becoming one dimensional and making medicine your entire world is the fastest way to burn out. If you’re like me and in a long term relationship, take some time with them to unwind and maybe watch a movie. Doing things together like cooking dinner can maximize time efficiency and you can have fun too. Going out on the town or taking a mini-vacation on a long weekend can really recharge your batteries. Taking care of yourself is very important. Beware of going too hard on the relaxing, though, so on that note:
The Problem: College Part II
This is something a lot of premed students don’t realize, but med students still party pretty regularly. Some people use it to (rightfully) unwind occasionally, but some go way too hard. Sounds a lot like college huh?
How Success works
So besides avoiding pitfalls what are some other things you can do to excel in med school?
Advice from your elders
Talk to people in the class above you, preferably several of them to compare the different strategies each of them had. They’ll be able to advise you on which resources are better and also may even have some study material left over that they can bequeath on you. Don’t get too caught up on doing exactly what they did but see which strategies were used and feel free to pick and choose as it suits you.
Figure out where you like to study, and be honest with yourself. A lot of people LIKE studying in a big group but if you don’t get any work done then it’s not a good fit. Going back to the previous suggestion, constantly re-evaluate how much you get done vs how much you enjoy your studying environment. Studying at home can be cost efficient and enjoyable but if you’re not getting enough done because of all the distractions then suck it up and head to the library. Additionally I’d like to go ahead and recommend some Bose QC-25 noise-cancelling headphones, you’ll thank me later.
As I stated above, question banks are gold. But you need to balance the cost with its utility. If your school has a question bank they pay for consider using it but if it isn’t good then feel free to ignore it.
By far the best Question bank is UWorld, but it’s expensive and its questions are a little advanced for first year so keep that in mind. UWorld has some pretty challenging questions that really make you understand the material, there are some real NBME questions that are similar to UWorlds difficulty but most are actually easier than UWorld. Uworld also has the best explanations, images, and charts.
Kaplan Qbank and USMLERX are tied for second place in my opinion, with a little bit of an advantage towards Qbank. These questions are some what simpler but they have some tough questions too, explanations are decent and the overall difficulty of these tests were comparable to the NBME and in house tests we encountered in 1st and 2nd year.
Other question banks include USMLEZ, Exam Masters, and some others. If your school provides them for free they’re not bad, but I would recommend the other banks unless money is really an issue.
Resources: Review Books and Videos
These are great, but you need to know which ones to use for each class. The bible of med school is First-Aid, but on top of that you’ll need a good review book for each class. I felt that First-Aid Organ systems was good for some classes like cardio but useless for others. BRS was good for pathology and physiology but less so for others. It comes down to personal preference and what your professors like to focus on. Hit up your classmates and elders to find out which books are best for which class. Sketchymicro is really clutch when it comes to microbiology, you can save a bunch of time and really solidify information.
In addition you should be watching Pathoma. Dr. Sattar is a blessing upon us and those videos are golden. The book is also good but the videos are awesome. Some people liked Dr. Najeeb for physiology and organ systems but I thought he took too long to explain things.
This should be a good overview, as usual, any questions are welcomed.