So a lot of my students want to know what its like to be in Medical School, and I’ll admit I was curious when I was a pre-med too.
Overall, what’s med school like?
It’s intense. It is a LOT of work. My school has tests nearly every other week for the first two years so you’re constantly in study mode. You adjust though; you learn how to scrape together time here and there for personal relaxation, to run errands, or to get other stuff done. Time management really is key, along with staying motivated.
Med School overall is not too dissimilar to a SUPER intense private college, where everybody is really smart. The material flies at you and tests seem to be always around the corner, but once you get used to it you’re ok. The getting used to it part can be the problem. Med students are used to being at the top of their class in undergrad many of them with relative ease. It’s tough to come into med school, study hard and then realize you’re at the bottom of the curve. For other students it’s the opposite, they’ll work hard and score high, and then get worn out trying to constantly stay at that high level of performance. In medical school, it’s a sprint AND a marathon. Some accept their fate and shoot just to pass, which is still a lot of work, but manageable. They’ll often be able to even go out on a weekly basis, and have real actual social lives. Some go too hard in college part deux and fail (yes you can fail med school, details on that in a later post). The rare creature may be able to have a social life and also score incredibly high, but generally in medical school you need to study hard and study often in order to crush classes. You’ll have to be constantly challenging yourself and changing how you study to optimize time. You’ll learn to focus on material that is the most “high yield” (get used to that term you’ll hear it a lot) and going back for the details when you can, because in med school there is just too much info to know everything. I’ll post more about how to do well in med school in a different blog entry.
The TL;DR version: Med school is intense and will be the hardest thing you do up until now, but it is rewarding. You can survive it, and yes you can even enjoy yourself during these 4 years.
So you’ve been accepted, congratufuckinglations! Now what?
Deciding on a school
More than one acceptance is an extremely advantageous position to be in, but how you handle your acceptances can be challenging. Generally, prior to May 15th, you can hold multiple acceptances at once. Some elect to immediately withdraw their acceptance at other schools the minute they get a “better acceptance” in order to free up the spot for other students. This is generally what the medical schools would like you to do because it frees up spots for them to fill sooner, which makes their job easier.
Others (myself included) hold out to see how the dust will settle, and take their time to decide on what school they will go to, because it is an EXTREMELY important decision. I feel this is the most logical route because the school you originally thought was “better” may not be a correct fit for you for whatever reason. You may learn more about the area, the school, or just the geographic location relative to your family (too close or too far) and may wish you hadn’t rescinded your acceptance so early. Additionally, after March other schools can see where you’ve been accepted. This information may potentially guide ADCOM’s to make a decision on your application. If they thought you were a borderline applicant but then see you got accepted to 5 schools already, maybe they should think harder about you. Additionally, if you have an acceptance to a school that really wants you to go there, but they see you have several acceptances you might take over them, they might offer you a scholarship to entice you to come to their school (which is what happened to me). Clearly, being in this position is awesome, and I can only hope you find yourself here.
I do advise you to be considerate and not hold onto acceptances too long if you think there is no chance you’d ever go to that school since you are preventing anyone else from getting that spot.
Gathering requirements, completing health/background paperwork, and finalizing transcripts
The last hurdle before you can call yourself a medical student. You have to fill out pre-matriculation paperwork (not fun), complete vaccination forms, attest to being capable of being a student, signing honor code contracts, paying for background checks and drug screens, and having finalized transcripts sent to the school (yes, again). You may have to do this several times if you genuinely don’t know what school you want to go to. This may be a drag, but it’s ok. You will get used to filling out forms that you don’t want to fill out, as it comes with the territory of being a doctor.
You also have to decide on when and where to move, who to live with, or if you should splurge and live alone. This can be a difficult decision, and I suggest you become active on the Facebook group that will be created for your class. Get to know your future classmates; a bad roommate can really be tough while you’re trying to figure out med school. I suggest as a default, living alone for the first year and figuring it out from there. Where you live will vary by school so, again, be proactive and talk to current students (after you get your acceptance) and ask where students live, their motivations for living there, how far the commute is, how much they pay, is the building noisy, etc. Again, the default should be a quiet location; far enough away from campus to be away from undergraduate shenanigans, but close enough where trucking to/from campus isn’t a nuisance. Rent isn’t really the biggest factor, but it should be considered, see future post on med school loans and budgeting.
The Preclinical Years
First year is by far the most stressful of med school, and FEELS like its the hardest academically, because you are still getting oriented, have no idea if you’re studying enough, too much, or if those non-science classes are worth the effort. You’ll wonder whether you should be joining an interest group, running for office, or this or that. At this point, you may be extremely stressed, but as you progress through the first year you get your bearings and realize it’s manageable if you budget your time appropriately. If your school records lectures and attendance isn’t mandatory, you should CONSIDER skipping class to study (funny right), and then watching lectures later at 2x. You will get very used to watching everything sped up, your friends will wonder how you understand any of it while you will wonder why everybody doesn’t watch everything at 2x.
Every school is different, but my school’s first year courses consisted of: GMC, Anatomy, Physiology, Pharm, Path, Clinical Skills I, ‘Feelings’ classes, primary care preceptor, Emergency room rotations, etc.
GMC was our basic science wrap-up; it was an intense 8-week class that covered Biology, Biochemistry, Cell Biology, Genetics, etc. Basically everything you should have remembered from undergrad with new stuff thrown in too. This class really set the pace, welcome to med school.
Anatomy: The quintessential preclinical med school course. This is what you think of when you think of medical school. Studying and memorizing anatomy, learning tons of new medical terminology, realizing how complicated the body is. Most schools do this over the course of the entire year, dissecting a body as they go through the classes throughout the year. My school does it differently; we have an INTENSE 4 week course where you learn it all as fast as you possibly can. They manage to do this because they use pro-sections of cadavers, which are basically pre-dissected bodies. You go in, you see what you have to see, you compare it to anatomy books, you find all the things you’re supposed to find, and then you go back to studying. This time savings is enormous, mostly because the student doesn’t have to sit there and tediously cut out what they’re supposed to see and then invariably fail, and have to look at the professor’s example or a fellow student’s cadaver. While controversial, I like this method of med school education.
Physiology: This is where we expanded on what we learned about the body in anatomy, and started to understand exactly how the body does the things that it does. This class had a calmer pace if you could understand things better than you can memorize (like me).
Pathology: This is where we started learning how all the beautiful anatomy and physiology can go wrong. We basically learned every major disease in every organ system that we would then re-learn in detail in period 2 and beyond.
Pharmacology: Drugs. Prescriptions. What you think of when you think of a doctor. I can tell you first hand there are too many drugs, too many side effects, and too many interactions. This class was just the tip of the iceberg but gave us a nice intro to the Pharm that would then be touched on again in 2nd year during organ systems.
Clinical Skills: This class was an intro to what some call doctoring, the actual process of doing doctor stuff. How exactly do you go about (properly) interacting with patients, making them feel comfortable enough to open up to you. You learn to do this while also learning exactly what questions to ask and how to ask them. You also start the very difficult task of properly forming a differential diagnosis, a process that seems simple until you start doing it. We also learned to do a full physical here too. We had written tests and quizzes but arguably the most nerve wracking are the OSCEs (objective structured clinical exams) where you go in and interact with a standardized patient. You are to obtain a history, do a full physical, and write a note. All of this while being recorded and graded based on your demeanor, questions, skills, and note writing. All of this within a tight time limit.
Emergency room rotations: Basically within our first few months we were thrown into the ER to learn by doing, a trial by fire. I enjoyed these rotations because it was a time to learn without being graded and reminded us of why we’re doing all this memorization and learning. It also allowed us to start get used to being in the clinical setting in a clinical capacity.
Primary Care Rotations: Here we went out into the field with a primary care preceptor (PCP) and working in a real clinic, writing notes, and using what we learned on real patients. Here for the first time we became a part of the actual healthcare team taking care of real patients.
Feelings classes are non-science classes like ethics, socio-economic factors of healthcare, medical jurisprudence, etc. They are typically held on Fridays for us and thus: Feelings Fridays. They generally don’t require much outside class work, and some people question their usefulness. While I feel I would organize the classes differently, I recognize the reason we have them. They teach us how to handle complex situations that you just wouldn’t be able to instantly know once you get to the clinical years.
Second year was when random memorization started turning into a logical application of what we learned in order to thoroughly understand the anatomy, physiology, and pathology of a disease and also included a little about how we diagnose and treat these conditions. These classes were split into organ systems, including: CardioPulm, Hematology Oncology, Dermatology, MSK, Renal, Endocrine, Psych, and Neuro. Each class had it’s own headaches and hurdles, but I enjoyed second year far more. I felt like I was learning real medicine and I was comfortable being a medical student.
M2 year also included other classes including another round of ethics and other feelings Friday classes in addition to:
Clinical Skills 2: More advanced maneuvers, more experience generating differential diagnoses. In second year the line between our science classes and our clinical skills class became quite blurred, because the content we studied in CS2 would reflect the organ system we were learning. I thought this was a very good way to organize the curriculum. This helped us reinforce what we were learning but also helped keep us thinking clinically, how would this disease present, what other diseases might it look like or what other diseases is it associated with?
Geriatrics: This consisted of a class and a clinical rotation, where you would learn about how different medicine is when it comes to the geriatric population but also got experience interacting with elderly patients who often were nearing the end of their life. It also allowed us to see the effects of polypharmacy on an aging population.
NHELP is the flagship program for my school wherein a student is assigned a family who cannot afford healthcare and that family will be taken care of by a team including a medical student, nursing student, law student, social work student, and the appropriate faculty including physicians, lawyers, social workers, and such. This creates a program that is not only informative for the students but a service to the community.
Step 1 (basic science knowledge)
This is the beast. This is THE test of medical school. This will determine where you go to residency. This will decide what specialty you will get. The MCAT was a beast in and of itself, and perhaps rivals USMLE Step 1 in terms of implication and stress, but as far as difficulty and study time required: Step 1 is in a league of its own. This is a full day test that tests EVERYTHING you should have learned in your first two years. The test is taken either after second or third year, depending on your program. Scoring is on a different scale too: passing is 192, but nobody shoots to pass because passing means nothing. A mean score is 230+ but people shoot for the mythical 260 or 270 (96th and 99.9th percentile respectively) in order to get the best residency possible. More on this to come in future posts, suffice to say, it’s a big deal.
MS3 is a different beast. You’re given responsibilities like taking care of patients and the attendings will actually use what you say and discover to determine what to do next (scary). This year involves much different expectations and you must approach it vastly different than the first two years. There will be a lot more self study and you will have to practice your note writing, honing in differential diagnoses, knowing exactly what tests you will order given a certain patient presentation, and knowing how you will treat them based on the results of your tests. There will be a lot of time spent at the hospital, basically a full time job’s worth of hours. The schedule varies based on which rotation you are in but generally involves pre-rounding on patients, rounding with the residents and attendings, presenting patients, and studying when you can.
The rotations for 3rd year are generally similar across medical schools and include Family Med, Internal Med, Surgery, Psych, Neuro/Radiology, Pediatrics, and OB/GYN. The first three for my school are 8-week rotations and the rest are 6-week rotations. At the end of each rotation is a shelf exam for that subject, and these tests are pretty challenging. The score is compared to other med schools across the nation and really gives you an idea of how you stack up on a national scale.
This time involves a lot of interaction with practicing attendings and you will get used to being “pimped” which is when an attending (at seemingly random moments) will ask you questions (on seemingly random topics) and expect you to know the answer. If you are successful he/she may continue to ask you questions, and if you continue to be right they may continue to ask questions until you don’t know the answer. They will then explain the right answer or tell you to look it up and report them later on. This is a somewhat intimidating experience but is an opportunity for the physician to assess how much stuff you know and whether you can recall information on the fly. Do well here and you’ll lock in a great assessment (which will be factored into your clerkship score), do poorly and they might take that into account.
Fourth year of medical school is where things get more fun and are less stressful. You’re the big man on campus and you’re given greater freedom and more responsibility on the wards. This is the time where you can choose rotations based on your interests, and you try to impress faculty/attendings enough to give you letters of recommendation.
Fourth year is generally considered to be basically vacation, because when you’re not trying to impress physicians for a letter you don’t really have to work too hard. There are no shelf exams generally, and you will actually have scheduled “vacation time” which you should use wisely. People use this time to prepare their residency applications, go on interviews, button up research projects, or just relax. Fourth year also allows you to choose externships at outside institutions or even opt for “sub-internships” where you will fill the role of an intern at a hospital to see how you hold up.
Unfortunately as alluded to before, this is when you build your application for residency. This involves basically everything you did to get into medical school: Calculating final GPA/class rank, using your STEP score, obtaining LORs, detailing research/volunteer opportunities, etc. This can be stressful.
During fourth year medical students are required to take two additional STEP exams: Step 2 CS (clinical skills) and Step 2 CK (clinical knowledge). Step 2 CK is a written exam that is arguably more difficult than STEP 1 and covers more advanced topics but is generally not as hard to study for because it covers all the stuff that you learned in 3rd year in the wards and studying for shelf exams. Step 2 CS is an OSCE type test (Objective Structural Clinical Examination) where you see standardized patients in a very controlled environment and are required to take a history and perform a physical followed by writing a note. Both parts of STEP 2 are hard on their own but manageable for a student who studied well during 3rd year. The scoring for STEP 2 is far less important as the scoring for STEP 1, the latter will largely determine where you go for residency and what specialty you match into. There is a STEP 3 that students take after graduation but that’s not important. Generally the mantra for studying for the STEP exams is: 2 months for STEP 1, 2 weeks for STEP 2, and a number 2 pencil for STEP 3.
Graduation, and Transition to Residency
The culmination of your applications and interviews at residencies is the residency match. Basically you rank programs and they rank you based on how much you like each other, the ERAS program has an algorithm consisting of statistics and magic, and it spits out which residency program you will attend. They don’t send this immediately to you, however. They wait until the end of your fourth year, to add suspense. Then the most important day of your life comes, Match Day. This will involve you opening an envelope in front of all your school and announce what program you got matched into. It’s basically a big party and everyone is very excited.
If you didn’t match you open up an empty envelope and everyone throws eggs at you…. just kidding.
Students who don’t match are emailed before match day to avoid embarrassment. They are offered the opportunity to apply for a supplemental offer and acceptance program (SOAP) where phone interviews are held and unfilled seats are filled. This is not an ideal position to be in but relatively few students per year have to SOAP (~1-5% per class) and even less will finish the SOAP process without a residency slot. Typically students who have to SOAP either didn’t apply to enough programs or overestimated the strength of their application. More on this to come in future posts.
I hope this post clarifies any confusion about how medical school works and gives you a little insight into what the next 4 years of your life will entail. Keep in mind that the majority of this content is based on the opinion and experience of one third-year medical student, and may or may not be applicable to all schools.