Survive Medical School

I want to help people," you've probably said to yourself or told some jaded interviewer on the road to medical school. Chances are you probably meant it. Make no bones about it medical school is like any other rude transition from the social and intellectual coziness of college life into adulthood. You may or may not emerge with your dreams intact. Like salmon swimming upstream, some fantasies make it and some fatigue and wither. Before the first day of class, make a list of the reasons you want to be a doctor. Write them down. Be explicit. Keep the list handy, maybe on a small sheet of paper in your wallet or your purse or your jacket. Read about experiences of others, such as LeBaron's Gentle Vengeance, Klass's A Not Entirely Benign Procedure, and Rothman's Wliite Coat, to name a few.

Medical school begins with the preclinical years, which are usually heavily lecture oriented and full of unfamiliar information. One can identify various personalities during the preclinical years. First are the model students, who conscientiously take detailed notes, attend all lectures, have a clear study schedule, and generally do well on exams. These individuals may lack an inborn gift for academic success but do well nonetheless. Somehow, these people are able to create a comfortable studying routine, but they do it at the expense of leading somewhat unexciting lived outside of school. 

Next are the serious gunners, who predicate their worth on how well they compare to others. These are generally aggressive and often younger students who study to excess and often alienate their peers by their competitiveness. Their social lives are either mind numbingly boring or convulsed by periodic sessions of release. These students occasionally achieve brilliant academic success, but they do it at the expense of learning few skills that are truly useful to healing. They are at high risk for burning out. 

Then, there are the cool slackers. These are students who still believe that to be caught studying is tantamount to social suicide. For them, it's cool not to study (although they may secretly be doing so). These individuals usually tempt fate by not studying on the eves of major exams. While they lead somewhat swashbuckling lives compared to the model students, they fail to learn balance and discipline. These individuals invariably find the culture of medicine suffocating, and while they may pass medical school, they are often confused about what to do with the degree. 

As in any field, one sees lost souls as well, people who chose medical school for lack of a better life plan. Pushed by domineering parents, jumping ship from a previous career, or seized by some existential crisis, these individuals are miserable because studying material uninteresting to them is destroying their souls. Lost souls usually feel out of touch with their feelings and are in serious denial. While they may escape from previous pressures for a time, they question their life plans daily. They are at high risk for social isolation, although they crave connection with others. 

Finally, there are the truly gifted, who walk on water and emerge from the preclinical years unscathed. How do you know if your are one of these few? If you have to ask, you probably are not.

It is often difficult to figure out what type of student a person will be. In any event, it's key to think about your personal coping mechanisms and to be aware of them. Do you feel adequately supported? If not, why? Are you overaggressive, slipping into gunner mode? Are you out of control, like a cool slacker? Or is medicine not a good choice for your career, and are you a lost soul? Talk to your classmates for support. Most of all don't forget the dirty little secret about the preclinical years: almost everything you kill yourself memorizing is, frankly, useless for the actual practice of medicine. The advice I offer for these two years is to put them in perspective. 

The clinical years, on the other hand, are critical. You'll learn real patient care. This is a good time to read Shem's House of God (take it with a grain of salt) and to start taking everything much more seriously. As you are acculturated into the role of doctor (a worldview that is slightly authoritarian, highly invested in scientific proof, and suspicious of any strong personal emotion), expand your exploration of the human side of medicine. Read, paint, talk to your nonmedical friends more frequently, and call your parents often. You'll appreciate their perspective. 

The key lessons to take away from the clinical years are: 

• It's not critical to know all the details; instead, know where to find the details. 

• All people, including you and your patients, desire and require connection to your fellow humans. 

• Know when you're in over your head, but don't underestimate your own abilities. 

• Sleep is not a psychological construct; it is a physiological need. 

• Learn how to read medical journals for useful content on a regular basis. 

• Know how to use a small number of medicines and procedures well instead of knowing a lot of things superficially. 

• Learn what you can and can't change about a patient's illness. 

• Develop a thick skin for nonconstructive criticism. 

• Remember that pain is simply pain, and nobody deserves it. 

• Don't forget that common diseases are common, and uncommon presentations of common disease are more common than common presentations of uncommon diseases. 

• Talk to your patients every day, and try to learn at least one nonmedical lesson from each one. 

It is never too early to begin contemplating your future. Although it's not true that you need to enter medical school knowing what field you wish to enter, it's disingenuous to counsel students that you'll figure out what you want to do in your own time. Be proactive; speak to many practicing doctors (in and outside academia) early on, and envision yourself in their shoes. Be honest with yourself. For example, if you really hate dealing with stools, gastroenterology is probably not for you, despite what your preceptor thinks. The other reason to think early is for planning purposes. Getting involved in, say, a pediatric epidemiology project (if you're interested in pediatrics) makes you a much more attractive applicant to pediatrics programs than if you just worked out all summer after second year. In this way, you also come into contact with your medical school's departments, which are usually willing to mentor students who enjoy their fields. Obviously (as in anything else), don't go overboard. There's no need to wake up for Sunday morning surgery conference every week as a first year student just to impress the department heads. 

How to SURVIVE MEDICAL SCHOOL

Thoreau counseled us to all "live deep and suck out all the marrow of life. " That's hard when you're a sleep deprived mess trying to study for USMLE Step I. Ultimately, medical school opens the way to a fascinating and profoundly rewarding profession. Just don't lose yourself en route.