Pre-Clinical Years of Medical School

Dave here.  My blog posts are few and far between, but I figured I’d write down my thoughts at the end of my medical school career.  This way, when we print off our blog and put it into a book (this blog is our way of scrapbooking/journaling), I’ll be able to reflect years down the road and remember a bit about my experiences.  I’ll try not to get too personal, but personal enough so you can maybe get the feel of how the journey was for me.  I’m not planning on proofreading this so please forgive any misspellings or grammatical mistakes.   

Pre-Clinical Years

1^st year of Medical School:  The 1^st year of medical school was interesting.  I remember being quite nervous at the beginning, wondering what on earth I was getting myself into.  All in all, it wasn’t nearly as bad as I had imagined it to be.  That’s not saying much, as I’m typically pessimistic about stuff (I kind of do it on purpose, as it almost always leads me to being pleasantly surprised).  It was, though, quite the adjustment from college.  I remember being extremely busy in college, but it was a different kind of busy.  In college I remember my hardest semester was when I took 18 credit hours, did around 30 hours/week of extracurricular stuff (including work), and got engaged.  In medical school, that changed.  All of a sudden I was doing very little extracurricular stuff but was taking an insane amount of credit hours.  I enjoyed the material I was learning in medical school, but missed the variety from my college days.  One of the hardest parts of 1^st year was staying motivated and engaged during countless hours of studying. 

Another difficult part of medical school was learning how to prioritize and focus on what’s important.  I really wanted to excel in school and maintain a solid family life, which for the most part I felt like I did.  I probably neglected my family a bit too much though.  I recommend what some people did during the 1^st 2 years that I regret not doing.  Block away time every day (like 6-8 PM) when you spend time with your family away from studying.  If you don’t, it’s easy to neglect your family.  I didn’t have time for much else beyond those two things and church.  You lose contact with friends and don’t see other family as much, but that’s part of the journey.  I remember missing multiple family vacations, and many hobbies I previously enjoyed fell to the wayside.  But, you make those sacrifices in most graduate programs so it’s not a big deal.

People always ask what medical school is like.  Many say that it is like drinking from a fire hose.  I don’t really like that analogy, I felt like the material was manageable if you put in the time.  The metaphor I like more is that medical school is like having to eat a stack of pancakes every morning, and if you don’t eat the stack one day, the next day you have to eat 2 stacks.  You quickly realize that if you do what you should every day, it may be painful but you should be able to get things done.  If you take a few days off, all of a sudden you have 8 stacks of pancakes to eat the day before a test.

 For the most part, the stuff in the 1^st 2 years of medical school isn’t conceptually difficult; it’s just a massive amount of information to memorize.  The learning in 3^rd and 4^th year gets more challenging, because patients and diseases unfortunately do not always behave like we learned in textbooks and the questions you are supposed to answer aren’t in multiple choice format.  But that’s what makes medicine fun!

2^nd Year: The 1^st year was generally full of basic science classes like genetics, biochemistry, anatomy (dissecting cadavers), embryology, and histology.  While that was interesting, it wasn’t nearly as interesting as the much more clinically applicable material we learned during second year.   The 2^nd year let us take our basic knowledge from 1st year and apply it to different organ systems (heart, lungs, GI, etc.). 2^nd year was great because you’re in the groove of studying, you’re friends with the majority of your classmates, you’ve adapted to the life of a med student, and the material is much more interesting. I actually think 2^nd year would be easier than first year if you didn’t have the pesky Step 1 board exam at the end of the 2^nd year.

Step 1 and the months leading up to it, for me, were easily the most stressful moments of medical school.  For those that don’t know about Step 1, it’s a national test that every medical student across the country takes around the end of your second year.  It’s a very important part of your residency application, especially if you are trying to go into a competitive specialty.  Just for people’s info, I’ll throw in a chart of the average Step 1 scores for certain specialties in 2009.  In general, the higher the Step 1 score, the more competitive the specialty.  Note: U.S. seniors are 4th year medical students so just look at that. 

That being said, Step 1 is not everything.  I saw people with great Step 1 scores not match, and people with subpar scores match.  But everybody knows a great Step 1 score is a huge bonus for your application, and a bad Step 1 score greatly hinders your chance of matching into a competitive specialty.  I talked directly with one residency director of a competitive program who told me that they get 400 applicants for 12 residency spots, and they interview the 60 students with the top Step 1 scores (that didn’t bring any added pressure on test day :)).  Obviously not all programs are like that, but some are.  Other things, which I’ll talk about later, are also important for matching including research, letters of recommendation, clinical evaluations, personal connections, clinical grades (not standardized across the country so don’t mean as much), where you went to medical school, extracurricular stuff, and the AOA honor society.

Anyways, I was so glad when that blasted test was over and that I did very well.  I cherished having actual free time again.  Free time during the later part of 2^nd year is tainted free time because you usually fill it with either studying, or you do something else and feel guilty that you are not studying.   That may sound neurotic, and it probably is, but whatever.  I’m starting to shudder just thinking about Step 1 again so I’m going to stop talking about it. 

I was able to get in some extracurricular stuff during the first 2 years to maintain some kind of variety.  In addition to research, I was also the ASUU assembly representative for our Medical School and was responsible for helping student groups get funding through ASUU.  That was fun.  I was also co-president of our student AMA chapter and enjoyed learning about the political side of medicine.  All in all, the 1^st 2 years were the least important years in terms of learning how to become a great physician, but nonetheless important.  You really don’t learn how to practice medicine sitting in a classroom; you have to go experience it.

One other interesting part of the 1^st 2 years that people don’t realize is that classroom attendance was optional for us.  The majority of our class did not attend class.  It’s optional in most places across the country, from what I’ve heard.  That may sound absolutely insane, but let le me explain.   They record all of our lectures and post them online, and they post the PowerPoint lectures online.  You didn’t miss anything not going to class if you listened to those.  

So, I personally had 2 options.  I could either:

A) Drive 25 minutes from my house up to the U, park out in no-man’s land because I bought the cheapest parking pass available, walk 10 minutes to class, go to class and listen to somebody read their PowerPoint slides, walk 10 minutes back to my car, and drive 25 minutes home, or

B) Study at home in my PJs or a nearby library and still listen to every lecture online with the accompanying PowerPoint and not miss anything at all.  I could listen where I wanted, when I wanted.  I was a fan of listening on double speed for professors that talked slowly. 

What would you have chosen? I won’t go into what I did, but I did do a bit of both.  Both strategies had their pros and cons.  The objective of the 1^st 2 years was to learn the material, and either option A or B worked just fine.  After our class, the U changed the policy and mandated attendance.   I’m not sure how I feel about that.  On one hand, professors put in a lot of time and energy and deserve to have a big audience. On the other hand, I’m paying $30,000/year tuition and probably deserve the right to choose how I want to study.  Why should it bother a professor if I listen to their lectures online instead of in person if I’m going to do very well on their test either way?  Anyways, that’s always an interesting topic for discussion.  You can probably tell what way I lean based on my comments.  

That’s all I got for now.  I wrote way more than I planned, and could have easily written more.  I’m going to have to divide this up.  My next 2 blog posts will be on:

-       - 3^rd Year (most fun, interesting, and frustrating year) and 4^th year (pure bliss)

-       - Residency applications, interviews, and the match (not too bad and kind of fun) and finances (2^nd most stressful thing of medical school for me)

If anybody wanders onto this blog and has questions for me, pre-med or not, feel free to fire away.