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The Medical School Experience


If you just look over the class schedule, you may not get the impression that medical school is all that difficult. After all, you probably have taken 4 courses per semester at your undergrad institution before. What is different in medical school is the amount of material covered in each course. Despite the fact that you "only" take 4 courses or so at a time, these courses still combine to over 24 credits per semester. Medical school is difficult due to the large amount of material presented and tested in each course.

To find out more about the medical school experience itself, you may want to read some of the Medical School Diaries written by actual medical students.

First and second year

Make no mistake about it, medical school is intense and time consuming.

For most students, the hardest course, right at the beginning, appears to be Biochemistry taught in the first semester of the first year. It is a very intense experience and a course some students have to repeat during the first summer to make up for a poor grade. Especially for students without any or little Biology background, this seems to be a tough course.

Gross Anatomy (or Clinical Anatomy) is the other heavy duty course during the first semester. This course usually gets all the attention - most people have heard about the cadaver dissections.
Other courses, especially Physiology, Pathology, and Pharmacology are also very intense courses.
If you ask students which course is the hardest, you may get varied responses, but typically Biochemistry and Pathology top the list.

It takes some long hours studying and memorizing to do well in each course.

By the time you are in second year, the excitement of being in medical school has worn off to some degree and the intensity and difficulty seems to increase slightly. By this time, most students say they are getting tired of studying, are getting burned out and are ready to move on to clinical rotations. Third and fourth year clinical rotations are much closer to practicing medicine than the basic science coursework completed during the first two years.

Learning and study habits

Learning and study habits vary by student, with some students reading the text books, others attending lectures and yet others studying notes. Interestingly, most students report that they do not have time to do all three.

However, some study habits can also vary by course. Some courses have very comprehensive class notes and all exam materials are drawn from them. Studying the notes is, therefore, the most effective way to study. Other times, exam material is drawn more from text books, so reading the text book is most beneficial.

It appears that you figure out which method of "absorbing" the material works best for you and then you spend your time putting that method to use.

There are exceptions on both sides of the spectrum when it comes to study habits and time spent studying, but many student report something close to the following schedule during their first 2 years of medical school:

Mon - Fri
8:00 am - 5:00 pm -- Attend lecture and lab and/or spend time studying
5:00 pm - 8:00 pm -- Eat dinner, relaxation, family or free time
8:00 pm - 11:00 pm -- Study time (may vary)

Sat and Sun
Study varies on the weekend. Some students take one of the two days off, others take both days off. Yet others spend one or two half-days on weekends studying.
Before exams, most people study through the weekend.

Before major exams
The week before exams, most students also report an increase in time spent studying. So, the schedule outlined previously is more typical for non-exam-preparation-weeks. During exam preparation (for a week or two leading up to exams), many students appear to be busy studying from early morning until late at night every day.

Note that some students study much more, basically every waking moment and others don't study as much. Generally speaking, students seem to take time for some limited hobbies, family, or going out on the weekend. But, much less time is available for these types of activities while in medical school.

Did you ever hear: "You cannot cram in medical school"?
Well, apparently some medical students don't know that, because there are a few students who cram a week or two before exams and still do ok. Some of them may not be in the top of the class, but they are doing well nonetheless. It all depends on what type of person you are.

But, generally speaking, cramming does not work very well in medical school. For most students, it takes a lot of time on an ongoing basis to keep up with the material. Even most people who were successful crammers in undergrad have to change their study habits. Only few people (perhaps the very brightest) can get away with cramming or little studying during medical school. So, don't plan on being able to cram for a day or so before exams, if you did so in undergrad.

Third and fourth year

Once the USMLE1 (or COMLEX1) is out of the way and 3rd year rotations begin, life apparently improves significantly for most medical students. This is usually a very exciting time and an (overdue) transition out of the classroom and into clinical medicine.

During third and fourth year, lots of time is spent learning basic clinical skills and gaining general clinical knowledge and experience in preparation for residency.

During rotations, many of the less pleasant chores fall on the medical student since they are the most junior members of the medical team and "stuff rolls downhill". The residents don't want to do many of these chores and had to do plenty of them already during medical school. So, medical students get to do them. "Oh, that looks like a good job for a medical student."

As part of the medical team, you are also given responsibility for patients (with the help, guidance and supervision of residents and attendings). Responsibilities include patient histories, reporting on the patients on rounds with the team and learning about their health problems, treatments, etc. in the process (and being able to answer questions about them).

Most rotations are followed by some sort of test (shelf exam) which becomes part of a grade earned on each rotation besides subjective written evaluations from the attending physicians and/or residents during the rotation. Medical students usually prepare for the shelf exam and some of the anticipated questions (relentless pimping by attendings) during the rotation by using review books published for every rotation - they are very helpful.

Some rotations are more intense than others. Generally speaking, the 3rd year is one during which you will not see your spouse or other friends and family much. Particularly OBGYN, Surgery and Internal Medicine can be very intense with long hours from early morning (sometimes 5 am) until very late at night with little sleep in-between. A few rotations require very long hours and many rotations require taking call.

A few rotations have been described as easier than others, including those that are not involved in inpatient services. Example may be psychiatry, outpatient pediatrics, family medicine and various others (typically outpatient), which may have hours from 8-5 or so.

Fourth year is "easier" with less hours spent in the hospital, but it really depends again on the types of rotations you choose for your electives. If you pack your schedule full of exciting surgical rotations or other inpatient oriented rotations, expect to have long hours. You have some ability to choose your schedule by selecting your elective rotations and thereby can influence the intensity of fourth year somewhat.

At the end of the 4 years, or at the beginning of your residency, you take the USMLE2 (board exam) for MDs or COMLEX2 for DOs.

The USMLE1 (or COMLEX1) score, reflecting mastery of the basic sciences learned in the first 2 years of medical school, is used heavily in the residency selection process by residency directors. The USMLE2 (or COMLEX2) is required, but the score is much less important, since most residency decisions are not influenced by them (although a few very competitive residencies or fellowships may use this score as well).

A note about grading and ranking students

Note that regardless of grading and ranking, as described below, the draw-backs and advantages are not that significant. You will do fine at any medical school with any grading and ranking system and be able to get into any residency, regardless of the systems used at that particular medical school.

Many medical schools use a Pass/Fail system and do not award other grades than these. This supposedly cuts down the competition among students and makes the school experience less stressful. On the other hand, this also makes it harder for residency directors to sift through the applications, which means that you will not be able to stand out on your grades. So, your grades will not be able to help you in your quest for getting into residency - which is generally considered a drawback - and more of the decision is based on board scores.

Honors/High Pass/Pass/Low Pass/Fail
As you might have imagined, this system is very near the A/B/C/D/F system, just with different names and used by many medical schools as well. The pros and cons are obvious from the prior discussion of the Pass/Fail system. Supposedly, there is more competition among students and the experience is more stressful. At the same time, it is easy to show residency directors that you are a top student (or not) in your class with your transcript and GPA. High Pass and especially Honors grades help you look good to residency directors, so this grading system is generally considered more helpful than the Pass/Fail in regards to finding a residency spot.

Grades and Residency
Some people claim that the grades of your preclinical medical school years (the first 2 years) don't matter much when it comes to your residency application. It is true that your 3rd year rotation grades are much more important. Typically, your 3rd year grades count twice as much as your pre-clinical grades when considering your grades. So, they are less important, but not unimportant, either.

Class rankings
Most medical schools will rank all students in a class academically from first to last. So, it is easy to find out if you are in the top 20% or bottom 20% of the class since you will be given an exact number rank. If there are 150 students in the class, you will look good if you're towards the top and "less good" if towards the bottom. This ranking is also sent to residency directors when you apply for residency spots. It can help or hurt you.

Some medical schools have decided not to rank the students in their classes for the same reasons mentioned above for the Pass/Fail system - mainly to limit competition among students. Not being ranked can also be a drawback since it is harder to stand out, similar to the Pass/Fail system.

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