Medical school is hard, and other medical student thoughts

Some reflections on my first semester of medical school.

1.  Medical school is hard. Yes, it’s true — medical school is as hard as people who have been through it make it out to be.

I was skeptical when I started mostly because I felt I had challenged myself while doing my undergrad degree and in graduate school.  I had taken heavy loads of difficult classes in both of my degrees.  My last semester of graduate school I took 18 hours of the highest level epidemiology classes at one of the top programs in the country.  I didn’t see much daylight that semester and thought I was prepared for anything med school could throw at me.

But the difficulty is not conceptual, but sheer volume of information.  Probably the biggest contributor to the large amount of information medical students must internalize is lingo.  Medicine truly does have its own language.  I read somewhere (and I wish I could find the source now) that the average English speaker’s vocabulary consists of roughly 15,000 words while medical vocabularies run in the neighborhood of 18,000 (don’t quote me on those figures).  Thus, medical students effectively have to double their vocabulary (most of which are Latin derivatives that are impossible to pronounce, let alone spell).  Internalizing all of the vocabulary plus learning the complicated science behind the inner workings of the human body is a daunting task.

2. Half the battle is knowing where to be and when to be there. Maybe other programs are different, but at my medical school you are put into various groups to do different activities.  I have one group for histopathology lab, another for anatomy lab, one for small group discussions of cases and “problem based learning”, another for the clinical skills lab, an academic society, plus the multitude of student organizations.  None of these groups meets on a regular basis and only a few meet in the same place every time.  Thus, a big hurdle in the beginning is organizing your time, not only so you make sure you use your time wisely, but also so you are at the right places at the right times to fulfill your obligations as a student.

3.  Medical students are cool people. During our white coat ceremony one of the speakers threw out the statistic that the people admitted to the school of medicine are in the top 3% of their peers.  I’m not exactly sure how they came up with that figure (I don’t think I’m in the top 3% of anything), but the overall point of the statement was that those admitted to medical schools are high achieving people.  It is true.  I’m amazed by the things my fellow medical students have done.

It seems almost all of them have traveled abroad, most speak a second language (on some level), many have done some cool research, some have done extensive volunteering or work with underserved populations, and all are very nice people.  Yes, medical students are nerdy in the sense that they actually applied themselves during undergrad and enjoy learning things.  However, unlike some graduate students, med students tend to have excellent interpersonal skills and are generally pretty fun people (sorry other grad students).  My advice to future med students — get to know your peers.  They will amaze you.

4.  Not a lot of “medicine” is learned in the first semester. During the first semester, it’s actually really hard to feel like a “true” med student.  Depending on the program, most of the classes are continuations of the pre-med basic sciences with additional emphasis placed on the role these sciences play in human physiology.  You learn a little about drugs and certain disease processes, but it seems very abstract and much more about the science (possibly due to the fact that most of the first and second year classes are taught by PhDs and not MDs) than the actual medicine.

Some schools start in the cadaver lab right away (mine does not), which is where people really begin to feel like they’re actually training to be a doctor.  Obviously you have very limited patient contact.  But there are instances where you do get to interview patients or perform exams on patient-actors–these were the best days of the first semester.  It’s pretty much a necessity that the first semester has to be pretty bland, med students really have to crawl before they can even think about walking.  Knowing that the best doctors understand the basic science aspects of medicine very well was (and is) the biggest factor motivating me to truly internalize this information.

Josh Herigon is a medical student who blogs a Number Needed to Treat.

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  • Dr. Dredd

    You think med school is hard, wait ’till you hit residency…

  • PAULMD

    All this and a paycheck to!

  • Vox Rusticus

    If medical school can be likened to drinking from an open fire hose, residency could be seen as the same, but while running.

  • stargirl65

    When you get to residency you get to do it all while staying up all night and rarely getting to eat a real meal.

  • PAULMD

    During my internship in Chicago in the early 90s, the highlight of my day was a post call, beeper off, uninterupted BM at the hospital. That was living large.

    I don’t mean to be gross or rude but to merely illustrate the intrusion on your even most basic visceral functions and the joy of being able to “answer the call” unincumbered.

    • Wombat

      During my internship last year, my pager went off just as I had stepped into the restroom. I spent a grand total of maybe 6 minutes in there. When I got out, my resident had already been paged, and was hunting me down, trying to figure out why I wasn’t answering my pages in a timely manner. Medical school was a great vacation compared to internship. Get up at 9am for classes with optional attendance, and finish by 4pm? Every weekend a golden weekend? I want to be back on that schedule!!

  • jsmith

    You’re right that it’s the volume of material, not its conceptual difficulty. Unfortunately you actually do need to know a lot of this stuff you learn, especially in your pathology/disease process course.
    Grad school is butter compared with med school. Grad students at least get to sleep.

  • http://afmarcom.com Angelique

    Josh — This is a really interesting post, and I like your blog, too!

  • Gerry

    Yes!!!! PAULMD! I thought I was the only one who felt like I won the lottery if I could have an uninterrupted BM during a call night! Internship shaved a year off my lifespan. Was it worth it? Hell, yeah! Mom gets to say, “My son the doctor….”

    • Primary Care Internist

      Ditto. I still am conditioned, by residency, to enjoy the occasional uninterrupted BM, a “luxury” most others will never fully appreciate the way docs can.

      • Anonymous

        So true, I second that. My non-medical friend would never understand that how would one survive on crackers and water only.

  • solo dr

    Med school has its pros and cons. The fire hose of information is overwhelming, and at least 80% of the basic science first two years will never be used in private primary care practice. Unless someone is going into research, they could whittle down the embryology, biochem, stats, microbiology, pathology, and pharmacology by at least 80%. My school wasted two months on medical humanities classes that could be summarized in a 20 page handout. Test after test on slides and electron micrographs simply becomes a rite of passage. The details in anatomy serve little to make me a better doc. Most of the pharmacology was on drugs that are rarely used in primary care by PhDs who had never seen a real patient. Often the profs would choose areas to teach that they were doing research on but not necessarily that were useful for practicing physicians.

    The clerkship years are where I felt I started to learn about medicine and how medications work and are prescribed.. The few MD teachers in the first two years of med school had not been around real patients either since residency. The 3rd and 4th year clinicals at least had some good patient contact and interactions, through my private practice rotations.

    Residency was more of a survival and honing of my skills. I’m not sure how the time limits are nowadays, but my record was 40 hours of work without sleep while caring for 20 or more inpatients at a busy hospital. I learned more seeing the thousands of patients and reading about the patients/meds/illnesses in my primary care residency than all my years of med school put together. I also had residency teachers who were all physicians who had years of real world private practice experience. I felt I learned how to be doctor and how to care for patients after med school. Med school felt like test after test, and then getting an MD but without the capabilities of really knowing how to treat patients.

    I look at med school as the MD that gets you into residency, along with Step 1 and 2 of the boards. What is taught in med school does not necessarily prepare you for the first two boards, but the board review books really saved a lot of us. Step 3 and my ABFM boards made feel like I was taking tests based on doctoring and not simply basic science facts. I did not have to study for Step 3 or the ABFP tests, as much of the tests were based on treating patients. Residency helped me become a real doctor with real knowledge, who can put the knowledge to real world use. Seeing over 6,000 patient visits a year now hones my skills even greater. I continue to do CME and read about my patients to stay up to date. What amazes me is how many docs do not maintain board certification and are not up to date on current meds and treatments.

  • Patrick

    “Medical students are cool”, I love that, it’s so true. Residents are too. You need the spirited and witty interaction with peers as crazy as yourself to make it through the fire, especially the third year of medical school and all of the residency years. Great post. Thanks!

  • Ralph

    What true statements. It seems no one understands or appreciates all the studying and work required as much as a fellow Dr. My wife still can’t believe I can function on only a few hours of sleep. My response is do it for years on end studying and you get used to it.