6 things I wish I had known at the beginning of medical school

It’s amazing how quickly you can lose track of time as you power through the books. Once everything is setup — coffee to the left, pens and highlighters to the right, Grooveshark playlist perfectly tuned — you can suddenly look up and realize that three weeks have flown by and there are 123 multiple choice questions to be answered in the morning.

Over the past year and a half I’ve learned a lot: pages upon pages on everything from the toes to the head and a few things in between. Along the way, I’ve also discovered the following six things that I wish I had known at the beginning of medical school:

1. Everyone has their own way of learning. On more than a few occasions (including just yesterday), I’ve found myself severely doubting my methods of preparation. One classmate will have the Leaning Tower of Pisa modeled out of flashcards on his desk while another sits in the corner watching YouTube videos on the Spinothalamic Tract — and it freaks me out. The questions flash by in my mind: “Why didn’t I do that?” “Is that a better way?” “How does he get all those cards to stack up without falling over?” In the end, though, I always come back to the realization that there are a million different ways to learn the material, and you simply can’t do it all.

2. Starbucks is expensive, but refills are cheap. Did you know that coffee refills are fifty cents at Starbucks? You probably did, but I had no idea. Everybody sets up shop at a coffeehouse from time to time, and I was amazed when someone finally let me in on the cheap coffee secret from Seattle.

3. There is time. At the beginning of first year I skipped a good friend’s wedding because of an exam early the next week. I also missed my cousin’s graduation from PT school because of the beckoning of biochem. I wish I hadn’t done that. 18 months later, I can see that there will always be another hour for books and highlighters, but your cousin only becomes a doctor once.

4. The library has lots of books. This is probably another one of those obvious Starbucks-type things, but having never had much use for the bookstacks in undergrad (I was an engineering major), it took me a little while to realize that just about every book I could need can be found somewhere on the dusty shelves. This may have been useful information before I bought $500 worth of books I’ll never crack open again.

5. Otoscopes might be necessary sometime, but it’s not now. The first week of school we were given a list of mandatory equipment. There’s really not much need to elaborate on this, other than to say that I now have an all-too-expensive otoscope/ophthalmoscope sitting in the back corner of my closet.

6. I get by with a little help from my friends. You can try to do everything yourself. The to do list will grow longer, your hair will turn grayer, and your Jack Russell will shoot you dirty looks from the living room couch. Only recently did I come to this important realization, and it is by far the most critical lesson I’ve learned. It’s the study partners, froyo friends, and late night companions who keep you sane and lighten the load.

Rick Pescatore is a medical student who blogs at Little White Coats.

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  • http://nonmaleficence.wordpress.com Nonmaleficence

    I can’t agree with you more about, ‘there is time.’ There were a few occasions that I absolutely regret missing. Especially since I usually wouldn’t be able to study very efficiently on that weekend any way because I was thinking about that wedding or family reunion that I was missing out on.
    Good article.

  • http://littlewhitecoats.blogspot.com Rick

    Good point, Non.

    Thanks!

  • Anonymous

    Training is a long road. You are absolutely right, “there is time”. You meet people along the way the made many sacrifices, missed births, weddings, funerals. Some will say its part of the job and made them stronger but most have regrets. These events are important and make us human.

  • http://expatdoctormom.com/ Expat Doctor Mom

    Dear Rick

    Great tips!  Couldn’t agree with you more on the oto/opthalmoscope.  It was $325 when I purchased mine in 1990!  A lot of money for someone who is living on loans.  I still have mine though but it did not come in handy until private practice when I initially did home visits.

    I just posted tips for med students on my blog last month:  http://expatdoctormom.com/2012/01/how-to-be-a-good-mentor-bonus-top-tips-for-medical-students/

    Like your blog.  Keep up the good work and enjoy this time in your life.  You will miss it!
    Best,
    Rajka

  • Anonymous

    Even though South African Medical Schools are different from American ones, my whole teaching philosophy to students now is based on your first point. We can get sucked into being told what is the right and wrong way to study, but everyone is different. Great Post!

  • Anonymous

    I found #1 to be the most helpful because, it’s true, when I’m studying at the med school, I’ll frequently hear people discussing particular things they’re doing that I’m not, and I’ve questioned my methods a bit unnecessarily at times despite the fact that they’re working well for me.  The video and flashcard students are very typical.  I was actually in one of the study rooms a couple weeks ago and overheard a girl raving about the Kaplan USMLE videos on immunology and how she wouldn’t feel prepared otherwise.  I remember thinking, “am I okay just having read First Aid?  Maybe I’m not prepared.”  Then I decided that my background and current prep have been sufficient, but it still got me stressed thinking that I haven’t done, nor will I do, a particular prep method that someone else swears by.  I also have a good friend who writes absolutely everything onto flashcards.  She has thousands stacked in her room.  I’ve thought about going down that route because the reinforcement aspect is strong, but it just takes too much time, and I’d rather spend that time covering additional material than reviewing the past.  Plus, I don’t ever write things down.  To each, his or her own.

    I’ve found that reading and memorizing material then answering practice MCQs is the best way for me to learn.  I’ve also done a lot of reading online (forums, etc.) and those who tend to score the highest on the USMLE study that way.  For example, I read the First Aid chapter in microbiology, thought I knew the material well, then answered some practice questions from USMLE Rx QBank.  I got a vignette of a girl with a bunch of problems who had “rough-surfaced eggs” in her stool.  I was like “I KNOW I saw those words in First Aid.”  In fact, I knew which page and the location on the page that description was on, but I couldn’t quite recall the organism as fast as I needed to.  Then when I saw the answer was Ascaris lumbricoides, I was like “of course, only the most common nematode infection,” and then it stuck.  The questions are good because they induce shock-value when you get them wrong.  They’re also particularly helpful when you think you know a topic well and still get them wrong because then the material really stays for the long-term.  The same is true for a question I got on Leishmani donovani.  The Tx is stibogluconate (an antimony compound).  I got it wrong initially, but now I know it and won’t forget it.  So I think the question method is the way to go for generating greater subsequent rapid recall.  Luckily, there are a few strong QBanks out there.  My plan is to read First Aid a minimum 4x and complete >10,000 unique MCQs (between USMLE Rx, Kaplan and UWorld QBanks) by the time I sit the exam.  The former is the shelf knowledge and the latter the application.

    As far as #2 is concerned, I seldom drink coffee so that doesn’t really apply to me.  Plus, they only have two Starbucks in my city’s proper, but those aren’t even near our med school campus, so I’m not even sure that our students get their fix as much as they need to.  I’ll drink Australian breakfast tea sometimes when I’m studying at home and feel languid.

    #3 and #6 I feel should be grouped together.  They are very true and can be difficult to come to terms with.  Fortunately I’m a realist and haven’t restricted myself from seeing friends nor going to an occasional party.  You realize that if the time needs to be made to study, it will be found somewhere, but sometimes 5 hours spent away to have brunch with the girlfriend’s parents won’t kill.  This is also how I felt the entire time I was home in December.  I hadn’t seen Mom nor Grandpa in a year, yet I was spending 12 hours/day in my room doing PhD stuff.  I still made sure to spend dinner or some of the evenings with them though.

    As far as #4 and the library having “a lot of books” is concerned, I actually disagree on this point.  Although the library has its share of resources, it tends to be more aggravating than not to try and acquire a high-demand book and then know you can only borrow it for 24 hours.  Or if the book isn’t high demand and you’re allowed to borrow it for longer, then it probably isn’t the one you need nor is it up to date.  I think generating a home collection of initial texts is a good idea.  They don’t need to be 2012 hardcovers, but many recent used copies suffice and are substantially cheaper.  I also tend to reference my books frequently, so I wouldn’t be able to handle being dependent on the library for them.  Reference books, such as Grey’s, are a whole different story though.  Sure, then the library shelves can be your friends, but isn’t everything in a major tome simply online nowadays?

    #5 is probably the saddest truth for most med students.  To be honest, I believe I’m one of the only ones who hasn’t fallen into this boat.  When we first commenced, everyone was off buying the Littman Cardiology III stethoscope for $400 when they don’t even know what a murmur is.  Some even bought electronic ones for $1000.  And don’t even get me started on those who bought, yes, oto- and ophthalmoscopes.  These might be good during your specific residency, but for now stick to the basics and your clinical skills manual.  Plus, even if your rationale is that you are merely investing for the future, the technology changes constantly and you’re better off spending the cash only when you really need to.  Fortunately for me, I have a 1984 Littmann lightweight stethoscope that my mom found in the linen closet back home.  I’ve thought about investing in a newer, better piece, but I’ll wait till I get to residency, which at that point if I actually do get a surgical placement in the US, I’d opt for an electronic one (graduation present??).

  • http://twitter.com/MNAHEC Minnesota AHEC

    Thanks for posting! I think it’s good for students in the early phases of a medical education to hear the experiences of those who’ve “been there, done that.”