9 essential tips for new medical students

Whether you’re starting medical school or beginning your second year, this post is for you. Will probably work just as well for PAs, NPs and any other health professional student who hasn’t started clinical rotations.

Our former babysitter just graduated from medical school and the WhiteCoats are just as proud as her parents are. Then I started thinking, what advice would I give to students starting medical school?

Our first day of class, one of the professors got up in front of the class, spent a minute or so giving every student a  stare with the “eyeball” for which he was famous, then gave us this brief warning before launching into a discussion about the Krebs Cycle (which has absolutely no practical application to clinical medicine whatsoever).

“If you want to graduate from this medical school, there are two rules: Don’t fall behind and don’t fall in love.”

Most of us sat there pondering his statement while comments about fumarate and oxaloacetate went in one ear and out the other. By the way, I still remember the mnemonic for the Krebs Cycle after all these years: “Attention Oll Comanche Indians — Killing Season Starts Friday Morning Officially.”

In the end, everyone fell behind, and a lot of us fell in love. Medical school is where I met Mrs. WhiteCoat. We all still managed to graduate.

Here are some of the things that will help you in your studies:

1. Cramming is bad. Everyone does it, but it doesn’t help you learn. To me, learning was understanding the concepts, not memorizing the words. Even anatomy and pharmacology were about memorizing relationships. They still are. I learn directions by seeing where things are on a map and by relating those things to the place I am going. I learned medicine in the same way.
I also used to try to read ahead in the books so that when a professor addressed a subject and I didn’t understand it, I could ask questions in class about it. Didn’t always work out that I could read ahead, but when I did, it seemed to help my understanding and retention.

2. Avoid study groups. There were always people in our class who studied together. They always used to interrupt each other’s studying with unrelated questions or with discussions about the latest TV show. When crunch time came for tests, they knew what was happening on “Friends” but didn’t always have a grasp of the concepts for the tests. That wasn’t for me. I would just bring my book to a secluded spot in a little known building on campus, plug my headphones into my CD player, and listen to instrumental music (George Winston – you’re the man) while I studied. Scary that MP3s weren’t even around when I was in medical school.

3. Focus, dammit. Turn off your internet connection. Shut down your computer. Don’t even take it with you. Stop checking your e-mail messages on your phone. Don’t take it with you, either. Or take it and pull the battery out of it. Take your book, some ear plugs, an MP3 player, some paper, a pen, and take notes on what you’re trying to learn. Writing things out helps you remember concepts. All the other distractions make it harder for you to concentrate on learning.

We didn’t have “smart phones” when I was in medical school, so I didn’t have to worry about that distraction. Think about it now, though. Does it really matter whether you get your BFF’s text message immediately or a few hours from now? Do you really need to check your e-mail that often? Does it matter that you won’t get to read my latest post for a few hours after I hit the “pubish” button? If there’s something that important pending, then deal with it before you go to study. When you study, focus on studying.

4. Get copies of old tests. This is very important! Most professors are not industrious enough to create new questions for each exam. And there are only so many questions you can ask about the same topic. Therefore, many questions are repeated. Some may have wording changes, but most questions have the same concepts. By learning and understanding what concepts appeared on previous tests and are therefore important to the professor, you’re well on your way to learning the concepts — and passing the tests. Back before we had all these fancy computers and scanners, the students used to have a copy service where we paid extra so that we could get paper copies of previous test questions.

5. Don’t get down on yourself. You’re going to do poorly on tests. I did. Almost everyone did. Don’t you just feel like bopping the guy in the head who aces every test and then sits there with his smug grin bragging about it in the study lounge? You may be smart, but you’re a tool, pal.

You know what they call the person who graduates lowest in his medical school class? Doctor.

You don’t need great grades in every subject to be a decent doctor. Trust me. I’m living proof.

Study hard, do your best, keep plugging along, and don’t get discouraged. If you put in the effort, you will graduate.

6. Learn what medicine is all about. Don’t just stick to the textbooks. Read journal articles or medical blogs about topics that interest you. Yeah, it’s more reading, but those articles are only a few pages, will hopefully be more enjoyable, and will help bring together all of the facts that you are learning to show you how to apply them. There’s a big difference between “book sense” and “common sense.” You need both to succeed.

7. You’re not a doctor. Don’t act like one. We had one guy in medical school that used to wear scrubs and a white coat while he was in the grocery store. He drove a nice car and used to pick up on a few women that way. Total fool. Most of the people in school rolled their eyes when he walked by – even when he was dressed normally.

Even I wasn’t immune to the allure of being called “doctor.” Funny thing is that now I detest being called “doctor.” When I was a student, I used to carry a medical bag in the back of my car wherever I went. Still do now, but at least now I have the proper equipment and I know how to use it. Then — well, I’m not sure how many accident victims would benefit from me testing their reflexes or doing a funduscopic exam on them. I also had a large bore needle that one of our more senior professors said we could use as a “makeshift cricothyrotomy to establish a temporary airway.” Then we thought how cool we would be saving someone’s life by sticking an IV needle in their neck. Now, I still laugh at some of the stuff I used to carry in that bag. Thank goodness I never actually pulled the bag out of my trunk.

People will ask you for medical advice. Tell them you aren’t a doctor and you don’t know. Or tell them you haven’t studied that topic yet. Don’t act like you know what you’re talking about. More often than not, you’ll give them the wrong advice and you could get yourself into trouble in the process.

8. Set aside a day to relax. All work and no play makes Jack a dull boy. We usually had our exams on Monday mornings. Most of us studied all weekend. Sometimes during weeks with less difficult tests, we’d take a Saturday night off and go to the bars. However, Monday afternoon and evenings after school, everyone relaxed, partied, went to the beach, played cards, and acted like normal people. Some of the fondest memories (and the most incriminating pictures) I have from medical school were from events that took place on Monday nights. Make friends and have fun. It’s a school, not a prison.

9. Don’t forget your family. Your family is proud as heck of you for making it into medical school. Call them once in a while. Better yet, write them an e-mail and send pictures. Chances are that they sacrificed a lot so that you could go to medical school and they probably brag about you to all their friends. Give them some material to brag with. Without your family, you probably wouldn’t be where you are right now. Trust me … you’ll miss them when they’re gone.

I’m sure that there’s more stuff buried in the back of my mind. Maybe I’ll add it in an update to this post. Start with these bits of advice and you’ll be way ahead of the curve.

And if some day you see a contracted old curmudgeon in diapers mumbling about how he used to write a medical blog, take pity on your old pal WhiteCoat.

“WhiteCoat” is an emergency physician who blogs at WhiteCoat’s Call Room at Emergency Physicians Monthly.

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  • http://twitter.com/riotofcolor1 riotofcolor

    ““Attention Oll Comanche Indians — Killing Season Starts Friday Morning Officially.”

    10. Stop Perpetuating Racism. When you hear racist statements suffused with the acceptance of genocide, speak out against them.Don’t accept any form of racism in education.

  • http://profiles.google.com/lukethelibrarian Luke Rosenberger

    I think today’s students could use some more nuanced advice regarding focus, rather than “Turn off your internet connection. Shut down your computer. … Take your book, some ear plugs, an MP3 player, some paper, a pen, and take notes on what you’re trying to learn.” At our Medical School, students are required to have laptops, because their textbooks are electronic, not to mention most of the materials they use from our library as well. They need to learn how to annotate these e-textbooks and PDF articles online, and how to take notes effectively on their computers/devices without being distracted by other interruptions. I think many struggle with both of those things. Also, group work is part of the curriculum now — mandated by the LCME — so students need to know how to work effectively in groups as well as by themselves.

    • WhiteCoatRants

      Good point regarding electronic textbooks.
      I created outlines of topics (in outline view) using MS Word during residency which seemed to help me. Don’t know if it would help others.
      Annotating PDF files is a topic for another post, but agree that it would be useful topic to discuss.

  • http://www.facebook.com/marc.frager Marc Frager

    Be very cynical of authority. Best to think for yourself and draw your own conclusions!

  • Mara Klein

    Would you mind very much spelling out the words your mnemonic stands for for all us unitiated med students out there?

    • hursty_4

      I have never heard that one before but he said it was for the Kreb’s Cycle so it must be this:
      “Attention Oll Comanche Indians — Killing Season Starts
      Friday Morning Officially.”

      Acetyl-CoA + OAA -> Citrate -> Isocitrate ->
      alpha-Ketoglutarate -> Succinyl-CoA -> Succinate -> Fumarate ->
      Malate -> OAA

    • WhiteCoatRants

      Hursty is correct.
      Now if I could only remember what happens to oxaloacetate …

  • http://twitter.com/suztherapist Suzanne Rodgers

    If it’s not done already, the importance of mental health to physical health.

  • hursty_4

    “Attention Oll Comanche Indians — Killing Season Starts
    Friday Morning Officially.”

    Acetyl-CoA + OAA -> Citrate -> Isocitrate ->
    alpha-Ketoglutarate -> Succinyl-CoA -> Succinate -> Fumarate ->
    Malate -> OAA

  • http://www.facebook.com/tommy.y.fu Tommy Fu

    This piece says a lot of things that need to be said. I agree with just about all of them, but agree with this previous comment that today’s students could use a few nuance adjustments and additions.

    Additions: I would add “take time to develop your own definition of success, and don’t use everyone else’s as a default”. This goes along with your statement that not everyone does well on everything. As people who’ve always been good in school, I think we’re inherently uncomfortable with failing and what really helps me is being ok with “not winning them all” and just the ones that I’ve realized are personally important.

    Nuances: To your point about balance (in the form of taking a day off), I think accessing mobile devices during breaks does serve an important purpose (as long as it is done with restraint) in that platforms like Facebook, text messaging, and twitter give us a vital sense of connection with the outside world in a med school environment that can be inherently cold, competitive, and isolating (especially if you are studying alone). For the most part, I like to think people recognize the trade-offs they are making in being distracted and have the sense to correct them to an equilibrium point over time.

    The the point about not giving anyone medical advice, I agree with you that above all, we don’t want to harm anyone who places their faith in us. I disagree, however, with the tactic of completely avoiding answering questions, mainly because I think with good sense, many med students are able to juggle that task of being helpful with not going beyond their capabilities. The key seems to be in whether or not we provide “actionable” information or opinions. I usually try to just explain to people what the underlying condition is, how it works, and provide them with some context and formal information sources without prescribing any info that would dictate their subsequent actions. Relative to patients navigating the scattered, unverified world wide web of health information and companies with hidden incentives, its possible for med students to add value through initial guidance without prematurely donning the credibility of a certified doctor.