By Dr. Lisabetta Divita
If you are considering medical school, it is important to realize the commitment of time, energy, and money this represents. While being a physician has countless personal and financial rewards, the path to achieving that goal is fraught with trials of different sorts.
The decision to become a doctor should not be made without significant thought and personal reflection—you should be honest with yourself when you arrive at this decision. Also, you should be fully aware of what is involved in medical education, particularly medical school.
If after careful thought you still strongly desire to wear the long white coat, you should steel yourself for a bumpy ride. You should also acquire as many tips and tricks that you can—and implement them—starting on the very first day of classes.
MS-1 and MS-2
The first realization that needs to be made, essentially from day one, is the sheer quantity of facts that will need to be committed to memory. While you certainly had challenging classes as a premedical student, most college classes pale in comparison to the enormity of material presented in preclinical courses.
Take a good, hard look at the way you studied in college. What worked? What did not? Do you study best alone or in a group? Could you benefit from studying a little alone and in a group? Do you get more from a lecturer or from reading notes/books? You need to know what works for you and then do it religiously starting on the first day of classes. If you did not need to study too much during college to get great grades, good luck to you. There will be little time to experiment with different study styles once classes start.
The best approach is to assume that the volume of material conveyed in medical school will far exceed your experiences in college. Therefore you will need to develop new and reliable study habits within the first few weeks. Organization is a top priority. Make sure that you have a copy of any material that could be asked on an exam. This could be slides, notes, lectures, and required reading. These things do not need to be purchased in all cases, but if you are going to rely on community or free resources, you must be able to guarantee that they will be there when you need to study them.
How will you know what could be asked on an exam? Obtaining exams from previous years is perhaps the most important investment you could make. Get copies of previous exams. Old exams give you the best idea of the style and scope of questions that will be asked. There is simply too much information not to focus; the best way to focus is to get a feel for how previous classes were tested.
Remember, too, that each preclinical course will be taught by dozens of faculty. Each faculty member may lecture as little as one hour to several hours, but the material will be presented by several. Therefore the questions that faculty submits for the exam will be of different styles and degrees of difficulty. Individual faculty lecturers are mostly the same from year to year (as are their lectures) so their questions will be similar from year to year as well.
Everything that was uttered during lecture and contained in the syllabus or notes is fair game for the exam. The lecture and notes should be the starting points for each course and then work your way out from there. If the notes are thin or the lecture was a bit rushed, make sure you consult a book or study guide to fill in the material. Often a lecturer will provide the primary literature from which the lecture was drawn. If you can manage it, take at least one look at this material. Many times, this is what the lecturer would have said if there was more time. This material is also likely to be the source of exam questions. It takes legwork on your part but it can be very worthwhile.
There will be plenty of resources at your disposal; too many, really. For instance, many MS I students buy a copy of Harrison’s during first year. This is a very, very dense book and not a very efficient way to spend your limited study time. Likewise, most first year students will diligently buy all of the required textbooks without delay. You will learn that this is not always necessary or a good idea.
Realize that your primary goal during years I and II is to get A/Honors/Pass on your medical school courses. Preparation for Step I of the USMLE or COMLEX will come later. In the first two years, it is all about the grades. Study time should be about the exam and learning the content that will be tested. Sure, the interesting stuff may beckon you to read further, but make sure not to substitute depth for sufficient breadth. Read it all once (or thrice) and come back for the interesting stuff if there is time.
Even if you are a “solo study” type, it is best to have a core group of classmates that you can count on for notes/study materials/borrowing books/crying fits. This relationship is a give and take, so be there for the group when needed and they will be there for you. Organize your studying such that you are a valuable resource to them as well. Being aloof with your peers can really cost you at test time. Reach out to your classmates early so you have a network in place when you need it.
Recommended Books for the first two years of medical school
Note, these are just suggestions and not something you have to rush out to the bookstore and buy.
- Atlas of Human Anatomy by Sharon Colacino
- Gross Anatomy, Board Review Series by Kyung Won Chung
- Lippincott’s Illustrated Reviews, Biochemistry by Denise R. Ferrier
- Textbook of Medical Physiology by John E. Hall
- Rapid Interpretation of EKGs by Dale Dubin
MS-3 and MS-4
Preparation starts before the first clinical rotation. Ask students transitioning from third to fourth year what is required on the wards. Learn about a SOAP note and how to write one. Learn about a third year’s place on a medical or surgical service. If you can, find out which attendings like to teach, which attendings are “good” and which attendings are “malignant.” Some attending physicians are very particular—learning about their quirks ahead of time can save you when you present patients.
Also, get the practical things in order before the first day of third year to the extent that you can. If your hospital uses paper charts, know where they are and what they look like. Open one up and see how it is organized. If the charts are computerized, make sure you have adequate access (usernames and passwords). You will be running to the clinical lab and radiology a lot during third year, know how to get there quickly and where the respective staff members usually hang out. Get a handle on the nursing station and key staff on the floor/unit. You should have a vague sense of the different job titles and functions.
Your goals during third and fourth year expand a bit. Grades are still important, but learning how to take care of patients is really the top priority. If your focus is to always provide the best care of your assigned patient, the learning and grades should fall into place (with hard work and effort, of course).
You will probably have one or perhaps two patients at a time while on the wards. Those patients are also cared for by an intern, primarily. You should try to take ownership for your assigned patients as much as possible without stepping on the intern’s toes. You should know darn near everything there is to know about your patients, which can be a challenge when you are “sharing” with an intern. The intern will be writing orders, getting study results, doing procedures, and making calls of behalf of the patient at lightning speed. Many things will be happening that you never know about until they are old news. The intern will move faster than you (get used to it), especially when you are new to the clinical years.
- DO NOT slow the interns/residents down
- DO care for your patient whenever possible
- DO assist/perform as many procedures as possible (IVs, central lines, arthrocenteses, paracenteses, etc.)
- DO get all labs/study results as soon as they are ready
- DO personally experience all interesting physical findings (your patient or not)
- DO ask the senior resident/fellow general questions
- DO ask the intern questions about your patient (that you cannot find out yourself)
- DO NOT switch these last two items. In other words, DO NOT pimp the intern and DO NOT ask the resident/fellow about lab results
Also make sure that you know how to present patients. This skill will serve you for the rest of your career and it will be used to determine your clinical grade. Medical students like to include everything in the H&P during the presentation. This is painful for the attending and the team. Alternatively, if you do not mention the pertinent negatives along with pertinent positives, your attending will wonder what was omitted. Perfect patient presentation is not something you can do right away—however you can certainly practice it. Listen carefully to everyone that presents patients. What causes the attending to interrupt? What causes the attending to zone out or look exasperated? What questions does the attending ask and when? Adjust and improve your presentation accordingly.
Some attendings are impossible to please and are maliciously rude—the so-called malignant attendings. These unique individuals need to be taken with a respectful grain of salt. It is the (bad) luck of the draw if you find yourself with one of these attendings. If you do, keep in mind that 1) your rotation will be over in a few days/weeks 2) what the attending wants, the attending gets 3) your performance in the clinical years and in your career will be based on the input and training of hundreds of doctors (and patients). Do not let a few malignant attendings spoil your clinical experience. Simply cater to their capricious whims for a few weeks and write an appropriate review once the grades are submitted. Malignant attendings are a sad fact of life, but over time they seem to get relieved of most teaching responsibilities, which was probably their goal anyway.
Recommended Books for third and fourth years
- First Aid for the USMLE Step 1 and 2 by Tao Le and Vikas Bhushan
- Maxwell Quick Medical Reference by Robert W. Maxwell
- Tarascon Pocket Pharmocopeia by Steven M. Green
- Blueprints Obstetrics and Gynecology by Aaron B. Caughey
- Step up to Medicine by Elizabeth A. Darby
- Surgical Recall by Lorne Blackbourne
These are just some tips to use during your journey in medical school. Don’t be discouraged throughout your first two years of medical school and patiently wade through the massive amounts of material. Learn as much as you can in during your third and fourth years and do not become discouraged if you encounter a malignant attending. Best of luck on your medical school journey!
Dr. Lisabetta Divita is a physician, medical writer/editor and premedical student mentor.