At this stage in my career, I have finished the pre-clinical portion of my journey. This part of training encompasses the first two years of medical school, which are primarily spent in the classroom. Early medical school involves lots of lectures about the complex mechanisms of disease, lots of studying, and lots of exams. I have also completed USMLE Step 1, the first test of a series of medical licensing exams that are taken throughout one’s medical career.
As this first major part of my journey comes to an end, I find myself reflecting upon what I have learned thus far. Medical school is tough, and the experience is a little different for everyone. However, I would like to share a few pieces of advice that may be helpful especially for students who will find themselves sitting in their first medical school lecture soon.
Insecurity is OK – and you are not alone in it.
I arrived to medical school already having some doubt about my abilities. I had always heard about the difficulty of medical school, and I wondered if I could do it. I began to experience a degree of “imposter syndrome,” feeling as though the real me didn’t match how I looked on paper and the school would “find out” that they had only accepted me by mistake. This concern only intensified as I met some of my new peers; I listened to them describe their past experiences before medical school or their knowledge of a particular subject area with words I didn’t quite understand. I felt unqualified and uncertain.
Years later, I have learned that these feelings are experienced by almost every medical student – but verbalized by very few. This is at least in part because, throughout our preparation for medical school, we have been conditioned to show very little weakness. We are tasked with achieving the best grades, the best test scores, and the best positions in the things we do. We are pushed to achieve and led to believe that only those who can survive this intense demand are suited for medical school. Any slip along the way – or even the fear of a slip – makes us incapable, and that seems incompatible with being a medical student. So we learn that we must suppress any sign of struggle and pretend the emotions associated with it do not exist. In reality, so many of my peers felt exactly as I did, in the beginning of medical school especially. They, too, felt like the sore thumb of the school. They, too, felt like the “dumbest person” in the program.
I hope you will know from reading this piece, that you are not any of these things. In fact, there is not really even a way to measure this possibility – test scores are one thing, but intelligence and capacity to be an excellent physician extend far beyond those metrics. You will have strengths and skills that some of your peers may not, and they likewise will thrive in areas in which you may be weaker.
Despite our fears and common beliefs, I have realized that these differences are not a problem that must be overcome. Instead, this is the beauty of a field that should reflect diversity, where physicians and colleagues can constantly learn from each other and share in our collective knowledge for the benefit of our patients. We are better in our imperfect form, sharing our perspectives and experiences with each other.
Your path will be different from that of your peers.
A lot of medical school is a shared experience. As you progress through your first two years of classes, you will often share the same class schedule and exam material. But just as you will have different strengths and weaknesses than those around you, your skills and life experiences will also lead you down a slightly different path. The way you study will be different. The way you balance your life will be different. The way you spend your time and the ways you choose to learn about medicine as a whole will be different. Importantly, please notice that I did not say that the way you do anything will be wrong. It will be different and unique, as it should be – you are your own individual with your own goals and your own potential.
In all honesty, this can be one of the hardest points to grasp during medical school. It is easy to look around and compare yourself to other students. You may feel as though one student is walking along the path at a faster pace that you are, or that they are getting involved in a certain club or activity with which you are not very familiar or interested. We tend to be hard on ourselves in these cases, feeling like the path we are walking is lesser than the path of our peers.
This is not the case, and I wish I knew that earlier. Throughout medical school, you and your peers may each face different obstacles. Sometimes, one of your friends may have to take some time off or alter their schedule to attend to a family emergency. You may have to deal with your health or with a disability. Your other friend may be struggling with the material, adapting their schedule to spend more time trying to change his or her strategies. When you compare each of the activities and ways that you are using your time, you will see that they are very different. But, again, this is OK.
The important thing about medical school is that you are using your time as well as possible, working your personal hardest, and following your own passions. Meanwhile, it is crucial that you are giving yourself the space you need to be healthy and well. This entire balancing act will look different for everyone. There is no “right” pathway to becoming a physician, and your experiences will only make you stronger in the future if you embrace them and allow them to help you develop empathy or other important skills. Your path is not wrong simply because it is different.
Medical school is a time to learn how to be an excellent physician, not an excellent test-taker.
There is more to medicine than knowledge of disease. For example, medicine also involves the application of this knowledge – the type of learning that we can only receive by seeing medicine in practice and interacting with patients or healthcare providers. Medicine involves learning how to tell a patient that he/she or a loved one has cancer. Medicine involves becoming comfortable with uncertainty, and sometimes, coping with death or loss.
As such, it is vital to spend time learning in situations far beyond the classroom. Spend time shadowing a physician who looks like the physician you want to become someday. Spend time volunteering in settings with patients, talking with them about their experiences with illness or with healthcare. Spend time speaking to mental health advocacy groups or chronic illness support groups about the complexities of illness. The highly important things you will learn will not be found in any of your textbooks.
As a medical student, it is easy to feel like your time is limited, and there is almost always a seemingly unconquerable mountain of material to study. Many of us place everything we have into the task before us. If we are given material to know, it is likely that we don’t simply know it; we’ve studied it from multiple resources to fill in any gaps and get the full picture, diagramed out the entire pathway, and memorized it front to back and the reverse.
But this is my challenge to you: sacrifice some of that time. Yes, even if it means you score a few points lower on a test or quiz. Learning from patients and learning about other aspects of the job may not be on the exam you take tomorrow, but it certainly will show up in your future practice. These lessons are some of the most essential things you can learn to help your future patients. They are worth your time.
Your patients will be one of your greatest teachers.
This does not simply involve the technical components of medicine – although I will admit that your patients will know about medications you’ve never heard of and can often describe to you, in detail, procedures they’ve had or realities of their disease not found in textbooks. This information is invaluable.
However, the lessons we can learn from our patients extend even deeper. As early as your first year of medical school, patients will surprise you with just how much they trust in your professional confidence. They will share with you some of the most intimate details of their lives. They will tell you stories from walks of life that you never really knew existed. They will tell you about their hardships, their fears, their reality.
These are, without a doubt, the most prized lessons I have learned in my career thus far. My classes can give me valuable insight about the pathophysiology of heart failure – the hemosiderin laden macrophages, the ventricular ejection fraction, the potential murmur of mitral regurgitation or aortic stenosis. But until I spend adequate time with patients, I am missing a large part of the story.
What symptoms or obstacles does my patient face on a daily basis as a result of this diagnosis? What most impedes him or her from living the life they may have lived before getting sick? How are they coping in managing the medication schedule, frequent doctor visits, or the potential hospital stays? What are their greatest concerns, and how has the medical system helped alleviate these – or failed them entirely? How can I, as a future physician, best serve this patient and those who have a similar story? Until I’ve spoken with patients and asked this question, I cannot know – and my ignorance to this information does a disservice to potentially thousands of patients.
When all else fails: reach out. It’s OK to ask for help.
Find mentors in the medical school, perhaps in your school’s medical student services or student achievement offices. Identify those who are genuinely concerned about students and who can lend a compassionate hand if/when one is needed. Seek out physicians or residents or older medical students who share in some of the struggles you have faced. Try your best to identify these people as early as possible, creating a network of support around yourself. If and when you begin to feel trapped, having a few numbers to call will provide a relief beyond measure.
Know, overall, that asking for help is not a sign of weakness. In fact, it is a sign of great strength. It is the vital realization that you, like all human beings, have limits to what you can achieve alone. The sooner we acknowledge this, feel comfortable with this, and are willing to accept this, the stronger we will become. This will allow you to spend more of your time not struggling or pushing against a motionless wall, but finding ways to overcome any weaknesses that you may have so that you can do your job more effectively – both for your health/safety and for that of your patients.
By asking for help, you allow yourself to form community with others. You allow yourself to create a team. Learning to talk about your uncertainty and your experiences with those who can understand your struggles and advise you in helpful ways is an invaluable strength. Use it!