Advice for New Medical Students

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Alex Folkl, Medical Student, Emergency Medicine, 01:30PM Feb 3, 2010

It's January 16th, 2010, but thanks to the University of Vermont's accelerated medical curriculum, I'm nearing the end of my pre-clerkship courses (I write boards in February and start clerkship in March; for all of you on traditional, two-year pre-clerkship schedules: It's okay to be jealous). It's cold and dark here- as it usually is in Vermont in January- and I've put away my textbooks for the evening, so with nothing much else to do, and clerkship year looming, I thought I'd take the time to reflect on a few of the things I wish I'd been told when I was a younger, more-anxious, orientation-week first-year medical student.

Lesson 1: Medical school is hard, but not in the way you would expect

I expected my pre-clerkship classes to be leaps and bounds more difficult- conceptually- than undergrad and graduate coursework. I was wrong. Conceptually, pre-clerkship classes are really not that hard. Show up, pay attention, go over the material as much as you can, and just about anything will stick (this includes things like intermediate metabolic pathways, which are way too detailed for anyone's good and, for me, had never stuck before). What's hard is the volume: There is so much material that it's oftentimes difficult to determine what warrants another pass and what can safely be left for another day. Back home, I remember watching friends in vet school stumble around under stacks of books, with scribbled notes fluttering about like so many falling leaves- and asking, "Do you really need to know all of that?" I was always surprised when they said "Yes, and by Friday." Not anymore. But you can't always know everything. Part of the preclinical years, for me, involved striking a balance between knowing everything and knowing enough to feel competent. I would advise everyone to find that balance, although I'll admit it's easier said than done. You overshoot, and undershoot, and eventually you get it right.

Lesson 2: You can have lots of time, if you want it.

One of the things I was most nervous about, before starting med school, was losing my nights and weekends to endless study. I have hobbies, after all, some of which (rock climbing) take me out of town for days at a time- and I have a wife, who immigrated to the States to see me through my medical education, and with whom I'd prefer not to lose touch. Well, I'm happy to report that despite the workload- and thanks in no small part to a newfound ability to schedule effectively- I've had enough time to stay sane, active, and happily married. In fact, what surprised me most was how much time I had- so much so that I got overconfident and overcommitted. In the last two years- among other things- I've headed up three student interest groups, helped write a manual on cultural competency in health care, and worked on health outreach with a handful of local organizations. Eventually it got to be too much. The lesson for me was that the opportunity to do more is ever-present in medical school- and it's definitely useful to gain extracurricular experience in areas like leadership, project management, and so on- but that the more you do, the less time you have- and over-commitment like this can be enormously draining, both mentally and physically. I'm interested in primary care, so now- to keep from over-committing- I ask myself if a new opportunity will help make me a better primary care doc. If the answer is no, then I say no.

Lesson 3: Everyone has an opinion.

Ask ten medical students how to study for a class, and you will get ten different responses (the explosion of anonymous punditry on the interweb only exacerbates the problem). The tricky thing is, they're all correct- it worked for them, right? But they may not be correct for you. I have a friend who's a couple years ahead of me in the Vermont curriculum and has loads of advice on what books to buy, what lectures to attend, and so on. It's good advice, well-intentioned, and this person has done very well with it, but I've decided that we must approach classes in a different way, because this advice generally has not worked for me. The key is sifting through the noise to figure out what works for you. Just like controlling the volume (Lesson 1), you'll overshoot, and you'll undershoot, and eventually you'll get it right.

Lesson 4: Medical school will change you.

I had hoped that it wouldn't. I was happy with pre-medical me. After all, pre-medical me was good enough to get into med school. But there's no way around it: Medical school comprises a new and incredibly weighty set of responsibilities, both obvious (e.g. being competent enough to patients' lives) and less obvious (e.g. finding that perfect specialty wherein you're both happy and financially secure... this last because, let's face it, medical school is pretty expensive and it'd be nice to pay back those loans). The application process does a good job of screening for the people who absolutely should not be here, but unless you're transferring in from another high-pressure profession, there's very little you can do to truly prepare for the less-tangible challenges medical school will bring. I'm halfway through and I already don't quite recognize the person I've become- but that's okay, because I happen to like the person I'm becoming. So give in to the process, and let it do what it will.

Lesson 5: Everything's important.

I can't count how many times I've been told "This class/lecture/activity isn't important for the boards/clerkships/getting into residency/etc. But I think that's all a bunch of nonsense. That small group session on end-of-life care may not be testable material, and being able to identify the specific translocations that lead to hematologic cancers may not help much if you plan on going into opthamology- but it's all important if you want to become a good, competent, well-rounded physician. And, of course, if you get pimped on rounds. Now, you may not be able to know everything (Lesson 1), but if you're in med school because you want to become a good doc, you should probably give it your best shot.

That's it for now. In the next year, I'll be dealing with the challenges of boards, clerkships, immigrating (I'm American, but my wife is Canadian, Ontario is home, and I'd like to get back as soon as possible), and... starting a family? Big year ahead, and, I'm sure, many more lessons to learn.

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