How to Succeed in Medical School

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In general, medical school is an extremely rigorous educational pursuit, arguably the most difficult kind of graduate education to attain. Prior to engaging in this four year commitment we recommend really enjoying the months before starting medical school by taking a trip, studying abroad, or simply relaxing at home. It is tough to go straight into medical school after college, and while possible, we recommend against it. While you are in medical school you should make an effort to be healthy. The stress of school will overwhelm you at some point in your education. If you can adopt healthy habits early on, like working out and eating healthy, it will really serve you well in the long run. After all, you will be training to become a professional who encourages others to be healthy, so you might as well practice what you preach.

Your main priorities in medical school are to obtain straight As, and to perform well on the USMLE Step 1 exam. These two factors are the biggest determinants in residency placement. Extracurricular activities are not as important during medical school in terms of having a role in residency placement. You should think of medical school as training for your future career. You should focus on actually learning all of the material because it builds on each other. One day you will have to explain bits of medical science to patients, so the better you understand it now, the easier it will be to teach to patients.

YEARS 1 and 2

During the first two years of medical school you will learn basic medical science. The style of learning is similar to college with presentation style lectures. Students take notes while professors lecture usually with the help of PowerPoint slides. The lectures are generally based on a reading assignment. Ultimately, the student is tested on the lecture material with a written multiple choice (or short answer) examination. While this sounds very similar to college, medical school courses have a significantly higher volume of material and the material is conceptually more difficult. Do not underestimate the difficulty level of medical school courses. There are several strategies to deal with this big change from college level learning.

To effectively prepare for medical school exams, we recommend the following:

  • Repetition is key. In order to actually learn medical science you have to review the information several times. You should read your notes and actively try to memorize the material as you are doing this. Repeat this several times (at least 5 times). Then you will finally feel like you are beginning to understand the material. Repeat learning the material as many times as you can prior to the exam. Many times you will feel like you do not understand the material until you have tried to memorize it first. This is normal and the recommended approach to studying the material.
  • Before medical school starts purchase First Aid for the USMLE Step 1. This is a review book that students use to prepare for the USMLE Step 1 exam. This book will not help you perform better in your courses. However, it will help you synthesize the information within a greater context. As you prepare for your courses review the parallel information in the First Aid book and make notes in the book. In this way, when your first two years of medical school are complete you will be able to review comprehensive notes as you prepare to take the USMLE Step 1.
  • You will most likely have access to the PowerPoint presentation slides prior to the actual lecture and we recommend that you review these lecture slides before coming to class. What you will realize in class is that most professors talk pretty fast and that their words are very important for the actual exam. If you are spending most of the lecture trying to follow what they are saying you will likely not be able to take good notes, and as a result you will have inadequate notes to study from for the exam. If you come to lecture having already read through the PowerPoint slides you will know what information is missing from the slides and can better focus your note writing.
  • On the same note, each lecture is generally based on a reading assignment from a textbook. It will be difficult to do so, but if you read the pertinent reading prior to class, it would help you understand the material immensely.
  • Most medical schools offer free tutoring to medical students offered by upperclassmen who have already taken the courses. We recommend signing up for tutoring. The tutoring sessions can serve as another repetition of the information and you can ask more in depth questions as you begin to have questions about the information.

PBL

Some schools offer an alternative kind of learning style during the first two years called Problem Based Learning (PBL).  PBL is a group based learning style in which the group of students attempt to work on a problem together. Each student ultimately contributes to the knowledge gap by looking information up and teaching it to the group. By the time the problem is solved, hypothetically, each student has learned from one another and they have actively participated which is thought to further the learning process.

Physical Exam Skills

Additionally, while you are in your first two years of medical school you will be taught physical exam skills and you will be tested on these skills. This is taught during the first two years of medical school so that by the time you are a third year medical student and are rotating on clinical services you have the skillset to assess a patient. This assessment is crucial to the role of a physician and the information gathered from the physical exam helps to determine the next step in the treatment process. When a physician listens to your heart or lungs he or she is gathering useful information that will guide his treatment decisions.

Years 3 and 4

During your third and fourth year of medical school you will no longer be learning in a classroom setting. Instead you will be learning by being a member of the medical team taking care of patients on a daily basis. The medical team will consist of an Attending physician (supervising doctor), a third and/or fourth year medical student (you), and possibly a resident physician.  You will be responsible for assessing patients daily and contributing to their treatment plans. You will give patient presentations daily summarizing your subjective and objective findings and your proposed assessment and treatment plan. These presentations are extremely important and often a source of anxiety for medical students.

During your clinical rotations you will be evaluated in three main ways:

  • Your evaluations from physicians who are supervising you: At the end of your rotation the physicians who supervised the medical team will evaluate your performance on several different points including medical knowledge, history taking, physical exam skills, clinical decision making, written & oral communication, and professionalism with patients and staff including hygiene and grooming. These evaluations may determine a significant portion of your grade (up to 90% in some schools).
  • Your score on the shelf (NBME) examination: For the core clerkship rotations (third year of medical school) you will likely have to complete a shelf exam at the end of each rotation. The shelf exam is a written multiple choice exam that is administered nationally. The exam is intended to test knowledge that a third year medical student should know about the specific rotation (Internal medicine, Surgery, etc.) by the end of the rotation. The exam ranks you amongst the rest of the medical students across the country. A significant portion of your grade on this exam (up to 50% in some schools) will help determine your grade in the clerkship. The exams are relatively difficult.
  • Your assignments/quizzes: Depending on the clerkship you may have quizzes, essays, or projects that will also count towards your final grade in the rotation.

Your grades in your core clerkship (third year of medical school) are strong determinants of residency placement. During fourth year you will be participating in clinical rotations that do not have a shelf exam component. In these rotations your grade will be mostly determined by your evaluations alone. Your grades during your fourth year clinical rotations are not significant determinants of residency placement.

Professionalism

Professionalism is a growing area of concern for most medical schools. It is important that you interact with people in a pleasant way. You should communicate well with the entire medical team and the patient and his or her advocates (if the patient gives consent). You should dress professionally to your clinical rotations on your third and fourth year of medical school. For men this means slacks, dress shirt, and tie. For women this means long skirts or pants and dress shirts. You should avoid casual or provocative clothing.

Commitment to learning

While you are rotating on different medical services you should actively read about the patients you are caring for. If you are doing things correctly, you will often find that you are staying up late preparing for the next day and reading about your patients’ conditions. For each clinical rotation there are several books we recommend.

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