Tips for Surviving Medical School

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
  • ŸGross Anatomy, Board Review Series by Kyung Won Chung
  • Lippincott’s Illustrated Reviews, Biochemistry by Denise R. Ferrier
  • ŸTextbook of Medical Physiology by John E. Hall
  • ŸRapid 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.

This article was originally published on StudentDoctor.net on February 21, 2010.

Dual Degree Medical Programs

Interest in dual degrees among U.S. medical students has increased considerably during the last decade. Students can now supplement their medical education by pursuing graduate or professional degrees in nearly any discipline, including public health, bioethics, business administration, law, the humanities, and the basic sciences. Pre-medical students should be aware of the different educational opportunities available, as interest in a particular program may influence the medical schools to which they apply and require additional standardized testing, application essays, and recommendation letters.

Obtaining a second degree requires a substantial investment of time, money, or both, but can be incredibly rewarding and provide the training and credentials leading to a specialized role within medicine as a physician-scientist, physician-executive, or global health leader, in addition to many other possibilities.

In this article, I will first discuss several of the most popular dual-degree programs. Following this overview, I will address some of the critical questions students should consider before applying for or beginning a dual degree program.

MD/PhD: The physician-scientist

MD/PhD programs are among the oldest and most well established of the dual degree programs. The vast majority of medical schools offer an MD/PhD of some variety. The purpose of MD/PhD is to provide training in both clinical medicine and the basic sciences, creating physician-scientists who spend the majority of their time conducting research as faculty members at academic medical centers or research institutions.

MD/PhD students typically spend between six and eight years completing their education, which is followed by standard residency training. Most programs provide full tuition and a stipend of approximately $25,000/year, making positions highly desirable and very competitive.

Students typically apply for admission to both the MD and PhD programs simultaneously, which entails additional essays, interviews, and recommendation letters. However, many programs allow currently enrolled medical students to apply for entry into their school’s MD/PhD program if additional funding is available. Though competitive applicants must have excellent MCAT scores and GPAs, quality and quantity of research experience is critically important for admission to any program. Although many programs only require students to take the MCAT, some also require the GRE, so prospective students should research admission requirements of all schools they may apply to well in advance.

Most students spend the first two years as medical students taking the standard pre-clinical courses. When their MD-only classmates enter the wards and begin clinical training, MD/PhD students break away and enter the laboratory, where will they will spend the next two to four years conducting research and eventually write and defend a PhD thesis. After completion of the thesis, students return to the hospital where they will finish their medical education by completing their clinical clerkships and electives.

MD/MPH: The global physician

The MD/MPH is probably the most popular of the combined degree programs. The MPH coursework provides focused training in epidemiology, biostatistics, community health, and health policy, which prepares graduates to approach healthcare from the population level. The MD/MPH is particularly useful for students interested in preventative health, global health, or healthcare policy.

Most MD/MPH programs take five years to complete, but some programs allow students to take all of the required coursework for both degrees within four years. While some of the more prestigious MPH programs have generous scholarship opportunities, most students should anticipate an equivalent of five years tuition to complete both degrees, even if pursuing a four year program. For most programs, students can apply during the first, second, or third year of medical school, but those pursuing four-year programs typically must apply at the beginning of medical school. The MCAT is often accepted in place of the GRE.

MD/MBA: The physician-executive

The number of MD-MBA programs has grown exponentially during the previous two decades, from five in 1993 to more than 50 today. With the enormous focus on healthcare reform and the business of healthcare, demand for physicians with focused training in healthcare management and business administration will likely continue to increase.

MD/MBA programs are usually five years in length. Students typically apply for admission to business school during the first or second year of medical school, though students can often apply to both concurrently. The GMAT is generally required for admission to the business school, though this may change in the near future as some business schools have recently starting accepting the GRE in place of the GMAT. The structures of MD/MBA programs are variable, but in most programs students devote the majority of the first through third years to medical school, the fourth year to business school, and the fifth year completing requirements from both schools.

Graduates of MD/MBA programs can find careers in hospital administration, academic medicine, healthcare consulting, entrepreneurship, industry (pharmaceuticals, biotech, medical devices), managing private practices, or leading healthcare organizations.

MD/JD: The physician-attorney

There are many MD/JD programs throughout the country, most of which require seven years to complete. However, few students tend to participate in these, largely because of the time required to complete both degrees and the enormous cost of attendance. Students typically apply to both the medical and law schools concurrently, requiring the applicant to have taken the MCAT and LSAT.

In general, admitted students devote the first two years to medical school, years three through five to law school, and the final two years to completing their clinical training. Graduates of MD/JD programs can be found on the faculty of law and medical schools, as leaders of various medical and legal organizations, as medical malpractice attorneys, and in general medical practice.

Questions to Consider

1. Is a second degree necessary for my career goals?

Before beginning a second degree, you need to seriously consider and determine what you really want to do. Many premedical and medical students have a tendency to get blinded by ambition and the endless pursuit of prestige, seeking additional degrees simply to have “more letters after my name.” This is foolish and self-defeating. Spending additional years and thousands of dollars pursuing a degree that you will not use will not impress anybody and/or help you begin your career, particularly if you do not want to work in a capacity related to your additional degree.

On the other hand, if you know that you want to work, for example, in global health policy, then an MPH may be almost essential. Do a quick search of job openings at the CDC in global health or health policy – most require an MPH or years of equivalent experience for an application to even be considered. In this situation, the time and expense of obtaining the additional degree is easily justified.

2. Can I afford it?

Medical students are drowning in debt. Those who pursue dual degrees (with the exception of the MD/PhD) will amass even more debt than their MD-only peers. Sit down with your parents, financial aid officer, or anybody else involved in your finances and figure out exactly how much debt you will have at graduation if you pursue the extra degree. Make sure to factor in the additional year(s) of deferred earning potential that pursuing the second degree will require.

3. Is now the best time?

Remember that you do not need complete all of your formal education while in medical school. Some residency programs allow residents to work towards a master’s degree while completing their training. The program might even provide some or all of the funding required to pay for tuition. There are also many executive and part-time programs that allow working professionals (including clinicians) to complete a master’s or professional degree in their spare time. Waiting until after medical school may be particularly attractive to students who are not certain that an additional degree is required for their career goals or those unwilling to defer gainful employment for additional years.

4. Am I compromising my education by combining degrees?

Not all dual-degree programs are created equal. Make sure that you will not be compromising your education by trying to do too much or compressing a two year program into a single year. When comparing different programs, see which structure makes most sense to you. For example, I am currently an MD/MBA candidate at the University of Pennsylvania. When I was applying to medical schools, I also looked at schools that offered four-year MD/MBA programs. Completing the degrees in a shorter time period was obviously appealing to me, but I wanted to get the “real” MBA experience, which I thought I could only enjoy by spending time as a full-time MBA student, working on a daily basis with traditional MBA students. I therefore only applied to programs that featured at least one full year of MBA coursework. However, for other students the four-year combined degree might be a better fit, depending on their personal needs and expectations.

Conclusions

Dual degree programs have become increasingly popular among US medical students in recent years. There are now dual degree programs to match nearly any student’s interests and schedule. While I have provided an overview of the most popular programs, there are many other options available. Though there are many benefits to pursuing a second degree during medical school, students should carefully consider the pros and cons of any program before investing the time and money required for an additional degree.

About the Author

David Flynn is an MD/MBA candidate at the University of Pennsylvania School of Medicine and the Wharton School. He is also the founder of Prepera (www.prepera.com), a premedical tutoring and advising firm based in Philadelphia.

 

This article was originally published on StudentDoctor.net on May 12, 2010.