Of the 4 years in med school, what are classes like? Do you have homework to turn in, lab reports to write up, experiments to design, essay papers? Or is it lots of cramming for exams and oral presentations on rounds?
Primarily the latter.
It varies by school, but the general outline is as follows:
Firt two (“preclinical”) years:
These are similar to any other undergraduate or graduate training: scheduled classes, labs and their associated write-ups, reports (for a few classes), and a heavy emphasis on exams. Increasingly schools are working to include patient contact, clinical experiences, and sociological discussions and exposure into the preclinical years, but it usually amounts to a couple of hours a week at most.
At the end of this you take Part I of the NBME boards, a two-day multiple choice exam on basic medical science (actually, I understand the testing may have changed in recent years: computerized testing can assess/adapt to your “level” based on your early answers, and avoid asking question that are “too hard” or “too easy” to be relevant to distingishing you from other similar students. Such testing doesn’t require you to answer as many questions as a single paper test that has to cover the entire spectrum of students)
Third and fourth (“clinical”) years:
There is little formal coursework in these years. You are “in the trenches”, in a hospital, clinic, practice, whatever. On some rotations, you may only be there from 9-5 (or even shorter hours) but on others you may be in the hospital 16 hours a day, six days a week (or on the infamous “every third night call”)
Everyone around you realizess that you basically know diddly, so the actual clinical responsibility falls on the residents (MD/DOs undergoing specialty training) and attendings (MD/DOs who have completed any specialty training and are in actual practice). However, you are expected to shoulder as much responsibility (and patient load) as you can handle – and to grow visible in your capabilities over the course of each rotation. You will also do incredible amounts of “scut” [Tedious tasks like delivering samples, drawing bloods, arguing on the phone, getting results or records) 3rd/4th years students often refer to themselves as “Scut monkeys” and perhaps the most popular guide to essential info [Gomella] is so universally called the “Scut monkey handbook” that though every US-trained doc will recognize it on sight, I doubt 1-2 in 10 could tell you its “proper” name
There is litttle formal coursework, though any good clinical rotation will have regular “rounds”, a term with many meanings. “Morning rounds” are a review, examination and discussion of every patient on your team’s service at the beginning of the day. Some services “round” at the start of every shift, so you’ll round when you arrive (to find out current status) and at the end of your shift (to brief the next shift) “Grand rounds” are more like the lectures you are used to: lectures of general interest or important but less common topics, presentations on interesting recent cases, papers or lectures by visiting experts, etc. There are also other lectures and presentations: “Radiology rounds” where the radiologist reviews/teaches all the imagine of all the patiens on your service; “M&M” (Mortality and Morbidity conferences) where the doctors discuss all the complications and possible mistakes of the week, with an eye towards improving care; etc.
All the above are for students, residents and attendings alike. Depending on your school, you may also have lectures specifically for students, non-rotation projects, outside visits (lke seeing patients in home or community settings) etc.
During this time, you will give daily oral presentations of your patients, and write daily reports on their condition in the medical record (this is usually a highly stylized, targeted review, often just a few formatted patient lab values and a couple of paragraphs of text.) You will also probably do at least one “topic presentation” a month (a researched “report” on a topic, presented orally, though you may be asked to submit a written version as well)
At the end of the second two years, you take another massive standardized exam (NBME Part II) with a more clinical leaning. You’ll take a third major standardized exam at the end of internship, with a more practical bend, but by then, it should be entirely drilled into your subconscious. The saying is “For Part I, you do 2 weeks of intense review; for Part II, you study 2 days; for Part II, you bring a #2 pencil.”
Writing skills are very important in medical school and medical practice. However, it’s an area where almost everyone complains that improvement is needed
In my med school we have a 3-hour essay based exam in each subject in Dec/Jan and May/Jun for the first 3 years, with the odd (once or twice a year) 5000 word essay and some lab reports and work books to write.
For the last 3 years we still have the exams, plus some OSCEs (Objective Structured Clinical Exams), Viva Voce examinations, group projects and the odd essay.
Irish students don’t act as “junior interns” in our last 2 years, we have 9-5 hours when we are expected to be in hospital if there is something to do…effectively this means only 3 or 4 hours a day on the wards, plus 3 hours of lectures and tutorials per day. We don’t have to do on-call either. Which means we have a much better social life than our American counterparts!
My medical school is in the middle of converting from a 6 year to a 5 year course, but the info below is pretty much what they teach.
Years 1-3
Biology
Chemistry
Physics
Physiology and Neurophysiology
Biochemistry and Neurobiochemistry
Anatomy and Neuroanatomy
Year 4
Pharmacology
Pathology
Microbiology
Years 5-6
Psychiatry
Obstetrics and Gynaecology
ENT and Opthalmology
Paediatrics
Surgery
Medicine
In my personal experience there is no point buying any of the huge textbooks (apart from Kumar & Clark’s “Medicine”), I tend to by books from the “At a Glance” series or Mosby’s “Crash Course”. Trust me, they tell you most of what you need to know, you can get the details from the big books in the library.
Anyway, you learn pretty quickly that there are some stock answers to rattle off, for example, any psych patient should be treated using the “bio-psycho-social model”, and then it’s plain sailing.
" Viva Voce " ? Que?
Oral. As in, an oral exam: Delivered live, as opposed to written down and handed in. (Viva voce: Living voice, unless I’m mistaken in my Latin.)