Audiobottle’s description of the first two years is similar to my experience. Having completed the entirety of med school, I have had more time to become cynical about the whole process and the career, so you may sense that in my description of things. My description applies to med school in America…other countries may differ.
A good work ethic and a good memory will take you further in med school than sheer intelligence will. The complexity of the concepts you have to learn in med school is not much harder than a rigorous undergraduate college class, but the volume of material and the pace at which you must absorb information is exponentially more difficult than undergrad.
All physicians in America must take a 3 step licensing exam to be able to practice. Most schools make their students take “Step 1” at the end of their second year. For Step 1, pretty much everything you covered during the first two years of med school is fair game, so studying for it is a very stressful time for most med students.
It’s much more intimidating than the MCAT (the entry exam for med school) because you have much more to lose if you don’t do well on Step 1 (if you don’t pass it - and a small number of med students never do pass it - your first two years of med school were all for nothing).
It’s not enough just to pass, though. Your performance on Step 1 plays a big role in determining what specialties you have a realistic shot at specializing in and how good of a program you can get into. Many students who entered med school dreaming of being a hot shot Dermatologist or plastic surgeon have to adjust their expectations after getting a mediocre Step 1 score.
Once you are done with Step 1, you start 3rd year which means the majority of your time is spent doing hands on work in a hospital. You do “rotations” through different specialties to get a general medical education and also to help you decide what specialty is best for you to specialize in later. You are still expected to study after work,so in many ways it is more difficult than the classroom years although a lot of people find it to be more fun since they get to feel like a real doctor finally.
Rather than formal classroom lectures, a lot of your teaching during the clinical years (3rd year and 4th year) takes the form of “pimping” - getting quizzed by a resident or attending, giving an answer, and if you’re wrong they tell you what the answer is. Depending on teh personality of the pimper, this can be a non-threatening educational experience, or it can be very embarrassing and unpleasant. Some doctors are rather aggressive about “pimping” you for very obscure, random facts and making you feel stupid if you don’t know it. The docs in some specialties tend to be nicer and more easygoing than those in other specialties. Surgeons have a reputation for being less friendly than pediatricians, not surprisingly.
In some ways third year of med school is very cool. You get to do things and see things most people don’t ever see. I drove the camera during laparoscopic surgeries, I delivered babies, I saw people die, I sewed up lacerations. However, it is a tough year. In addition to working normal hours and studying, you usually will have to be “on call” for whatever specialty you rotate with, which means that after you’ve worked a full day you stay all night to help the resident with taking new admissions or answering phone calls from nurses. At least nowadays though there are legal limits and the maximum amount of time that you are supposed to be in the hospital uninterrupted is 30 hours. However, some hospitals adhere to the duty hour limits more strictly than others do.
Hospitals have a unique culture of their own, and there is a strict hierarchy. Med students are at the bottom of the totem pole, which means med students are sometimes treated quite disrespectfully and unprofessionally. It can sometimes be discouraging to be an adult in your 20s or older, a college graduate with several years more of education, but yet have to deal with being told “Pick it up!” after a surgeon you’re working with drops a pen on the floor, or getting yelled at by a nurse (OR nurses, in my experience, are very angry people - probably because they get yelled at by surgeons, who probably yell at nurses because nurses yelled at them when they were med students - and so the circle is complete).
Most students take “Step 2” during the end of 3rd year or beginning of 4th year. Step 2 is actually two tests - one a written exam focusing on clinical principles you learned during 3rd year, and the other test is a hands-on, practical test. You have to act out interviewing and examining actors who are pretending to be patients. The practical exam was put in place basically as a way of screening out foreign trained doctors who can barely speak English but want residency training in America, so for an American-born English speaker it is not a hard exam…just very expensive and inconvenient. The main problem is that the testing organization charges you a high fee to register for the exam, and most people have to travel a long distance to go to the testing site (I had to fly to a site 600 miles away to take it).
During your fourth year of medical school, you are applying and interviewing for residency, so the expectations of you at the hospital are generally lower than they are in third year.
However, the process of interviewing for residencies is a stressor in itself.
Residency selection is decided by a process called “The Match” where you make a rank list of how you prefer the programs that interviewed you ( your #1 choice, your #2 choice, etc. for as many interviews as you went on) and in turn the residency program makes a rank list of how they prefer the people they interviewed. The lists are put in a computer that matches applicants and residency programs with the ideal goal being that if you ranked Resideny A #1 and they ranked you their #1 candidate then you “Match” at the program.
You find out where you matched on “Match Day”, a special day in March when all the med students across the country find out their results. It can be a very exciting great day if you wind up getting matched to the residency program you want to go to. However, it could also be a terrible day if you wind up matched to an undesirable program or (worst of all) DO NOT GET MATCHED AT ALL. That means you are unemployed and facing a huge student loan debt.
Unmatched people have to go through “The Scramble”, a frantic process in which you call programs that also went unmatched (that is, that have an open spot because nobody they interviewed there ranked them highly enough to wind up at that program). Most of the time, the programs that have open spots in the scramble are undesirable in one way or another (hence why nobody Matched into the program to begin with) but it is better than nothing.
Unfortunately, because of the rapid increase in enrollment of medical schools in recent years, many of us in the biz are expecting that in the next few years it will become harder and harder to Match into a desirable residency. My personal belief is that the powers that be are intentionally letting this happen to force med students into primary care careers (for its combination of long hours, low pay, low prestige, high paperwork, and the fact that much of primary care work is being taken over by nurse practitioners and physician assistants, being a primary care doctor is viewed as one of the most undesirable careers in medicine currently, even though PCPs do provide a very valuable service).
After med school graduation, you start residency. Most people take Step 3 in their internship (first year of residency). But residency is another long story…