What's it like being in medical school?

My mother has worked lower-end jobs in the medical industry her entire life and my father spent most of his career as an accountant at the UW Medical Center. I know a few people who are looking to go into medical school.

I’m not really looking into going into medical school (note: this statement is only very slightly untrue!). I’m just curious, what exactly is it like going to medical school?

I’m in my second year, so I suppose I can speak for the pre-clinical years at least. At most schools, the pre-clinical years are the first two, and they deal mainly with science courses like anatomy, biochemistry, pathology, pharmacology, etc, etc. Everything I say will of course be my own experience, but from talking with friends at other schools, I think it’s more or less the same.
The second year is far harder than the first year, but the first year is plenty difficult. Part of what made it more difficult for me was the massive quantities of memorization. I majored in electrical engineering, which didn’t require much memorization, but did require a lot of problem solving/critical thinking skills. Med school was tough because I didn’t have to solve many problems (physiology being the only exception first year), but I did have to memorize more than I ever thought possible. I would routinely study 4-8 hours a day, depending on how much I was able to cram in, and around exam time that would go up to 12-14 easily.
Besides the main science courses, there are courses on how to talk to patients, how to handle ethical dilemmas, biostats/evidence based medicine, and shadowing of physicians in various fields to see how the pros do it, so to speak. These courses often get shoved down in importance because they just aren’t “worth” as much, but they are pretty important and useful.
At my school, on an average day I’d be in class from around 9AM to 12 AM or so, and sometimes we’d have afternoon classes or labs that could go until 4 or 5 PM. Weekends were a time to try to catch up on that week’s stuff. The amount of material covered becomes pretty overwhelming at times; compared to undergrad, it’s like taking all your science courses at once, and in half the time. When you combine that with being in a class full of people who were all presumably at the top of their undergraduates, it can make for a stressful environment.
To avoid making this too long, I can sum up second year as being to first year, what first year was to undergrad.
Hopefully that gives you a rough idea, but if you want to know more, ask away. I know there are several other med students here in various stages of school who can probably answer as well.

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. :slight_smile: 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… :slight_smile:

Nothing to add (until next year, hopefully :confused:) except that both posts have been fascinating so far. Sounds like a hell of a good time to me, but I tend to thrive on stress.

I’ve noticed a disturbing trend of doctors acting pretty jaded about the entire process, though. Is it really so disillusioning to get through the system? Or are pre-med-school expectations generally too high?

As a first year, I can concur with everything that’s been said, but I would also like to add that while medical school is largely memorization as compared to analysis, there is slightly more application than in undergrad. For instance, if you learned that the vibration/touch/proprioception modality of sensory information has tracts that are ipsilateral up to the caudal medulla and contralateral thereafter, while the pain/temperature modalities are contralateral at about 2 dermatomes higher than when there they originate from, an underglad class might ask you to regurgitate just that, whereas a med school question will be more like, “a patient complains of numbness in the fifth left digit and insensitivity to touch in the left calf. Which spinal tract and where would a lesion be likely to occur?” And you’d have to combine the previous knowledge with the fact that for some modalities higher parts of the body are more medial and lower parts are more lateral, until the pons (maybe?) where they decussate . . . anyways, suffice it to say, it gets complicated, and I think it’s not so much memorizing “words on a page” as being able to organize and categorize that information well and quickly.

It’s also highly stressful and I walk around with a vague throwy-uppy feeling all the time. I am actually now taking beta-blockers for test anxiety, cause I used to get so stressed on tests, esp. anatomy practicals, that I would just fold and do terrible.

Also, lavendarviolet, have they really increased the number of seats? I’ve heard just the opposite . . . that the competition grows every year . . .so getting a residency is harder than before? That makes me even more throw-uppy.

I am most jaded by the process of getting IN to med school. The small number of spots and the large number of applicants necessarily means a large number of qualified students won’t get in, and may never get in. Once you’re actually in school, it’s surprisingly hard to fail out.
Honestly, it really is a great time, despite all the long hours, the inevitable blow to your ego when you realize there are a hell of a lot of people more academically talented than you, the aforementioned pimping by attendings/residents, etc. The whole process is one of cramming as much into your head as you possibly can, seeing what sticks, and then cramming it back in again (ad nauseum) until you can hopefully help somebody.
That’s some sad news about matching into desirable residencies. I’m accumulating a mountain of debt, and while I know that no matter what field I go into I’ll be able to pay it off, it’d be nice to pay it off relatively sooner. Then again, I have no idea what I want to do, so hopefully 3rd year will help me decide. And even more hopefully, my board scores will leave those doors open.

Yes, and Yes.
Pre-meds often have a very rosy view of medicine: They picture making big money for a glamorous career where you truly Help People and Make a Difference.

I don’t think most pre-meds really understand how much they will have to sacrifice through the whole process of medical education. Maybe if you have previously held a job that required you to work 80 hours a week (or 30 hours straight) including many holidays/weekends, required you to take abuse from superiors, deal with mountains of paperwork, spend significant amount of time away from your family, you know what you’re getting into…but the TYPICAL pre-med doesn’t get to see that side of medicine when they are doing their standard volunteer experiences.

Let’s be real: For all the talk about altruistic reasons for becoming a doc, many pre-meds are attracted to the career because of the hope of making a lot of money. The reality is that medicine is not the easy path to riches some people think it is. While most of their friends from college are gainfully employed and hopefully putting a bit of money in savings, the medical students have to take out huge student loans to pay for med school (most med students graduate with student loan debt in the neighorhood of $150,000 to $200,000). When you graduate med school and start residency, you will be making about $45,000/yr (even if you live in an expensive city like Chicago or NYC, the residency programs across the country all pay about the same amount of money). After graduation from med school, you also need to start paying back your loans (and these kinds of loans don’t go away even if you declare bankruptcy), so $45K doesn’t go as far as it would for many other people.

After you’ve graduated from residency, then you hopefully will get to finally make a six figure income, but then you also have new expenses to factor in (malpractice insurance can be very expensive depending on your specialty and the state you live in, for example). Not to mention that the health care system is obviously in a state of transition and we can’t be sure that the current level of compensation for physicians will hold up over the long haul. In most other countries, physicians don’t make nearly as much as they do in America (hence why doctors from elsewhere in the world fight desperately for the chance to do a residency in America).

Glamor?
I have spent a ridiculous amount of time in my life asking people to describe their vomit and feces in detail (although I would like to let people know right here that, no, really, you don’t have to bring in a sample to show us as some people do - the description is enough).
I can say from personal experience that there is nothing glamorous about doing a rectal exam on an 85 year old woman.
I had no idea that a live human being could produce the kind of horrifying smells that I have experienced emanating from a poor man who had a truly nasty bedsore.
Just a few weeks back I was sprayed with blood while doing futile chest compressions on a CPR case where the person was basically already dead…as most people we end up doing CPR on are, really.
No, it ain’t like the TV shows make it seem.

Helping people? Well, yes, sometimes. However, for every patient who is pleasant and appreciative, there’s at least another one who is rude, demanding, and ungrateful. Prescription drug abuse is rampant, and if you look at the emergency department (for example), half the battle is figuring out who has a legitimate request for pain medication and who is just a Vicodin addict.
Even though he is even more cynical than I am, the emergency physician who writes this blog does give you a good idea of the kind of patients that you will have to get used to dealing with if you go into medicine:

Making a difference? Again, sometimes…but those cases tend to be the exceptions. A lot of medicine is algorithmic and generally there is not that much “creativity” in how you approach cases where you can truly say that Doctor A made a difference that Doctor B would not have. A lot of patients will get better no matter what you do and all you’re really doing is providing reassurance and/or supportive care (especially in outpatient settings and pediatrics, where the patients are usually not all that sick to begin with). Of course, if you go into it with the attitude that (for example) as an outpatient Pediatrician you are not going to be saving lives daily, but that your expertise could really make a difference on the rare occasions you pick up on a rare, life-changing diagnosis or identify and report child abuse, then you may be satisfied with that.

While I’m sure it is still competitive to get into med school, the sheer number of seats in med schools has increased a lot over the last few years as a number of new medical schools have opened (and more continue to open each year), while the number of residency spots has not grown to keep up with the pace.
This thread over on StudentDoctor.net has all the numbers from people who know more about the situation than I do.

My advice to current pre-med applicants would be to try to get a lot of exposure to family medicine and talk to primary care doctors about what their life is like to see if it’s something that you truly think you’d be satisfied with.
With the way things are heading, it is not very realistic to go into medical school thinking you can count on becoming an elite specialist like a plastic surgeon or dermatologist - so you could end up very disappointed and unhappy if you don’t enjoy primary care medicine but are forced into it by the upcoming situation with residency slots. The powers that be want to see more family medicine doctors out there, so I would not count on there being much of a push to create more residency spots for specialists like neurosurgeons or dermatologists.