Now that I’m in medical school, how do I survive?
First and foremost, keep up on studying. Do your best to not fall behind. When you study, mix it up a bit. Scope out multiple study places outside of campus or find a group of two or three people with similar study habits who can be a study support system. But also establish stress relievers—exercise, listen to music, read popular novels and magazines, or whatever relaxes and refreshes you. Joining student clubs or organizations helps to change your focus periodically, making you more rounded and improving your CV.
What can I expect each year? When do I get out of the classroom to practice hands-on medicine?
For the most part, the first two years of medical school consist of intense classroom instructions, labs, studying, and testing. Many medical schools, however, are working more hands-on learning into years one and two.
Years three and four of medical school will put this learning to use as you go through a series of clinical rotations in a variety of specialties. This is a great opportunity to try out these specialties and narrow down your choices for your residency and your career. By the time the fourth year rolls around, you’ll be looking at residency programs, going out for interviews, and looking forward to “Match Day” to find out where you’ll do your residency.
What tests do I have to take in medical school? How do I prepare for them?
You’ll have all kinds of tests during medical school, most of which are exams that test your comprehension of course work and reading.
However, you’ll also have to take a series of standardized exams that test whether you are ready to become a physician. Here is a brief description of these standardized tests from “Succeeding from medical school to practice,” an online publication from the American Medical Association:
“The United States Medical Licensing Exam (USMLE) is the exam administered by the National Board of Medical Examiners (NBME). The Comprehensive Osteopathic Medical Licensing Exam (COMLEX) is the licensing exam administered by the National Board of Osteopathic Medical Examiners for graduates of osteopathic medical schools … Although its primary purpose is for licensure, the USMLE has many secondary uses by both medical schools and residency programs including promotion and graduation decisions for medical students as well as ranking of residency applicants. The USMLE currently consists of three separate exams, known as ‘steps.’
- Step 1 assesses the basic sciences taught during years one and two of medical school. Most medical schools require students to have taken and/or to have passed Step 1 before or shortly after starting clinical rotations.
- Step 2 currently has two separately administered components, Clinical Knowledge (Step 2-CK) and Clinical Skills (Step 2-CS). Step 2-CK tests knowledge and application of the basic clinical sciences taught during the core clinical rotations, and Step 2-CS tests a student’s basic clinical skills, including physical examination skills, clinical decision-making, note-writing ability, and interaction and communication abilities with standardized patients. Most medical schools and residency programs require the passage of both components in order to graduate and begin the first year of residency. Some schools also offer or require their own clinical skills exam, which can prove useful in preparing for Step 2-CS.
- Step 3 represents a more advanced assessment of clinical knowledge and decision-making that is usually taken toward the end of the first year of residency.”
For more information, check out the USMLE website. COMLEX has a similar structure. Get details on the National Board of Osteopathic Medical Examiners website.
What can I do if I pass Step 1, but I don't get a high enough score to be competitive for highly selective specialties?
You can retake any of the steps in the USMLE if you fail or do not finish the step. There are some cases in which you can retake the steps if you do not get the score you want, but for the most part you are not allowed retakes if you passed a step. Individual medical licensing boards establish limits; some states allow unlimited retakes but most vary from three to six times. Check with the Federation of State Medical Boards or the individual licensing authority in the state where you intend to apply for licensure.
2nd-3rd year transition
What should I consider when scheduling third and fourth year rotations? What electives should I consider based on what specialties interest me?
There are a couple of schools of thought when it comes to clinical rotations. Some medical students find it beneficial to start off with general clinical experience, such as primary care or emergency medicine, to get a more rounded set of knowledge and skills before going into a more specialized area.
Other students want to get early exposure in specialties that interest them in order to get a feel for whether they really want to pursue that specialty. It all depends on your preference.
Either way, if you’re interested in particular residency programs or institutions, make sure you do at least one elective rotation there so you have an opportunity to work directly with attending and resident physicians in those programs. This will help you decide whether you’re a good fit with a program. Plus, you’ll have the chance to impress attending physicians help decide which medical students they will accept into residency.
Any sage advice for students going on rotations?
You have to speak up; none of your faculty or residents will have a clue about how much you know unless you talk. Take advantage of the opportunity to learn from those who are caring for patients and who really want to teach you.
Medical students looking or going into residencies
Who should I consider when asking for letters of recommendation for residency?
If you were deciding on which medical students to accept into a residency, from whom would you want to receive letters of recommendation?
The answer is pretty simple: Physicians who can assess their qualifications to be in a given residency program. The more accomplished and highly regarded this person is, the better.
Go for letters from attending physicians first. You can include letters from senior residents but some programs or specialties will not accept recommendation letters from residents. The key is to do well in your studies and in your rotations, making sure you get to know these individuals so they feel comfortable recommending you.
How important is research or involvement in clubs in first and second year?
Many residency programs are looking for well-rounded individuals who are motivated and can handle multiple tasks. Therefore, involvement in extracurricular activities will never hurt you. However, don’t allow these activities to interfere with your studies. They should supply you with a refreshing break from, but should not replace, hitting the books.
How do I decide on a specialty or a residency program?
You won’t make many decisions that are more important than your specialty and residency program. Neither decision is final. You can change specialty or move to another residency program. But undoing that decision is very difficult and time consuming.
When it comes to choosing a specialty, many students think they already know what specialty they want to enter. It’s important to keep an open mind and allow the clinical rotation process to expand your thinking. One early decision to make is surgical versus non-surgical. Other factors, according to “Succeeding from medical school to practice” include “personal history, clinical interests, experiences during rotations, duration of training involved, and financial and lifestyle considerations.”
Many of the same considerations play a role in choosing a residency program. “Succeeding from medical school to practice” also suggests considering:
- Academic versus community setting
- Multiple hospital system (gives you the opportunity to work in a variety of settings)
- Large or small program
- Teaching hours
- Autonomy
- Quality of life of residents
Each program and each institution have their own personality. When you go out for interviews, try to get an overall feel for this personality and see if it matches your expectations.
How does the National Residency Match Program work? Am I guaranteed a residency? What happens if I don’t get one?
The National Residency Match Program (NRMP) is the method most allopathic (MD) medical students use to match up with a residency program. According to the NRMP website, the NRMP “provides an impartial venue for matching applicants' and programs' preferences for each other consistently. Each year, approximately 16,000 US medical school students participate in the residency match.” An additional 18,000 independent applicants—former graduates of US medical schools, US osteopathic students, Canadian students, and graduates of foreign medical schools—“compete for the approximately 25,000 available residency positions.”
Most medical students who enter the NRMP do match with a residency but you are not guaranteed a match. There is hope for those who don’t. Flexibility is the key as there will be open programs that do not match your preferences. You also may want to explore other career paths such as research or an advanced degree program.
How do I budget my loans for the year?
Your first stop is your financial aid office at your medical school. You can also read up on student loans at https://www.aamc.org/initiatives/studentdebt.
The Foundation of the Pennsylvania Medical Society, the philanthropic wing of the Medical Society, offers student financial services. The Pennsylvania Medical Society offers a CD called “Docs in Hock” that will help you better understand student loans and repayment options.
You need to understand and handle your student loans. No one else will do it for you.
What are good or standard benefits in a resident contract?
The Accreditation Council for Graduate Medical Education (ACGME) sets forth requirements for residents contracts (see page 6) with which all ACGME accredited residency programs must comply. The ACGME states that a resident agreement/contract must contain or provide a reference to at least the following institutional policies:
- Residents’ responsibilities
- Duration of appointment
- Financial support
- Conditions for reappointment
- Grievance procedures and due process
- Professional liability insurance
- Health and disability insurance
- Leaves of absence
- Duty hours
- Moonlighting
- Counseling services
- Physician impairment due to substance abuse or other factors
- Harassment
- Accommodation for disabilities
Of particular interest to many medical students is the number of hours they will be required to work when they are residents. Work hours are now restricted by law to 80 hours per week but there are some exceptions. The ACGME has a wide range of information so you can become more familiar with work hour rules and policies.
What won’t medical school teach me that I should know more about?
Medical schools have adjusted their curriculum in recent years to make your education more rounded and to teach students about non-clinical matters like ethics and communications.
Many physicians also wish they had learned more about the business side of medicine and how financing often plays a huge role in the delivery of health care. You’ll have to undertake much of this learning on your own by reading publications from the AMA, the Pennsylvania Medical Society, and other organizations, and by engaging your training physicians in discussions about non-clinical topics.
Contributors: Katie Lund, Peter Lund MD, Brittany Massare