3.31.2008

What was medical school like? Years I and II

I remember being a pre-med. I had the full college experience, IMO. I studied to maintain an academic scholarship, had part-time work (intermittently), and pledged a sorority. I dated more than one guy, did some local traveling, and made lasting friendships.

I remember being very concerned about 'med-school prep.' I wanted to take the "right" classes...and do the "right" summer programs. I had to volunteer, and participate in campus organizations so I could distinguish myself from the 'average' student. I did undergraduate research that resulted in publications. I took MCAT prep courses, and followed the recommendations of the premed office on campus regarding which classes I should take when...when to apply to med schools, and which schools I'd likely get in to.

I gained early acceptance into medical school. This acceptance was arranged such that I didn't *have* to go to this school if I decided to continue on in the application process and I happen to gain acceptance into another (more desirable) school. I decided I wanted to come back home, so I applied to the local schools. Got accepted. Decided *not* to go to the 'early acceptance' school.

I was ready for medical school. I'd done 2 or 3 (med school/MCAT prep) summer programs. I'd taken all the requisite courses, including anatomy, physiology, advanced chemistry, microbiology...everything. I felt pretty prepared...but utterly unprepared at the same time.

I remember the first 'meet and greet.' Everyone seemed nice enough. I guess I expected everyone to look like 'revenge of the nerds' or something...but they all looked normal enough. They were social and some boasted full "prior lives" as policemen, firefighters, nurses, teachers, mothers, fathers, military...

The average age of my first year class was 30. That means that half the class was *over 30* in their first year of medical school. I had no idea everyone would be so...old. There were even a few people close to 50 (after having raised families or whatever)!!

There were quite a few smallish/informal meet and greets. Some indoors (dinners hosted by alumni, or AMSA, or some other group). Some outdoors, usually in the quad. Sometimes there were booths up urging us to join this group, or that group. Some upper-classmen were there, offering advice, or representing a club. We had picnics/BBQs. It was very nerve-wracking.

Then, our first welcome lecture. The one where they introduce lots of faculty. The one where they give you your first taste of what medicine is *really* like. They explain the horrible state that is American healthcare...and basically express frustration with the field. They seem to hate so many things...and are so bitter. Jaw on floor, you try to take in all of this information. You try to understand the bitterness, and convince yourself that "I'm not going to be so bitter when I grow up." Then, as if they're reading your mind, they say "you just wait...you'll see. Come talk to me in 10 years."

And school hasn't even started yet.

There was the white coat ceremony, where a few friends/family get to listen to a lecture about how wonderful being a doctor is and how doctors love patients so much (stark contradiction to the lecture *you* and your classmates sat thru just days prior)...and you get the (short) white coat (as if it's important or something). Everyone is so proud of you.

Then, the first real lecture happens. The big lecture hall. Everyone stakes out a seat. I liked to sit on the front left side, about 5 rows back. I liked to have the seat next to me empty. Everyone's very excited. The lecture is introductory and entitled "is healthcare a right?" Clueless to the political implications (as many medical students are completely apolitical), you start formulating your thoughts based on this lecture...and others that follow.

At our school we had these 'classrooms' where everyone had a desk (with lots of locked storage). In each of these rooms (there were about 10 of 'em) there were about 16 student desks - arranged alphabetically by last name. The person that happened to be sitting next to you, was your partner for the year. In these rooms there were slides, microscopes, bone sets, television with videos...learning aids, stuff like that. Immediately everyone brought artifacts from home to decorate their spaces. Magnets, plants, pictures, books, lamps, snacks, etc.

I remember the first day of (real) class. After the intro courses, and the welcome to our school speeches...the first real day. We were each given a stack of papers about 1 and a half feet tall. "Learn all of this by December." In addition to the stack, we had pre-filled notebooks for lab (gross anatomy and histology). Learn this too...and be sure to be able to identify these slides (box of micro slides handed to each of us), and you have to show up once a week for ICM (intro to clinical medicine).

I don't remember all of the classes off hand, but I do remember anatomy (lecture/lab), physiology (which is *quite* separate and much more difficult than anatomy, unlike in college). Microbiology (lecture and lab). Biochemistry (like hard core biochemistry); pharmacology, neuroanatomy, preventative medicine (epidemiology) embryology, and family medicine/ICM. The exams were during 'exam week' with 3 exams a day M W F. The multiple choice wasn't 'regular' multiple choice. They asked us to 'choose all possible correct answers'. If you chose too many, you missed the question. Missed one...also missed the entire question. There were k-type questions. I'd never taken a *multiple-choice* exam that was so difficult.

And they try to trick you. You have to read the questions very carefully, and consider the *exact* wording of the question. For instance, they'd show a picture of a large white blood cell...surrounded by a bunch of small red blood cells. White blood cells are big, have nuclei; red blood cells are smaller, and do not. (see above picture for example). Well, the question will be: "what are the characteristics of the predominant cell type in this slide." You ask yourself, predominate as in this big ass WBC? Or predominate as in the sheer number of RBCs shown. They were talking about the RBCs...and basically wanted to know if you knew that they had no nuclei. But, many students assumed they were referencing the WBC (that was huge, front and center)...and they missed the question.

Year one was also the year of gross anatomy. We had a few people who had issues with gross. The smell, the dead bodies, the thought of dead bodies...the dissecting. They would faint, couldn't stand blood and gore. We had pregnant students who had to wear respirators. But these issues are all worked out (through desensitization exercises). The only time it was difficult (for me) was when we got to the hands (and some of the women actually had pink fingernail polish on)...and the face. Usually, everyone kept the face and hands covered until the moment we *had* to actually dissect them).

There were all sorts of bodies, all sorts of ages. Mostly old white men...but lots of old white women too. Not so many of anything else...so when someone actually had a black body, it was very cool to compare/contrast the structures and such. Likewise, a young person, with well-defined muscles, offered something that the old people didn't. The bodies (on the inside) of course were more alike than different...but there are differences.

We had lab coats in plastic bags in lockers located in the gross lab. We were divided into groups of 5 per cadaver. We started with the back. Two people are supposed to dissect, one on each side of the body, and two others give 'instructions' on the proper technique/strategy by reading aloud the directions provided in the notebook. The notebook had key terms, and a list of structures that we're supposed to find and learn. And learning, not just their identity, but their blood supply (and the origin of said blood supply, it's branches, where it ends, what type of muscle lines the walls of the vessel), the nerve supply (and any thing else that the nerve innervates, muscles, organs...and where the nuclei of the nerve is housed...and which nervous system is responsible for the actions of the nerve).

If you cannot find a structure (either because your body didn't have one...but more likely because you destroyed it dissecting)...you had to come back to the lab after others dissected their bodies, and find someone who did it right. The person dissecting is supposed to switch day to day. Lab was 2x week. Lasted from about 1-6pm. There were TAs and tutors there for part of that time.

Lots of things to recognize, and the exam consisted of secondary/tertiary questions. Never are there questions like "what is this structure?" Too simple. Rather, a cadaver arm will be completely dismembered from the body, laying on a stool, covered with a towel...except for a 2x2 inch window. Three different color pins will be stuck into 3 structures. A card next to the arm will read: Where are the cell bodies located of the nerve that innervates the structure indicated by the red pin?

Even if you know the structure indicated...and even if you know the nerve that innervates it...damn if you know where the cell bodies of that nerve are located.

And 'knowing' what the structure is in the first place is a minor miracle in itself - being that you can't tell which way is up/down/right/left (since the arm, at least you think it's an arm, is detached from the body). And, to make matters worse, the tiny 2 inch opening makes it difficult to orient yourself with even local cues.

There are like 30 or so stations, with a portion of the class scheduled to take the exam at various times during the day. The questions are shuffled, but are the same. Each station has one student. Each station has 3-5 questions. You are timed. At the end you are (sometimes) allowed to go back to previous stations for 5 minutes or so.

Micro was alot like gross, except you get seasick looking at slides. And part of the exam was administered via a slide show.

All lectures were optional except ICM. Some students would show up for the first day of the semester...and disappear with their stack of notes, slides, and notebooks until exam time. We had a note taking process where the notetaking responsibility was shared among all students. So one student would attend a particular lecture, tape it, take notes, and go home and type them up nice and pretty. Then distribute them to the rest of the class.

There were tapes and videos of the lectures. And old lecture notes and exams from years past. So, there was plenty to study. I went to class everyday, but didn't attend every lecture. Some professors were great...and others wasted your time. Some topics were very confusing to try and do on your own...and others were quite clear after reading the notes. So, you pick and choose which lectures you wanted to attend. Our medical school spoon-fed us...which I think is a good thing being that I'm now over a quarter million dollars in debt because of it. It's the least they could do!! I deserve to have 'eaten well' for that much money!!

Medical school is like....they took everything you've learned in all of your undergraduate science courses and composite it into 2 days of lectures...as your introduction. On day 3, no matter what you've done in undergrad, no matter which courses you've taken, or how great your professor was at teaching it...on day 3, it's like you had *no* prior knowledge of the material. On day 3, everyone is on the same level playing field...science majors, biochem PhDs, art majors, and those who took every premed course they could. No matter.

I remember sitting in front of the computer, taking a practice biochem exam (WITH MY NOTES OPEN), and still utterly confused, flunking the practice exam one week before the real thing...and I graduated from undergrad with a degree in CHEMISTRY and a minor in biology!

At my medical school it was imperative that you pass all exams. There was a curve so that almost everyone passed...except in a few subjects. If you failed an exam, you had to retake that exam and pass it. If you failed the retake, or didn't take the retake, or it was the last testing period of the year (hence no time for a retake)...you had to retake the entire year's course in the summer. If you failed the summer course, you had to repeat the entire year of medical school. There were always a few students who had to repeat their first or second years.

The students helped each other. There was no pyramid nor was the curve based on the highest scores. The curve only served to lower the pass percentage in the instance that more than 10% of the people scored below 70%. Pass was 70%. Honors was 90%. Our grades were pass/fail/honors.

Do not need to be smart, per se, since it's mostly memorization. You just had to know what to study, and how to study. And you had to know how to take the test. Anticipate the questions...learn to read carefully...do the practice exams...and study in groups (at times). You had to use your time efficiently, especially if you had other things going on competing for your time. I didn't know anyone in my class that worked...but there were a few parents. I realized that I had to read the material 3 times in order for it to stick...and that was straight forward stuff. The complicated stuff...physiology, epidemiology, and biochem...I actually had to *figure out* before I could attempt to memorize.

Second year material is more complicated than first year. Second year was organ system based, and 'illness/pathology'. Whereas first year was micro/histology, second year was pathology. Whereas first year you're learning about the heart and cardiovascular system, in year 2 you're learning about congestive heart failure and strokes. It was easier than first year because you are now an 'experienced' medical student, able to pick and choose what's important to study...and how to take the exams so you pass. Also, a few things are repetition, and you have a base to hang new knowledge on...
***

Overall, most people who flunk out of med school, do so during 1st and 2nd year. And of those, almost all flunk out because of some competing personal issues. Family, marriage, financial, illness, mental, emotional, etc. Not because the work is too hard. Because, actually...it's not. It's memorization. It's being able to choose the 3 most important points in a given lecture...and commit those 3 points to memory...then reproduce those points in one way or another on an exam. It's knowing what to study. Focused study. If you don't focus, you won't do well. You cannot know everything...and if you try, you will have a more difficult time.

It takes some time to become okay with going from being the top in your class (from kindergarten, onward) to being "average" among your med school class. It's hard to incorporate 'family time' and 'friend time' into your life. You feel guilty for spending your Thanksgiving "goofing off" with family rather studying in preparation for mid-terms. And movies are out...2 hours of "lost time" is just...unacceptable. You take your backpack *everywhere*, just in case you get 'stranded' you won't fall behind in your study. And don't even think about getting sick...

No one in our class had outside employment. There were a few parents, usually fathers with stay at home wives and the rich grandparents supporting the young family. Many students even stayed at home where their parents prepared healthy meals daily and washed their clothes. No wonder they did well!!

You cannot spend the time worrying about money...so you must take out loans to support yourself (if you don't have rich parents). You have to have a car and a computer. You have to spend money taking exams and joining organizations.

Living close to school is a plus (that way you avoid wasting valuable study time on the road). If you must spend lots of time in your car...get some audio lectures to listen to.

There were a few women who managed to have babies in med-school and do very well. They often did not attend lecture, spent all day studying in the library instead. Stayed late (until 6 or so) in study groups/labs. Were very focused and didn't take breaks or goof off during 'study-time'...and did well. On the other hand, those of us without kids/families spent 12-14 hour days in the library, 6 days a week (easily). We snuck food into the group study rooms. We did alot of chit-chatting, and often went from study site (i.e. library)...to another study site (i.e. cafe')...and yet again to another study site (i.e. someone's apartment). Our lives were studying in different locations...sometimes inefficiently moving from place to place, talking about off-topic things.

The first 2 years are fun...but requires lots of attention (to say the least). There's no real patient contact (that ICM bullshit doesn't even begin to count as 'patient contact'). Your life is your backpack. Your notes are guarded with watchful eyes and taken everywhere (there's no way you can lose those notes after spending 2 months color-coding everything, and highlighting the pertinent points). And the fun you have is...in the gross anatomy lab, eating pizza and drinking beer while comparing the structures in various cadavers!!