My First Week of Medical School

Many people have asked me, “What was medical school actually like?” “What was you day-to-day schedule?”. I will attempt to describe my first day in medical school from the time I woke up to the time I fell asleep in this essay.

I woke up at my usual time of 4:30AM. I was raised on a farm and getting up early is as much a part of my life as brushing my teeth every morning and evening. I am fortunate that I actually have always had less of a sleep schedule than most of my buddies and thus, I generally awaken around 4:30AM without the need of an alarm clock. I also roll out of bed and hit the shower while my single cup of “Joe” is brewing.

Over coffee, I usually catch up with the newspaper (online) and then I headed out the door for my walk to the subway station. This walk generally took about 20-minutes and was a built-in source of exercise for me for the first couple of weeks of medical school. My coursework on the first day consisted of Introduction to the Practice of Medicine Class at 8:AM- 10AM, Psychiatry at 10AM to noon. Lunch was from 12 noon to 1PM. Afternoon was Gross Anatomy Lecture from 1PM-3PM and Gross Anatomy Lab from 3PM to 5pm.

All of our lectures were in 50-minute blocks with 10 minutes of break in between each lecture. This allowed us to get a drink, walk around and prepare for the incoming lecturer. It also allowed the media person to set up in between the lectures as our lectures were available for download and all PowerPoints were down-loadable from out seats. Most of us took notes on the Powerpoint slide sheets or just listened in class.

Our syllabi had been handed out during orientation so that we knew the objectives and content with each lecturer. We also knew which textbook readings were to be covered. My Introduction to the Practice of Medicine course had a syllabus that contained an outline of the lecture. There was no text reading for this opening lecture that included the duties of a physician, how to fill out a death certificate and how to gather and interpret vital statistics for a locale such as birth rates, death rates and rates of disease.

With all of my syllabi and text books, I would remove the covers, take the books to Kinko’s and have the bindings removed. I would then have three-holes punched and I would place these sheets in large 3-ring binders. I had a binder for each course. In the evening before each course, I would remove the syllabus sheets for that course, remove any textbook pages that I thought I might need and place them in a small 3-ring notebook along with sheets of lined notebook paper (for taking notes). This was the notebook that I brought with me to school. I would have the subject matter divided by separators so that I had all of my information with me for the day.

I would download my PowerPoint slides and place copies of these in my subject notebook when I got back home for the day. My lecture notes (or copies of note service) would also go into each subject note book. My textbook pages would go back into that textbook three-ring binder.

On my first day, I took notes and placed them in my Introduction to the Practice of Medicine binder when I arrived home at the end of the day. For psychiatry, again, the lecturer had no slides but discussed Erickson’s stages of development and Piaget. I took notes but knew that detailed explanations of these subjects were in my textbook.

For Gross Anatomy, I had the text pages with me and made notes in the margins of the material presented by the lecturer. I also made a few notes on photocopies of my Netter plates for use in our lab. During Gross Anatomy lab, I had my list of structures that I had made from scanning the dissector. I had also reviewed the relevant plates in my Netter atlas and had made photocopies of these plates. My photocopies were stapled to my list of structures.

In our first Gross anatomy lab, we studied the bones of the vertebral system and skeletal structures. We were also given instruction in how to work with the diener to keep our cadavers in good condition for the entire semester. We were also introduced to our cadavers and our tank groups (each was six people).

After lab was over, I took the subway back home (45-minutes) and walked from the subway station to my house. I then took an hour, made dinner, ate and begin to study and review the material from the first day’s lecturers. As I studied, I made notes an questions in the margins of my books, syllabi and note sheets. Since most of my notes were typed, I printed these out and placed them in my subject binders. I also studied and memorized the relevant bone structures using my bone box that was issued to me during the first day of Gross Anatomy laboratory.

My next task was to preview the notes for the next day’s subjects and do any readings/problems that had been assigned. After my previewing, my textbook pages, relevant notes and syllabi pages were placed in my daily notebook which went into my backpack. My next days courses were Biochemistry, Microbiology and Microbiology lab.

My day ended about 11 PM and I hit the bed because I knew that my next day would be starting at 4:30 AM. Since Tuesdays and Thursdays were shorter days (class started at 8AM but ended at 4PM) I actually had an extra hour on these days. We also had a Microbiology Discussion session on Tuesdays and a Biochemistry Case Discussion session on Thursdays where we would discuss clinical cases from the standpoint of these subjects. Our instructors would bring a case, present it and then we would discuss these cases in detail from the standpoint of the basic science involved.

When we started to actually dissect the cadavers, my Mondays, Wednesdays and Fridays included 2-3 hours of dissection in the evening after class was done. I would get some dinner at school and then get into the dissection laboratory to study and complete dissections. The extra dissection/study moved my bedtime back to after midnight on these nights.

I also studied in the dissection laboratory and with my study group on Saturdays. We would have an early breakfast (at one of the nearby churches to help them raise funds) and then study and quiz each other until noon. We would then study and quiz each other in the Gross Anatomy lab after lunch and generally until 3 or 4pm. After that, we would do another group session in Biochemistry and Micro and then head home around 8pm.

Sunday’s were generally my day of rest. I would spend a couple hours in the evening putting together my materials for my Monday classes but most of my studies would be completed in the time that I had put in Monday through Saturday.

If this amount of study time seems extreme, it was extreme in some ways. I would not stop until I felt I had mastered the material. I also made the crucial mistake of neglecting my physical conditioning in favor of my studies when I should have incorporated my studies into my physical conditioning routine. I ended up gaining a considerable amount of weight but my grades were excellent. At this point in my life, I know that I have to strike a balance and now I am in excellent physical condition with no neglect to my academics/reading.

Medical school was all about balancing my studies with my life. I learned to multi-task and I learned how to focus on getting things mastered and completed. I also learned the value of discipline. My schedule didn’t allow much “downtime” but the “downtime” that I had was utilized to an ultimate degree.

It becomes easy to procrastinate in medical school because the days are long and the material seems voluminous. I fought procrastination by asking myself, “Why are you avoiding getting on with this task?”. Since I never had a good answer for this question, I just broke the task into smaller tasks and checked them off until they were done.

As I have said in other posts on this blog, the telly went by the wayside. I would spend a bit of time on Sunday scanning the log for shows that might be of interest. I would program my recorder for the shows of interest and watch them the next Sunday if I felt like a bit of relaxation. In most cases, my relaxation became hanging out with my classmates and the telly wasn’t much entertainment. I still tape shows that I love or documentaries that might be of interest to my students as I am teaching more these days.

Other things that tended to waste my time in medical school were phone conversations. I seldom use my telephone more than 5 minutes per week and tend to use e-mail communication more. I also pick and choose the meetings that I attend. Many times, academic committee meetings can be a total waste of time and energy and thus, I pick and choose whenever possible. If something is mandatory, the organizers generally will time the meetings around the schedules of those folks who are attending.

One of my medicine professors encouraged us to read the case reports in the New England Journal of Medicine every week from the first day of medical school. He said that we might not understand all of the aspects of each case but that this habit would prove invaluable as we moved through the curriculum. He was totally “on the money” with this one. I can’t tell you how studying and reading these cases helped me on all steps of USMLE and in residency too.

Medicine requires that you read and keep up with the journals of your discipline. I strive to read selected articles in New England Journal of Medicine, Journal of American Medical Association weekly. I also read American Surgeon and Archives of Surgery regularly along with Nature Medicine (excellent articles to be found in this journal). I keep a computer log of the articles that I have read and their sources. This keeps me current with the literature as much as possible.

It’s On to Medical School!

You have managed to go through the medical school admissions process and you have selected the school that you will attend. At this point, approximately two months out from actually starting classes at medical school, what are some of the things that you might want to place in order? Graduation from undergraduate is behind you and those wonderful celebrations are over. It is now a good time to look at some of the basic necessities that you are going to need in order to start your freshman year of medical school off on a solid foundation.

Have you found a place to live? The ideal “home” for a freshman medical student should include, a bed (mattress on the floor doesn’t work well), a desk with good lighting (preferably in front of a window), a bathroom with both tub and shower, and some manner of kitchen facilities. If you are doing the “dorm” situation, a small-refrigerator and coffee/tea pot are bare essentials if you don’t have access to a kitchen or kitchenette. Other “niceties” are a sturdy bookshelf for organizing your textbooks, a filing cabinet for papers and notes (2-drawer is fine) and a comfy chair with reading lamp for change of position. A large-sized dry erase white board (60-incher) is good for concept mapping and writing down upcoming test dates etc. You can fall asleep while looking at one of your concept maps. Leave the telly at home but an MP-3 player and radio are good to keep on hand.

You won’t be spending loads of time in your “crib” so you don’t need to load up on creature comforts. You home should be something of a sanctuary but you don’t need to spend thousands of dollars on furniture for your apartment and an interior decorator. You will be basically doing the three “Ss” in your apartment(shower, study and s–t) and rushing out of the door on most days. Even on weekends, you life is going to center around your studies for the most part. If you have a family (or significant other person in your life), then you may need to make more sophisticated provisions but in essence, medical school is going to make your life pretty simple and fairly routine.

Your home should be an easy commute to your medical school. Hours of sitting in traffic or hours of driving to and from school are a very bad idea. There will be days when you are just exhausted and traffic/commuting will be the very last things that you will want to contend with; not to mention having enough energy to hit the books and notes after you have battled traffic. When I was a freshman medical student, I had a 45-minute subway ride into the city each day. I used that time to preview lecture material or just relax and listen to the sounds of my environment. I definitely would not have put that much time into driving. Before starting third year, I moved much closer to school and my clinical rotation sites.

Most of your time will be spent in and around school. You will attend classes and you will study your notes and books in the evening on a daily basis. The more information that you have to remember, the more organized you want to be in every aspect of your life. I planned as much of my day as possible around my classes and study schedule as I became the ultimate multitasker. It was always my goal to get ahead of my professors and stay ahead of them as much as possible. This task became the goal of my organization skills.

If you have an automobile, you need to scout out parking as soon as you hit town. It may work out that you end up parking your car further away from your school and getting a short but brisk walk to school and a secure parking spot that you can count on. At my school, parking was such a premium that taking the subway daily was a better option for me until third year. It just wasn’t worth the money to park or the worry that my car might be broken into as several of my classmates discovered. If you school has safe and secure parking, again, park far and walk more. Your nerves and stress level will appreciate the extra exercise.

On weekends, I would drive into school for sessions in the Gross Anatomy lab or study groups. Since I didn’t have to deal with traffic on the weekends, driving made more sense those days. Having the car also gave me an option of finding a great restaurant for a good meal as a reward for getting my studies done.

I also made sure that I had at least three months of expense money in my savings account for any emergency. Things that might come up would be your financial aid being delayed or an extra expense that you didn’t budget for. I kept a very strict budget and could account for every penny of my expense money. Again, not having to pay for parking saved loads of change for me. I also had the option of working on holidays which added to my stash of emergency cash. I would work any holiday as keeping up with my studies gave me holiday time as extra days. In addition, holiday pay was very very lucrative for me. (I was a registered respiratory therapist with a specialty in pediatric critical care). I did not work during the regular school session no matter how thin the budget was stretched. It was difficult but my studies came first.

During the summers between my first and second year and between my second and third year, I had either a paid position (in addition to my contract work) or a paid fellowship. I would leave a couple of days to do absolutely nothing but I could not afford to do too much vacation during these summers. The summer between my first and second year, I was a peer tutor for our pre-matriculation program. The other summer, I had a pathology fellowship. In both cases, I furthered my career and honed my knowledge which proved great for boards.

Food turns out to be a fair expense for most medical students. The worst thing that you can do is rely on fast food. It has too much fat and you end up paying with your health and energy level. I would limit my eating out to once per week and explored the ethnic restaurants of my city. I would eat Vietnamese, Ethiopian, Jamaican, Thai, Japanese and Cambodian food every Saturday evening. My study group loved to go for breakfast (or Sunday dinner) at a nearby church. We would get a good home style meal and support the community which, loved having a table of hungry medical students. We learned to be very careful because “food coma” could be a major problem after one of these great meals.

If we were studying at one of our houses, we would “pot luck”. Sometimes it would be a mixture of supermarket “take out” but we tried to keep our “study meals” nutritious and non-fattening. The worst thing would be those late night sessions before an exam when the Nacho Cheese Doritos would be out on the table. There is something about crunch snacks that fits well with study time.

Collect your favorite study supplies and stock your desk as soon as you can. I had colored pencils, different colored highlighters and my favorite four-color pen. I also had a large cork board above my desk for pinning notices and sticky notes. My other favorite technique was to cut the bindings off the back of my text books, punch three holes and carry only the pages that I needed to read instead of the entire book. To this day, my pathology text (Big Robbins) is divided into two notebooks. I did the same with my Gross Anatomy text, Pharmacology text and all of my syllabi too. Kinko’s can do this little task for you.

Another essential piece for my desk was a kitchen timer. I kept one in my backpack and one on my desk. I would set the timer for 50 minutes and study for those 50 minutes. I would then take a 10-minute break and back to another 50 minutes. This kept my mind refreshed and kept me more efficient. I would also check off each subject as I studied them. This check-off was more psychological so that my mind would see that I was making some progress. During my study breaks, I would walk around, get some water or just look out the window and let my mind rest. (See the purpose of having your desk in front of a window).

Purchase a good medical dictionary such as Stedman’s Medical Dictionary so that you can look up words and terms as you come across them. I made it a point to look up any words that I did not recognize and keep a running vocabulary list. I also obtained a subscription to the New England Journal of Medicine on-line. I would print out the Case Reports and read them on the subway. The medical dictionary came in handy for these articles. I also learned how to present patients and increased my general medical knowledge. I also read the review articles and any original research that was of interest to me. I would scan JAMA in the library but NEJM was my daily reading in some manner.

Other supplies for me were ringed binders, large coated paper clips, erasers, No. 2 pencils, an electric pencil sharpener (I love sharp pencils) and narrow ruled notebook paper for written notes. I usually took class notes on my laptop computer. I used a mini cassete recorder (I have now replaced this with a digital recorder) for those days when I found myself dozing in class. I would make study drill tapes and listen to them when I walked or exercised.

First Year of Medical School

A short while back, some of my pre-med students asked me about memories of medical school. I thought it might be fun to write about some of those here as well as residency experience so here goes from the beginning…

My medical school had a classical curriculum with problem-based-learning intergrated. We had the typical first-year, second-year types of classes. Lectures went from 0800h to 1600h daily. We had some Tuesdays or Thursdays when we would be able to get out earlier but we spent loads of time in class (way more than students currently attending). Some of my classes had computer-based-learning exercises and some had laboratory projects that had to be completed. In short, school was the equivalent of a full-time job with much time spent on weekends reviewing and keeping up with the pace. The best thing was that all of my classes were very interesting.

My first lecture of medical school was in Biochemistry. The professor essentially covered an entire Organic Chemistry course in a 50-minute lecture. The material was extremely detailed and presented in volumes. This particular professor had a reputation for “rocket” lecture delivery and he got the job done. The great thing was that I understood everything well and could see that this was the basis of the next 50-minute lecture which started off with lipid biochemistry.

My next class was the first part of Gross Anatomy. Our lecture was on surface anatomy and types of neurons. Each lecture was 50 minutes followed by a 10-minute break. I think those 50-minute lectures were the beginning of my 50-minute attention span. After lunch, Gross Anatomy lab started with a brief introduction and then a long laboratory on the vertebral column. We were all given bone boxes (containing human bones) to take home for further study. Every bone was present except the skull bones. Needless to say, we were required to learn every bone and every part of every bone.

By the time the day was done, I had received the equivalent of about 3 weeks worth of undergraduate lectures on one day. Since I had my syllabi, I knew what would be covered in lecture and I knew what readings and material would have to be previewed for the next days lecture. After each lecture was completed, I would quickly fill in any gaps in my notes and briefly scan through my notes for completeness. Over lunch, I would start to memorize as much of my morning lecture as possible too. We had an hour for lunch so I would grab something quick and then spend the rest of the time pouring over my notes.

On the way home, I would study some more or just watch people. I took public transportation because I didn’t want to worry about driving. My commute time was my time to relax and think about the day or plan my evening. When I got home, I would grab my gym bag so that I could get a quick swim in before dinner. I would dine with my fiance and then hit the books for a couple of hours. By that time, it would be around 8pm so I would go to bed. I would wake up at 2am and study until 6 am. I would then take a shower and get off to school.

When I was studying, I would finish studying the material that had been presented that day. I would then review the lectures for the day before and preview the materials for the next day’s lecture. On the weekend, I would review the entire week’s lectures in addition to reviewing an entire week’s dissection in the Gross Anatomy lab.

I made study tapes to drill structures and notes so that I could listen to them while I was walking or running. I would also make concept maps and fill them in on large sheets of paper as I went through biochemistry. I always wanted to keep the “big” picture in mind as I studied.

We had an exam week about every five weeks during the semester. There would be two “reading” days (read catch up) and then exams would begin. For Gross Anatomy, we would have the lecture exam in the morning and the laboratory practical exam in the afternoon. Between the exams, I would go to the art museum and get completely away from campus. I couldn’t stand to be around people who were so stressed about the exams.

In addition to Anatomy and Biochemistry, we had lectures in Psychiatry and Introduction to the Practice of Medicine. The Psychiatry lectures were always interesting and covered topics like development, personality disorders, sexuality, psychiatric drugs and the roles of various types of psychiatrists. Lectures in the practice of medicine covered topics like law and medicine, types of practices, alternative and complimentary medicine, history of medicine and medical education models. Psychiatry and Introduction to Medicine provided a bit of relief from the rigor of Biochemistry and Gross Anatomy but we were tested on these subjects so they required our attention too.

Our first semester ran from the middle of August to the second week of December. I can promise that the time goes by very quickly and soon Christmas vacation upon us. At the end of the first semester, we were done with Gross Anatomy and Biochemistry but still had more lectures in Psychiatry and Practice of Medicine. In addition, we had Histology, Microbiology/Immunology and Neuroscience lectures too. Second semester had a bit more material and more lectures. In addition, we had to dissect brains and spinal cords in Neuroanatomy. We were also given slide boxes with every type of tissue for histology. We would learn to recognize tissues and electron micrographs of every type of cell.

By the time second semester is over, we had learned a huge amount of material. Most people were happy to get exams done and get home for the summer. I was selected to become an instructor for the students who would be coming into our pre-matriculation program. I would be teaching Biochemistry primarily in addition to Gross Anatomy and Immunology. It was an honor to be asked to instruct in this program and I knew that I would enjoy working with these students.

The students who participated in the prematriculation program were medical and dental students with a conditional acceptance into medical or dental school. By successfully completing this program, these students are offered a seat in the school that they were conditionally admitted to. During this rigorous summer, we gave study tips, extensive reviews and got to know some very determined folks. In addition, these students have a huge head start when the actual courses start because they have been exposed to the material. It is a great program and I enjoyed the summer. In addition, we, the instructors are paid very nicely and can get some research done at the same time.

I finished my first year strong with honors and a much stronger interest in medicine than before I started school. When I looked back on all that I had learned, I was amazed. Little did I know that second year had even more to learn and would build upon my foundation of first year.