While it might be a breath of fresh air to finish an undergraduate education, plunging into medical school next is a rigorous challenge that all prospective doctors must prepare for.
Medical School vs. Undergraduate Coursework: What’s the Difference?
“Undergrad is difficult, especially as a premedical student, and we have this goal in mind and we’re really oriented towards that goal to a point where maybe we let go of other things like family and friends and things like that during undergrad,” says Ayleen Hernandez, a fourth-year student at Baylor College of Medicine in Texas. “There’s a weight off our shoulders once we’re in med school, but then the weight comes back quickly because it is extremely difficult.”
The first year or two of med school are reminiscent of undergrad, she says, because the are very lecture-based.
“However, the content and the amount that we get all at once makes it so difficult,” she says. “There’s a metaphor that med school is like drinking out of a fire hydrant because it’s so much information all at once.”
Another analogy she hears a lot is that med school is like a stack of pancakes. “If you eat one pancake a day, it’s not so bad,” she says, “but if you let the pancakes accumulate, and then you have to eat 10 pancakes in one day, then it gets really bad.”
Hernandez says new med students need to be sure to stay on top of their work and have good time-management skills.
[How Long Is Medical School and What Is It Like?]
“In undergrad, you usually have three or four, maybe five classes depending upon if you’re on quarters or semesters,” says Suzanne Allen, vice dean for academic, rural and regional affairs at the University of Washington School of Medicine. “Just think about doubling that as far as the amount of information you’re supposed to learn in any given quarter or semester. We’re providing information to people, probably at least twice as much as you experience in undergrad.”
Allen says she tells incoming students that medical school is a full-time job.
“Even when you’re doing the book-learning phase of medical school, you can expect that you will be working eight hours a day, either in class or studying for the amount of information that we’re expecting you to learn,” she says.
Year 1 of Medical School
The first year and a half of the four years at medical school is what Allen calls the classroom phase or foundation phase. Students learn all systems of the body, such as the cardiovascular, pulmonary and gastrointestinal systems.
“For most students, the first year is the hardest year and the first year of medical school, at most institutions, tends to be very scientific, foundation-based with a lot of scientific information,” says David Lambert, senior associate dean for medical school education and a professor of medicine at the University of Rochester Medical Center in New York.
He says the first two years are similar in that students learn about the different organ systems and begin to connect that information with their clinical work when they get exposure to actual patients.
One change in medical school over the last decade or two is having clinical patient interactions much earlier in a student’s four-year journey, experts say.
Students jump into clinical work right at the start of medical school at the University of Washington, Allen says.
“That’s, of course, much different than when I went to medical school,” she says. “We have a course that runs throughout the foundation’s phase called ‘Foundations of Clinical Medicine.’ In that course, students are learning how to do a history and physical exam, and then they’re actually interviewing patients during the exams.”
[Read: Communicating with Patients: What Premeds Should Know]
Early clinical work has become prevalent at many U.S. medical schools.
“During the first year, our students are working with standardized patients, task trainers, high-fidelity mannequins,” says Stephen Charles, associate dean of curriculum at Baylor College of Medicine. “Starting in the very first course, they really are focused on how to take a history and physical exam, and students will go into clinical preceptorships their second week of medical school.”
Preceptorships are mentoring experiences in which a practicing doctor voluntarily provides supervision and personal training to a med student during the first two years of school.
Year 2 of Medical School
“For year two, they’re summarizing and we have a course that gives students time for self-reflection and self-directed learning to consolidate all of the information that they’ve learned in year 1 across the organ systems,” Charles says.
Baylor also has a fundamentals of academic scholarship and translational research course that teaches students basic skills in clinical and other types of research areas of interest.
“When they take this course they also have to have found a scholarly adviser or inquiry adviser to help mentor them through a research project,” he says. “Students actually are getting to pick the research project that they would like to focus on that they think will help them in their careers, and the students will work on this research project for the rest of their medical school until their fourth year.”
Some projects focus on topics like behavioral research, community-based research, educational research, health services research or quality improvement.
Lambert says transitioning into the second year of medical school is a bit more fun for students because they get to see how the organ systems and the diseases and processes associated with them fit together as they engage in clinical work.
“At about 18 to 24 months is when students have some really immersive clinical experiences and they go through different rotations like surgery, pediatrics, psychiatry, family medicine, all of those,” he says. “That is challenging, in a different way, because there’s the integration, there’s the socialization, there’s the reality of health care there.”
This period is when interpersonal and patient care skills are really developed. Lambert says it’s also physically challenging to students, since they haven’t been in that work environment before, but it’s also much more rewarding.
Hernandez says this was the hardest time frame for her — during the second half of the second year in med school — and was like having a full-time job.
“This is when we join and start our core clerkships, which we start in January, and those core clerkships are basically all of the required rotations that we all need to be trained in … all of those well-known specialties that we need to have familiarity with,” she says.
For 12 months, they’re rotating toward those clerkships, taking exams and joining a team in every rotation, Hernandez says. “We’re there as learners, but we also try to be useful to the team and form connections with patients. So it’s really kind of our first introduction to being almost like providers, but of course we’re still learners.”
[Read: What to Expect in Medical School and Beyond.]
Most students take the first part of the three-part United States Medical Licensing Examination, or USMLE, after the second year of med school. The first part recently transitioned to pass/fail.
Step one, typically taken at the end of the second year of medical school, is basic science, biology, the “nitty-gritty” of medicine, but not clinical applications such as how to use medicine to treat a patient, Hernandez says. The second step, which focuses more on medicine and patient interaction, is graded and taken after the third year or in the fourth year of med school.
Step three is typically taken after the first year of postgraduate training, also known as residency. Passage of the USMLE is required to receive a license to practice medicine in the U.S.
Years 3 and 4 of Medical School
At Washington, Allen says, the rotations are in the third and fourth years. They include 12 weeks of internal medicine; six weeks each of family medicine, pediatrics, obstetrician/gynecology, surgery and psychiatry; four weeks each of emergency medicine and neurology, and one-month rotations — often considered sub-internships — in advanced patient care.
“If you’re going to go into family medicine, you would do an advanced patient care rotation in family medicine, or if you are going to go into pediatrics, you do it in pediatrics,” she says.
Initial rotations are when students really hone in on a specialization.
Lambert says the last year of med school tends to be a bit lighter because there is more time for electives.
Washington requires five one-month electives in areas such as global health, cardiology, hematology and orthopedics.
“Students will do electives in those particular specialties just to get an idea of, is this really the specialty they want to go into,” Allen says. “Students may try to do that elective in their third year. They actually have a six-week period where they can do an elective during their third year, so they don’t have to wait till they’ve finished all of their required rotations before they do that.”
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How Hard Is Medical School and What Is the Med School Curriculum? originally appeared on usnews.com
