Advice for a First Year Medical Student

I recently had quite a long conversation with a college senior that was just accepted into medical school for this coming fall. As a rising fourth year medical student myself, I would like to think that I have navigated the waters of academia and figured out both efficient paths to success and avoidance of roadblocks and setbacks. However, I was quite overwhelmed with the number of questions and concerns that this particular student had. But in retrospect, I can recall my own naivete and fear of the unknown that is medical school.

After answering all of his questions, I realized that many soon-to-be first years may not have the advantage of mentors or advisers. Lacking guidance, students are willing or forced to charge forward and hope for the best. These are the same students that suffer the inevitable fatigue and burnout. But I believe that there is a smart and efficient way to approach medical school. That is not to say there are any shortcuts or cheats. Rather, I wanted to share with you my advice on 5 easy steps to being a better medical student from day 1.

1) Be willing to be selfish

You must be willing to prioritize personal time and to continue to do the unique things that make you who you are. And trust me, the time can be found in any rigorous program. Doctors aren't robots, and you should never plan to train like one. Medical school must be a time for you to continue to develop your hobbies and your personality. These are the individual characteristics that will make your patients love you one day. More importantly, these are the activities that will keep you both sane and free from stress.

2) Get 8 hours of sleep

No debating this one. First the benefits – you will study better, be healthier, and feel happier. There are enough distractions and obstacles built into the medical education that you should not be adding to the list. Sleeping in class, rereading text, and mental sluggishness are not paths to engaging the curriculum. Turn off the light, set your alarm, and keep track of your sleeping schedule. After all – you are training to be a doctor who will one day advise patients on healthy practices. Limit the sacrifices you make in your own health along the way. Healthy eating and regular exercise follow, as well.

3) Subscribe to just one health policy daily email or news blog

Medicine, particularly in the modern world, has much importance beyond the realm of clinical information. As a doctor, you will one day be called to be a leader, and your understanding of health policy and health systems will drive your success. You do not have to understand every sentence, or even read every word. But be open to absorbing what you can so you will be better aware of health care on-goings. The future of medicine is in dynamic health delivery systems. While you're cramming over the Krebs cycle, take a five minute break to review the latest info on real-world medicine issues. ACOs are being built and discussed right now – embrace that change and learn as the systems are being designed. (Feel free to email me for the full list of my daily subscriptions – aaronge@pcom.edu). Read during rounds when your attending is off ranting about something esoteric and his back is turned. Read it while your on the bus or in the bathroom. Again, time can be found if you look for it.

4) Study Smart

There is a difference between studying for a test and studying to be a doctor. While these two goals sometimes coincide, they are often very different in nature. I find that, for some reason, medical students have difficulty wrapping there minds around this concept. Here is what I mean – medical students often look to prepare for exams as if they need to know everything about a given subject. Buying multiple textbooks and review guides is more than common. Gaining this knowledge is the right thing to do, and will make them a better doctor in the long run. But it may distract you from your goal of doing your best on given test – and worse, it may lead to burnout. If an exam has questions that are drawn from lecture, then information outside of lecture is irrelevant for the scope of that test. You need to make a personal decision as to how much supplemental information you need to be successful. I'm not telling you to take any shortcuts in learning medicine, I am telling you to be prepared for what matters. You have at least 7 years to go through medical school and residency, and then a lifetime to practice. You cannot possibly learn everything in a day, month, or year. Don't sweat the details during your first year, anymore than is already forced on you.

5) Smile

As easy as this simple act sounds, this may be the most difficult of my suggestions. But stick with me! I am a firm believer in the power of positivity and confidence. You will get through medical school. That is not in question. But you have a choice as to HOW you get through medical school – to complain, suffer, and grieve through the process.....or to enjoy the ride. I believe that smiling, appreciating the best that you have, and keeping a positive attitude effects you in two ways. In the first, you will have the advantage of internal confidence and lower stress. From a medical standpoint, you will be less rattled on test day and benefit from decreased cortisol - both can go a long way! The second effect of positivity is the external impact you will have on those around you. How do you think nurses respond to medical students that complain or look upset during morning rounds. I know that a genuine smile and greeting has led to nurses and residents that have been willing to go the extra mile to offer me support. How do you think an attending or residency coordinator will respond to the stolid student, versus the upbeat one? The truth is that letting in negativity and suffering through complaint are a means of externally expressing defeat. You do not want to be that kind of medical student. Smile, you are living your dream!

I genuinely want all of you to do well, and to be great and successful doctors. After reading many other medical school advice posts on more tangible or “hard” skills, I wanted to offer a different perspective. As always, you have to do what works best for you, and everyone will find success with different methods. But I do hope that some of my advice gives you a different perspective on how to achieve that success. Good luck!

Medical Student Burnout and Unprofessional Conduct

Recently, AAFP News Now released an article titled

Unprofessional Conduct Among U.S. Medical Students Linked to Burnout

It focused on an article recently released in JAMA entitled

Relationship Between Burnout and Professional Conduct and Attitudes Among US Medical Students

I had the opportunity to be interviewed for this article and was featured on an inset within the article that shared a minority of my interview. As I am currently rotating on inpatient medicine at a local community hospital, I am once again experiencing our health care system at its finest - a lot of wasteful spending and unnecessary testing. I am taking a look back at what I had wrote down for the interview and decided to paraphrase the majority of my response into the following blog post regarding the health care system and medical education.

When looking at the advances we have made in biochemistry, genetics, and molecular biology, we are being asked to know so much more information in much greater detail – and still within these 4 years worth of medical school.As more requirements are created and more scientific advances are brought forth, more time is needed in lecture and studying for tests like the USMLE and shelf exams. Most traditional programs are 4 years with 2 years of foundational science and 2 years of
clinical experience.

For one, I believe that medical school admissions do not do a good job
at identifying candidates that will provide an adequate workforce and/or will be good for medicine. It must be extremely difficult to screen applicants to figure out who is genuine about the profession – who is going into medicine because they truly want to go into medicine... on the other hand, who is going into medicine because they test well, and/or because their parents forced them into it throughout childhood. This is definitely a minority of students but nevertheless, takes away seats from other potential medical students who may choose to serve a better purpose and population within our health care system's needs.

Maybe we are not bringing enough students into medicine that come from
underserved areas; maybe we are not screening correctly in the
admissions process to accept students who display genuine altruistic views
and who do not fabricate an artificial personality in an interview
and/or on a personal statement. The 40 MCAT, 3.9 pre-med GPA and 5
publications may look good on paper but may fail miserably at
developing into an altruistic and compassionate physician.

It would be interesting to figure out specific determinants that make
students less altruistic and less likely to serve the medically
underserved. As medical students, we are molded by the experiences we
are faced with during clinical rotations. Were these students who had more
contact with patients who manipulate the health care system for
primary or secondary gain? In most cases, our attitude in respect to
patient populations trickles down from our attending physicians,
residents and interns.

With defensive medicine taking precedence in many situations, medical students take notice of the frustrations felt by our superior members of the team. Are these attitudes more likely to occur in underserved areas? If so, medical students are not only discouraged, but definitely overwhelmed at the amount of follow-up
required of the large volume of unnecessary testing that occurs. We spend so much time trying to cover our back that the amount of quality learning that actually occurs is dramatically reduced.

If we took just half the amount of time we waste on defensive medicine
and documentation and shifted that towards more time for teaching
rounds and instructional time by attending physicians and residents, I
believe medical students would feel more satisfaction with their
education and clinical experiences. As it is, medical students spend
most of their time trying to help the interns and residents with
non-educational work (what we refer to as “scut work”) so that we may
eventually have time at some point for educational purposes.

Additionally, because there is so much more hand-holding by attending
physicians towards the residents and all the way down to the medical
students, it is difficult for medical students to convince themselves
that they are actually contributing to the care of patients. Taking
all of this together, it does not surprise me that studies are showing
that medical students are burning out, documenting non-factual
clinical findings, lacking altruism and altogether becoming
unprofessional throughout the process.

The medical community as a whole needs a “face-lift” in regards to everybody’s attitude towards health care delivery. I do not think this will be possible until the health care system undergoes a much more meaningful reform to address the issues that attending physicians, residents, and medical students face due to the current clinical environment. The current political environment is not going to alleviate any of these issues because nobody is willing to commit to long-term changes in health care delivery and tort law.

Without meaningful tort reform, proper emphasis and payment for primary care, and population education about meaningful health care reform and personal responsibility, we will not peel through the layers and fix any of the intended and unintended consequences that have accumulated throughout years of failed policy and legislation.