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Chapter 2-Year 1 of Medical School

This is a very important year, as often your grades here will set your trend for the rest of the next 4 years.  One of the most important selection criteria used (although many will try to tell you different) for getting into residency programs will be your Step 1 Board scores after year 2.  Some say the best way to prepare for step 2 of the boards, is by doing well during your first 2 years, and I agree with that statement.  The better you learn the material presented in year one, the easier it will be to recall during your review a year later.  This is not to say go crazy or go overboard preparing for them too early because there are many other criteria for residency selection.  Just keep the boards in mind early.  The structure of the medical school curriculum at most schools will divide Years 1 & 2 into basic science studies, and year 3 & 4 for clinical sciences (in the wards).  There are many variations, I know that Duke for instance completes all of their basic sciences in year 1, then year 2 is spent in the hospital wards completing all of the clinical rotations (like most school’s year 3), and then year 3 students get an entire elective year to pursue scholarly research or studies toward a second degree.  In the fourth year, students complete all clinical electives, including the opportunity to complete up to 8 weeks of away electives.  So as you can see, although I think this is the most extreme of variations, continue to read the following information, adapting it to your own schools curriculum. 

Many schools for instance where I completed my basic sciences at Dartmouth, focus on basic science courses like Gross Anatomy, Histology, Biochemistry, Microbiology, Cardiac, Renal, Pulmonary, Endocrine Physiology, Neurology, GI, and more, then revisit similar topics in an organ based curriculum during year 2.  What is meant by an organ based approach is studying topics on specific organ systems using clinical case presentations.  For instance:  a 46 year old female comes into your office complaining on pain with urination.  This type of case may be presented during your Renal course when discussing Urinary tract infections.  Probably not the most delightful example, but you get my drift.  Instead of just clinical discussion we may also focus on the biochemical pathway of kidney tubules, in addition to genetics, anatomy and so on.

What you have to remember about this year are the two hardest obstacles for most.  First, to understand medicine and its practice, you must speak its language, and like learning any other language, it can be difficult to become literate in the beginning.  Another example: A 36 yo G1P2002 woman with a Past Medical History significant for intermittent odynophagia, presents with two days of dysphagia, hemoptysis, and negative hematochezia…Again, do you get my drift.  Not to fear however, when I first heard sentences like that I would say what the ???, but now I can dish out several review of system questions, and create a list of differential diagnosis for this case, and that is what medical school is all about.  Its an experience where you grow into a doctor, and you don’t even realize the tremendous strides you make.  Some times you may even doubt yourself, but come graduation time you will be ready, you’ll see.

The second obstacle is being able to deal with the amount of work presented in medical school.  I often use my own experience as an example.  When I graduated high school, and had my first inorganic chemistry test during my first semester of college, I thought, man, that was the hardest test I ever took in my life.  After several more test, I thought man, if I could only go back to high school, it would be so easy, and this stuff here in college is really tough.  When I took my first test in medical school I thought, man, this definitely is the hardest test I ever took (which definitely went out the window after Step 1, but don’t get scared), and boy if I could go back to college it would be a breeze.  Your brain is like a muscle and you will have to exercise it before you can do the hefty lifting needed for med school.  Get the picture.  I once heard an expression to sum up the first year of medical school, it is like taking a sip of water from a fire hydrant, and that also pretty much sums up my point. 

However, one important fact that you must keep in mind, and you must always remember.  Getting into medical school is very competitive, and you would not be there if you where not already a great student, and ready for the challenge.  That was the purpose of the MCAT, college GPA, AMCAS application, and interview.  You can and will make it.

Now a couple of more tips for year 1:

Gross anatomy

This is one of the best classes in medical school, because you will be very surprised by how much you will recall during your surgery rotation in year 3 and the rest of your medical career.  First and foremost it is a tremendous honor, to be able to study the human body in this way, but again you will learn so much about the human body, and it will serve as an important foundation for your medical education, especially for all of those budding surgeons out there. About a book, well your school will recommend a text and atlas for anatomy.  I would recommend having these.  The other resource I would recommend is the Netter’s Atlas of Human Anatomy.  It is a great text, although everything is drawn, it is a great text to use to learn to identify structures.  Of course the structures in the human body won’t be so classically placed every time, but if you know where for instance an artery originates and its course, you’ll be able to find it in the human body.  When taking lab practicals, you will be asked to identify these structures, and they will always give you textbook examples, not anomalies, and I believe this is where Netter helps the most.  Secondly, it is a great book to have for the rest of medical school as a reference, and when creating presentations.

Extracurricular activities (part 1)

These are very important during years 1 and 2.  As you will see during interviews for residency in the future, especially for competitive positions, everyone interviewing will have good grades, good letters of recommendation, and good boards scores, and these types of activities become the highlights of your interview.  Furthermore, one of the things I think that program directors value a lot these days, of course after boards, grades and research, is a student who conceptualizes a project, works on it, finishes it, and comes up with something tangible to represent his or her efforts at the end.   However, all that said I will not advise getting started with any extracurricular activities or projects during the first half of your first year.  Reason being, there are a lot of adjustments that you must make.  First getting settled into a new place, with a tremendous work load, and ultimately your grades are very important for your class rank at the end, and for good step 1 board scores.  So my recommendation will be to focus on getting the best grades possible during the first half of the year, or at least during the time when you have gross anatomy, as that usually is a very time intensive course with many lab hours.  I think the summer after your first year is the best time to start extracurricular activities, however you have to start planning for them at latest during the second half of year 1.  Some deadlines for some research projects (which you can often find back home if you are going to school away from home) fall before December of your first year, so find out about these types of programs early, and plan accordingly.

Financial Aid Again

For many, this will be the first time you are completely in charge of your finances.  Remember to live within your budget.  Nothing is more stressful than studying for a final exam, and not having enough money in your pocket to purchase take out food or groceries.  Furthermore, you must plan very carefully because the two checks you get every year, never get in on time.  You won’t usually get your first check after several weeks, and the second check in January never comes soon enough.  Also, don’t try to compensate for these times with your credit cards because they can also drain you.  During your medical school years you need as little distractions as possible, so make a good budget and stick with it.  Oh yeah, and don’t forget to fill out the financial aid applications for next year on time, they can be a very big pain if you leave them to the last minute.

Contacts:  Another good point to keep in mind during year 1, is to make contacts with faculty.  I don’t advocate brown nosing at all.  What I mean about making contacts, is that if you do really well during a class, and you find that there was a certain professor that you believe taught well, approach them, and tell them that you enjoyed the course (especially good if you honored that course) and that you might be interested in their field.  During medical school it will be very useful if you can identify a mentor, to help guide you locally, and perhaps provide opportunity for research or to join them on a project.  Most medical faculty who teach, are usually very involved in research or other types of academic projects.  These professors will later serve as useful contacts not only for a possible project during year 2, or during the summer between years 1 & 2, but potentially a longer term relationship, and perhaps a letter of recommendation when applying to residency at the end of year 3.  Furthermore, these same professors are always looking for a dedicated and motivated med students to help them out in academic endeavors.

Clubs

Many schools have a fare where the school clubs and organizations will have an opportunity to introduce themselves and activities.  Be sure to attend these.  Groups like the American Medical Student Association (AMSA-www.amsa.org), and the Student National Medical Association (SNMA-www.snma.org), are great for all students as they don not focus on any particular specialty, and will provide an opportunity to interact with upperclassman, who can lend good advice.  They also provide an opportunity to meet and speak with involved faculty members locally, but also nationally during their annual national meetings.  Other organizations like the interest groups (i.e. surgical interest group, or emergency medicine interest group) are useful for not only those who are fixed on a specialty, but also those interested in finding out more about them as a potential future specialties of practice.  They often host meetings with practicing physicians in their respective fields, and thus opportunity to gain first hand insight into what the field is really like.

To set up a list of goals for this year:

-Do well in ALL of your classes

-Develop a study method that works for you

-Set up extracurricular activities for the summer between years 1 & 2, or for second year early (deadlines usually start coming up in February or even earlier for summer electives)

Begin thinking early about what important career choice factors are for future selection of a specialty.  For instance, either surgical vs non-surgical field, long term patient contact (primary care) or only short term patient contact (ER), or even little to no patient contact (Radiology), lots of family time, to little family time, moderate pay to lots of pay.  These are the main questions you must answer when selecting a specialty to practice in.  Its still early, but just keep them in mind.

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