<p>I used to read this forum back when I was an undergraduate student, and I realize now that I had no idea what medicine was really about, what to look for in a medical school, and how medical school is structured, etc. None of my family is in medicine, so I never knew the workings and had to learn as I went through it. Now as a med student about to graduate (and released semi-early from my rotation today), I thought I'd share my experiences to hopefully help people who were in my position 4+ years ago. Some of this is basic, but I figure it may be of use to some of you.</p>
<ol>
<li><p>What do you need to get into med school?
This one is pretty much answered ad nauseum in the forums, and I don't really feel the need to get into this. Basically, a good MCAT score, high GPA, good extracurricular, medical experience of some type, sob story, etc. Since getting into medical school is competitive, you should do as well as you can before you apply... Pretty logical if you ask me</p></li>
<li><p>What IS medical school in the US?
Medical school is a 4 year program typically done after your undergraduate education is completed. There are tons of variations of exactly how these years are divided up, but the general gist is 2 years of "basic science" and 2 years of "clinical training". </p></li>
<li><p>What are the "basic sciences"?
Your first two years consists of learning essentially A) how the body works B) how the body fails to work and C) how to fix it. </p></li>
<li><p>What is first year like?
1st year is traditionally the anatomy, physiology, neuroanatomy, embryology, biochemistry, human behavior, immunology-type courses. These are the most like your undergraduate courses that you'll experience in med school. They're relatively straight forward, but have a much larger breadth of knowledge that you have to assimilate. For example, you may not have to remember the exact structure of every molecule in every step in glycolysis like in undergrad, but you'll have to know the pathway inside and out. It's daunting when you start, but it's very manageable. People in your family will start to ask you medical questions during this time, and you'll try to act like you know something, but you really don't have any idea. You won't feel like a doctor after this year. Consider it like a final year of semi-relevant premed courses. By the time you finish medical school, this information will be essentially forgotten. Oh, and yes, you do dissect human cadavers (in most schools anyway).</p></li>
<li><p>What is second year like?
2nd year is traditionally the disease and pharmacology year. You'll start to learn about the pathology of disease, and you'll actually be able to start diagnosing things after about midway through the year. While you'll memorize tons of diseases and drugs, seeing the big picture is difficult this year. You're thrown so much information that you basically learn things in little pockets. Some schools have this year in organ systems (you learn clinical symptoms, pathology, pharmacology, microbiology of heart disease) while some spread out the actual classes independently (you do all of pathology, then all of pharmacology, etc.). As for which is better, it's really personal preference. I personally think organ systems are the way to go, but some may prefer seeing the same disease multiple times throughout the year from different angles. This is probably one of the first things you should look at when you are picking med schools to go to. </p></li>
</ol>
<p>You may also start seeing patients and doing some clinical things here, like seeing a patient with a random medical resident or attending, or listening to heart sounds, or doing practice standardized patients. You're going to be awkward doing this, and you still won't feel like a doctor. Sorry. </p>
<ol>
<li><p>What are the "clinical years"?
These are the 3rd and 4th year of medical school where you are doing 1-3 month rotations such as surgery, medicine, pediatrics, family medicine, OB/Gyn, psychiatry, neurology, acute care, etc. The exact time frame and year you do these is variable depending on your school.</p></li>
<li><p>What is 3rd year like? And what is call?
3rd year is tiring, but great. You actually get to see patients, and usually on your own. Your typical day depends on your exact rotation, but for my schools worst month (trauma surgery and emergency surgery), I was on q3 call. This is a good time to discuss "call", as I had no idea what this really meant before medical school. "q" stands for queue, meaning a repeating event. q3 call means "call" every third night. "Call" is essentially when you're in the hospital longer than everyone else, typically meaning overnight. As per ACGME rules, doctors cannot spend more than 30 hours at the hospital consecutively without time to go home and sleep, and cannot spend more than 80 hours a week in the hospital. The exact number of hours that youre in the hospital on call depends on your service (surgery, medicine, etc), but on trauma, I was arriving at 3:45am every day and leaving at 1-1:30pm on my post-call and pre-call days. On call day, you would arrive at 3:45am and leave around noon the following day - thus around 30 hours. Typically, I got 1 day off a week, but sometimes 1 day off per 2 weeks. Medicine at my school was q5, so an overnight call every 5th night. This is another point that you will want to ask about on your interviews... Some schools don't require students to take overnight call; you leave at 10pm or something and come back at 6am. It's really variable, but good to know. I found that you learn more when nobody is around at night and you can follow around your resident and do procedures, but then again, sleeping is nice too.</p></li>
</ol>
<p>You typically have to take medicine, surgery, pediatrics, ob/gyn, and psychiatry your 3rd year, plus a couple more rotations. Hopefully, you'll find out what you like and what you don't like, at least to in a general way, during this year. Your responsibilities will include things such as SOAP notes, rounding, possibly putting in orders, procedures, scrubbing in on surgeries, etc. These will be all explained below in another topic.</p>
<ol>
<li> What is 4th year like?
When you start 4th year, you will be better than the incoming interns (1st year residents). After 3rd year, you will have been exposed to the basics of medicine and will have it all fresh in your mind. If you do your Acting Internship (essentially, you act like an intern for a rotation, taking more control of your patients with your resident helping you and signing orders) early, you will be a great help to your team. However, you typically get to relax more 4th year. Residents/attendings understand that this is essentially your last year of freedom before you start residency, and will cut you more slack. Still, you're expected to be efficient, quick, and be able to formulate a decent plan for patients. You have more options in terms of what rotations you want to do this year, and you can try out a specialty and see if you're interested in it. Later this year, by October typically, you have to choose your specialty and interview (covered below); youre usually given about 2-3 months off for interviews.</li>
</ol>
<p>This is a great time in your life, and you'll have free time again. All I can really say is that it's wonderful. You feel like you know what you're doing and while you'll still frequently be wrong or have a different plan than your attending/residents, it's still much more formulated and well-planned. You're familiar with the computer systems, labs, nurses, and can actually hold a somewhat decent conversation with other physicians. The downside is that you still have no real power, and still have to run every single thing by your attending/resident. </p>
<ol>
<li> What is residency/fellowship?
Residency is what you do after medical school - this is when you learn your specialty of choice. There are something like 30 specialties to choose from, including things like surgery, internal medicine, pediatrics, ob/gyn, psychiatry, urology, ear-nose-throat surgery, anesthesiology, dermatology, plastic surgery, radiation oncology, radiology, pathology, etc. All of these have different time commitments, measured in years AFTER medical school. Surgery, for example is typically 5 years long, with medicine and pediatrics each being 3 years. How you pick one specialty will be covered later. You will work harder in residency than during medical school, and you really learn your specialty. Many people say you don't learn your field until this point. Bright side of residency is that you actually make money (~45k a year, depending on location).</li>
</ol>
<p>Of a side note, some residencies first require an "internship", which is a yearlong program typically in surgery, medicine, or a transitional year that ends up being much like the rotations from your 3rd year of medical school. For example, radiology (which is 5 years total) requires a 1 year intern year before starting the 4 years of radiology itself. Depending on the location and specialty, you may have a program that packages these together at the same institution, or you may have to move twice - once for your intern year and once for your residency.</p>
<p>Fellowship is an optional step after residency. It's another 1-4 years typically depending on the fellowship and specialty. It allows you to move from, say, medicine to cardiology. Medicine and surgery have many fellowships that are typically longer (read: 3-4 years) and more drastically change your practice. Most people doing cardiology or gastroenterology, for example, won't want to practice general internal medicine. You don't have to do a fellowship, but it typically leads to better pay. You don't make much money during this period (essentially scales as it would for another year of residency).</p>
<ol>
<li><p>What are residents/interns/fellows/attendings?
All of these are doctors. Interns are first year residents. They're the ones you typically run around and learn from. Residents technically include interns, and are post medical school graduates in their chosen field. A R3, for example, would be your 3rd year resident. Fellows are those people finished with residency and working on their fellowship in their subspecialty. Attendings are physicians who completed residency (and possibly fellowship) and are the head of the team and fully licensed physicians. They're the ones whose ass in on the line if someone really screws up and are there to make sure residents don't kill anyone.</p></li>
<li><p>What is "scrubbing in"?
This is the process of washing and scrubbing your hands and arms to get ready for surgery or a more involved procedure. It's part of sterile technique, and Im sure youve seen it done incorrectly hundreds of times on TV. Typically, it takes 5 minutes or so for a good scrub, and you can't touch anything not sterile after it. The scrub nurses in the operating rooms will help you gown yourself and glove you in preparation for surgery. DO NOT touch anything that isn't sterile after this, or you will contaminate things, and worse.... get yelled at.</p></li>
<li><p>What do you do during surgery?
As a medical student, you typically watch. You may also get to retract, which means pulling the skin/tissue out of the way with a large metal retractor. It gets tiring, and it's boring. I had to hold up a very large womans pannus with something called the Batman retractor for 2 hours once, and my arms hurt like I lifted for an equal amount of time the next day. You will hate retracting. If you're lucky, you MAY get to cut something or scissor something, but you will likely get at least some time to suture things back together - typically the skin. If you're interested in surgery, practice knot tying by putting suture through the button holes of your white coat and practice the one and two handed ties as youre walking around. You'll get to do more if you're competent at tying good knots. </p></li>
<li><p>What is a SOAP note?
It stands for subjective, objective, assessment, plan, and it's the way physicians organize their notes on patients. Every day in a hospital, every patient needs at least one note from a MD stating what happened, and what's going to happen. This is your main job as a medical student. You gather labs, talk to the patient, check vital signs, do a physical exam, and write your note on all your patients every day on every service... well, except things like pathology and radiology. These are typically very quick on surgery, and very long and drawn out on medicine. </p></li>
<li><p>What tests do you have to take?
Tests are frequent during the basic science years, probably 1-2 per month. 3rd year, you will likely take a test after every rotation. 4th year at my school, there are no exams. :)</p></li>
</ol>
<p>Board exams, such as Step 1, Step 2 CK, and Step 2 CS, are national exams you have to finish before graduation. Step 1 is 7 hours, and you typically take it after your 2nd year, and it is over the "basic sciences", as you would expect. Step 2 CK is 8 hours, and is taken after your 3rd year when you have finished the core rotations. It's similar in style to Step 1, but over more clinical scenarios. Step 1 and 2 CK are both very important for residency admissions. You need a high score on one, or preferably both, to get into a good or competitive residency. The average on both is around 220. This is something you definitely want to know when picking your med school.... What is the average score on these two tests? Step 1 is more important for residency, since everyone has to have it completed by the time they apply. Some people don't take Step 2 until after they match, or at least until they know that the score won't be reported until the rank lists are in, because they're worried about doing worse on it than Step 1 and hurting their chances. My advice: take it late only if you have an awesome step 1 score (>255-260)... Otherwise, you'll get asked why you haven't taken it already and it throws a red flag at residency programs. Each of these tests costs around 500 bucks, and you can't retake them if you pass (which is >190 or somewhere around there). People typically study 1-2 months for Step 1, 2-4 weeks for Step 2 CK.</p>
<p>Step 2 CS is 12 cases of standardized patients done at 5 testing centers around the country. This one is only pass/fail, and 96% of US students pass it. It's 1000 bucks, and entirely too stressful for what it's worth because of the 2-3 month waiting time for score reports, but hey, you have to do it. You don't really have to study for this if you were awake 3rd year and at least know basic diagnoses.</p>
<p>Step 3 is a 2 day test done after you graduate, typically during your intern year. Since I'm not there yet, I won't write about it. Basically, nobody cares about this test from what I've heard, and you just have to pass it, even though it has a numerical score like Step 1 and 2 CK. </p>
<ol>
<li><p>What are "orders?
Orders are what the physician writes to tell nurses and other ancillary staff what to do. A doctor may write something like "Start Cipro 400mg PO q day" and the nurses will give the antibiotic every day. Medical students can't technically write orders. As 4th years when you're trying to act more like residents, you may write the order yourself and then have your resident "sign" it, though signing may be actually on paper or on the electronic medical records depending on your school/institution. </p></li>
<li><p>What procedures can you do as a medical student?
I did things like lumbar punctures, bone marrow biopsies, paracenteses, abscess drainage, etc. You can typically get a lot if you're interested and want to do them. If not, typically another student on your team will want to, and you can get out of it.</p></li>
<li><p>What is "rounding"?
Rounding differs depending on your service (medicine, surgery, etc.). It's when you talk and present your patients to your team (residents/interns/attending). You'll do this pretty much daily 3rd year, and its more or less in the format of your SOAP note. It's intimidating at first, but gets substantially easier as time goes on as you learn what to include and what you don't need to include. However, it's excruciatingly painful in medicine, where rounds can last 4-5 hours post-call, and you just want to go home.</p></li>
<li><p>When/how do you pick a specialty?
Honestly, whatever you come in to medical school wanting to do, you'll likely change your mind. Or at least seriously consider changing your mind. Keep your mind open 3rd year. You won't be exposed to every specialty by the time you graduate, as you have limited time for electives. So if you want to do ophthalmology, anesthesiology, radiology, etc., you better do an elective as early as possible to see if you really like it. Nothing would suck worse than starting a residency, doing a few years of it, and then switching out because you hate it. Granted, it's better than doing what you hate your whole life, but the object is to avoid this. Consider how many years each one is, consider the hours you'll be putting in both during and after residency, and pick what you think you'll be interested in doing 20 years down the line. But if you're reading this, this is likely 4+ years in your future, so you probably don't need to worry about it quite yet.</p></li>
<li><p>But what about getting "clinical experience" earlier than your third year? Isn't that good??
This is something all interviewees ask... Seeing patients earlier seems like a good thing, right? You get to feel more like a doctor, right? Wrong! Nothing will make you feel less like a doctor than seeing a patient, not knowing what questions to ask, not knowing how to do an exam, and having no idea how to piece together the history/physical that you likely did wrong. Seeing real patients your first year is worthless. 2nd year is understandable, at least in small amounts, so you can see exam findings that you've learned about in class and figure out how to actually do an exam. You'll see more patients than you want 3rd year, so don't rush it. Seriously, you don't want to see patients in the hospital early on. It's just a waste of time.</p></li>
<li><p>What are "standardized patients"?
These are actors that med schools use to pretend like they have diseases. This is also what you test on during your Step 2 CS exam. They're typically good at knowing their disease, but give much shorter answers than real patients and won't expand on anything unless asked. It's annoying and awkward in general, but you get used to it. It does help in preparation for 3rd year, but kind of worthless after that.</p></li>
<li><p>What is grading like in medical school?
Really, this is pretty random between schools. Some have letter grades like undergrad, some are variable levels of Pass/fail (like Honor, High pass, pass, fail, which sounds a lot like A, B, C, F to me.... but whatever), and true pass/fail. Class rank plays an important role in residency applications, as far as what quartile of the class you're in. I'm not sure which is better really, as grades make people study harder, but pass/fail is pretty nice. Some schools have a mixture, where you'll have pass/fail some of the years, but grades the rest. I don't really think this matters as much as many people think, but if I had to choose, I'd go with pass/fail since the only objective measure of your performance becomes your board scores. You just better be a damn good standardized test taker for Step 1 and 2.</p></li>
<li><p>What is AOA?
Alpha omega alpha - the med school honor society. Traditionally the top X % of your school (based on school of course), but expanded recently to be based on extracurricular as well. Being AOA is tremendously helpful in residency match and makes matching into competitive specialties like radiology and dermatology much more viable.</p></li>
<li><p>How do I get ready to apply for residency?
For the best outcome, from most to least important (from what I've heard), Step 1 > GPA/Class rank > Letters of recommendations = Step 2 CK >= Deans letter. The deans letter is essentially a few page thing stating your class rank, any obstacles you overcame, evaluations from your rotations, problems professors/clinicians have had with you, etc. Your dean writes it (how about that....) and you really don't have much say in what's put into it. </p></li>
</ol>
<p>You typically can start applying September 1st of your 4th year, and then hear back from programs after that. You interview in October - February, typically with time off for these interviews, at anywhere between 5-20 places depending on your stats and your specialty, then match to one place in March. Some specialties match in January (like urology, child neurology, ophthalmology), but this is an exception to the rule, and if they need an intern year, theyll match for that still in March.</p>
<ol>
<li><p>What is "The Match"?
The match occurs every year on the 3rd Thursday in March at 12pm eastern time. It's a (hopefully) joyous time where you match into the specialty that you want. After you finish interviewing in Jan/Feb of your 4th year, you rank all the programs you interviewed at and they rank all the applicants they interviewed. It's put into a magic computer that tells you what you're going to do with your life for the next 3-7 years. If you match, you're bound to that program. The algorithm favors the applicants overall, but there is the possibility that you don't match. If you don't, you find out the Monday of that same week, and you have to "scramble". All the positions that did not fill through the match are then open in any specialty. Some specialties don't have any spots left ever (like Dermatology, Plastic Surgery), but others have plenty (like medicine, general surgery). You have to call up those programs and see if they'll accept you. It's not optimal, and you may end up in a different specialty than you want. But the only other option is to wait a year and reapply.</p></li>
<li><p>In summary, things I should look for in a Medical school?
Overall, look for objective measurements... Organ based vs. traditional basic science years, call schedule for clinical years (how many hours in the hospital weekly in surgery/medicine), average board scores, grading system, class size, time off 4th year (# of months), how much sleep do you get on call (hours), rank in US News... Objective measures will give you better data than "Yeah, I sleep a lot". You don't know what "a lot" is, so ask, "On average, during surgery, how many hours did you get to sleep on call". Then do objective measures, like are the students happy, are professors approachable, etc. </p></li>
<li><p>Is what I want to do competitive? How good do I have to do to get in?
Check out the official NRMP Charting Outcomes pdf. I'd look at pages 13-19 to get a general idea. Note: this does not have any of the early match specialties. <a href="http://www.nrmp.org/data/chartingoutcomes2009v3.pdf%5B/url%5D">http://www.nrmp.org/data/chartingoutcomes2009v3.pdf</a></p></li>
</ol>
<p>Anyway, I hope this gives you a better idea of what medical school is like and if its for you. Ive enjoyed it and would do it again, but its a long road. Good luck to you all!</p>