Getting into medical school is the desire of many. Most people think of medical school as a pinnacle of learning, where only the smartest can survive. But, what does medical school actually look like once you get into it?

Partly, that depends on you, the student. It also heavily depends on the school that you get into. However, there are aspects that are common across all medical schools, and for the most part, they are reasonably equivalent from an academic point of view.

The offer

For many people, and definitely for me, getting into medical school was exhilarating, and it was a relief. I finally had certainty that I was capable of getting into medical school, because even getting into medical school is an achievement. Everyone around me was congratulating me, celebrating this achievement with me.

However, underlying all that was the uncertainty. The uncertainty of whether I belonged, the uncertainty of if I could handle medicine, and the uncertainty of what my future looked like. I had previously been uncertain as to whether I was capable of doing well enough in my undergraduate study, particularly as I had dropped out of undergraduate study previously (in my early 20’s). I was also over 30, I had a life, I had expenses, I had a partner. Even after the first semester or two, I knew that I could complete the undergraduate degree.

That said, I was still uncertain whether I would be good enough, whether my grades would be high enough, to even get an offer to study medicine. I did rather well on my GAMSAT exam on my first attempt, and thankfully I received an offer from the medical school at the University of Queensland (UQ), although I was aware I had “barely scraped in”. Turns out, the GAMSAT requirement for UQ in 2018 had reached all the way up to 74 for a commonwealth support place (CSP), with even bonded medical placements (BMP) ((Bonded medical placements are a scheme whereby the government provides the same level of contribution as a Commonwealth supported place, but on the condition of the student working one year rurally after graduation)) reaching up to 73. Tie-breakers are determined by your undergraduate grade point average (GPA).

As such, I had just missed out on a CSP due to my GPA, but I was only 1 GAMSAT point over the minimum requirement for a BMP. With that background, I wasn’t certain that I would be able to handle medicine. I felt like an imposter. I felt like I didn’t belong. Apparently, though, many students feel that they don’t belong in medical school, and imposter syndrome is reasonably common. My advice to anyone who gets into medical school is: You deserve to be there. You are meant to be there.

Finally, there was the uncertainty of what medical school even looks like. I knew that I had gotten into medical school, that my next four years (plus the intern year after it) were defined by that. However, what would the course look like? What would the university be like (I was travelling interstate for this, as is reasonably common for medical school)? What would study be like? What study could I do beforehand to try to get a head start? Those sorts of questions are the point of this post, and I will attempt to address them more thoroughly.

The course load

The first thing to understand with medical school is the quantity of material you are required to absorb. It is frequently stated that learning medicine in medical school is like trying to take a drink of water from a fire hose. While accurate, I personally prefer the analogy of eating a stack of pancakes each morning for breakfast.

Simply, the pancake analogy for the medicine study load is that instead of studying at university, you are instead eating pancakes. In undergrad, you might have eaten 3 pancakes a day, maybe 2, maybe 5, it all depended on what degree you were completing. Then, you get into medical school! Congratulations! Now, everyone must eat 10 pancakes a day, every day. At first, it is easy. It’s only a few more pancakes then you were eating in undergrad, and besides, you love pancakes! So, you chow down, ploughing through the pancakes, easily eating 10 pancakes a day.

But, after only a few weeks, you start getting sick of pancakes. It’s too many. You can’t be bothered to eat that many *every* day. The problem is, any pancakes you don’t eat on any given day are added to the next day. So, if you decide to give yourself a break and only eat half the stack one day, the next day you have 15 pancakes sitting there for you to eat. Within only a few days or weeks of not keeping up, the pile becomes insurmountable and along with that you just can’t be bothered to even attempt it. This is one of the causes of medicine drop outs.

For me and for most of my peers, we started studying medicine and it was easy enough. You sort of feel in the groove. You are running on pure adrenaline. But, around weeks 3-5, it hits you. There is a lot to study in medicine. Nobody goes into medical school thinking it is going to be easy. However, around that time is when the scale of the task, the difficulty of studying this course load, finally hits you. Around this time is when people start thinking “I didn’t realise there would be this much in medical school.” You start hearing your peers complaining about having to study on the weekends, and how they’ve never had to do that before. Plus, you start hearing people complaining about not having everything handed to them on a silver platter.

The course engagement

The overall structure of studying medicine depends on the school you get into. Some schools follow a regional approach, studying everything to do with the head before moving on to the chest, etc., with each region being studied in isolation. Other schools, including UQ, use a systemic approach, with each module being broken up into systems such as cardiovascular, respiratory, renal, musculoskeletal, etc. Furthermore, some schools spend the first year studying the normal anatomy, physiology, etc., of the whole body, and in the second year study the microbiology, pathology, pharmacology, etc. Other schools, again including UQ, study each system fully, with the normal, the pathological, and the treatment all being studied alongside each other. Personally, I prefer the UQ choices as it lends itself to a better understanding, and understanding something is a requirement for me to remember it. I’ve often said that if I remember something, I’ll never forget it.

At least at my school, and from what I understand many schools, the actual study of medicine is a self-driven undertaking. Sure, there’s lectures every morning at 0800, and you have a fairly busy timetable, including clinical coaching, case-based learning tutorials, histology, pathology, microbiology, anatomy, and radiographic anatomy. That is just for the clinical science and clinical practice courses, to say nothing of the supporting courses. At UQ the supporting courses are Health, Society and Research (commonly called HSR, which covers epidemiology, biostatistics, public health, advocacy, and more), and Ethics and Professional Practice (a half course which covers, well, what it says on the label).

At one point I added up the contact hours (on a week with most activities occurring) and, including travel time, the total contact time came to 37 hours. That doesn’t include study time. Medical school is busy. However, in all of that, the only weekly mandatory participation (at UQ) is clinical coaching and case-based learning.

Mandatory activities

Clinical coaching is where you learn things like how to perform the physical examinations, how to take patient history, how to interact with the patient, etc. Case-based learning is like my Think Like A Medical Student series, where you work through a case, trigger by trigger, analysing the cues, forming hypotheses, and determining what else you need to know (i.e., what further questions to ask, examinations to perform or investigations to order). These two classes (clinical coaching and case-based learning) are extremely valuable, with the former teaching the practical sides of things (along with our procedural skills workshops) and the latter teaching how to think from a medical perspective and actually working through cases.

These sessions are performed with our case-based learning (CBL) group, which consists of up to 10 people of various backgrounds. The CBL group lasts for the year, and most people form a camaraderie with their other members. These same CBL members go through the courses with you, and they are there for your CBL classes, your clinical coaching classes and assessment (in fact, one of them will be your demo patient for this assessment), your pathology tutorials, your microbiology tutorials, your HSR tutorials, your anatomy practicals, etc.

At UQ, there is one clinical coaching session a week, lasting two hours. The content loosely matches up with the modules in the clinical science streams, and we spend a few weeks learning the clinical practice side of each module before completing an assessment. In the first year, the assessment is on our peers, although we did complete a simulated patient for our second attempt at taking a history. These assessments are graded as pass/borderline/recycle. Recycle is realistically a fail grade but provides a second attempt to pass at the end of the semester.

There are two case-based learning sessions a week, each lasting 2 ½ hours. The first session is a longer, main case that takes the whole timeslot, often with 5-7 triggers that are designed to be more challenging or involved. The latter two sessions contain short cases (each around one hour) along with any presentations on group identified focus tasks that were identified in the main case.

Optional activities

Finally, there are all the optional activities, ranging from anatomy and histology through pathology and microbiology. As to anatomy, at UQ this is a 2-hour scheduled session in the gross anatomy facility. In the first three weeks, we performed dissection on a limb in order to form an appreciation for this. After that time though, we have been studying using prepared prosections (parts of cadavers) and models. This is one of the biggest differences to many other schools, as many schools (particularly in the USA) involve performing dissection at every stage, with one body being dissected by a group of students over the length of the semester or year. Commonly as well, at other schools, access to the anatomy laboratory is available at all times. These differences mean that anatomy at the University of Queensland is more like a tutorial than an ongoing dissection activity. This does mean that we get less time with the specimens. However, it also means that we get more focused learning, and it means that the specimens that will be used in our end of year assessment are the specimens that we’ve had access to.

The other activities vary from week to week, with only a couple of microbiology sessions early in the first year, histology and radiographic anatomy (RA) sessions roughly once per module, and pathology sessions loosely every other week, with other things thrown in at varying times as well. These sessions are very much like tutorials but vary depending on the discipline: pathology expects you to have completed study and the tutorial questions before attending, whereas RA and histology are much more like a teaching session.

Own Study

For me, I never studied during my undergraduate degree. If I had, maybe I wouldn’t have had the uncertainty I mentioned before, and maybe I would now be studying under a CSP instead of a BMP. However, we can’t change the past, so there’s no sense in dwelling on that. Learn from it and move on. That said, many of my peers who did study during their undergraduate courses still were not prepared for how to study in medicine with the sheer volume of material and the speed required to complete it. Like the pancakes analogy, you can’t fall behind or you will never catch up. Studying on your own is a requirement in medicine, although everyone has their own system.

What I found works for me is to study using textbooks and resources from the United States of America, including materials specifically designed for taking their licensing exam (USMLE Step 1). I quite heavily augment this with flash cards for my study, using a deck known as Zanki. Zanki is a deck that has been formed from First Aid for the USMLE Step 1 (the bible for students attempting the Step 1 exam), Costanzo’s Physiology, Pathoma, and Kaplan. These resources that it builds on are what are often seen as the gold standard resources in medical school (although the Robbins Pathology text is often more authoritative for medical school, Pathoma is more USMLE focused). However, another deck (Dope Medicine) seems to be superior to Zanki from my experience. I just happened to start using Zanki before Dope was available, and once you have tens of thousands of cards in review, switching to another deck would be insane.

I also use SketchyMedical for studying microbiology and pharmacology. I referred to this resource (and studying with flash cards) in my Remember Everything post, and still stand by it. I have found myself remembering things during rounds and exams purely from being able to picture the scene in one of these videos/pictures.

However, everyone finds their own system that works for them for medicine, and I do not claim that my model works well for everyone. It is just what works for me. Through studying in this method I have found that I both review old material and learn new material in only a few hours a day, with up to five hours study occurring at the peak (middle of the nervous system module). However, this is without attending lectures and even most optional activities, this is five hours total for the day.

Medical school is what you make it

So, fundamentally, medical school partly depends on the school you go to. But it also heavily depends on you. The system that works well for you to study may look identical to my study model, or it may look nothing like it. Maybe you attend every lecture and learn well in a group environment, more power to you. The one thing I stand by though is that most people could study or understand medicine, at least if given enough time. The only difficulty is figuring out how to study the volume of content at the speed required. That struggle, that journey of self-discovery, is what defines the early stages of medicine. Until next time, be healthy and continue learning.

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