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<http://www.nextgenmd.org/> The Next Generation: An Introduction to
Medicine
Published on the first day of every second month. Produced in collaboration
with editors of the New England Journal of Medicine.
Volume 3
Number 2
November 2006
A First-Year in Medical School
A NextGen <http://www.nextgenmd.org/series.html#freestanding> Free Standing
Perspective Article
Based on an interview with Lester Leung, a first-year medical student at
Tulane Medical School.
_____
Pre-medical students have the much-mocked reputation of being academic
machines, and ruthless at competition and grade-grabbing. While being just a
caricature, this reputation does underline the hard work pre-med students
invest in their education-but just into what are students getting
themselves? Having freshly started his first year at Tulane Medical School
this August, Lester Leung shares his experience on the transition from
college to medical school.
"The biggest difference is the people, your classmates," Leung says promptly
when asked about what one immediately notices upon entry into medical
school. Unlike the college student population, which tends to fall within
the ages of 17-20 during Freshmen year, medical students could be starting
their path to becoming physicians at any age between 21 and the mid-forties.
The student body, furthermore, is not just a few students on the higher end
of the age range, but is usually pretty well distributed. Some arrived
directly from college-as Leung did-many have taken a few years off, others
have already an MPH or another degree, and still others already have had
professions, but found medicine to be their calling. With this age range
comes a variety of experience, personalities, and emotional maturity levels.
Confidence levels also differ enough, though any form of arrogance will
appear petty, because as Leung explains, "Any difference in understanding
among students is minor compared to what we [as students] know now and what
we [as physicians] need to know in the future."
Shock and Awe Education
Academically, medical school has about "ten times as much material as
undergraduate studies" in the same time span. "It's a lot of material," as
Leung puts it lightly. Every lecture has a list of "learning objectives," or
specific details and concepts that a student should understand and retain.
The list helps one focus on the goals of each lecture, but in general, since
there are no assignments or problem sets, everything is self-directed.
Professors provide many ways to learn, but students must depend on
themselves to decide which method best suits them, and how much material to
retain. "You could learn just enough to pass, or just enough to reach a
certain score, or to do to well while looking deeper into areas that
interest you-I actually enjoy having some trivia, as long as they do not
push other things out of my brain," says Leung.
Leung believes that the immense volume of academic work may be actually more
challenging than the complexity of the information, especially for students
who had studied life sciences as undergraduates. However, he also notes that
medical schools are changing in their expectations and standards. "The
growing assumption is that today's students will be doctors ten year from
now, and already now doctors are practicing in a way such that what they
need can be readily looked up-they don't need to know all the details, but
need to know how to collect them, react quickly, and tie the knowledge
together." Thus while a certain degree of memorization undoubtedly exist in
the medical education, medical schools are striving to strike a balance
between demanding their students to remember the information, and training
students to more holistically integrating knowledge and create frameworks.
Seeing medical school as a place for gaining knowledge would be simplistic,
as emotional education and growth in maturity are very much parts of the
learning as well. While the common adage states that people "find
themselves" during their college years, and many medical students assume
that they are already done with personal development, people actually
undergo vast changes during medical school regardless of their age upon
enrollment. The shock and awe comes in not just in the difficulty of
learning all the academic material, but in forcing one to be more serious
and dedicated to the profession in medicine, and to set higher standards for
oneself since every mistake physicians make could have grave impacts. Leung
believes that "Medical education is unique in exposing students to be
face-to-face with life" and other issue not normally addressed, such as
"spending hours and hours with dead bodies." He mentions that many medical
students are weary of answering question about anatomy class. Many say, "I'm
tired of talking about it," because so many people have asked about working
with cadavers-probably since "people are fascinated by death and the body,
especially in our culture," says Leung, "because we spend so much time
running away from it."
Clinical Experiences in the Pre-Clinical Years
There are roughly two types of classes for first-year medical students:
classes that deal with the science in medicine, and those that address the
art of medicine, which can cover anything from patient-physician interaction
to distributive justice. While formal clinical training from the medical
school does not began until the third year, some medical schools do allow
first or second year students who are eager to learn more and eager for
early exposure to gain clinical experience through extracurricular
activities. The activities lend first- and second-year students opportunity
to practice and experience for rotations later in their training.
Although students cannot perform many procedures before their third year,
they can take histories, conduct physical examinations, measure and record
blood pressure and pulse rate, and generally be an extra set of eyes for the
physician treating the patient. They can also perform simple tests such as
the PPD (Purified Protein Derivative) skin test for tuberculosis, which
requires only a subcutaneous injection and checking for a small bump under
the injection site a few days later, which would indicate a positive result.
Leung describes that students were first taught to inject using saline
solution on oranges, and then on one another, before moving on to using real
injections on patients.
Many medical schools, such at Tulane, also allow the existence of
student-run clinics. Training hospitals and clinics give many clinical
opportunities outside of the classroom through student-run clinics and
special programs with physicians. In New Orleans, for example, physicians
from Florida State University and Tulane University manage a temporary
emergency room after the charity hospitals that served as a safety net for
the uninsured closed after Hurricane Katrina. In such high demand, the
hospital has so many cases each day that patients often must wait six to ten
hours before getting care-it is in settings like this one that make first-
and second-year medical students' participation in clinical setting more
necessary and justifiable. Depending on the medical structure and coverage
of the community, medical students are some times encouraged or discouraged
to participate in clinical experiences before their clinical years. "From
the perspectives of medical ethics, the situation would be worse if students
do not provide the care" and fill in the void left by an incomplete health
system.
Unlike volunteering in college, medical students face higher
responsibilities even in their pre-clinical years. While college volunteers
may have fewer things expected of them, for medical students, "The white
coat causes patients to assume a higher level of knowledge and skills than
before, and to view you as part of the medical staff-you may even be
presented as a doctor." The heightened standards and expectations, however,
can prove to be intensely motivating "for medical students to work harder to
fulfill that expectation."
The Biggest Challenge
Schedules during medical school are relatively flexible, as "everything
outside of class is determined by you," says Leung. On a typical day, he
attends classes from the morning until three or five, with an hour off for
lunch. Not surprisingly though, most students are nearly constantly studying
outside of class. "Every administrator, educator and upper-classmen have
stressed the importance of finding something that works for you...Many
[advice] books for medical students counsel students to get enough sleep and
nourishment, and find a balance in life...But really, expect to be studying
the vast majority of time outside of class."
With this type of demand placed on the energy and time of
physicians-in-training, Leung believes that the biggest challenge for
medical students is maintaining relationships: "Knowing how to live while in
medical school [means] knowing how to manage commitments and human ties, and
being good to others and happy yourself"-all the while dealing with learning
vast amounts of knowledge and developing oneself. Academics can be so
demanding as to force students to strain for new ways of functioning with
familial ties, romantic relationships, friendships, and their coonections
with everyone else in their lives.
For the pre-medical students, who are perhaps already more academically
intense than their peers to gear-up for the challenge of medical school,
Leung stresses the importance of strengthening existing relationships. These
strong ties would "help you develop new relationships [in medical school],
and let you know that you as a person, as a social human being is doing
fine, and able to find happiness in people." He also mentions that in
medicine, the vast majority are great people, though some may not be
happy-"The more naturally connecting and happy you are entering medical
school, the more connecting and happy you are during medical school, and the
better you will be at taking care of others."
<http://www.nextgenmd.org/images/colophon.gif>
Serene Chen is the Editor-in-Chief of Next Generation and a member of the
Harvard College Class of 2006.
Lester Leung is the founder of the Next Generation and a member of the
Tulane Medical School of 2010.
<http://www.nextgenmd.org/> > Back to Current Issue
The Next Generation is an independent online publication produced in
collaboration with Editors of the New England Journal of Medicine. All
content referencing the New England Journal of Medicine is copyrighted
property of the NEJM and the Massachusetts Medical Society. All rights
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