A First-Year in Medical School
A NextGen 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."
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.