4th year medical student mentor--Ask a 4th year medical student (almost) anything

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

yankeebeckham

Full Member
10+ Year Member
15+ Year Member
Joined
Nov 30, 2007
Messages
67
Reaction score
115
I am currently applying to residency programs, which is making me look back on my days applying to medical school and it is instilling in me a strong desire to give back to my pre-med counterparts. Those were not good times. I was not your average candidate--I was a non-science major with a 3.0 science GPA and a 3.5 all over, When I came to sdn for advice, all I remember was people were MEAN. Everyone told me to give it up, I would never become a doctor, and they laughed in my face. At best I could perhaps hope for DO, which I was opposed to because I really wanted to do ortho and I knew that would be a harder road. People told me I must not know how to study or that I was undisciplined or that I was hopeless or I was a joke. I had a good story, but people did not know me at all, and they felt they could judge me. (There's something to be said about not getting life or career advice on an anonymous online forum). Perhaps it was other candidates who were insecure about their own applications needing to pull me down to build themselves up. One of the reasons I was a non-science major was precisely because I couldn't stand to be around pre-med students who acted like that. I decided to take an extra year, did a do-it-yourself post-bacc, got a 34 on the MCAT and applied the next year for MD schools. I finished the cycle with at least 5 schools to choose from (who remembers?), a number of interview I turned down, and a matriculation into a school I was very happy with. I am now applying for ortho residency programs.

The reason I write all of this is I feel like pre-med students are a very unique breed and the application process is extremely stressful. It can be so easy to lose perspective. When I reached out back when I was in college, unsure of how competitive I was (because I was borderline before my post-bacc) I wish I had someone there to offer me a word of encouragement and to show me some direction instead of shoot me down and tell me I was hopeless. I ended up in a very good school and I'm hoping my story shows other people not to let other people tear you down. There's a certain skewed logic in asking other pre-med students for admissions advice because you're all in the same situation and likely have the same information. Don't get me wrong, admissions is competitive, and it is important to be realistic about your chances, but at the same time, I find other people will ofter try to bring you down when they feel unsure about their own qualifications. You don't need a 4.0 and a 45 to get into medical school and you don't need to get into the #1 medical school in the country to become a doctor. I'm happy to answer any questions about what it's like to be in medical school and to offer any mentorship to those who find they are in a similar situation that I was in when I was applying. You will be applying for things for the rest of your life; I think going through the stress of it now makes it easier later on.

Members don't see this ad.
 
  • Like
Reactions: 30 users
Favorite moment of medical school?
Least favorite moment of medical school?
5 things you wish you could tell your M1 self?
5 things you wish you could tell your pre-med self?
 
What has been your most successful study strategy to help with retention of the mass amount of information in medical school?
 
Members don't see this ad :)
-Did you ever feel like you might fail a class in medical school because the other candidates seemed smarter? Were you near the bottom of the curve?

-Even if you, yourself didn't, do you think there is enough time to sneak in exercise for 1.5 hours every other day if you are disciplined? I've been working hard for several years to lose weight and become fit, and I'd like to maintain it.

-What did you do over the summers?

-Did you make any friends in medical school or was it more cut-throat?
 
- What are the most important considerations when choosing a med school? What factors are commonl overlooked/ undervalued, and which are exaggerated?
- Any regrets?
- Any surprises about med school and medicine?
 
I'm not OP but I'm also and MS4 at a US Allo school. I've just come here to drop some unwarranted answers to undirected questions.

Regarding failing - I never thought I would fail because everyone else was so smart. In my personal experience, I worked just as hard to get into med school as I did while I have been here. In fact, it may have been easier in some ways. I found it was easier to get involved in topics that were more directly health/bio related that obsucre Organic chem reactions and crazy physics differentials. Conceptually medical school is not very difficult.

Regarding exercise - 1.5 hours a day is extremely doable. Let's say you're a hard worker and you wake up at 7 am and go to lecture. You're done by noon usually. Let's say you're even HARDER worker and you study for THREE WHOLE HOURS after lecture - its now 3 pm. At this point, you have enough TIME to get a 1.5 hour workout in. The only things you may lack are MOTIVATION and ENERGY. Get those however you've been getting them until this point in your life.

Regarding friends in med school - if you are aunable to make friends prior to med school, you wont make any friends in med school either. If you made friends before you're all good. And you'll meet cut-throat people the rest of your life. Most people arent. But many people in med school work hard and won't brag. Everyone is working on projects/volunteering/papers/studying and they won't necessarily announce it to everyone. You just find out about people winnig research awards, giving presentations and what not. If you somehow think that's cutthroat beh

Regrets - not doing more cool stuff when I had more free time prior to admissions and during M1 and M2. (Looking back, I had so much free time in M1 and M2

Summers - I did research, got papers published.

Least favorite moment of medical school - 2 am, surgery call, community hospital in the ghetto, tearing open sugar packets and pouring sugar on a 90+ year old woman's prolapsed rectum which had become edematous over 3+ hours, while she farted blood and stool. My resident resorted to sugar after multiple manual attempts failed. I hadn't slept in what felt like days. And the vegetative growths on her prolapsed rectum looked like tiny pieces of flesh popcorn {she had never gotten a colonoscopy}. It only reminded me how hungry I was becuase the cafetaria wasn't open on Saturdays. The smell of blood and **** was everywhere. My back itched. And the granulated sugar kind of made this blood/sugar/**** slurry. In all I guess its was a 6/10 on the excitement scale. Also, I'm pretty sure the sugar thing is an outdated trick, but I don't really care. I hate surgery.
 
  • Like
Reactions: 16 users
Favorite moment of medical school was probably when they let me finally participate in surgery in a meaningful way in my 4th year--putting in some screws, making incisions, etc. I've always wanted to do ortho and just because you know what you want to do does not mean you're excused from the rotations you don't enjoy. So you have suffer through a lot of boring crap and then 4th year comes and you're finally getting to do what you want to do and they hand you the knife and it's a really good feeling.

Worst moment? This wasn't terrible, but this kind of summarizes everything I hate about medical school. It's the end of a very long day and I step into the elevator to go home. I have my short white coat on, signifying to all my status at the bottom of the totem pole and we all know stuff rolls down hill. A doctor I don't know steps into the elevator with a large pile of crap. She looks at me and asks me if I'm a medical student. I nod. She unloads her large pile of crap into my arms and directs me where she wants it delivered. I wasn't even on her service.

My M1 self? My school was pass/fail and it's really hard to fail, so I wish I had studied a lot less. I also wish I had studied more for the boards and less for our curriculum. I got involved in research early, which I was happy about. I wish I had done more outside of school and more in the community, not as a way to boost my CV, but just as a way to feel connected to my new home. Like I sad, I tried to avoid pre-med students like the plague when I was in college, and unfortunately all those med students were at one point pre-med students. It's good to have friends outside of med school.

My pre-med self? Calm down, the world will not end if you don't go directly to med school from college. In fact, the time I took off from college to med school were the best two years of my life. I benefited tremendously from that time. And you can tell the students who go straight through lack something compared to those who take some time to have some experience outside of school. Also, pre-med students are all nuts in their own way so whenever you talk to them you need to remember that. So if you ask them a question and they give you an answer that makes you feel bad about yourself, just remember, they're crazy. You need a strong sense of self and perspective to get through this process. The most important thing is to be genuine and be who you are. It makes me so sad to read these forums and all these applicants are trying to change themselves to be the perfect applicant. If you have the drive to be a doctor than there's something within you that's true and that should be the basis of your application. Be passionate, explore your interests. Take introductory Swahili, go fly fishing, write poetry. Be genuine and be yourself. If you think something is boring and your only doing to seem impressive--don't do it! You will be starting yourself on a long road of making yourself miserable. Becoming a doctor requires a lot of self-awareness and lot of personal integrity. You need to know, "this is who I am and this is who I am willing to be" and even when you're doing things you don't enjoy, maintaining the values that are important to you. One of the most important things I've learned in med school is how to maintain a positive attitude and have a good time when I'm doing something that's making me absolutely miserable.

For studying? DO NOT MEMORIZE--LEARN. Medicine is all about pattern recognition and you could be successful by memorizing every little detail about every little thing, but who has time for that? Take the extra time to learn the reason behind why things are the way they are. Then it won't surprise you why a certain level goes up or down in a condition, Or you could be given a condition you've never heard of and figure it out. The people who memorize are the ones who study 15 hours a day and it's out of their head the day after the test. Learn the underlying principles, they will show up again and again. Maybe before the tests you need to fill in a few details. It will be worth the investment to understand why.

No, I never came close to failing. I go to a very good school and I've always fancied myself near the top of the class. I'm not sure what I'm basing it on since my school does not rank. High self-esteem, perhaps.

If you make it a priority, you have time to do whatever extracurriculars you want to. I got a master's degree during my first two years.

You only one have summer and I did research and did a medical service trip.

I don't know anyone who doesn't have friends. I'm not cut-throat, so my friends are not cut-throat. I found the traditional pre-med student unbearable in college (and thank goodness most of you all tend to calm down by med school), but most of my friends tend to be non-traditional--non science majors, older students, those who took time off, going into less competitive specialties, more relaxed.

It's kind of up to you what you value in looking at a med school. I think everyone judges med schools based on the first two years because that's what they see themselves doing immediately and forget to factor in what they'll be doing for years three and four, which are arguably more important. For me pass/fail was a huge deal because it made the feel of the school more collaborative. Curriculum was important. Ability to do research was important--some urban schools your competing with a lot of different schools to get mentors. School mission is important because some schools explicitly state they only want to train primary care docs. I think scheduling is another thing people overlook. When will you be taking step 1? Will it be easy to schedule aways in time? How many required electives in weird things will you have to do? How many tests in 4th year are there? How many sub-Is? It also depends what you want to do?

I think I truly underestimated how bad the administration is and it is bad everywhere I looked.

Surprises? I underestimated how much bs there is and I am disappointed somewhat by the culture. There's a lot of work that goes on that doesn't involve taking care of patients. Writing notes, fetching things, dealing with insurance companies, dealing with the social situation. The culture was also somewhat alarming to me. I came from two very small private schools in which I was taught to question everything and that my opinion mattered. The reality is when you're a 3rd year med student, you're not always a welcome addition to a team. They certainly don't want you to question how things are run. You are there to be seen and not heard. There's a game to be played. I remember my first day on 3rd year I asked my attending a question and he turned around and just gave me a look of supreme annoyance and asked me what I thought. I didn't know. That's why I was asking him. I wanted to know more, but I never asked him another question. I adored working with my patients, but the medical education system, particularly clinically is broken. I've been assigned to give presentation on days when the residents knew they would not be there. You get "pimped" and asked esoteric knowledge and ridiculed if you don't know the right answer. My residents would much rather I got them coffee or that I just disappear somewhere than to teach me something about a patient. But you can't fault them, they are extraordinarily overworked. The entire way I've learned is to never been taught how to do something, been yelled out for doing it wrong, and then to do it right the second time. It's been a very humbling, but also disappointing and soul-sucking experience.
 
  • Like
Reactions: 14 users
to OP, how'd you decide on Ortho? It seems like most specialties seem super interesting from the outside looking in and I would want to know how you came to decide on your residency choice.
 
Amazing and detailed responses. Thank you!
 
Ortho was the reason I went to med school. I was a jock growing up and then I was an injured jock and so it was the way in which I had exposure to the healthcare field. Our healthcare system is completely broken and what I like about surgery is that you a least get the chance to make a measurable difference in a patient's life. You get to fix something and there's a record of something you've done. And I hate rounding. A lot. I wasn't a science person so throwing drugs at things I find totally unsatisfying. In terms of choosing between surgical specialties, I find general surgeons to be overworked and under appreciated and as a result they can be some of the more grumpy people you work with. Plus I don't like stool. I like a lot of short cases, which works well with ortho. I like the physicality of it and that it's not super intricate. And you'll find each specialty has a type or an attitude--I get along with ortho folks. I could never do Ob-Gyn, for instance.

But if you don't know you want to do, you need to shadow and try everything. Even though I knew what I wanted to do, I kept an open mind. Things I thought I would like, I hated, and things I thought I would hate, I really enjoyed. So there's no way to know until you get out there and often you have to be very proactive about finding out what you're passionate about.
 
  • Like
Reactions: 2 users
Surprises? I underestimated how much bs there is and I am disappointed somewhat by the culture. There's a lot of work that goes on that doesn't involve taking care of patients. Writing notes, fetching things, dealing with insurance companies, dealing with the social situation. The culture was also somewhat alarming to me. I came from two very small private schools in which I was taught to question everything and that my opinion mattered. The reality is when you're a 3rd year med student, you're not always a welcome addition to a team. They certainly don't want you to question how things are run. You are there to be seen and not heard. There's a game to be played. I remember my first day on 3rd year I asked my attending a question and he turned around and just gave me a look of supreme annoyance and asked me what I thought. I didn't know. That's why I was asking him. I wanted to know more, but I never asked him another question. I adored working with my patients, but the medical education system, particularly clinically is broken. I've been assigned to give presentation on days when the residents knew they would not be there. You get "pimped" and asked esoteric knowledge and ridiculed if you don't know the right answer. My residents would much rather I got them coffee or that I just disappear somewhere than to teach me something about a patient. But you can't fault them, they are extraordinarily overworked. The entire way I've learned is to never been taught how to do something, been yelled out for doing it wrong, and then to do it right the second time. It's been a very humbling, but also disappointing and soul-sucking experience.

lol wow. penultimate sentence is so true. they don't teach you how to do something even when you ask how to do it. then you finally get the chance to do it and they get pissed if you don't do it right. then they take it from you and do it themselves. seems like there's no time for real teaching in medicine
i write notes and people say "work on developing assessment and plan" without even a hint of how to do it properly. so frustrating
 
  • Like
Reactions: 1 user
Seems like there are more cons than pros to medical school and being a doctor in general. Being able to treat patients seems to be the main pro.
 
What kind of technology do you use in school, i.e. notetaking, studying etc.?
What are some important things/tools that you would recommend getting prior to starting school?
 
Members don't see this ad :)
I would say there are more cons than pros to going to medical school. But for me there were more pros than cons to being a doctor. So that kind of left me no other choice than to suck it up. I ascribe to Mark Twain's philosophy of, "I never let schooling interfere with my education."

The big piece of technology I got for medical school was a smart-phone so I could check my email all the time and that has proven really helpful, but I feel like I was already ten years behind the curve by the time I got one, so surely everyone must have one by now. Um, I use my laptop a lot. I used onenote to import all my lectures into one place. But I don't like to take notes because I feel like it interferes with my ability to listen, so I seldom took notes, I just used the slides. Sorry, I'm one of those people who actually buy books and read them. Not much on the technology.

I can't imagine anything you would need prior to starting school. I know there's a great urge to get your hands dirty and get ahead, but you could spend the next few months trying to prepare and be going in totally the wrong direction and cover in 4 months what is covered in an hour in lecture. It's not worth it. As hard as it is, enjoy this time. You will never, ever again in your life be this free again until you retire. And then you'll be too arthritic to enjoy it. So go rock climbing or something. There's no point in reviewing the stuff you learn in college because you really don't need it and if you do, by the time you use it again, you'll have forgotten it. The only thing I can think of is if you've been living in a dorm, you're going to need pots and pans and things of that nature, but if you're moving far away for school, you might as well get that where you're going to be living.
 
  • Like
Reactions: 2 users
How many hours a day do you typically spend studying throughout med school?
 
  • Like
Reactions: 1 user
Depends on the person and the season, so to speak. I think 3-4 hours a day during M1-2 was not atypical for me, but we had a curriculum that was extremely self-directed and we spent very little time in class, so I don't really consider that studying so much as learning for the first time. I went to lecture for M1 and not M2 because I am not an auditory learner but like to learn by reading. I was just spending lecture time on facebook and playing words with friends, and I figured that time could be better spent asleep, or playing words with friends in my pajamas. Obviously I kicked it up during exams. For M3, I probably studied about 1-2 hours a day of dedicated study time not around exams, but I did a very good job of taking advantage of down time at the hospital (of which there is a lot!). I always brought a book with me and would be reading and not just chewing the fat if I wasn't involved in something meaningful because getting enough sleep was very important to me. I was usually in bed between 9-10 on rotations that I had to be up before 6. For M4, I only read books for fun now. It's amazing. I would say I definitely study less than most of my friends. I read very quickly and I remember most of what I read on the first time. And for me studying is never an interactive process-no notes, flashcards, or anything like that, which saves a lot of time. The important thing is to find what works for you. At first I was feeling guilty and forcing myself to study more because I thought I was being lazy and just doing it wrong. But I did very well on the exams and thought there was no reason to follow someone else's study habits when mine worked just fine for me and allowed me to have much more of a life. The trick for me was to make a consistent effort throughout the semester and to really understand the material and the rationale behind it to minimize memorization.
 
  • Like
Reactions: 4 users
Did you have a significant other going into or throughout medical school? If so how much time did you spend with them on average during pre-clinical and rotations?
 
Nope, no SO. Just me and the cats. I've found being single and trying to find a relationship and not wanting to date anyone in my class (would rather be with someone outside of medicine) to be VERY challenging.
 
What kind of personality type are ortho people usually? I don't believe in perpetuating stereotypes like "all ortho guys are jocks," and ortho is the specialty I'm most interested right now.
 
Hmm, I think ortho folks are very smart and hard-working, but for being such a competitive specialty, many are very laid-back and easy going. Many are jocks. I find they are lot nicer and approachable than other surgeons. Many have a good sense of humor. Everyone is different, of course.
 
  • Like
Reactions: 1 user
Thank you for doing this yankeebeckham! I am also in a similar situation that you were in: non-science major, low sGPA, and feeling pretty discouraged. However, I decided to apply to a combination of MD and DO schools, and I was recently accepted into my top choice MD school.

EDIT: You answered my questions already! Thanks!
 
Last edited:
  • Like
Reactions: 1 user
Depends on the person and the season, so to speak. I think 3-4 hours a day during M1-2 was not atypical for me, but we had a curriculum that was extremely self-directed and we spent very little time in class, so I don't really consider that studying so much as learning for the first time. I went to lecture for M1 and not M2 because I am not an auditory learner but like to learn by reading. I was just spending lecture time on facebook and playing words with friends, and I figured that time could be better spent asleep, or playing words with friends in my pajamas. Obviously I kicked it up during exams. For M3, I probably studied about 1-2 hours a day of dedicated study time not around exams, but I did a very good job of taking advantage of down time at the hospital (of which there is a lot!). I always brought a book with me and would be reading and not just chewing the fat if I wasn't involved in something meaningful because getting enough sleep was very important to me. I was usually in bed between 9-10 on rotations that I had to be up before 6. For M4, I only read books for fun now. It's amazing. I would say I definitely study less than most of my friends. I read very quickly and I remember most of what I read on the first time. And for me studying is never an interactive process-no notes, flashcards, or anything like that, which saves a lot of time. The important thing is to find what works for you. At first I was feeling guilty and forcing myself to study more because I thought I was being lazy and just doing it wrong. But I did very well on the exams and thought there was no reason to follow someone else's study habits when mine worked just fine for me and allowed me to have much more of a life. The trick for me was to make a consistent effort throughout the semester and to really understand the material and the rationale behind it to minimize memorization.

Did you study like this for the MCAT too (no notes/flashcards)? That's impressive!
 
In your observations you belive that someone with a tremor ( Ei: Essential Tremor ) can do Ortho ?
 
I took a class (online) for the MCAT. I had a lot to make up for. I tried to study on my own, but I didn't have a clue where to start and I was also doing it the same time as my coursework and it just wasn't going well. I knew if I botched the MCAT I would be sunk. So I took a summer off when I had no classes to study for it. I found for both premed and medical school for standardized test the most important thing you can do to practice is just questions, questions questions. I really took the MCAT course for access to the study material, so I would know what to read and mostly so I would have exam questions to practice with. But I didn't take notes or anything on them, I just did a ton of practice tests and questions, questions, questions. It's the best thing to do for shelf exams, Step exams, etc.

I've never met anyone with a tremor in ortho. It doesn't mean they don't exist. There are meds you can take for it, so perhaps it was just well treated. But I imagine it would be difficult to be a surgeon if one had a tremor that was not under control. You don't want a shaky hand. There's a sports med path through family medicine which might be good route for someone who is interested in the field and can't operate.
 
You've already answered my question and I thank you for that, but I'd just like to thank you again. Reading through your posts I feel like I'm sitting down and having a conversation with you. It's really refreshing and I'm sure I'm not the only one who appreciates it. So thank you for that.
 
  • Like
Reactions: 3 users
You mention that our healthcare system is broken? How? and what ideal system is there out there in other countries that may be a better model for healthcare that should be implemented in the US? Thanks
 
It's broken in a lot of ways. There's a medicine we want to prescribe, but the patient's insurance won't cover it, so we prescribe something else that's inferior. Or maybe we're seeing a young person come in with a devastating disease that could have been prevented or detected earlier, but she didn't seek care because she couldn't afford it. Or we're seeing a patient come in every single week with an exacerbation of the same disease because they can't afford the lifestyle changes or weren't provided the educational opportunity to take care of the disease. I get really tired of seeing primary care patients in the emergency room, discharging them with an inhaler back into an environment with smoke and unemployment and whatever else caused the situation, knowing they'll be back the next week and they still won't have a PCP and we'll probably give them another inhaler. We have a system that won't pay for routine well visits, or nutritional counseling or any of that soft stuff, but emergency surgery to cut off your necrotic, diabetic foot? Sure, no problem. And then you'll be lost to follow up and we'll cut off the other one in 5 years.

I don't know what the solution is. It's got to be systemic and not patchwork. Knowing the systems in all the other countries is a little above my pay grade, but after all this schooling, I think I should be making more money and making more medical decisions than insurance companies. I think Japan and Scandinavia have fairly good reputations for having functional systems, but I really don't know much about them to make a sound argument; I just know reputation
 
Last edited:
  • Like
Reactions: 1 user
Just for illustration and since this is an excellent post, I want to provide a couple of examples to back up your points. The more education these students go into medical school having, the better.

It's broken in a lot of ways. There's a medicine we want to prescribe, but the patient's insurance won't cover it, so we prescribe something else that's inferior.

I think of anticoagulants for this one. In many cases, something like Xeralto or Lovenox is indicated, but we pick Coumadin instead because it's cheaper despite the fact that it's much harder to regulate its levels and efficacy, which fluctuate wildly based on the patient's eating habits and other factors.

Or maybe we're seeing a young person come in with a devastating disease that could have been prevented or detected earlier, but she didn't seek care because she couldn't afford it.

This one hits home. The best example is cervical cancer; it's a completely preventable disease that should no longer exist; we have the tools both to prevent it on a large scale (HPV vaccines) and to screen for its precursor condition before it becomes cancer, but many women can't afford to get the vaccine or receive regular pap smears.

Or we're seeing a patient come in every single week with an exacerbation of the same disease because they can't afford the lifestyle changes or weren't provided the educational opportunity to take care of the disease. I get really tired of seeing primary care patients in the emergency room, discharging them with an inhaler back into an environment with smoke and unemployment and whatever else caused the situation, knowing they'll be back the next week and they still won't have a PCP and we'll probably give them another inhaler.

COPD and Congestive heart failure patients are known for requiring this kind of care, though there are countless examples.

We have a system that won't pay for routine well visits, or nutritional counseling or any of that soft stuff, but emergency surgery to cut off your necrotic, diabetic foot? Sure, no problem. And then you'll be lost to follow up and we'll cut off the other one in 5 years.

Again, a poignant example, and when you all are in your clinical years, you'll see it time and time again: patients with completely preventable and/or controllable diseases in end-stage presentation for no reason but that our health care system doesn't actually help them get better.
 
  • Like
Reactions: 1 user
There's a sports med path through family medicine which might be good route for someone who is interested in the field and can't operate.
Also through IM and PMR fyi - you really need a steady hand for injections ^^ but there is still a large non-procedural non-surgical medical side to sports med
 
Another thing I think needs to be considered when it comes to "fixing" the healthcare system, I think many people over look how much poor health and poverty and lack educational opportunities are connected. If you want a healthy populous, you can't just take a bunch of impoverished people and tell them to go to the doctor more of often. What is the doctor going to to do? People need to have a sense of security and have their basic needs met before they can thrive from a health perspective. They need the economic freedom to afford nutritious food, to be able to have the time off to go to the doctor when they're ill, to feel they can take a leave of absence from work so a small problem doesn't become a big problem, to have the education to make good choices, possess health literacy and pursue work that is meaningful to them, to live in safe neighborhoods where people can get out and be active and make meaningful relationships with one's neighbors and in the community. People need to be free from the stress of day-to-day struggle of merely surviving in order to thrive because high levels of stress makes us more prone to disease and makes pre-existing conditions worse. We need an attitude change as a society that values health and wellness and not just material wealth. If we want a healthy population, we don't just need more doctors, we need a strong middle class. I think too often when we look "health care reform" we look at questions of access and reimbursement when the problem is so much deeper and really challenges our American values. I think there is a lot more we should be doing, but I don't see it happening in the current political climate.

Unnatural Causes is a very good documentary for anyone who finds this topic interesting.
 
  • Like
Reactions: 12 users
Can you (or any medical students) post a sample weekly schedule? I've tried looking this up and have only seen random ones, that usually excluded certain things.

How much realistic free time can you expect to have, assuming good academic performance? I've heard mixed things about this, and I think it probably depends. Just curious.
 
  • Like
Reactions: 1 user
I don't have an answer to your question, but would just like to say that your avatar is amazing - lol
 
I think you're having a hard time finding something online because it really does vary. What time period do you have in mind? M1-M2? M3? M4? Which rotation? Which school? How do you study? What kind of activities are you involved in? Even when my roommate and I were taking the exact same classes our weekly schedules look ridiculously different--you wouldn't even be able to tell we were classmates. I was in a master's program so I was in class when she wasn't. I slept in until noon on the weekends and she was one of those people who had to memorize every single fact and so she would study 15 hours a day. I needed to have sports on in order to be able to sit still long enough to read anything, so it looked like I never studied. Some schools you might be in class 8-12. Some are 9-5. Some are totally online. On rotations, if you're in surgery, you could easily be working from 5am-7pm. On psych, it might be 7am-4pm. So throwing out a blanket statement, "this will be your schedule" is not helpful. If your one of those people who need to study 15 hours a day, you'll have less free time than someone who only needs to study 3. You need to figure out what works for you and set up a weekly schedule around that.
 
It's broken in a lot of ways. There's a medicine we want to prescribe, but the patient's insurance won't cover it, so we prescribe something else that's inferior. Or maybe we're seeing a young person come in with a devastating disease that could have been prevented or detected earlier, but she didn't seek care because she couldn't afford it. Or we're seeing a patient come in every single week with an exacerbation of the same disease because they can't afford the lifestyle changes or weren't provided the educational opportunity to take care of the disease. I get really tired of seeing primary care patients in the emergency room, discharging them with an inhaler back into an environment with smoke and unemployment and whatever else caused the situation, knowing they'll be back the next week and they still won't have a PCP and we'll probably give them another inhaler. We have a system that won't pay for routine well visits, or nutritional counseling or any of that soft stuff, but emergency surgery to cut off your necrotic, diabetic foot? Sure, no problem. And then you'll be lost to follow up and we'll cut off the other one in 5 years.

I don't know what the solution is. It's got to be systemic and not patchwork. Knowing the systems in all the other countries is a little above my pay grade, but after all this schooling, I think I should be making more money and making more medical decisions than insurance companies. I think Japan and Scandinavia have fairly good reputations for having functional systems, but I really don't know much about them to make a sound argument; I just know reputation

In Japan the Government set fixed prices for medicals procedures for instance an MRI cos about $90 and a daily inpatient stay in a hospital cost about $15 a night , if we were to apply systems similar to Japan or Scandinavia or even England , Health Care would not longer be about making money, instead it will become about providing good care to patients, and well that just not going to work out for big corporate interest out there, also Doctors would be making 40-80k a year instead of 6 figure salaries, which would deter many from ever goin into medicine !!!
 
In Japan the Government set fixed prices for medicals procedures for instance an MRI cos about $90 and a daily inpatient stay in a hospital cost about $15 a night , if we were to apply systems similar to Japan or Scandinavia or even England , Health Care would not longer be about making money, instead it will become about providing good care to patients, and well that just not going to work out for big corporate interest out there, also Doctors would be making 40-80k a year instead of 6 figure salaries, which would deter many from ever goin into medicine !!!
Dude, you can't just apply another country's system, even when it seems to work well for them. It's like apples and oranges.
But yes, american healthcare is expensive.
 
  • Like
Reactions: 1 user
Yes, that would totally be a shame if health care will become about providing good care to patients.

Like I said, I don't know a lot about these systems--just that they seem to have a good reputation within their own countries. I think many doctors would be willing to take a pay cut (albeit minor) to not graduate with a crippling amount of debt that takes them 30 years to pay off. I studied abroad in college and shared a flat with a medical student who had her whole tuition paid for from birth until she is a practicing physician. Will she make less than me? Her salary will probably be less, but I'm not sure once you factor in the cost of tuition and the feeling of value one receives to be invested in by one's country that it is really that different. Plus the feeling of achievement to be able to act in the best interest's of one's patients--don't underestimate how crappy it feels to not feel like you're doing the right thing for your patient because your hands are tied by the system.

By I really don't want this thread to descend into a political argument. I'm going in to ortho and I like that I'm able to do elective procedures and get imaging relatively easily without a long waiting list--but then again, that's why I chose ortho.
 
@yankeebeckham Thanks for doing this! What other specialties, if any, stood out to you besides ortho? What would you consider the "ideal" game-plan to pursue ortho starting right from M1?
 
Dude, you can't just apply another country's system, even when it seems to work well for them. It's like apples and oranges.
But yes, american healthcare is expensive.
is really not apples and oranges more like yen vs dollar thats the only difference, and hey I guess we should say japan has one of the highest life expectancies in the word? when it works it works !

Also Not A DUDE here !!
 
What kind of volunteer work did you do and what did you find the most enjoyable (or disliked the least).
 
is really not apples and oranges more like yen vs dollar thats the only difference, and hey I guess we should say japan has one of the highest life expectancies in the word? when it works it works !

Also Not A DUDE here !!
Currency is hardly the only difference between any two countries. Even countries that share the same currency can be different.
Japan also has one of the highest suicide rates in the world.
I was using dude as a gender-neutral pronoun. I'm sorry if you thought I was calling you a male.

Back on topic, I'm glad that the MS4 is aware of different healthcare systems and that they're aware of problems within ours.
 
What kind of volunteer work did you do and what did you find the most enjoyable (or disliked the least).

Another MS4 here, figured I'd chime in. Whatever you do to volunteer shouldn't just be a checkbox on your application - I come from a medical school that does student interviews, and it's immediately obvious when somebody did some type of volunteer work just because they figured they needed it to round out their application. The most important thing is to find something that you are passionate about, and where you can really make an impact. If you like working with kids, think about doing Big Brothers/Big Sisters. If you're passionate about helping people down on their luck, volunteer in a homeless shelter. Medicine truly is a career where much of the time you are expected to put other people (patients) first - medical schools want to see that you are service-minded. Honestly, do whatever it is that you think would be meaningful to you - and dive in and get super-involved in whatever that is. My primary volunteering experience was in EMS, I also did some work in my religious community as well as at a camp for mentally and/or physically disabled adults and children. The only volunteer work that I did not enjoy (and this applies to all of my pre-med extracurriculars actually) were things that I did only to improve or even "round out" my application. Think about what you're passionate about, or what you enjoy, and start there. It's okay if it's not medically based - it can often be difficult to find volunteer experiences where you can really participate as a pre-med that do actually involve medicine. Also, I know a lot of pre-meds think that they don't have time to get super-involved...I promise you, you do. I worked multiple jobs in college and still volunteered 20+ hours a week - it's just an issue of prioritizing and making the time.

Hope this helps!
 
  • Like
Reactions: 1 users
Currency is hardly the only difference between any two countries. Even countries that share the same currency can be different.
Japan also has one of the highest suicide rates in the world.
I was using dude as a gender-neutral pronoun. I'm sorry if you thought I was calling you a male.

Back on topic, I'm glad that the MS4 is aware of different healthcare systems and that they're aware of problems within ours.
Wow really ? I just going to stop for world peace, and to not derail the topic, but I can't even.
 
Does medical school affiliation matter in residency placement? If I were to apply for a residency spot at a hospital that my medical school is not affiliated with, would I be at a disadvantage?


Thank you!
 
Has there been any talk in your lectures or experiences about:

1) semantic big data organization of health records or diagnosis cross-referencing platforms (type in symptoms-->suggested possibilities)

2) 3D printed organ transplants

3) any other medical advancements that maybe on the horizon

For some reason I want to say that I would like to be part of these things in an interview although I don't know if would hurt me (for whatever reason).
 
For other specialties, it's really about personal preferences. One person's heaven is another person's hell, so to speak. I remember hanging out with my friends and them talking excitedly about rotations they were on thinking, "those were the worst 8 weeks of my life." Generally if you like surgery, you're going to like other surgical rotations, but even that's not always true. I HATED general surgery. Too many grumpy doctors, grumpy patients, and too much stool. I think people who like ortho tend to like EM, and I really enjoy it. I could never do it, though, because I don't like the "patch them up and send them out" approach. I love working with kids, so I really enjoyed anything to do with peds. It's all about personal preference--try as much as you can and see what you enjoy.

For the ortho game plan, I think your first few months should be spent trying to settle in and figuring out medical school works. Once you figure out how you like to study and you have a game plan on how to handle the material and you've had some academic success, you can start adding more to the plate. The first thing I would do is try to find a PI through which you can do research. Between 1st and 2nd year is a great time to be doing the project, so you need to find the project beforehand. Hopefully you can cultivate this relationship that you can continue to do research throughout your time in medical school beyond the first summer. The longer you can stay in one lab, the more likely you are to get published. Secondly, I think it's important to start finding mentors. Talk to your advisers about your interests and see who they can point you towards. Likely this will be some upperclassman, who can provide invaluable, candid advice. Make an appointment with the chairman at your home program. Your research PI can be a mentor. The fellow I did research with was a huge mentor for me. Just see who you can seek out, ask questions, be proactive, make connections. and listen to their advice. Depending on who you are, how you study, how your school works, how you test--sometime during your 2nd year your attention needs to really shift towards step 1. This is the only part of your application that can totally sink you. You don't need to score 300 or anything obscene, but if you totally botch this, you're done. Programs have minimum cut offs and if you score below it, no matter what you do, you won't be able to do ortho, which sucks. So this is an important test. After Step 1, it's all about excelling at the curriculum. Do well on your rotations, and try to get publications out of the research you've started. For MS4, it's all about the Sub-I, which are when you act like an intern in your field of choice. You do them at your home program and then almost everyone does at least one away rotation at a program they'd like to do residency. These are like auditions for residency so it's all about working hard and being personable.

SarVa nailed the volunteering question. For applying to med school, there are things you have to do, and there are things you like to do. It's nice when there is as much congruency as possible between those two categories. So you have to get shadowing, you have to have volunteer work to show you are service oriented, you have to take organic chemistry (ugh). But medical schools are looking for diverse, passionate, well-rounded, genuine people, and it will come out in the interview when you talk about your experiences. So if you love to do something, you should do it even if it won't help your application. And if you have to do something (like volunteering), try to think of a way that makes it line up with your interests as much as possible. For me, I love sports, kids, and have a passion for education, so I did a lot of coaching, teaching/tutoring, working at a camp for kids with illnesses. I tried to volunteer at a hospital where my job was going to be to clean tables and after one day I was like, "peace out, I don't need this." There's enough in this world that I'm passionate about that I can volunteer in such away to share myself with others and bring joy to myself and not make myself miserable or to make up for someone's unwillingness to pay for menial labor.

Medical school affiliation does play a small role in residency placement. Say you really want to go to program X and they just had a student match there a few years ago and he was a really impressive resident, they would certainly look favorably amount other medical students applying there. I'm not sure if it would increase your ability to match there, but I think it would make them look at your application closer and may increase the likelihood of an interview. I also think it would be naive to ignore the fact there are medical schools that are considered "name brand" that have a very good reputation. It certainly does not hurt to be from a top school when applying to residency. Board scores are supposed to be the great equalizer, but human bias will always play a role. If you are trying to go to program X and the program director went the same school as you or one of your letter writers, that may also help you get a closer look, but I don't think it's going to help you match--it'll just open that door. Now, having said all that, I don't think the opposite is true. I think all the above confer advantages, but I don't think the absence of the above confers a disadvantage. So if you go to school Y and you want to go to program X, I really don't think you are at disadvantage so long as you are a competitive applicant for their program. If you are really interested, you can do an away rotation and boost your chances even more. I think it is very typical for someone to want to go to residency somewhere other than their home program. Also, not being from a brand name program or having great connections isn't going to hurt you, they are only added benefits.

Digital MD:
1) You mean like Watson? No real lectures, but I'm a 4th year so it's been a long time since I've been in a lecture. You'll find in medical school it's a real struggle to find enough lecture time to cover the most basic topics you need to know as a doctor that the cerebral future horizons kind of stuff is not going to get any air time. It's going to be: how do we recognize and treat pancreatitis because you're going to be a doctor really, really soon--not how is new technology possibility changing the practice of medicine over the course of the next 5-10 years
2-3) Same thing. We might get a slide or two at the end of each lecture that says this drug is in trials or something, but nothing particularly ground-breaking. Nobody has the time (or the desire) to get 200 students in a room and talk at us about esoteric things that may or may not be on the horizon. There is always something on the horizon and medicine is a vast place. Perfectly fine for you to talk about it in an interview, especially if it's something you're interested in like for research. Just keep it grounded and in check with reality. Understand what your role would be with working on any of these projects and what impact it would actually have in the near future. Don't say you're going to build some technology that's going to make doctors obsolete in the next 3 years. Just be insightful and explain the need you think the project is filling. It's totally cool to come off as totally passionate about something and show you like to read and learn a lot about something. As long as you're genuine and not trying to come off as impressive.
 
  • Like
Reactions: 2 users
I think of anticoagulants for this one. In many cases, something like Xeralto or Lovenox is indicated, but we pick Coumadin instead because it's cheaper despite the fact that it's much harder to regulate its levels

What are you talking about? Xarelto has no levels to regulate. It has no antidote. Why would it be indicated when you can use something that can be reversed with vitamin k and ffp as opposed to nothing
 
I appreciate the time you have spent on the responses. Great insight, I guess coming from tech I was just curious if there was any buzz on what is currently happening. Best not to bring it up in an interview. Many thanks again.
 
No problem. There may be buzz; I'm just not hearing it. People tend to self-segregate into things that interest them. So if you're interested in cardiology, you hang out with cardiologists. If you're interested in public health, you hang out with public health folks and maybe get an MPH. If you're into tech stuff, maybe there's a tech special interest group and they would get a special guest to come and lecture to the group about a topic they found interesting. But there would have to be really, really good free food and it better not be pizza to get me to go to that. It terms of plopping down the entire class for something like that--it just doesn't happen; there's no time. I don't see the harm in bringing it up in an interview if it's something that really interests you. I think being passionate and genuine are the best things you can be in an interview.
 
What are you talking about? Xarelto has no levels to regulate. It has no antidote. Why would it be indicated when you can use something that can be reversed with vitamin k and ffp as opposed to nothing

It's a bit beyond the scope of this discussion, but the main reason is that its potency can be reduced by the patient's diet. If you have a patient who won't adhere to a consistent diet, you can end up with a pt/inr that fluctuated wildly and may be sub-therapeutic. CYP-450 interactions can also play a role in the medication's efficacy, so yet another thing to look out for, though these interactions can also affect xerelto.

In addition, having no value to check for efficacy means less work for the patient; they don't have to come in for blood draws to monitor the levels!

Ultimately, we need more studies to determine which is indicated in which situations, but there are definitely indications for xerelto over warfarin, and there are definitely physicians who prefer it over warfarin.
 
Last edited:
Well the argument in favor of xarelto (and other new generation anti-coagulants) is that since they don't need monitoring, you'll save money on the back end since they don't have to get frequent lab draws. And that you obtain more consistent therapeutic levels since as mentioned above coumadin is very sensitive.

But, there is a big scerfuffle over these drugs right now (pradaxa, specifically) right now - since it turns out:
(a) you can actually monitor its therapeutic levels
(b) monitoring them reduces the risk of adverse bleeding events
(c) The pharmaceutical company knew this and intentionally didn't disclose it in order to market their drug as not needing monitoring.

The risk of bleeding with these drugs is also very real, since at present there is no direct antidote and you basically just have to give a ton of activated factor complexes and hope. Supposedly there is some forthcoming data out of europe about increased incidence of head bleeds, but I haven't seen it yet.

And then there is the flipside which is that coumadin is actually pretty reliable - we've been using it for years - and dirt cheap. So in summary, I don't really think that xarelto vs coumadin is the best example of our "broken" healthcare system.

I think it's still a pretty good example; if a physician believes, based on clinical judgment, that one of these drugs is the far better choice, but is forced to pick another based on cost, we have a problem.
 
  • Like
Reactions: 1 user
Top