If you started medical school all over again would you change anything?

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Cowabunga521

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Maybe learn to cook a certain meals, or start studying a more effective way from the beginning, or just get involved in a certain/club organizations much earlier?

Is there anything that you would change?
 
Maybe learn to cook a certain meals, or start studying a more effective way from the beginning, or just get involved in a certain/club organizations much earlier?

Is there anything that you would change?

My school gives the option to take a fifth year to get a Master's in clinical research. I'm a graduating fourth year now, and many of my friends who did take the Masters year are loving it. If I did med school at the same school again, I would have put more thought more seriously about taking the Masters year.
 
I would have tried to have tougher skin, received more support from my closer knit circles, and worked my absolute hardest to achieve AOA and would have done some research between years 1&2. I also would have seriously considered living at home under the roof of my parents. Went home for a rotation closer to their place and while it seemed like I was getting less done with them always bugging me they helped me a lot emotionally I actually honored my first shelf and it wasn't even close.
 
I would have focused less on class material and more on boards from Day 1. Also, I would have done research starting in the first semester. I'm realizing now that my 90+ % exam average means nothing since I go to a true P/F school.
 
Tell myself to bust my a$$ first year instead of being satisfied with being average. Not saying I didn't work, but I could have put a lot more hours in first year and focused more on having a "balanced life" than I probably should have. I expected myself to do much better second year than I did, and wish I would have had more cushion going into second year. Even more important, I wish I'd gotten used to putting in more time on a daily basis and developed a consistent study plan. Changing things up depending on the system worked fine first year, but it really hurt me during second year.
 
I matched at a very fancy psychiatry program that was my top choice and honestly probably the best possible fit of any in the country. I worked really hard for that but in retrospect it was all worth it. Life is good and I dont have many regrets.

I guess I could have tried harder to attend more of the school social functions but I don't live right near the school and I have a significant other I've been dating for almost 6 years who lives with me and enjoys spending time with me, so that was one of the sacrifices I made.
 
I would have made more friends amongst my classmates.

First year (first semester) is the best time for that. I was too much of a hermit.
 
Tell myself to bust my a$$ first year instead of being satisfied with being average.

Just FYI, when I review residency applications, I don't particularly care about your first and second year grades. I mean I want to see you didn't fail your classes, but that's about it. Your clerkship grades, on the other hand, matter a great deal.
 

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Just FYI, when I review residency applications, I don't particularly care about your first and second year grades. I mean I want to see you didn't fail your classes, but that's about it. Your clerkship grades, on the other hand, matter a great deal.

I don't know much (since I learn what I read from seniors who post here) but I find it interesting that little weight is given to preclinical grades that are usually objective (based on exam performance) and a lot of weight is given to clinical grades that are usually subjective and random (besides shelf exam scores), since evaluations depend more on soft skills and personality (i.e. being likable). Having a generous attending who gives the highest grades vs a crappy, strict attending who refuses to give honors adds the randomness into the evaluation. That and the problems with rotation sites and quality could hamper clinical learning needed for a good intern year.
 
I don't know much (since I learn what I read from seniors who post here) but I find it interesting that little weight is given to preclinical grades that are usually objective (based on exam performance) and a lot of weight is given to clinical grades that are usually subjective and random (besides shelf exam scores), since evaluations depend more on soft skills and personality (i.e. being likable). Having a generous attending who gives the highest grades vs a crappy, strict attending who refuses to give honors adds the randomness into the evaluation. That and the problems with rotation sites and quality could hamper clinical learning needed for a good intern year.

Is medicine pretty much a personality contest? Discouraging.
 
I don't know much (since I learn what I read from seniors who post here) but I find it interesting that little weight is given to preclinical grades that are usually objective (based on exam performance) and a lot of weight is given to clinical grades that are usually subjective and random (besides shelf exam scores), since evaluations depend more on soft skills and personality (i.e. being likable). Having a generous attending who gives the highest grades vs a crappy, strict attending who refuses to give honors adds the randomness into the evaluation. That and the problems with rotation sites and quality could hamper clinical learning needed for a good intern year.

Most schools weight the shelf as a decent portion of the clinical grade. As for the subjective portion of the grade, unfortunately that's all we have for judging your performance on the wards. Yes, different attendings may be more lenient or strict with grading, but it seems unlikely you would get only the most strict or only the most lenient attendings across every rotation. Also, we need some sort of system for identifying problems with students that lie outside of "amount of medical knowledge possessed". You need skills in communicating with patients, families, and other members of the healthcare team. You need to be organized and complete patient care tasks in a reasonable amount of time. The rest of the team needs to be able to trust that given an assignment, you will complete that assignment in the way it was assigned and not just make up your own way of doing things. I can't assess that you know any of these things by looking at test results concerning calculation of electrochemical gradients across a giant squid axon.

Bottom line, evaluations for promotion in almost every profession (not just medicine) are mostly or entirely subjective. This is not a good thing, but it's also not as bad a thing as you might think.
 
Some measurement being "subjective" does not necessarily make it bad or worthless. Medicine is a service profession in addition to being one in which you are constantly working on a team of physicians or other health professionals. The "soft" qualities can be more relevant to your performance than knowing 5% more about biochemistry pathways than the next guy.

Furthermore, Step 1 is a very significant part of the residency application process and many already bemoan how much emphasis is placed on it, and that is definitely a test of knowledge, memorization, and basic science and physiology skills you presumably developed in the pre clinical years.

I think it's an exaggeration to say that all clinical evaluations are therefore "random" or that all bad evaluations are the result of a malignant attending.

Premeds and some med students seem to have an almost mystical reverence for "meritocracy" but in the real world where people have to interact, work, and cooperate with one another there are more important things than flash card knowledge.
 
I don't know much (since I learn what I read from seniors who post here) but I find it interesting that little weight is given to preclinical grades that are usually objective (based on exam performance) and a lot of weight is given to clinical grades that are usually subjective and random (besides shelf exam scores), since evaluations depend more on soft skills and personality (i.e. being likable). Having a generous attending who gives the highest grades vs a crappy, strict attending who refuses to give honors adds the randomness into the evaluation. That and the problems with rotation sites and quality could hamper clinical learning needed for a good intern year.
Another thing that should be taken into consideration is the MSPE will have the histogram of grade distributions from your rotations. So it will have how often "generous attendings" give out honors for your school so the PDs have some context in terms of is everyone getting Honors or is everyone LP and where you stand in the rest of the class.
 
Most schools weight the shelf as a decent portion of the clinical grade. As for the subjective portion of the grade, unfortunately that's all we have for judging your performance on the wards. Yes, different attendings may be more lenient or strict with grading, but it seems unlikely you would get only the most strict or only the most lenient attendings across every rotation. Also, we need some sort of system for identifying problems with students that lie outside of "amount of medical knowledge possessed". You need skills in communicating with patients, families, and other members of the healthcare team. You need to be organized and complete patient care tasks in a reasonable amount of time. The rest of the team needs to be able to trust that given an assignment, you will complete that assignment in the way it was assigned and not just make up your own way of doing things. I can't assess that you know any of these things by looking at test results concerning calculation of electrochemical gradients across a giant squid axon.

Bottom line, evaluations for promotion in almost every profession (not just medicine) are mostly or entirely subjective. This is not a good thing, but it's also not as bad a thing as you might think.

Ok thanks! This makes sense especially comsidering residency, fellowship and jobs all involve evaluation in some way. Soft skills are certainly important, but I guess it's worrisome to be paired with a malignant attending who has a major impact on my future, especially if that attending is in the specialty I would like to pursue.

Another thing that should be taken into consideration is the MSPE will have the histogram of grade distributions from your rotations. So it will have how often "generous attendings" give out honors for your school so the PDs have some context in terms of is everyone getting Honors or is everyone LP and where you stand in the rest of the class.

Ah that's interesting to know. Although a drawback is the MSPE could also include negative evaluations from critical attendings without your knowledge, thus having a similar devastating impact like a bad letter.
 
I would have tried to have tougher skin, received more support from my closer knit circles, and worked my absolute hardest to achieve AOA and would have done some research between years 1&2. I also would have seriously considered living at home under the roof of my parents. Went home for a rotation closer to their place and while it seemed like I was getting less done with them always bugging me they helped me a lot emotionally I actually honored my first shelf and it wasn't even close.

I would have focused less on class material and more on boards from Day 1. Also, I would have done research starting in the first semester. I'm realizing now that my 90+ % exam average means nothing since I go to a true P/F school.

Tell myself to bust my a$$ first year instead of being satisfied with being average. Not saying I didn't work, but I could have put a lot more hours in first year and focused more on having a "balanced life" than I probably should have. I expected myself to do much better second year than I did, and wish I would have had more cushion going into second year. Even more important, I wish I'd gotten used to putting in more time on a daily basis and developed a consistent study plan. Changing things up depending on the system worked fine first year, but it really hurt me during second year.

These really caught my attention. This stuff about going hard and gunning for AOA and jumping into research ASAP in the first semester is a little worrisome. Like would you guys really be more satisfied with your lives if you had done that? Were the benefits of a better social life / balanced lifestyle not worth it in the end?

The mindset I'm coming from is that I'd be telling first semester premeds to slow it down a bit.
 
Just FYI, when I review residency applications, I don't particularly care about your first and second year grades. I mean I want to see you didn't fail your classes, but that's about it. Your clerkship grades, on the other hand, matter a great deal.

So as someone who reviews residency apps, what about the clinical grade matters the most? Shelf scores or the attendings evals? I ask because my school's clinical grades are based 100% on your shelf score (Honors determined by where your national percentile is). So at my school you could get horrible comments from attendings and still honor everything or you could get exceptional reviews from your attendings and never honor a single course. It makes the system much more objective, but our clinical grades are essentially worthless if you're looking at them trying to see what an applicant's clinical skills are...

These really caught my attention. This stuff about going hard and gunning for AOA and jumping into research ASAP in the first semester is a little worrisome. Like would you guys really be more satisfied with your lives if you had done that? Were the benefits of a better social life / balanced lifestyle not worth it in the end?

The mindset I'm coming from is that I'd be telling first semester premeds to slow it down a bit.

I think it's important to work hard, if for no other reason to prepare yourself for boards and keep your options open. Research can be really important for some fields, but generally speaking, Idk how much research during the first two years actually helps unless you're really serious about it and get some solid pubs unless it ends up being in a field you plan on applying to (shows interest). I think having some balance and outside life is essential, it's what keeps you sane when things get really stressful. At the same time, most people who've been through it will tell you it's worth busting your butt if you end up matching the field you want. The people that end up forced into a less competitive specialty because they didn't work hard enough will tell you how much they wish they worked harder and how the next 30 years of doing something they don't want wasn't worth taking 2-3 years of med school easy. It's a balance, you just have to figure out what the right work/life balance is for you as an individual.
 
I don't know much (since I learn what I read from seniors who post here) but I find it interesting that little weight is given to preclinical grades that are usually objective (based on exam performance) and a lot of weight is given to clinical grades that are usually subjective and random (besides shelf exam scores), since evaluations depend more on soft skills and personality (i.e. being likable). Having a generous attending who gives the highest grades vs a crappy, strict attending who refuses to give honors adds the randomness into the evaluation. That and the problems with rotation sites and quality could hamper clinical learning needed for a good intern year.


I also find it interesting how everyone says Year 1/2 grades don't matter (I'm guilty as well), but honoring those years gets you AOA which is a huge deal in competitive specialties. It also makes half of your class rank which is also a very important factor.
 
These really caught my attention. This stuff about going hard and gunning for AOA and jumping into research ASAP in the first semester is a little worrisome. Like would you guys really be more satisfied with your lives if you had done that? Were the benefits of a better social life / balanced lifestyle not worth it in the end?

The mindset I'm coming from is that I'd be telling first semester premeds to slow it down a bit.

Well...keep in mind I'm on the cusp of applying and doing things like CV writing so there's inherent stress there. Perhaps if I get my dream match, I'll preach the opposite so guilty as charged there for that. That being said, it's not like I'm advising people to not branch out but I think it's more important to preserve the relationships you do have than try to invest a great deal in students who were just like me (resume builders, delayed gratifiers). I have definitely made my share of friends, but definitely came in too idealistic about the "lifelong friends" I'd make and I do envy those who were level headed enough to come right in laser-focused and view medical school as simply a stepping stone to a good residency.
 
I don't know much (since I learn what I read from seniors who post here) but I find it interesting that little weight is given to preclinical grades that are usually objective (based on exam performance) and a lot of weight is given to clinical grades that are usually subjective and random (besides shelf exam scores), since evaluations depend more on soft skills and personality (i.e. being likable). Having a generous attending who gives the highest grades vs a crappy, strict attending who refuses to give honors adds the randomness into the evaluation. That and the problems with rotation sites and quality could hamper clinical learning needed for a good intern year.
Preclinical grades matter to the extent that they comprise your class rank (for some schools, very little to none and for others more significant). But the grades in and of themselves, to my understanding, don't matter a whole lot because schools have different systems and Step is a more objective and standardized measure of preclinical knowledge.
 
I would have focused less on class material and more on boards from Day 1. Also, I would have done research starting in the first semester. I'm realizing now that my 90+ % exam average means nothing since I go to a true P/F school.
Uh, aren't you a first year?
 
These really caught my attention. This stuff about going hard and gunning for AOA and jumping into research ASAP in the first semester is a little worrisome. Like would you guys really be more satisfied with your lives if you had done that? Were the benefits of a better social life / balanced lifestyle not worth it in the end?

The mindset I'm coming from is that I'd be telling first semester premeds to slow it down a bit.
For what it's worth, I have what I consider a very balanced life, I don't feel like I'm sacrificing my future at all, and I am very happy. You can definitely put in good work towards your future without devoting your entire self to medical school 24/7. I work hard and do well in school and I have a good amount of research under my belt so far, but I also have a great social life and enjoy spending time with medical school friends outside of class.
 
Shouldn't you be getting good first year grades to set yourself up for STEP success?
 
>implying I had a social life

You're making the mistake of assuming that I gave up gunning for socializing. I have no friends. I gunned hard from day 1, but my efforts were misplaced. Instead of spending 16 hour day in the library studying for true pass/fail classes , I could have been doing research or memorizing high-yield board material. Instead I spent inordinate amounts of time memorizing my professors' worthless minutia that will never even show up on boards. I have nothing to show for it. The kids who averaged 80% have the same "P" on their transcripts as me, even though I averaged in the 90's. So no, I would never advise a premed to "take it slow" at first. I would tell them to come in guns blazing but to make sure that they have their priorities in order. I'm just thankful that I woke up when I did. At least I can salvage the last couple months of M1.

Question just for my own curiosity - do you ever wish you went to a traditionally graded school (disregarding the real-life circumstances/options you had when you picked your school)?
 
So as someone who reviews residency apps, what about the clinical grade matters the most? Shelf scores or the attendings evals? I ask because my school's clinical grades are based 100% on your shelf score (Honors determined by where your national percentile is). So at my school you could get horrible comments from attendings and still honor everything or you could get exceptional reviews from your attendings and never honor a single course. It makes the system much more objective, but our clinical grades are essentially worthless if you're looking at them trying to see what an applicant's clinical skills are...

Each school has a different system for grading. Before I can determine what your grades mean, I have to look at a couple things in your ERAS. First, I read any included blurbs provided by your school about how their grading scheme works. Second, I look at the included histogram of grade distributions in your class. I will know for each clerkship if only 5% of people get honors, or if 50% of people do. This is the most helpful part for me in terms of comparing candidates from different schools.

How much do comments from attendings matter? Depends on what they say. Most comments range from saying positive things to saying extremely positive things, so the comments really only give me any information if they are negative comments. That said, one negative comment won't sink your boat, as I understand you may every so often encounter an attending you don't mesh with. If your comments across multiple rotations point out the same deficiency though, then we may have a problem.

It's the things that set you apart from the pack, either positively or negatively, that will matter most in your app. For you specifically it sounds like the shelf grades will be most important, since they will determine your clerkship grades.
 
Shouldn't you be getting good first year grades to set yourself up for STEP success?
Some people find class lectures and exams to not be relevant to Step, and they focus on supplemental "high yield" studying. I'm of the opinion that if you study hard and do well for class, you don't have to work quite as hard for the supplemental stuff and you may get some more obscure questions right.
 
Each school has a different system for grading. Before I can determine what your grades mean, I have to look at a couple things in your ERAS. First, I read any included blurbs provided by your school about how their grading scheme works. Second, I look at the included histogram of grade distributions in your class. I will know for each clerkship if only 5% of people get honors, or if 50% of people do. This is the most helpful part for me in terms of comparing candidates from different schools.

How much do comments from attendings matter? Depends on what they say. Most comments range from saying positive things to saying extremely positive things, so the comments really only give me any information if they are negative comments. That said, one negative comment won't sink your boat, as I understand you may every so often encounter an attending you don't mesh with. If your comments across multiple rotations point out the same deficiency though, then we may have a problem.

It's the things that set you apart from the pack, either positively or negatively, that will matter most in your app. For you specifically it sounds like the shelf grades will be most important, since they will determine your clerkship grades.
Does this mean a student could do better by going to a school where they're the "big fish in a small pond?"
 
Does this mean a student could do better by going to a school where they're the "big fish in a small pond?"

As I said, anything that sets you apart from the pack. Going to a top-tier med school can also be a thing that sets you apart from the pack. Some admissions people may care about this, especially PDs who want to show that they draw residents from the best schools. I personally care most about clerkship grades, step scores and you convincing me during the interview that you are not the latest incarnation of HAL 9000.

Don't assume you will automatically get better grades going to a lower-tier med school. Several of these big name schools seem to have massive grade inflation, such that even with a grade distribution I can't really tell who is doing well. If 90% of your class got high pass or honors in a rotation, then all I really know is the people who "just passed" are the bottom 10% of the class. A person in the 60th percentile at one of these schools might be honors, while the same person at a school without grade inflation could be a pass. The main problem comes when trying to compare two honors candidates from a school with grade inflation. How do I know who is 60th percentile and who is 90th percentile? I can't know for sure, so that's a potential advantage to Mr. 60th percentile that he wouldn't have if he had gone to the school with no grade inflation.
 
Each school has a different system for grading. Before I can determine what your grades mean, I have to look at a couple things in your ERAS. First, I read any included blurbs provided by your school about how their grading scheme works. Second, I look at the included histogram of grade distributions in your class. I will know for each clerkship if only 5% of people get honors, or if 50% of people do. This is the most helpful part for me in terms of comparing candidates from different schools.

How much do comments from attendings matter? Depends on what they say. Most comments range from saying positive things to saying extremely positive things, so the comments really only give me any information if they are negative comments. That said, one negative comment won't sink your boat, as I understand you may every so often encounter an attending you don't mesh with. If your comments across multiple rotations point out the same deficiency though, then we may have a problem.

It's the things that set you apart from the pack, either positively or negatively, that will matter most in your app. For you specifically it sounds like the shelf grades will be most important, since they will determine your clerkship grades.

That's about what I thought. So my school determines honors based on your percentile compared to everyone who takes the shelf (in the country). The percentiles aren't exact, but basically below the 5th percentile nationally is a fail, and above the 75th-80th percentile nationally is honors (everything else is pass). In this case would you go so far as to look at the actual score/percentile someone got on a shelf or would you just look at H/P/F? It's kind of interesting because it means on some shelf exams a large portion of our class may get honors while almost no one may honor another exam. So for a candidate coming from a school like this, would you weigh the clinical grades more than someone coming from a school with significant grade inflation for clinical grades? Would attending comments hold less weight for me or just get glossed over since they're not part of the clinical grade? I'm curious because I've got pretty decent/average clinical grades but have been getting very strong attending comments overall and I'd like to think they'll actually count for something.
 
That's about what I thought. So my school determines honors based on your percentile compared to everyone who takes the shelf (in the country). The percentiles aren't exact, but basically below the 5th percentile nationally is a fail, and above the 75th-80th percentile nationally is honors (everything else is pass). In this case would you go so far as to look at the actual score/percentile someone got on a shelf or would you just look at H/P/F? It's kind of interesting because it means on some shelf exams a large portion of our class may get honors while almost no one may honor another exam. So for a candidate coming from a school like this, would you weigh the clinical grades more than someone coming from a school with significant grade inflation for clinical grades? Would attending comments hold less weight for me or just get glossed over since they're not part of the clinical grade? I'm curious because I've got pretty decent/average clinical grades but have been getting very strong attending comments overall and I'd like to think they'll actually count for something.

I can't always see shelf grades. It's not a routine thing that's reported. Sometimes the comments on each rotation will include the shelf score for that rotation, but this is not standard. I can always see your whole transcript, your USMLE scores, your LORs, Dean's letter, personal statement and any other data you put into ERAS yourself (research, volunteering, languages you speak, etc.).

I can see the total grade breakdown for each school, so grade inflation doesn't hurt as much for comparison between schools so much as it does for people within the same school (see the scenario I mentioned in my last post). It sounds like at your school there will not be much inflation (very unlikely that a big portion of the class is getting 80th percentile or better on the shelf). In this case getting an honors shows off your medical knowledge in that specialty. As I mentioned above, most attending comments are positive ones or "very strong" as you put it. These will be unlikely to make you stand out. They will certainly be better to have than consistently lukewarm or negative comments though, so they do "count for something".
 
>implying I had a social life

You're making the mistake of assuming that I gave up gunning for socializing. I have no friends. I gunned hard from day 1, but my efforts were misplaced. Instead of spending 16 hour day in the library studying for true pass/fail classes , I could have been doing research or memorizing high-yield board material. Instead I spent inordinate amounts of time memorizing my professors' worthless minutia that will never even show up on boards. I have nothing to show for it. The kids who averaged 80% have the same "P" on their transcripts as me, even though I averaged in the 90's. So no, I would never advise a premed to "take it slow" at first. I would tell them to come in guns blazing but to make sure that they have their priorities in order. I'm just thankful that I woke up when I did. At least I can salvage the last couple months of M1.

Does your school do AOA from clerkship grades only?

Are you now going for pass and focusing more on board material?


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Why is everyone so mad that the clinical years are more important than the pre-clinical?

You're going into a clinical profession, not to show off exactly how many details you memorized about some barely-needed knowledge. There's a limit to how important the pre-clinical side is, and it's pretty obvious why clinical would be more important...
 
Why is everyone so mad that the clinical years are more important than the pre-clinical?

You're going into a clinical profession, not to show off exactly how many details you memorized about some barely-needed knowledge. There's a limit to how important the pre-clinical side is, and it's pretty obvious why clinical would be more important...
And it's not as if Step scores don't matter just because your school is P/F preclinical.
 
Yes, I am...What's your point though? The fact of the matter is that I could have been more productive with my time. I don't subscribe to the school of thought that says you should wait until M2 to study for boards.

Yes, in hindsight, I think I would have been a better fit for a a traditionally graded school. I should have been among fellow gunners instead of "P=MD" types...I would have worked just as hard, but I would have had A's to show for it. I console myself with the thought that the students who just skated by will be in a for a rude awakening when the time comes to study for boards. I read a lot of Step 1 experience reports, and one thing I have noticed is that the elite scorers always tend to say the same thing: there is no substitute for working hard in your classes for the first two years...whether that is true remains to be seen

Yep. Preclinical grades count for literally nothing. Ranking, AOA, graduating with honors are all based on clerkship grades. I resent this system.

You should ideally be just learning the material well and reviewing...studying comprehensive Step material seems like a waste of time because you don't have the M2 knowledge necessary- at least that's my understanding.

Bold #1: Who cares? Why do you need some tangible reward for hard work?

Bold #2: Why? You wanted to be a clinician, right?
 
I would have utilized the pomodoro technique for studying day 1 and also stopped attending lectures earlier on. If you're the type that can't sit in a chair and focus for longer than an hour, do yourself a favor and don't go to lecture. Please. You'll make a lot of free time for yourself only listening to the lecture once.
 
Probably would not have gone. See where else life would have taken me
 
So would you guys advise studying materials such as First Aid alongside lecture material during M1 year? I'll be starting this July, and it would be great to have a little bit of a step up when the boards come, but I also don't want to lose my mind over studying early on. How much of the material will I really retain by starting that early?


Also, why was this thread moved to the premedical forum?
 
So would you guys advise studying materials such as First Aid alongside lecture material during M1 year? I'll be starting this July, and it would be great to have a little bit of a step up when the boards come, but I also don't want to lose my mind over studying early on. How much of the material will I really retain by starting that early?


Also, why was this thread moved to the premedical forum?

You'll get different answers from different people and for different curricula. It's a good thing to look at before exams if you have time - has a nice review of various things. I would not at all make it your priority until M2.
 
I would love to go back and do it all over again, but doubt I'd do much different. Would just love to go back and re-learn all that stuff, but with the clinical perspective I have know several years later. Hypothetically, if I could make my current salary doing it, I'd absolutely, 100% go back and repeat all 4 years of medical school.
 
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