miranda, you might not get a response out of Shinken since he last posted to this thread 9 months ago, but I'll do my best.
These are good questions. They're hard to answer because being in the thick of medical school is so different from being a pre-med, and it's hard to make yourself think like your self of 4 years ago.
I think medical school has actually matched my expectations pretty well. I had read SDN a lot, and had heard the most commonly cited high and low points about medical school. By and large, medical school has matched the impression I had. There haven't really been any big surprises. (Except, perhaps, the degree to which they
push liberalism on us, but whether that will bother you depends on your philosphical views.) What hasn't matched my expectations is how I would feel about all of it, how much I would feel like buckling down and working really hard. Why that is is hard to explain.
I had kind of thought I'd enjoy it in a masochistic sort of way. I prepared for the MCAT entirely by independent study, and did well. So I thought I'd do OK in my school's curriculum, which relies heavily on independent study, is strictly pass/fail, and has infrequent exams. The problem is that, at the beginning of a block, with the exam 12 weeks away, it was just just too tempting to spend my afternoon playing video games or surfing the internet. Getting to the point where the exam was just around the corner would put the fear of God in me, and I'd spend the last couple of weeks of the block trying to catch up, which usually proved unsatisfactory as you may predict.
If I was sufficiently motivated to study and get A's in my post-bacc program, and study independently to do well on the MCAT, why did I revert to being such a procrastinator in medical school? Well, I could cite several reasons. One could point out that when I was a pre-med, everything I was doing was geared toward the concrete, relatively short-term goal of getting into medical school, and once I did that, my subconscious mind said "mission accomplished!" I felt like I had hit the World Series-winning grand-slam home run and could sit on the bench for the rest of the game basking in my heroism, when in reality all I'd done is make the team as a rookie at the beginning of the season. I just wasn't mentally prepared to keep working hard.
Also, something I've just recently learned about myself and begun to correct is that I've tended to place way too much emphasis on seeking validation from women. This might seem off-topic, but it's been a very significant factor in my life. As I mentioned, I thought being able to truthfully state that I was going to be a doctor would make women like me. When it didn't, that only made me frustrated and resentful, thus making me even less attractive to women, resulting in even more despair over being a failure with women, resulting in even more frustration and resentment... It might sound ridiculous, but I can't tell you how many times during the past 2 years I sat down to crack open a textbook, found myself unable to concentrate after about 30 seconds of reading, and muttered to myself "if only girls' eyes would light up every time I entered a room like I thought they would, I'd be able to blaze through this stuff and learn it like the back of my hand in no time."
I think it's sloppy thinking when people give lists of reasons without being able to unify them, though, so whenever I'm analyzing something I like to give one definitive reason. And in this case, while the above two factors are relevant, I'd have to say the biggest reason is just that I was unprepared for how it would feel to have more work than one can possibly do. Everyone says medical school is like trying to drink from a fire hose, and it's easy to think "oh, I know it will be hard, but I'll just do the best I can and not worry about it," but you don't have a feel for how hard it really is until you get there. When I did my post-bacc, I took bio, physics, and organic chemistry all at the same time, and while that's considered a hard workload, I had time to to EVERYTHING I thought I was supposed to. I could read every assigned chapter in the biology textbook, make flashcards and go over them enough to remember every bolded term, type up my lecture notes, read every assigned chapter in the organic chemistry textbook, do all the assigned exercises, make flashcards and go over them enough to remember every reaction, do all the assigned physics problems and learn how to use every formula. I felt I was fully prepared for the tests and had learned everything I was supposed to.
In medical school, however, it's literally impossible to do that. Our first day of year 1, the first lecturer of the day said, "right now is the last moment of your life when you'll be caught up." That has been proven true in more ways than I could appreciate at the time. Imagine it's your first day of class. At my school we only have class in the mornings, so we get out at noon and theoretically have the entire afternoon and evening to study. So you have some lunch and sit down with your books. You start the first assigned reading for that day--20 pages of, say, a genetics textbook. The material is dense and dry and unfamiliar to you, and you soon realize that if you want to understand it it takes several minutes to read one page. You also realize that even if you understand it now, you're never going to retain it for the test that's 12 weeks away unless you reinforce it by some other means, say, making flashcards. But if you made a flashcard for every bolded term in the reading, it would probably take you an hour or two, and that's just for one of several assigned readings for one day! Meanwhile, you've got 2 or 3 other, similarly dense assigned readings for that day, plus you're scheduled to start gross anatomy tomorrow and are supposed to read a lab guide and/or a few dozen pages of your anatomy text. Also, your physical diagnosis course starts this week, so you're supposed to read a chapter of your physical diagnosis textbook and memorize all the little steps of taking the HPI because you'll be expected to do it on a standardize patient. That session, by the way, will take up one of your evenings later that week, which then won't be available for study time. So you've got that hanging over your head--and tomorrow, you're going to get a handful of new assigned readings, which, similarly, there is no way to realistically complete.
You've heard that medical school is like drinking from a fire hose, so you figure you'll just sort out the important points from the unimportant details. But how are you supposed to do that? Maybe at some schools, where they give you prepared lecture notes and a syllabus, those can provide some clue, but we don't get them at my school. Just reading the text, you have no idea what's important and what can be disregarded. Yet you know that to learn everything would be impossible. Furthermore, when you have your PBL sessions, or they send you into the hospital for some early clinical experience, many of your classmates talk and answer questions as though they really know their stuff, as though they somehow
were able to distill the important points from the readings and ignore the irrelevant details. (I've never really sought advice on this from my classmates, which was probably a huge mistake, but to this day I have no idea how they did it.) And you know that every day is going to be like this, 5 days a week for the next 12 weeks, at the end of which you'll have to take a test on everything you're supposed to learn.
I hope you can see that for me, anyway, it was easy to quickly fall into despair and think "what's the point in trying? I can't do all this, I don't even know where to start" and just start surfing the internet or playing a computer game.
That's my best explanation of why I've been so unhappy and haven't learned as much as I should have. I think I wouldn't have been so miserable if I had done this straight out of college; I've often thought of the fact that right now I could be 2 years into private practice as an anesthesiologist making $300k a year, either married with a family or with spare time to pursue my other interests. From where I am now, knowing that I won't be there until I'm 40, I think I would have been happier financing the pursuit of my other interests by some other means, one that didn't require such a colossal committment.
I think the reason for the disparity of opinions is just that some people are truly interested in it and some aren't. Everyone's interests are different. Some people are math and science geeks, some people are creative arts geeks. The people who are truly happy in medicine are those who are just innately, really interested in biomedical science, for whom that's their true passion. My true passion is writing, and anything that detracts from my ability to spend time writing I tend to view as a chore. When I think about practicing medicine full-time for the rest of my life I recall the apocryphal Thoreau quotation, "Most men lead lives of quiet desperation and go to the grave with the song still in them." I imagine myself in the midst of a busy day, trying to explain some patient's diagnosis to him, with this nagging thought in the back of my mind about having a novel at the top of the New York Times bestseller list, and living a life filled with regret.
) It helped that I wasn't yet pre-med during undergrad, I think. I wouldn't have taken half the courses I took "for fun" or as a challenge had I been neurotically worried about my grades.. my GPA probably would've been higher without those courses sure, but I think I'd have an entirely different attitude right now. 
