At the beginning of the year, everyone knows it will be tough and the that not everyone will be in the top 5% of the class, etc, etc, but no one really believes it individually for themselves. That's what they said in college, too, right? and hey, you all aced the MCAT and made awesome grades while having enough extracurricular activities to run a small country. maybe I'll make a B or two, but I won't REALLY have a hard time. Maybe the guy next to me will. yeah, I mean, who ever heard of his XYZ University anyway?
Then you don't do well on the first exam, and think this is just a fluke, surely I'll ace everything from here on out. It's only normal to have an adjustment period (which it is). I mean, new school, new friends, new city...it's tough!
Then you get the second exam, and your grade still sucks. And your self-esteem starts to plummet (along with everyone else's). People start getting bitter about school...all the lecturers suck, dissecting sucks, touchy-feely classes suck, debt sucks, non-med school friends suck b/c they have a life, med school friends such b/c all they talk about is med school. I'd say this is when many relationships in med school fall apart or solidify. Your significant other either becomes a savior or just another burden on top of the med school pile to deal with.
Then sometime between the second and third exam, you just learn to deal with it. Somehow or another, you magically become more efficient at studying. You learn what's worth spending time on, and what's not. Some stuff actually starts seeming interesting, and your grades will probably go up for several reasons. Not the least of which is the motivation you get from upcoming winter break.
Then second semester is a breeze comparitively. I think it's usually more work, but you don't have anatomy to deal with at most schools, and you just know how the system works. Plus you're not dealing with making friends, adjusting, etc. Then there's summer when everyone goes off doing something interesting, and it least in my class, everyone gets engaged!
Second year is so much better IMO. Much more interesting, little adjustment to make. Definitely more work, but it's doable.