Hi!

I'm sorry to hear that you guys are having a tough year. It can be really difficult for them, especially if they've never really been challenged. I'm glad you have worked out some time together. We found that dinner time was great for catching up. We'd try to cook at home and eat at the table at least once or twice a week, and we would try to have a date night once a week. It might freak him out a little at first to think of giving up a whopping four hours a week
😉 but it's definitely worth it for both of you.
Since he probably didn't have to study as much in undergrad, he probably never really developed the study skills that he needs to do well in medical school. What my husband would do is plan his studying before he actually sat down with the book. He would decide "I'll get through this chapter, then have a 20 minute break" or "I'll study between 4:00 and 6:00, then be done for the night." Things like that really helped because there was a definite end point, and after that he didn't have to feel stressed or guilty for not studying. Studying isn't something like writing a paper, where it's obvious that you're "Done", so it's kind of hard for students to stop. They think that more is better, but after awhile, there are sharply diminishing returns. If they focus for a set number of hours (with short breaks in between) and know that's all they have, they do better than when they just try to study constantly. A time management or study skills book might help him learn some better study methods.
This is a difficult time for him, and he will need your support and patience. But it is equally important that he treat you with love and respect as well. The next 8 years will be as tough for you as for him, just in a different way, and you will need him to be there for you. He's fulfilling his dream, but you're "suffering the consequences" of it.

It will be an adventure, and it can be fun if he is willing to make you a part of it.