by Cydney Foote
What to Expect During Medical School
As an incoming medical school student, you’re about to embark on four years of learning, working, and socializing – and then learning and working some more. The best way to prepare yourself for the long road ahead is to know what to expect.
In this post, we walk you through the various avenues of medical school education, from what and how you’ll learn to making time for your health and personal growth.
Curriculum Styles
When researching medical schools, you probably noticed that each one emphasizes different styles of teaching and that some schools offer more than one approach. Here are some of the different curriculum styles you might encounter:
- Traditional curriculum: Students learn about healthy normal anatomy and physiology in the first year and pathology and disease processes in the second year.
- Systems-based curriculum: Students learn about one organ system (e.g., neurological, musculoskeletal, cardiovascular) at a time, studying both the normal and abnormal aspects of the system. After finishing one organ system, they move on to the next.
- Problem-based curriculum: In this integrated approach, students learn about a variety of systems in the context of a single patient. Multiple systems might be involved (e.g., both the cardiovascular and renal systems), so students study the effects the systems have on one another. Some educators feel this is a more relevant and practical way to learn, while others have concerns that students might become overwhelmed or miss vital information.
Many schools use a blend of these methods, and almost all schools expose students to problem-based learning at some point during their four years. Regardless of the style your school emphasizes, however, it will typically monitor your ability to retain and use the knowledge in a practical (e.g., case-based) context.
Learning Opportunities
Do you prefer studying in a group or on your own? If you don’t know what your personal learning style is yet, now is a great time to figure that out. If you tend to be a visual or tactile learner, labs and hands-on situations should work well for you. If you’re more of a kinesthetic learner, time spent on hospital rounds will be a great way to reinforce concepts. If you’re an auditory learner, you should focus on lectures.
At some schools, lectures are mandatory, while at others, only small group classes and labs are mandatory. If you tend to tune out and fall asleep during lectures, you might choose to spend some of this time studying instead. However, don’t assume that all lectures are boring. Also, professors usually want their students to do well and will often drop hints as to what will be on exams. More importantly, you’ll have the chance to ask clarifying questions and hear what other students are struggling with. And when another student poses a question you had, it can reassure you that you’re not alone in your confusion.
Note-Taking and Sharing Services
Some medical schools organize a note-taking service in which students alternate taking detailed notes on lectures and sharing their notes with everyone else. The benefit of this system is that you can relax in lecture if you are not the assigned note-taker that day, knowing that everything will be written down and provided to you later. And if you’re sick or need to skip a lecture, you’ll still have the information that was covered in class. The drawback of having designated note-takers is that if they are not paying attention or don’t do a good job, they – and therefore you – might miss something important.
At some schools, professors send students their lecture notes before class, so students can read along from the notes while they listen. This removes the need for note-taking and might tempt you to skip class, but you would miss hearing your fellow students’ questions (and more importantly, the answers).
Some days, you might benefit more from being in class than others. Use your time wisely.
Developing Your Bedside Manner
You’ll learn a variety of ways of making patients feel comfortable, ranging from chatty humor and small talk to a simple squeeze of the hand or a kind smile. Attendings, residents, nurses, hospital techs, and, of course, the patients themselves will all have something to teach you. In the end, you’ll pick and choose the styles and methods that work best for you.
Your approach will vary from patient to patient, depending on their unique concerns, emotional state, and medical condition. Experiment with different ways of connecting and providing comfort, and you’ll eventually formulate your personal bedside manner.
Interacting with Patients
Medical students start by learning to take a complete patient history and review of systems, then progress to the physical exam. The first few times you interact with patients can be a little scary, so many schools will ease you into this by having actors pose as patients. Other schools rely on more-experienced patients who enjoy working with students. Many patients enjoy helping teach students and take great pride in contributing to their medical education. Their main goal is to help make you a better doctor. Let them show you how to make things more comfortable, and you’ll both come away feeling a positive connection
Want to hear what medical school is like from actual med students?
Check out our What Is Medical School Like? posts!
Personal Growth
Medical school is not only about the time you spend in class. It also involves total immersion in the medical culture. Your classmates become your tribe as you share jokes and trivia that only you can understand. You’ll find yourself talking about medicine all the time, especially during meals (even cadaver talk!). As a result, you’ll develop meaningful friendships with your classmates, which could continue for years to come. However, your family and friends outside of medical school might not understand the all-encompassing nature of your studies.
If someone close to you becomes frustrated with your inability to spend time with them, try to set aside regular times for a phone call or meal. Be sure to ask about their life, too. If you have a partner who is not in medicine, you need to take extra steps to ensure that they feel like a part of your world. Introduce them to your classmates, bring them to social activities, and take a break from talking about medicine whenever you’re together.
On the other hand, many doctor-doctor marriages have origins in medical school. For some, this is an ideal situation, because your partner will understand what you are going through and why you need time to study. For others, having a relationship with a non-physician feels healthier. Either way, if a relationship is to flourish during medical school, you must invest time and effort into it.
Taking Care of Your Health
Med students tend to imagine that they’re exhibiting signs of every disease they’re studying. Although you should never ignore concerning symptoms, when you think you might be dying from a rare condition, do a reality check. If you’re convinced that something is wrong, visit student health. They’re used to students presenting with a variety of med school–induced symptoms and will do their best to educate and reassure you if that is all that is needed.
On the other hand, medical students can experience all the same ailments that patients suffer from. They’re also prone to anxiety, depression, and stress-induced conditions. If you receive an unwelcome diagnosis, be open and honest about it with your professors. Medical leaves are not unheard of in medical school and can make all the difference in your ability to perform at your best as a student. You must take care of yourself so you can care safely for others.
Deciding on a Specialty
What kind of doctor do you want to be? At some point in medical school, that question starts to take on more weight. Now is the time to engage in some serious introspection and determine what your passions are, where your skills lie, and who you see yourself as in the future. Consider asking yourself the following questions:
- Do you see yourself in primary care? If so, will it be pediatrics, family medicine, internal medicine, or ob-gyn?
- Do you imagine yourself subspecializing in a particular area, such as neurology, cardiology, gastroenterology, or one of dozens of other options?
- Do you like doing procedures? Do you want a medical specialty that involves a lot of procedures, or a pure surgical specialty? Or maybe you would like a procedure-based specialty, such as interventional radiology or interventional cardiology?
There’s also anesthesia, dermatology, emergency medicine, radiology, ophthalmology, pathology, and psychiatry to think about (and all their subspecialties). In addition, there are combo-residencies for those who cannot choose one (internal medicine–pediatrics and family medicine–psychiatry). You’ll find residencies and fellowships in preventive medicine, rehab medicine, occupational medicine, pain medicine, and other areas, too. The AAMC website offers a complete list.
So how do you choose? First, consider which clerkships you enjoyed most. Did you like them because of the people you worked with or because of the work itself? This can sometimes be difficult to discern, because an energetic and fun-loving chief resident can make you enjoy surgery, while a grumpy or overbearing attending can take the fun out of an otherwise fascinating rotation.
A useful tool for narrowing down your specialty choice is journaling. Take just five minutes a day to record your impressions as you progress through rotations, and you might see patterns emerging that can help you pinpoint your preferences. And even the most hastily written entries will be invaluable when you begin working on your residency application.
If you’re seriously considering a specialty, be sure to do a fourth-year rotation in it so you can really understand the work and lifestyle. Stay overnight in the hospital with the residents to see how much time they spend with patients and how much sleep they get. Go to the clinic to observe the patient interactions. Can you envision yourself doing this job day in and day out? Is this a lifestyle you can sustain for the long run?
Applying for Residency
As you approach your final year of medical school, you’ll begin applying for residency training in your chosen specialty. Most specialties use the Electronic Residency Application Service (ERAS) and rely on the National Residency Match Program’s algorithm to connect interested applicants with available programs.
As you did when you applied to medical school, you’ll prepare a personal statement and descriptions of your experiences, and note your regional and practice preferences for your training. Rather than showing your interest in medicine generally and your potential for learning, this time, your application must demonstrate your skills and commitment to your specialty. Resist the urge to recycle your medical school application; you’ll want to emphasize your maturity and preparation for your chosen field.
You’ll also need to submit letters of evaluation. These should come from faculty members who have worked closely with you and can attest to your strengths and readiness for residency. If you feel that an attending has seen you at your best, ask them for a letter as soon as you finish that rotation. Do not wait until application season begins; by then, they will have seen many med students and might not have as strong a memory of you. ERAS allows you to submit and store as many letters as you need, then send certain letters out to each program. You can even continue sending letters out after you have submitted your application, so don’t hesitate to request a letter from attendings in your fourth-year rotations. These will often be your strongest letters because of the added independence and responsibility you’ll have.
There’s one part of the residency application process you probably haven’t seen before: the Medical Student Performance Evaluation (MSPE). After many schools adopted a P/NP grading system, the MSPE was created as a way of ranking and recommending students without a GPA. According to the AAMC, the MSPE is “a summary letter of evaluation intended to provide residency program directors an honest and objective summary of a student’s salient experiences, attributes, and academic performance.” Applicants are often asked to contribute to their own evaluations, particularly in defining their Noteworthy Characteristics. The MSPE will be required again if you apply to fellowships or other subspecialty programs, so it is essentially a permanent part of your academic record.
In September of your fourth year, you get to start choosing programs. Do you want a program with fellows and subspecialists (which might improve your chances of getting a fellowship in that area)? Or would you prefer to not have fellows competing for cases? Do you like the idea of a large program with many personalities and teaching styles, or a smaller one that acts more like a large extended family? Your USMLE scores and your letters of recommendation will carry significant weight for most residency programs, so be sure to choose residency programs with numbers that match yours. Some applicants apply to two separate specialties, with one meant as a backup if their first choice is highly competitive. Meet with your department chair or another trusted adviser to decide where you will be competitive and can succeed.
The Residency Match Program
After the residency interview season, applicants rank the programs they have applied to, and residencies rank the students they have interviewed. Then, a computer goes through both sets of inputs one by one, matching applicants with the highest school on their list that has open spots. Once Applicant A gets matched to a program on their list (let’s say their second choice), they are removed from consideration for all programs lower on their list, which opens those spots up for other applicants. If Applicant B was matched to Applicant A’s first choice but then gets matched higher on their own list (Applicant B’s), Applicant A’s first choice school will then reopen that spot. In the end, you only find out which one program you are going to, not all the temporary matches that occurred along the way.
Some fourth-year med student couples opt to apply through the couples match. When the lists are computed, the couple is accepted to the highest ranked program on their list that accepted both of them. The drawback is that if one half of a couple is not accepted at a program, the other person might be giving up their chance to go there. The upside is that if you let programs know you are applying as a couple, they might push another department to accept your partner. For example, if the department of surgery really wants one half of a couple, they might encourage the department of internal medicine to accept that person’s partner.
A Year-by-Year Breakdown
Each year of medical school is different, encompassing its own set of challenges and expectations.
First Year
Your first year of med school gives you a deeper understanding of the intricacies of human health and disease. Many schools offer their gross anatomy cadaver dissection this year. You might also take courses in genetics, microbiology, histology, microanatomy, pathology, and physiology. Most medical schools give first-year students an opportunity to begin seeing patients and learning the basics of the medical history and physical exam.
Many medical students find the first year intensely challenging, while others see it as a more human-focused repetition of what they learned in undergrad. For most, it is a rollercoaster of information and nonstop experiences. Like a toddler exploring the world for the first time, you might shift between feeling excited and scared. Bonding with your classmates over your shared feelings can be extremely therapeutic and reassuring.
Summer Break
Many students use the time between the first and second years – often touted as “the last summer” – to explore their interest in research, while others travel and participate in a global medicine experience. Many schools create opportunities for extra clinical exposures, so you can use this time to explore specialties you are interested in. You should be sure to use some of this time to recover from the intensity of your first year and to relax and catch up with friends and family.
Second Year
At most schools, you will deepen your basic science training in the second year, with an emphasis on pathology and disease states. You’ll develop your clinical skills and get further patient exposure. You might even find yourself in the hospital, though you’ll probably still have a considerable amount of classroom and lab time. You might delve into pharmacology, immunology, and/or neurosciences.
Year two culminates in the USMLE Step 1 or COMLEX Level 1 exam, which assesses your understanding of how the basic sciences apply to human health. Most schools integrate exam prep into their second-year coursework and give students extra time to study for the exam.
Third Year
The third year often consists of the following components.
Core Clerkships
Typical third-year clerkships include internal medicine, family practice, surgery, neurology, ob-gyn, pediatrics, and psychiatry. Some schools also have mandatory rotations in radiology, ER, and ICU. You might have an opportunity to take more specialized electives. If you’re considering a specialty, try to get exposure to it as early in your training as possible so you have plenty of time to determine whether it’s right for you.
Hospital Rounds
You’ll find yourself on the hospital wards, making rounds and seeing patients. As you work with a team of residents and attendings, you might even have some actual responsibilities, though they’ll probably be minor. You’re starting to become an integral part of the healthcare team, though no one expects you to save lives yet. In fact, one of the best parts of medical school is always having someone above you to make sure your patient is safe. While residents love their med students (you do a lot of work for them), you might sometimes notice that they’re too tired or stressed to answer your questions. Be sensitive to their readiness and recognize that they can’t put you first all the time. Being willing to help with any small tasks and waiting for that quiet moment when they can finally take a break will often pay off. Residents tend to save their best teaching moments for the med student who stays the latest and shows the greatest commitment.
Patient Care
Hospitals that are affiliated with medical schools attract patients with complex and rare diseases from community doctors and hospitals. You might see things that doctors in private practice rarely get to diagnose or treat. However, you’ll often be assigned to the less exciting or “bread and butter” cases. Take advantage of this, and do your best by each patient you work with. They’re allowing you to learn through their illness, so always be grateful for the opportunity.
MD/PhD Students
This is the year when many MD/PhD students find themselves separated from their classmates and delving deeper into research. They might get to do some clinical rotations during this time, with their main goal being not to forget everything they learned in the first two years.
Optional Year
Some medical schools offer a “gap year” between the third and fourth years for students to accomplish an in-depth research study, participate in global medicine trips, or undertake independent study. To qualify for such a year, you generally need to be in good academic standing and have a solid plan for what you hope to accomplish during this time. Check with individual schools to learn whether they offer this year and when the deadline is to apply.
Fourth Year
Here’s what you can expect during your fourth year of medical school.
Month-Long Electives
Depending on your school, this year could include a combination of specialty clerkships, sub-internships, research/independent study, and time off for interviews. Some schools continue to have required coursework in the fourth year, while others leave the program entirely up to you. Your main goal should be to decide which specialty you plan to pursue and to set the stage for acceptance to residency.
Clerkships
As a fourth-year student, you’ll be heads and tails above the third years, who will be just starting their clinical rotations. Your residents and interns will give you even more responsibility, and with that comes sought-after privileges. You might get to assist in surgery, admit patients, and participate in procedures. You might finally feel like a “real” doctor, even if only for a few minutes each day. Use this time wisely to get to know your attendings and earn their letters of recommendation for residency.
Exams
At some point during this year, you’ll study for and take the USMLE Step 2 or COMLEX Level 2-CE. These exams focus on the clinical applications of basic sciences and the understanding of disease states. If you’re hoping for a competitive training program, take your exam preparation even more seriously. Some medical schools provide tutoring or group preparation classes, and online resources are available.
Away Rotations
Sometimes considered month-long interviews, away rotations are visiting sub-internships that give programs an extended time period in which to see what a student is like. They also give the students a chance to experience the hospital and determine whether they like its training style. Here are some questions to consider:
- Are the hospital’s M&Ms (mortality and morbidity conferences) high pressure or relaxed?
- Do the residents get hands-on procedures, or do the fellows do more cases?
- Is there a focus on research or primary care training?
- Do the residents seem confident, well-prepared, and happy? (This question is perhaps the most important.)
Research
Med students often use elective time in their fourth year to complete, write, and submit research findings for publication.
Residency Applications
After submitting your residency application, you’ll hopefully find October through December filled with residency interviews. Traditionally, medical students choose lighter electives during these months to allow for the extensive time (and sometimes travel) involved in interviews.
Continued Support Throughout Medical School
We’ve covered a lot in this post, and it’s exciting, and maybe a little scary, to think about the unfolding of the next four years. But while you’re planning your busy schedule and emotionally preparing for patient care, know that you can depend on Accepted when you need us.
Our consultants have decades of experience guiding applicants just like you through every step of their professional journey, from medical school admissions all the way to fellowship training and a medical practice. Whether you want help crafting applications for sub-internships or scholarships, polishing your interview skills, or preparing a scalable CV that you’ll use throughout your career, we’re ready to offer tailored and professional support.
And with respect to residency and fellowship training, we’re the experts. Our Residency and Fellowship Support Package includes everything you’ll need for residency (and many fellowship) applications, leaving you more time to focus on medicine. Explore our Medical School Application Services, and give yourself the competitive advantage you need to succeed.
Since 2001, Cydney Foote has advised hundreds of successful applicants for medical and dental education, residency and fellowship training, and other health-related degrees. Admissions consulting combines her many years of creating marketing content with five years on fellowship and research selection committees at the University of Washington School of Medicine. She’s also shared her strategy for impressing interviewers in a popular webinar and written three books and numerous articles on the admissions process.
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