Sian Tsuei, a recent fourth-year matcher out of the University of British Columbia Faculty of Medicine in Canada, gives us his expert advice on succeeding in medical school and beyond.
1. Tell us about yourself:
Sian Tsuei: I was born in Taiwan, raised in Vancouver and have always been interested in exploring more about the world. Originally hoping to become a businessman, I pursued biotechnology and economics at the University of Waterloo, Canada, but my world took a turn when I came across a beggar during my exchange to the United Kingdom. My reflections led me to realize that if I had been born in a different home and endowed with a different set of values, my fortune would have led to a vastly different life situation. The realization of my social determinants drove me to pursue medical school, with a dream of creating a socioeconomically just society.
I am lucky that the next five years will be an exciting period for me to complete my Master’s of Health Sciences, Family Medicine and Public Health and Preventive Medicine certification that will open up numerous avenues to entwine academic, clinical and political possibilities for an exciting career.
2. Looking back on your medical school experience, what would you say to the young and naïve “first-year you”?
ST: Many people enter medical school with an ideal of what it takes to become a doctor, without specifying the associated lifestyle, specialty, scope and location of practice. Define the parameters of an attractive career for yourself as early as possible so that you can tailor your learning to that specialty. Find shadowing opportunities by e-mailing lecturers, attending physicians, and peers. Divide career choices by medical versus surgical, and specialist versus generalist to narrow the career focus quickly. Prepare before every shadowing opportunity and read about each case.
While each year offers unique demands, the most challenging year is the clerkship year when the ground shifts on a monthly, if not weekly, basis. The hierarchical, learning-by-shaming, overworking culture of medicine appears out of nowhere. It demands you to integrate all of your pathophysiology, history taking and physical exam skills to come up with an individualized, logical and reasonable plan, and present it in a coherent, succinct and even enticing manner. Again, maximizing clinical exposure with support from a mentor genuinely interested in your well-being and success early on will help with the transition.
Outstanding peers in this rigorous training environment can boil most students’ mind with self-doubting questions, but everybody goes through similar struggles, in private or public. Work hard; repetition is the key to success. I once studied gross anatomy with an outstanding student in my class. Three months before the exam he reviewed the lecture notes and went through all of the anatomical checklist items on every single specimen in the lab. Then he did it all over again a few weeks later.
3.What tips do you have for USMLE?
ST: USMLE is expensive and requires extensive preparation. To the American medical students, prepare for USMLE step one starting on day one of medical school and aim to go through USMLE World twice at least. Learn First Aid USMLE Step 1, cover to cover.
To the Canadian medical students, pepper a mentor who has taken USMLE about the pros and cons of taking USMLE and make a conscious choice to do it or not. They are expensive exams and take valuable time away from what little free time medical school provides.
4. What advice do you have for the students going through clinical rotations?
ST: The first impressions from the attending physician and your first impression of the work will significantly shape your subsequent interest in the rotation, which can impact your specialty choice. Discipline yourself to prepare for success. Leave nothing up to chance.
Before rotations start: Find a classmate who completed the rotation and ask them questions about the upcoming expectations and how to conduct a relevant history and physical exam. Maximize the pre-reading before the start of each rotation and, if possible, finish reading the entire prep book before the rotation.
Early stage of each rotation: Observe carefully the behaviours of the residents and attending physicians because each specialty brings its own personality and unique foci on history and physical. Seek feedback within the first week of rotation to adjust your behaviours.
Overall attitude: Remember that serving the patient is the reason for this profession. Continuously reliable and humble hard work pays off. Work through the information the best you can, commit to an approach, and answer for the actions honestly.
5. What things did you do during your four years of medical school that stuck out or particularly impressed your residency program?
ST: Ultimately, the formula to successful residency entry varies for each individual. The SWOT analysis (Strength, Weakness, Opportunities, Threat) for business analysis is a useful framework to analyze your personal attributes and how they fit within the desired residency. I recommend using this in first year to analyze your standings within the medical community and review it on an annual basis to establish where your strength and weaknesses are, and how you can take advantage of the upcoming opportunities while eliminating competitive edges of other applicants. Medical school, as collegial as they encourage the students are to be, is ultimately a competitive environment.
Personally my interest and experience in human rights, research and entrepreneurship drew me to pioneering research and advocacy related to human trafficking, global health determinants and founding a club for trafficked individuals. This became an interesting aspect of the residency interviews, as these longitudinal activities were clear markers of my genuine passion and my ability to lead.
Residency programs also might have been interested in the fact that I committed maximal elective time to one single residency program. This approach was likely equally helpful but risky, and not advised. It would be wise to complete electives at a few different programs if possible.
6. What attracted you to public health?
ST: The triple certification in Master’s of Health Sciences, Family Medicine practitioner and Public Health and Preventive Medicine specialist opens up numerous avenues to entwine academic, clinical and political possibilities for an exciting career. Clinical medicine like family medicine and internal medicine have the benefit of caring for one specific person, but public health can influence entire populations.
7. What recommendations do you have for medical students to maintain their sanity?
ST: Some say keep a balanced life style; some say work 24/7. Again, develop an individualized version of an ideal career as early as possible and tailor the life choices accordingly. For me, playing basketball helped me relax. Surrounding myself with honest, hardworking friends who acknowledge the difficulty of the training with a strong belief that our work and studying is meaningful helped keep the fighting spirit alive.
8. The floor is yours — what do you wish to share with current medical students?
ST:The challenging training aside, these four immensely rewarding years will help you grow tremendously in knowledge and skills to become a competent physician. Work hard and enjoy the ride.