A Taste of Your Own Medicine, Columns
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Confessions of a Fourth-Year Medical Student

ATOYOMWhen I was a first-year medical student, the upperclassmen said that medical school would get better and better. I didn’t feel like that by the end of first year—or during second year. Third year started and it finally picked up. Now, as a fourth-year medical student, I can definitively say that medical school really does get better and better—you just have to be patient (but not a patient).

Not everything in medical school is as clear-cut as creating a differential diagnosis for chest pain, but I’ll try to shed some light on common issues you’ll encounter.

On money. It’s an understatement for me to say that medical school is expensive. Just like medical school keeps getting better, it also gets more expensive every year. While there’s a price to pay for everything, there are ways to save money. Check with the school’s financial advisors for new scholarships. Review your bills and see where you can save money. Do you really need the gym membership when your hospital has a gym? Is a huge TV necessary? Do you have to eat out everyday? Try alternatives, like using the school gym or preparing food at home instead of buying food daily from the cafeteria. Stock up on food, like from a nearby Costco, and buy snacks, and meals, like frozen dinners, that you can easily take with you to class and the hospital. Even small adjustments can lead to big differences (which is the same thing you tell your diabetic patients about portion control for maintaining tight glucose levels).

On books. Don’t forget to count books as part of your expenses. Check out hard copies or electronic versions from your school’s library. Utilize online resources that your school might be providing, like uptodate.com, accessmedicine.com and accesssurgery.com. Share books with your classmates.

On health. Just because your patients are sick doesn’t mean you have to look sick, too. Which means, get eight hours of sleep, eat healthy, exercise an hour a day…wait a second. Are you doing that? Because I doubt many students are. Let’s face it—its hard to balance everything you want to do. It’s all about organization and making some sacrifices. Maybe you can exercise for 30 minutes before you head to the class or on your way home from the hospital. One thing I begrudgingly did with my colleagues was always use the stairs instead of the elevator to get somewhat of a workout into our busy day. Also, try snacks like trail mix and yogurt to stay healthy. Pace yourself with schoolwork so that you can sleep reasonable hours. Not only do you have to take care of your physical health, but there is also mental health. Do things that make you happy. If that means watching “The Real Housewives,” so be it. Everyone has a guilty pleasure.

On relationships. Relationships are hard enough to maintain, but throw in 13-hour days plus studying and you have a challenge on your hands. While people unfamiliar with medicine may not understand the demands on your time, it’s up to you to decide which relationships to keep. Maintain those that give you energy and avoid those that drain you. Remember that even the best relationships have rough patches, but learn to move forward with your goals without unnecessary drama. As one of my friend’s psych patients eloquently said,”Love is as dangerous a street drug as crack or heroin.”

On electives. One of the perks of fourth year is that you get to pick electives of your choice (or settle with whatever leftover classes are available). Take electives geared toward your career choice. For example, if you are going into internal medicine, take electives like endocrinology, infectious disease or nephrology. If you are going into family medicine, try an elective at a specialized clinic, such as one for HIV patients. If you are going into radiology, then take…radiology. It’s also fun to take an elective that you’re interested in but will never get the opportunity to do after graduating. So, enroll in sign language for dolphins!

On boards. No matter how much you hate the boards, they are a necessary evil. Rather than hide from your enemy, look it directly in the eye (at www.nbme.org). Students typically take Step 1 at the end of second year, Step 2 at end of third year, and Step 3 during residency. Each Step requires months of preparation—no more “just winging it.” Step 2 is actually composed of two parts: clinical knowledge (CK) and clinical skills (CS). Each part takes a day. You can take each day whenever you want and they don’t have to be back-to-back. You must register months in advance for each Step, but this is particularly important for Step 2 CS because there are only a handful of centers that accommodate this test since live actors are involved. Take it from me:I registered seven months in advance for my date. The boards are also very pricey, so this is something to add to your expenses. Don’t you wish you had an expense account like on “Mad Men”?

On extracurriculars. No one cares if you were class president when your grades and board scores are as awful looking at a gangrenous diabetic foot ulcer. Extracurricular activities are a great way to get involved, but they can also hurt you. If you find yourself constantly planning events and group meetings while pushing aside studying, then you have to drop something (and I’m not talking about the books). Extracurriculars are meant to enhance your medical school experience, but not be the entire experience.

On career. Congratulations! You have decided what you are going to do the rest of your life. Just make sure you take the actual rotation first. A lot of students start the first day of school with a preconceived notion. You have to listen to them ad nauseam as they say, “I’m going to be a cardiologist,or orthopedic surgeon, or whatever)” and then they sheepishly change their mind once they take the rotation and say they were never interested in anything else before then. You know who I’m talking about. It’s okay to change your mind, but make sure you make the ultimate decision. Don’t let influences from TV, movies, friends, family or colleagues sway you. You’re the one who’s going to be stuck with it the rest of your life. Pick something that will be satisfying and enriching years to come.

On distractions. Swat them away like an electric bug zapper!

On attitude. I’ve actually enjoyed at least some aspect of every rotation that I’ve been on. That’s because I went in with the attitude of, “do my best (and forget the rest) and learn as much as I can.” You may encounter a rotation that you absolutely hate for whatever reason. Try to turn that frown upside down because no one likes to work with Debbie Downer. You’re in class or at the hospital all day so you might as well make the best of the situation. You also need to treat the people you are working with with respect and professionalism. You don’t need to shine by trampling on your colleagues. Residents and attendings are too busy to know (or care) of any behind-the-scenes drama, but they’ll pick up if you’re not a team player. Don’t throw people under the bus because you’ll soon find yourself at the bus stop.

On advice. If you feel as confused as someone with hepatic encephalopathy, then see your dean of student affairs for some guidance. If medical school makes you feel as numb as someone with peripheral neuropathy, then perhaps talking to the school psychologist can help you blow off some steam. Or, vent to friends if that makes you more comfortable. Once you’ve settled on residency, reach out to the program director, attendings and residents to see what you’re getting yourself happily into. AAMC (not the channel with “Breaking Bad” and “The Walking Dead”) offers a lot of resources, such as providing timelines, explaining the Match, and providing sample resumes. Lastly, there are always upperclassmen like me. We have all walked in those disgustingly dirty clogs that only people working in a hospital wear. Get lots of advice, take it with a grain of salt, and figure out what works best for you.

Hopefully, medical school won’t be as painful as a getting an I&D in your groin without enough local anesthetic. Make the most out of your experience! Take it step by step … one board at a time.

Valentina Bonev Valentina Bonev (21 Posts)

Columnist Emeritus and in-Training Staff Member

Loma Linda University Medical Center

A Taste Of Your Own Medicine is a column that gives you a taste of medicine. It focuses on important and interesting topics relating to medicine and being a medical student.

Valentina is a general surgery resident at Loma Linda University Medical Center. She graduated from University of California, Irvine School of Medicine.