When I wrote The White Coat Investor: A Doctor's Guide to Personal Finance and Investing, I did my best to pass along the highest-yield information to those behind me in the medical pipeline. Throughout medical school and residency, I was both the recipient and the giver of that information. It always turned out that the best advice always came from those who were just ahead of you. So You Got Into Medical School….Now What? is a book written in that same vein.
Daniel R. Paull, MD is an orthopedics resident, and so his advice about succeeding in medical school is both fresh and proven (unless orthopedics has recently become an easy residency to match into.) I found his advice to be spot-on with my experience in med school, and so can highly recommend this book to any pre-med or medical student, especially if feeling anxious about your performance or if you are actually struggling in school.
The first five chapters are all about the first two years of med school. There are two chapters about the third year, a chapter on each part of Step 2, and then three chapters about the fourth year and getting into residency.
From the introduction:
You won't have to give up all your hobbies if you work intelligently and efficiently. The point of this book is to help you learn how to best manage your time in medical school. I almost always had time to do what I desired, and most weekends I was able to enjoy myself. I never had to pull an all-nighter, and seldom did I even have to study past 10 pm. My goal was always to do well in school while enduring as little stress as possible.
I had a similar experience in med school, except I quit studying at 5 pm, not 10 pm. Maybe that's why I'm in emergency medicine instead of orthopedics. Dr. Paull continues:
Sadly, this was not the case for a lot of my classmates, who all too often worked inefficiently and as a result became stressed, trading free time for anxiety. I learned how to avoid this trap through trial and error but often wished someone had told me what medical school was really going to be like. This guidebook is designed to help the student who is now in the position I once found myself in–without a guide.
So if you wish you had a guide to med school, and if you don't like foosball, then I'd suggest picking up this book. It is a quick read, just 219 double-spaced pages, but filled with lots of good advice.
Conceptual Learning Vs Memorization
The first chapter is best summarized with this quote:
The premise of this guide is this: the goal of every medical student should be to understand as much as possible and memorize no more than necessary. For example, let's say you must learn nine thousand facts, and five thousand of these can be predicted by learning the pathophysiology. You'll still have to memorize four thousand facts, but at least five thousand of them won't be subject to the vagaries of your memory.
Hard Work Versus Smarts
The second chapter spends a great deal of time trying to talk you out of being a crammer. I never really had that issue. In med school, I figured I was studying stuff I would actually be using the rest of my life, so I tried to actually learn it. Besides, I learned in college that an hour of studying before 5 pm was worth 3 hours of studying after 5 pm. If you still cram, you need to read this chapter. The graph of Hard Work Versus Smarts was an interesting concept, demonstrating how most premeds are missing one of the two attributes, but that your med school peers have varying amounts of each attribute. The earlier you can figure out if you're there because of your smarts or because of your hard work, the better you can adapt your approach to your attributes.
Diminishing Returns
My favorite chapter was the third chapter, and my medical school classmates will be the first to tell you that I thoroughly understood the concept of diminishing returns in med school. In my med school class there were three of us who routinely finished the test first. No one knew which of the three of us it would be on any given test, but within 60 seconds of one of us finishing, the other two would be done. It is no surprise that one of us ended up in anesthesiology and the other two in emergency medicine.
At a certain point, there is not enough additional benefit to extra studying to justify the time and effort spent doing so. You don't learn any better for the long term and you don't really improve your grades all that much. It is the same way on the test. I discovered that either I knew the answer, or I didn't. Sitting there going back and forth for a half hour over the answers to 3 questions out of a 100 question test was a poor use of my time when I could be playing foosball. Might as well guess and move on. If you can get a 90% with 4 hours of studying, but it will take you 8 additional hours of studying to raise that 90% to 100%, well, you can either go for a 100% or you can get 22 runs in at the ski resort. I can tell you which one I'm going to choose every time.
Study Anxiety
The fourth chapter discusses study anxiety, and how to have an appropriate level of confidence. The key, it turns out, is to have realistic expectations. Both overconfidence and underconfidence lead to problems.
What If You Hate Third Year
When I hit my third year rotations, I was like the majority of med students- I loved it! Even though this was before the 80 hour work week (I worked many more hours on some med school rotations than I did as a resident under the 80 hour rule) I was finally doing what I'd been preparing to do for so long. Sure, a lot of it was “fake it til you make it” but it beat sitting in lecture or the library wondering when your next chance to play foosball would be. However, apparently there are people who don't feel that way. Dr. Paull has this to say about it:
I have to note there are exceptions to this generalization. Some students prefer the second year. These are the students who reap greater enjoyment from studying and test taking than from actually interacting with other human beings in a clinical environment. This academic type of student just happens to love school, and it's not uncommon for these students to already have pursued multiple masters degrees or even a doctorate….Then there are those students who don't like the third year any more than they liked the second year, students who see the third year as just another unhappy chapter on the road to physicianship. This sentiment might arise from being stuck in an unpleasant rotation, but some students cannot find a rotation they enjoy. This is a bad sign and may mean they do not like medicine and went to school because they thought they would like it, because they were forced by pushy parents, or because they wanted to become a doctor because of the associated lifestyle….Suffice it to say that every medical school class has at least a handful of students who fall into these categories, but it's important not to let others' unhappiness color your own relief and joy.
I loved Dr. Paull's description of why it is important to get an attending to like you during your rotation is brilliant, as is his advice on how to become well-liked without being a brownnosing suckup.
The remaining chapters contain about what you would expect. You'll find specific advice on how to do well on USMLE Step 1, Step 2, and some test I never even took called Step 2 CS. However, I think he got the old quote wrong; you know, the one about how long you need to study for Steps 1, 2, and 3. “Two months, two weeks, and two number two pencils.” I learned it as “Two weeks, two days, and a number two pencil.” Again, that probably explains why he's an orthopedist and I'm an emergency doc.
At any rate, the book is the best I've seen for its intended audience- the student about to begin medical school who is feeling anxious and underwhelmed and wants to do the best they can in school. It would make an excellent graduation or “Congratulations you got into medical school” gift.
Buy So You got Into Medical School…Now What? today at Amazon!
What did you think? Have you read the book? Did you find it helpful? If you could give any advice to a brand new medical student about how to do well in medical school, what would it be? Comment below! (Also, I've got too many books in my house already, and I'm definitely NOT going back to medical school, so if you want my review copy let me know in the comments and we'll do a random drawing among those who express interest.)
I’d like a copy for my sister starting med school in 2016!
I am a current M1 and am also interested in the review copy of the book!
Entering the sweepstakes….
Being engaged with my medical school classmates was one of the most important things that got me through school. The examples some of my classmates set for study habits, study/life balance were critical to my success. Having a tight-knit environment also made the whole process a lot more fun (we did some epic post-finals beach week vacations where almost 2/3 of our class showed up). Classmates who ultimately didn’t enjoy medical school were often not very involved.
I’d be interested to read the book, but i’ll leave the drawing for those at an earlier stage who stand to benefit the most!
My biggest advice for boards of any type is to study the content you know the least about. It is much easier to improve scores from poor to average than from average to excellent. Let the topics you have down solid carry themselves.
Another way to say it…if you feel comfortable with what you are studying, then you are studying the wrong stuff.
As a current medical student, yes ortho is still among the very hardest fields to match into. EM has also gotten much harder over the last 5 years. My cousin does a lot of medical student advising and says that they have the most unmatched students in EM of any field. People don’t realize how difficult it has become.
Regarding the whole 2 weeks or 2 months thing, board scores have increased pretty dramatically across the board over time in all specialties. It’s an arms race and you don’t want to count on truisms from a different time.
The problem with any book on study habits is that different things really do work for different people. I know a medical school valedictorian and now derm attending who crammed every test. A good friend listened to every lecture 5 times and did very well. I don’t listen to the lectures once. You need to figure out what works for you.
Nice review. Definitely adding it to my list. Starting medical school this August so would love a copy!
M1 here (also Army HPSP, discovered this website when I was deciding between military and civilian… this website was very valuable and helped me choose military). I too am very interested in reading this book. I have an exam this upcoming Friday that probably will make me wish I had already read it, I’m sure it will prove to be useful for my remaining med school career!
Thank you for your service. I’m so happy you learned all about it before hand and still chose to serve.
want one for my sister por favor
Third year medical student here.
Incoming medical students definitely don’t be intimidated by medical school or feel that you’re an impostor. You’re there for a reason despite what accolades and accomplishments your classmates have you’re just as brillant if not more so.
The biggest way to take control of your academics is to plan your life. Don’t just haphazardly get through each day and week.
Get a calendar and on Sunday evening go and write in all the times you have class and labs or any other academic meetings. From there put in appointments and other obligations. After this schedule time for eating, sleeping and personal hygiene.
At this point you’re going to realize those 168 hours in the week are almost all gone and you haven’t even put in when you’ll be studying yet. Now is the time to fill out your calendar with the times you’ll be studying particular subjects. Once you have the specific subjects marked down you’ll want to take it a step further and make a to do list of what exactly you need to study in that particular subject (this will be done on a day to day basis as it will change and be based on what you accomplished previously).
You’re in medical school so should have a life too and it’s a great idea to also put social items on your calendar too. This way when you aren’t studying you don’t feel guilty over the fact you should be studying because you already accounted for it in your schedule for time off.
Lastly, follow this study regimen.
Only hit the books for 3 consecutive hours where you study for 50 minutes then 10 minute break and repeat 2x. As the fourth hour approaches and you feel the urge to continue studying this should be used for review of material you previously studied and not learning new material.
Once you have completed this cycle you need to take at least 1 hour break to do something totally unrelated to studying to allow your mind and brain to reset before hitting the books for another 3-4 hour session.
Lastly, self test yourself on the material.
Make flashcards, buy flashcards, teach a mini lesson to yourself on what you just learned and if you have difficulty then you don’t know the material and need to spend more time reviewing. You’ll only know this by actually making mini quizzes and exams for yourself using whatever learning modality you prefer.
Or you can just skip that second 4 hour session. It was a very rare day I studied for more than 4 hours in addition to class and foosball. I treated med school like an 8-5 job. Class in the morning. Study in the afternoon. Time off in the evening. Even when studying for Step I, I just studied morning and afternoon. I mean, how productive can your studying possibly be after 8 hours? I didn’t think it was productive enough to be worth it for me. YMMV.
Figure out how you learn. Some recall best from podcasts, some flashcards, some lectures, notes, books, etc. I found I got nothing out of lecture. Fortunately at my school attendance wasn’t required. I think I went to about 10 or 20 lectures in all of 2nd year. Spent the time learning it on my own.
The other thing I would say that worked for me, is I treated med school like a job. Maybe this is because I was a postbacc student and had worked for several years before returning to med school. I would spent a set number of hours studying then call it quits for the day. I was often down by 5 or 6 pm, so I could then spend time with my wife or friends, doing social things. There is definitely a point of diminishing returns with regards to time spent studying. This provided a good balance. I would say some of my classmates who I saw totally freaking out before tests or in general were ones who did not achieve a balance like that and studying or thought medicine all the time.
Amen. And they still are doing medicine all the time.
Figure out what works for you. Some people need more studying time to retain information than others. If you know you want to go into a competitive field, you’re probably going to study longer and harder then the other person going into FM.
I knew I wanted Ortho, thus studied every night 5-10 and usually 9-6 on weekends. Worked for me.
Do you really think you got as much out of that 13th hour in your day as the first hour? Why not study until midnight?
While I have no idea what it was like for you, I saw a lot of those who studied all evening studying very inefficiently.
My weekend study schedule did involve about a 1-2 hour lunch break, so basically two 3-4 hour sessions. We had exams every Monday morning either on the new material or cumulative, thus I felt it was needed.
But yes, I do agree that my the end of the night I was exhausted and was getting diminishing returns. However, it was a means to an end. I belive it helped me know a lot of the material for boards, thus I didn’t have to study as intensely.
There was probably about 20-30 of us who studied like me in the library, however, I was probably the most laid back and left earlier then most. In the end, a few of those people ended up scoring a few more questions correctly then me on exams and ended up top 5 vs my top 10.
I was also like you as I finished exams very quickly. Very rarely would I stay longer or dwell on questions. Either I know or didn’t. Marked a few questions to review at the end, but I would say I was usually one of the first 10 who finished exams.
I was usually the one showing up late to the library and leaving early compared to my classmates who were there for hours on end with frequent coffee breaks, Facebook checks, hallway phone calls, interruptions, etc. If you only give yourself 2 hours to study, you will work pretty efficiently. If you know you have all afternoon and evening, then there’s no urgency. Med school studying will devour your whole life if you let it. There’s always more to study (which I really resent sometimes!).
Also, not all med students are created equal. I had brilliant classmates who had strong science backgrounds, tested well and seemed to operate on an intellectual plane that blew me away. Then there were other classmates who made you wonder how they every made it through organic chemistry in the first place. They clawed their way into med school and so they probably needed to continue that level of effort to merely stay afloat. Personally, I performed much better and was much more relaxed when I stopped comparing to my classmates and focused on learning to my strengths with other like-minded students.
The amount of work you have will expand to fill the amount of time available to do it.
I studied with a small group of the same people who had similar habits to mine. We would always have a routine. About two weeks before each exam, we’d get together and study every night. Go through each lecture. The point is I had a schedule and a routine. Exams were six weeks apart and I didn’t study before those two weeks.
For step 1, I studied 12+ hours everyday in the library for over a month straight. Then went to the gym and listened to lectures before doing qbank questions. I had a calendar and stuck to it. I studied a little during spring break but didn’t study before that otherwise. I’m in practice in ortho now. That definitely sounds excessive, and you can study less than that and do fine. Point is I had a calendar and stuck to it. There were people who I saw studying everyday from first year medical school who fared worse. You can only retain so much for so long. Don’t burn out. I guess I studied harder than WCI, but I still likewise had a life outside of study hours. Also keep in mind med school becomes fun third year. Youre actually doing what you came to do, which is treat patients, so look forward to that.
I also used a calendar to study for Step 1. I think I studied for about a month. I went to the library at 8 am. I studied until noon. Then I ate lunch and played foosball for an hour. Then I went back to the library and studied until 5 pm. Then I went home. I think I might have studied Saturdays too, same schedule, but I can’t really recall and I’m positive I took Sundays completely off.
I never got the impression that I was particularly smart compared to my classmates. But my MS1/MS2/MS3 grades and board scores were all good enough to excellent and the things the residency programs actually cared about were apparently also excellent based on the results of the match. Perhaps there are some medical students who have to study twice as long as I did, but I’m skeptical. I just think a lot of med students keep studying way past the point where the law of diminishing returns kicks in. I just always took the perspective of long-term learning. If something I was studying seemed like I was just studying it for the test but would never use it my career, I limited the amount of brain power I wasted on it. Maybe I lost a few points here and there, but I think that was an excellent preparation for actually practicing medicine as a student, resident, and attending. I studied regularly, followed a plan, and NEVER crammed. Cramming is all about short term learning, and I didn’t see any point to that, especially since I wasn’t gunning for Dermatology.
R & R actually boosts the output of study time. Too much work can even have negative returns, especially if you don’t sleep or eat properly. It is true when you are a student, and it is also a good habit to learn for your future.
When I was in High School, I learned how to study, from a guidebook. The writer was a high achieving Engineer who had made it big in Silicon Valley. Two of the key points were – Study in blocks of 30 minutes, 25 minutes of study and then 5 minutes of break, and secondly, revise, revise, revise – revise at the end of each study session, and revise before you start studying the next day. After sometime, the words from the book would be etched in my memory like photographs. This was very helpful for taking tests when the question involved connecting two or three different points of information together.
I found that reading/studying well from one book was much better than going around like crazy over 5 of them. In Medical School, I would ask my seniors about their recommendation for a good book before I would even start studying – to choose study materials wisely. And then I passed on the information to my juniors. This asking for help saved a lot of time and money.
Just bought a copy for my son who starts med school this fall. We are encouraging him to switch now from the mindset of getting into med school to realizing that he is there. We tell him that how he handles med school sets the stage for how he handles residency, which sets it for how he handles his practice. It is time to learn balance and strive for having a life outside medicine. We have very fond memories of medical school. Like us, he was not the typical gunner type of pre-med. We encourage him to continue to avoid those types. I was always the first to turn in a test and found it funny why it would frustrate others. Sometimes, I would just wait to turn it in and sit there till others were also turning in theirs to be less of a distraction. Choose your study partners and friends wisely. Best wishes to all.
Having gone to a 3 year dental school and having most of my friends on the medical side, I must say I was jealous of their schedule. We were in lecture from 8-5 daily, then we had lab after that. Would routinely be at school from 6am to 9pm when it shut down.
Residency, on the other hand, was way easier. 7-3 then done. Didn’t realize what I was missing!
Interesting reversal. For most physicians, residency was far more difficult and had much longer hours than medical school.
Yep, my med school friends had time too burn in school, I didn’t get it at the time. But residency made up for it. Looking back, many dental schools take the first 2 years concurrent with med students so the course work is the same, then dental students have all the clinical work on top to learn how to do a crown, etc. But, after the 4 years you can go work, or do a residency which is usually much easier than dental school if you choose wisely.
Starting med school this August – I would love a copy! I thoroughly enjoy your blog by the way and have learned an incredible amount of information.
This book was given away long ago!