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.
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.
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.
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.)