Here, a diverse range of medical students, residents and professionals offer some advice and insights in a Q&A style format. The order of the questions and responses are arranged such that those earliest in their medical careers are first, with those further in their careers appearing as you proceed down the page. These are some very busy, and outstanding people! So, I just want to acknowledge their kindness and selflessness in contributing to this post. Hopefully, these questions and responses find you well and aid in the constant efforts towards your desired careers in medicine.
What do you wish you knew at the start of medical school that you now know as a 2nd year medical student?
David Rivetti, MS-II, University of Pittsburgh School of Medicine
If I could turn back the clock and give myself one piece of advice for starting medical school, it would be to develop an "advice filter" sooner rather than later. In talking to many of my colleagues, and also through personal experience, the amount of advice that you receive in your first few months of medical school can seem daunting at times. Whether it is an upperclassman who seems to be striking the right balance between coursework, research, and clinical opportunities, or professors looking to pass along wisdom about study strategies, you quickly realize that the amount of recommendations being offered seems to grow exponentially by the day. I think that it is important to realize that if you take on too many of the suggestions you receive, it might do more harm than good. Everyone you encounter has taken a different path to medical school, has unique career aspirations, and is cultivating distinct interests. As such, their priorities and strategies for success could be completely different than yours—and that is important to acknowledge when coming to someone for advice.
I would like to pass along some quick tips that I have found helpful in navigating the suggestions and advice that I received during my MS1 year at the University of Pittsburgh School of Medicine. First, find a small (~3-5) group of students in your cohort who you respect and enjoy being around. Ask them how they are tackling a particular course and how they are structuring their days. Some of the best pieces of advice that I took away from my first year came from conversations that I had with my peers. Second, find a few upperclassmen who are either pursuing a similar specialty as you, or seem to have a really strong sense of what it takes to be a successful medical student. Talk to second, third, and fourth year students—the perspective of medical students truly grows and changes with each year, and it is fascinating to hear about what students ahead of you are doing. Additionally, what it takes to be a successful first year medical student differs from the approach needed for a third or fourth year student. These conversations will help put the journey into context and serve as a reminder of why you decided to go to medical school. Third, stay true to what has gotten you this far, but be open to modifying parts of your studying or daily routine to accommodate the added workload of medical school. Often times what is needed is not an overhaul of your academic approach, but rather a couple of small changes to set yourself up for an incredible experience.
What are some struggles that you did not anticipate coming to MUSC as an MD/PhD student? How are you coping with them?
Mohamed-Faisal Kassir, MD/PhD Student (MS-II/2nd year PhD) American University of Beirut School of Medicine, Medical University of South Carolina
The first answer that comes to mind when reading this question on a hot July day is: the Charleston humidity – to say that I’m coping would be a lie.
On a more serious note, coming to MUSC as an MD/PhD student has been both challenging and rewarding. In our joint program, we have to complete the first two years of our pre-clinical medical education before moving to the PhD portion of the program; once done with the PhD, we return to medical school in order to finish the last two clinical years of our medical education. While the first 2 years of medical school were definitely not a stroll in the park – we sure were asked to memorize the weird names of too many bones and muscles – I would probably say that the most challenging aspect of my experience so far has been the transition to graduate school almost a year ago. Suddenly, I was pushed well beyond the comfort zone I had been building for two years and asked to take on undoubtedly different challenges than those I had grown familiar with. I was asked to design my own experiments, construct my own hypotheses, dig in the literature to find out more about a topic, and then critique that literature and independently think about what could have been done better… While this seemed like a daunting transition at the beginning, I soon came to realize how important this phase of my training will be in my development as a future physician-scientist.
With help and guidance from my friends and the faculty at MUSC, I very quickly adapted to this change and started working on and growing my critical thinking and analytical skills. Like a kid thrown in a pool and asked to swim (under adult supervision – I hope), I soon found myself swimming with the certainty that I can only get better at swimming – and doing science – with time! With the support of friends, family, and faculty at MUSC I have no doubt that this will be a very rewarding experience and that it will be the first step in my quest to carry the torch of knowledge from bench to bedside. I am excited to continue this journey and continue to learn along the way. I am very excited about the next experiment I do, the next article I read, and the next results I analyze. I am not so excited about going outside tomorrow morning – yet another hot, humid July day…
Coming from a smaller undergraduate university (West Liberty University), what challenges did you face in your pursuit of medical school? What advice would you give to other undergraduates attending smaller universities that might face similar struggles?
Kelsey Robertson, MS-IV, West Virginia School of Osteopathic Medicine
Having gone straight from undergrad to medical school, I’ve noticed some pros and cons when it comes to attending a small college. Many of my classmates attended large universities, so I’ve been able to talk to them about what was different for them in the med school application process. One of the main things I’ve noticed: Coming from a big school, particularly one with a good reputation, can serve as a perk on an application. Coming from a small school probably won’t be viewed as a mark against your application, however, it also may not offer any help. It’s more likely that the people who are reviewing your application and interviewing you are familiar with the large universities or could possibly be alumni themselves. Another thing that some students of larger institutions may benefit from is a medical school associated with the university. Not only will they have a foot in the door if applying to that medical school, they likely had research and volunteer opportunities associated with the medical school, which can look appealing on an application. Students attending larger universities might also have the option of asking for a department letter of recommendation, rather than an individual letter, which may carry more weight on an application.
While there may be some obstacles involved, getting into medical school from a small university is certainly possible. My advice is similar to advice you’ve probably heard in the past: Try to add as much on to your CV as possible. This includes field-related experience, volunteer opportunities, research, etc. A benefit of attending a smaller school that I personally had access to was the employment opportunities in the area. I was able to secure a job as a medical scribe for two years of my time in undergrad, and I believe that served as a positive note on my application. From what I heard at the time, getting a job as a scribe in the town where the large state university was located was very difficult due to all of the students who wanted the job. My school also did a wonderful job preparing me for medical school. In my first medical school course, I found myself feeling very comfortable with the biology material, which I attribute to the wonderful professors that I had in undergrad. Try to make sure you take advantage of the things that your small university offers. While the opportunities may not be exactly the same as larger schools, I found that my professors were always willing to help those of us who wanted to go on to grad school in any way that they could, and some even went above and beyond what might be expected from an undergraduate professor.
Having been through both PhD training and (most) of medical school training, in your opinion, how does one supplement the other, and what are some hurdles that you’ve had to overcome given these two unique sets of training?
David Osei-Hwedieh, PhD, MS-IV, University of Pittsburgh School of Medicine
I think the main difference lies in the fact that in PhD training you try to know a lot about one topic while in med school you want to know a few unique as well as shared qualities about a lot of things. In other words, PhD is smaller surface area but with great depth versus medical school where you have a large surface area but a much shallow depth to cover.
Coming from PhD, you naturally want to understand the why’s and the how’s of things but medical school doesn’t afford that luxury, at least not in the first two years. The answers to those questions reveal themselves in clerkship years and beyond. The focus of the first two years is to familiarize the medical student with the vocabulary and the ‘scaffolding’ of the craft. Building a good mental scaffold in the pre-clinical years accelerates the learning in clerkship years because it becomes easier to notice patterns, and it makes it easy to spot the why’s and how’s of things when they begin to reveal themselves.
I struggled with the philosophy of just memorizing lists, and frankly I am not sure if that remains the goal of the modern medical school curriculum because the board exams seem to reward reasoning skills more than just memory. I realized that knowledge gained by rote memorization never made it into my long-term memory. To bridge the gap, I had to dedicate more time to studying given that I had the habit of researching things while studying.
One of the best pieces of advice I received came from the Learning specialist at my medical school, Ms. Jeannerrette, she said, “subtle gains, David…”
What experiences during medical school led you to your current position as a Physical Medicine and Rehabilitation resident? What advice would you give to others that might be struggling to narrow down on a specialty for residency?
Michael Melson, M.D., Physical Medicine and Rehabilitation PGY-1, University of North Carolina School of Medicine
There's not really one particular experience that I could say led me towards PM&R, but a composite of smaller realizations that I took away from my clinical experiences in medical school. Entering medical school, I was actually dead set on going into Orthopedic Surgery. PM&R was a specialty that I'd never even heard of before. I wasn't even aware of PM&R as a specialty until the tail-end of my first year, and I really didn't consider it as a potential fit for me until early on in my 3rd year. I realized pretty quickly during medical school that surgery wasn't for me. You really have to love the OR about as much as you love doing anything outside of the hospital in order to get through a surgical residency.
Once I had that realization and ruled out most surgical specialties, I started to focus a little more on trying to pinpoint what I liked and didn't like about each of my clinical rotations. I knew from personal experience prior to medical school that I liked a lot about Orthopedics: the patient population, the idea of being able to help a patient get back to their previous desired level of functionality, and the ability to see a physical improvement. But I didn't like the OR, the lifestyle, or the culture that comes along with it. I started doing some research on my own to try and find a specialty that blended the things I knew I'd liked about my prior clinical rotations with my general medical interests, and I stumbled along PM&R again. At that point, I reached out to the faculty member that had given us a lecture about PM&R during our first year and inquired about shadowing her some over winter break to get a better feel for the specialty. She worked in a clinic setting alongside Orthopedic Surgery, and she functioned as a non-surgical proceduralist that handled a lot of the non-operative cases for Ortho. She did a lot of smaller procedures (EMG, epidural steroid injections, baclofen injections, etc), and I loved it! From there, I signed up to do an inpatient PM&R rotation (General Inpatient Rehab) as one of my electives during 3rd year just to make sure I'd like other aspects of the field, and I liked that a lot as well. I went on to do a selectives in PM&R at my home medical school in addition to a few away rotations in PM&R during 4th year before applying for a residency position in PM&R. I've honestly loved the field more and more as I continue to get more and more exposure to it. It really is the hidden gem of medical specialties! I'm now in my Intern year as a PM&R resident at UNC, and I'm currently planning on doing a Sports Medicine fellowship after I finish my residency.
The main piece of advice that I would give to someone struggling to find the right specialty for them would be to always keep an open mind because you can never be 100% sure what you'll really like until you get the experience of fully trying it out and experiencing it yourself. Most people don't know about the lifestyle, the nature, and the culture of each specialty prior to entering medical school. For anyone struggling to narrow down a specialty, I would recommend taking an approach similar to my own. Try to walk away from each of your clinical rotations with a few general things that you like and don't like about each specialty, and then use these features/interests to find a specialty that might fit you best. By the time you're a few rotations into 3rd year, you may not know for sure what specialty you want to go into, but you will at least be able to cross a few more off of your list and then use your elective time as an opportunity to try out what you may think might be a fit for you. Best of luck!
As a neurology resident, success is an obvious feature of your past; however, in hindsight, what was your biggest failure, and how did you learn from it?
Mark Rosenberg, M.D., Neurology PGY-2, Medical University of South Carolina
The commonly accepted definition of failure is the helplessness to accomplish a goal that an individual sets out to do. However, in my medical training I have come to accept another use of that term, and that is failure in the medical sense: a state where there is an inability to perform a normal function; much in the way a patient with chronic high blood pressure leads to kidney failure. For many, that normal function is going through the motions, and when I was in high school and college it was exactly that. In college, however, I was faced with my first experience with failure, both in the colloquial and medical sense. My grades were falling, and I felt the full reckoning of my passive attitude on academic discipline. My GPA continued to tumble and my dream of becoming a physician slipped further from my grasp. At that time, upon completing college, my inability to move forward (which was my normal function) was considered not only my greatest academic, but total life failure. It was then that I realized it wasn’t the acknowledgement of the failure that I needed, but rather to re-evaluate what that “normal function” was.
I had lived a relatively privileged lifestyle without making myself too uncomfortable or pushing myself into atypical situations. This was my “normal function” and upon completion of college I had completely failed in staying comfortable. In a moment of self-actualization, I realized that the framework of what I defined as normal needed to shift; instead of my homeostasis being comfortable it needed to become uncomfortable, from feeling exocentric to becoming egocentric (in the most literal term).
The decision to push myself out of my usual boundaries caused a normative adjustment which ultimately led to me applying to medical school in a foreign country. There, my newfound understanding that I always had to push myself caused me to feel non-complacent and strive to improve myself on a daily basis. In doing so I slowly climbed back from my past decisions in college and recognized that without them I would never have had to been forced to understand my hubris—or fatal egotistical shortcomings. My efforts were well worth it as I applied to residency in the US, which is arguably the most difficult hurdle for anybody training medicine outside of the US. Beyond that, I had matched into my most desired program: Medical University of South Carolina in neurology.
Experiencing failure ultimately leads to a philosophical crossroads: Do you consider it a failure or reframe it as a learning experience? By calling it a failure, more power is given to it, a burden of regret and inactivity; by understanding it as a learning lesson, however, there is no option but to move forward. When asked what my biggest failure was, I recognize it as my biggest learning lesson. The sheer understanding that there is no such thing as failure unless you wish to continue in the same “normal function”, which allowed for the function to break, is instrumental in growing. Without my “biggest failure” I would have not become the physician I am today and would have been stuck as that same person who nearly failed out of college.
Reflecting on your medical training, what is something that you unexpectedly did right, something not necessarily intuitive, that contributed to the successes that helped you get to where you are now?
Kalin Fisher, M.D., Orthopaedic Surgery PGY-3, University of Maryland Medical Center
I believe that the best thing I did for myself, perhaps, was shadowing some of the doctors I did while I was in undergrad. I often would spend my afternoons after class, and sometimes my mornings before class, shadowing and learning from some of the sports medicine and orthopaedic doctors in one of our sports medicine clinics. This is where I really gained an appreciation for medicine and orthopaedics and realized that I wanted to become an orthopaedic surgeon. Although we were busy, there was inevitably some down time, which I used to ask my preceptors questions; not just questions about how to get to med school, etc. but questions about lifestyle and job specifics, time for hobbies, and the such.
It wasn’t always easy, and I spent a lot of my free time getting up early and staying late for the OR and clinic, but fast-forward to 7 years later, and I’m now a medical school graduate, currently in my third year of orthopaedic surgery residency at the University of Maryland, which is regarded by many as one of the top 30 programs in the country out of over 170.
I’m proud to say that my family, friends, and positive influences all contributed to me getting to where I am today. My time spent with the doctors was priceless and definitely prepared me for the path I’m on today. I would have been very underprepared if I had never taken advantage of that opportunity.
In your experience thus far, what is a common misconception medical students carry about the practice of medicine?
Stanley Guertal, Doctor of Osteopathic Medicine (OU-HCOM), Emergency Medicine Attending Physician (2020 Graduate of CAMC EM Program)
The notion the practice of medicine is glamorous immediately stands out to me as a common misconception. We have all seen the portrayal of doctors in Hollywood as revered, respected, adored and typically adorned in pristine white coats and neatly groomed. This is simply not the reality of the situation. Those of you embarking on this journey will quickly learn that as a medical student you are often overlooked, discounted and wrongfully ridiculed. You will be the only ones adorned with the pristine white coat as you are held to a ridiculous (double) standard of divine "professionalism" despite sometimes being treated as the furthest thing from professional. You may be an important contributor to patient care as you may pick up something the resident or attending misses but still not be given the credence you deserve. You will find as you make the transition from medical student to intern a new battle will arise. Attendings, nurses and other ancillary staff will now know your name, as you have inherited the responsibility of doing the worst jobs that exist, but will often be mocked and disregarded as dumb or incompetent despite having sacrificed the better part of your prime to pursue a career in medicine. As residency progresses you will begin to earn the respect of your co-workers but will still encounter disrespectful and downright unappreciative patients on a daily basis. And that pristine appearance and clean white coat? You ditched those in the name of sleep deprivation and a general apathy toward your own well-being.
Things certainly improve when you become an attending (I have witnessed this phenomenon although just starting my own journey). You will have more free time, patients will inherently have more trust in you, and you will probably appear more refreshed and well groomed. But you will still have patients you cannot please no matter how hard you try, support staff who have not shared your same determination to perfect patient care and thus resent your audacity to expect jobs within their scope be performed on a timely basis, and consultants who always think of you as a pest (and a dumb one at that). This is not a profession to go into if you seek glamour, adoration or adulation. So why do we do it? Because along the way you will experience glimpses of that glamorous portrayal. You will meet some of the most awesome people as patients who will make you feel more appreciated than you can imagine, phenomenal nurses who are a delight to work alongside and inspirational consultants who are truly thankful for the work you do in tandem with them. It is simply important to realize early these experiences are the exception and not the rule. You practice medicine to serve—not because you wish to be served.
What is the most meaningful struggle that you’ve overcome in your career, and how has it made you more suitable for the role you fill today?
Louito Edje, MD, MHPE, FAAFP, Associate Dean, Graduate Medical Education, Designated Institutional Official, University of Cincinnati Medical Center, Professor – Educator, Department of Medical Education, Department of Family & Community Medicine
One of the most difficult struggles was finding a meaningful rubric for making critical decisions in my medical career. What specialty, what practice to join, what board position to accept, what committee to join? I found one and I use it regularly:
When you are making any critical life decision ask yourself four questions:
· What it is the BEST thing that could happen if I DO this?
· What is the BEST thing that could happen if I DON’T do this?
· What is the WORST thing that could happen if I DO this?
· What is the WORST thing that could happen if I DON’T do this?
It may take a rotation, a heart-to-heart with someone who knows you, a candid conversation with a trusted mentor or significant other to answer these four questions. It is more granular than a pro-con list because it forces you to think about perspectives you might not readily have in mind. Ultimately, you will make a decision having done your due diligence and mitigate any downstream regret. Additionally, when you say “No” to an ask using this rubric, your no is respected because you have given it thought.
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