Advice for a First Year Medical Student

I recently had quite a long conversation with a college senior that was just accepted into medical school for this coming fall. As a rising fourth year medical student myself, I would like to think that I have navigated the waters of academia and figured out both efficient paths to success and avoidance of roadblocks and setbacks. However, I was quite overwhelmed with the number of questions and concerns that this particular student had. But in retrospect, I can recall my own naivete and fear of the unknown that is medical school.

After answering all of his questions, I realized that many soon-to-be first years may not have the advantage of mentors or advisers. Lacking guidance, students are willing or forced to charge forward and hope for the best. These are the same students that suffer the inevitable fatigue and burnout. But I believe that there is a smart and efficient way to approach medical school. That is not to say there are any shortcuts or cheats. Rather, I wanted to share with you my advice on 5 easy steps to being a better medical student from day 1.

1) Be willing to be selfish

You must be willing to prioritize personal time and to continue to do the unique things that make you who you are. And trust me, the time can be found in any rigorous program. Doctors aren't robots, and you should never plan to train like one. Medical school must be a time for you to continue to develop your hobbies and your personality. These are the individual characteristics that will make your patients love you one day. More importantly, these are the activities that will keep you both sane and free from stress.

2) Get 8 hours of sleep

No debating this one. First the benefits – you will study better, be healthier, and feel happier. There are enough distractions and obstacles built into the medical education that you should not be adding to the list. Sleeping in class, rereading text, and mental sluggishness are not paths to engaging the curriculum. Turn off the light, set your alarm, and keep track of your sleeping schedule. After all – you are training to be a doctor who will one day advise patients on healthy practices. Limit the sacrifices you make in your own health along the way. Healthy eating and regular exercise follow, as well.

3) Subscribe to just one health policy daily email or news blog

Medicine, particularly in the modern world, has much importance beyond the realm of clinical information. As a doctor, you will one day be called to be a leader, and your understanding of health policy and health systems will drive your success. You do not have to understand every sentence, or even read every word. But be open to absorbing what you can so you will be better aware of health care on-goings. The future of medicine is in dynamic health delivery systems. While you're cramming over the Krebs cycle, take a five minute break to review the latest info on real-world medicine issues. ACOs are being built and discussed right now – embrace that change and learn as the systems are being designed. (Feel free to email me for the full list of my daily subscriptions – aaronge@pcom.edu). Read during rounds when your attending is off ranting about something esoteric and his back is turned. Read it while your on the bus or in the bathroom. Again, time can be found if you look for it.

4) Study Smart

There is a difference between studying for a test and studying to be a doctor. While these two goals sometimes coincide, they are often very different in nature. I find that, for some reason, medical students have difficulty wrapping there minds around this concept. Here is what I mean – medical students often look to prepare for exams as if they need to know everything about a given subject. Buying multiple textbooks and review guides is more than common. Gaining this knowledge is the right thing to do, and will make them a better doctor in the long run. But it may distract you from your goal of doing your best on given test – and worse, it may lead to burnout. If an exam has questions that are drawn from lecture, then information outside of lecture is irrelevant for the scope of that test. You need to make a personal decision as to how much supplemental information you need to be successful. I'm not telling you to take any shortcuts in learning medicine, I am telling you to be prepared for what matters. You have at least 7 years to go through medical school and residency, and then a lifetime to practice. You cannot possibly learn everything in a day, month, or year. Don't sweat the details during your first year, anymore than is already forced on you.

5) Smile

As easy as this simple act sounds, this may be the most difficult of my suggestions. But stick with me! I am a firm believer in the power of positivity and confidence. You will get through medical school. That is not in question. But you have a choice as to HOW you get through medical school – to complain, suffer, and grieve through the process.....or to enjoy the ride. I believe that smiling, appreciating the best that you have, and keeping a positive attitude effects you in two ways. In the first, you will have the advantage of internal confidence and lower stress. From a medical standpoint, you will be less rattled on test day and benefit from decreased cortisol - both can go a long way! The second effect of positivity is the external impact you will have on those around you. How do you think nurses respond to medical students that complain or look upset during morning rounds. I know that a genuine smile and greeting has led to nurses and residents that have been willing to go the extra mile to offer me support. How do you think an attending or residency coordinator will respond to the stolid student, versus the upbeat one? The truth is that letting in negativity and suffering through complaint are a means of externally expressing defeat. You do not want to be that kind of medical student. Smile, you are living your dream!

I genuinely want all of you to do well, and to be great and successful doctors. After reading many other medical school advice posts on more tangible or “hard” skills, I wanted to offer a different perspective. As always, you have to do what works best for you, and everyone will find success with different methods. But I do hope that some of my advice gives you a different perspective on how to achieve that success. Good luck!

The Hazing of Family Medicine

Every one of us who practices family medicine has had to defend our chosen profession against a myriad of antagonists. As mentioned in the post ‘Family Medicine is a Waste of Your Talent,’ we are sometimes told that we are too smart to pursue family medicine. Other topics range from salary comparisons between specialties to scope of practice. I’ve been told on many occasions that I should specialize for many different reasons but am rarely commended for choosing primary care. Luckily, most of us are unphased by such comments. However, I believe that there are students who are pulled from primary care because of what I like to call the hazing process. I conducted a small but national scale survey of students, residents, and attendings to see how others handled this phenomenon.

Students who are unwaveringly committed to primary care are not influenced. Students who are unsure about what they want to do are highly susceptible to take the criticisms as fact and start to question their dedication to primary care. These two findings did not surprise me as I had seen many students fluctuate in and out of favor of family medicine over the past four years. What I did not expect to find is the attitude that the established, experienced family docs had. As a whole, they vastly underestimated the effect this process has on students’ career choice. Most of the responders were academics who I thought would be more tuned in to the problem, but they seemed to have been in the ‘immune’ group when they themselves were students and thus, assume that everyone knows the negative comments are not well-founded. One felt that it is simply unprofessional to speak ill of another field while another described the issues as ‘tired old clichés’. I had a lengthy discussion with another physician who felt there must be some difference between those students who are susceptible to changing their interests at the suggestion of a peer or authority figure versus those who are not.

One thing stood out to me about the wavering group of students. They all had questions. They wanted to know if the things they were hearing were true. They’re not! Family medicine trained physicians work as hospitalists, they see plenty of kids (if they want), they do procedures (sometimes even operative ones like appendectomies), and they are not poor. Even being one of the lower paid specialties with an average income of $150,000, it still ranks in the top 5% income bracket in the US. And according to the 20^th COGME report, the U.S. is going to have to increase its recruiting efforts because we will need so many more family physicians in the coming years. So the potential for employment is about to skyrocket as explained in the post ‘Analyzing COGME: Increase the Number of Primary Care Physicians.’ Family medicine will be growing faster than any other specialty.

America wants more family physicians. When I meet people (who don’t work at the hospital) who ask me what my specialty is and I have the pleasure of saying family medicine, I am encouraged. At my local farmer’s market the vendors thank me for being interested in rural primary care. I met some people cross-country skiing who hugged me when I said family medicine. I often ask people how far they have to drive to see a doctor, where the nearest pharmacy is, or if there is a community health center in town. This facilitates a conversation about what primary care providers do for a community, even if the person doesn’t necessarily have a well defined perception of what a family physician is…and they like what they hear.

So my recommendation to students who are undecided is to take your concerns to the family medicine departments at your schools or to private practice family physicians in your communities. Not only can they first-handedly dispel these myths but they will hear loud and clear that family medicine needs to be promoted. If our students don’t know the truth about the potential within the field, how will our community members? If you ask someone what they would like from the medical system they will describe a family physician in a patient centered medical home. So let’s spread the word that it already exists and that we are happily working there by doing the following:

1. Help stop the hazing by confronting the hazers with data and confidence. Be proud of your choice because you will help lower health care costs and provide a much needed service to your community.

2. Get involved with your family medicine interest group, the AAFP, or your state chapter where you will be exposed to resources and peers because even if you are the only student in your class who is interested in family medicine, there are thousands around the country.

3. Attendings and residents need to reach out to students and be more active in representing the field of family medicine.

4. Do what you love and do it well. Explain why primary care is so important to your family members because the ultimate reward is choosing the right career, not making the most money.