“Is med school as hard as they say?”
I asked the question of many people ahead of me. The answer often came with a hesitation, a rocking of the head, a “kinda,” and an attempt at assuaging worries. Either it nonchalantly reassured me everything is fine, or wistfully told me to “enjoy your free time while it lasts.” I know the response well, because it’s the same one I’ve given in recent months.
It’s a difficult question to answer, not least because it forces me to place twelve months of lived experience into a bucket of “easy” or “not easy.” Months, like people, are complex. I’ve been stressed. I’ve been bored. I’ve felt depressed. I’ve felt overjoyed. My hesitation and shrug convey not apathy, but a warring of potential answers inside.
And so, I do what all medical students do when we don’t know what to talk about: I talk about classes.
“Yes, but Mod 2 is so much better than Mod 1.”
“No, it’s all about how much you let studying take over your life.”
“Yeah, honestly enjoy your sleep while you can before clinicals.”
“I mean kinda, but that’s what we signed up for and it forces you to grow #growthmindset.”
And of course, there’s the oft-repeated aphorism, “medical school is like drinking from a firehose. The material itself isn’t too difficult—it’s just the volume that’s overwhelming.”
All of the above are true to some degree, but incomplete. And it’s taken me a year to realize there’s something we always leave out of answering that question.
Medical school isn’t hard because of classes. It’s hard because the rest of life doesn’t stop.
So, allow me to let down my façade and replace my embattled shrug with some candor. Has the last year been hard for me? You bet, but it wasn’t because of biochemistry, CTB, repro, or GI.
It’s tough because I got an unexpected text from my mom in the middle of a virtual small group that my grandmother passed away. It’s because I moved to a new city far from home and left all my closest friends behind. It’s because relationships end, because of physical health issues, because I compare myself to other people even when I know I shouldn’t, because I struggle with loneliness and discouragement, and because I idolize what other people think about me. Oh, and have you heard there’s a pandemic?
Forgive the somber personal details. My intent is not to elicit pity, but to illustrate all of the real answers to the question “is medical school hard?” that we fail to mention. In fact, my point is precisely that I’m not unique in having a list like this. While the details will inevitably vary from person to person, I have no doubt each of my classmates could detail similar lists, because their lives have continued, too.
On top of the personal struggles, the weighty subjects in doctoring and ICM aren’t going to come with warning signs advising you to get some extra rest the night before. You’ll mindlessly show up to class with Zoom open on one tab and allrecipes.com on another, and next thing you know you’re discussing systemic racism, abortion, or how to deliver terminal diagnoses. You quickly realize medical school floods more than just your mind; it floods your heart.
And you want to talk firehose? Try keeping up with renter’s insurance, parking, unloading the dishwasher, weekly COVID tests, taxes, budgeting, KnowledgeLink, meal prepping, and laundry. Now that’s volume.
Medical school isn’t hard because didactics are a lot. It’s hard because the obligations of life don’t stop. You have to keep up with all of the above, and oh by the way, make sure you watch four hours of lecture each day with the corresponding flash cards. Lectures are less of an information firehose, and more of an obligational straw on a Zoom-fatigued camel’s back.
But you want to know the beauty of medical school? It’s wonderful because life doesn’t stop.
You’ll get to try Philly’s exquisite food scene, meet some of the most wonderful people, fall in love, tell your parents about your brilliant friends (I’m looking @ y’all, MS2s), see sunsets, join the Philly community, bike the Schuylkill, and eat water ice (@John’s) and hoagies.
All the while, you’ll get to marvel at the intricacy of the coagulation cascade, the splendor of the HPA axis, and place your ear against that profound whisper of “lub-dub.” You’ll get to look into patients’ eyes and ask them to tell their stories. You get to walk across that South Street Bridge in scrubs, and you’ll inevitably feel like an imposter, but you’ll smile, nonetheless. You’ll get to introduce yourself as “student doctor” and laugh quietly to yourself at how ridiculous that sounds. And you’ll get to do all of this while continuing to be a real person.
So it seems to me, we should seek advice not on how to navigate the firehose of classes (the answer is probably anki), but how to navigate the firehose of life. How do we diligently submit to the machine of medical education, while also drinking deeply of the thrills of life? How do we eat of the spectacular opportunities Perelman provides, while avoiding too much on our plates and leaving room to feast on the little joys? With the unsolicited eagerness of someone who’s been here, and the humility of someone who’s only an MS2, I offer three things to you, MS1s, that I hope might help answer that question.
1. Resist the pull
Medical school will invariably demand as much from you as you allow it to take, so I urge you to get comfortable around the median (it’s lovely here!). Please believe me when I say to you, “you’ve worked hard. It’s ok to be average now.” You don’t have to sign up for Clinicom, research, shadowing, or a specialty interest group just because everyone else is. Resisting the pull of medical education to take over our lives will require that we stop comparing ourselves to others and find our identity and self-worth in something other than academic performance. Easy to say, tougher to execute.
Many will remind us that we must learn all this information for our patients, and of course they’re right. We must train to be excellent clinicians. But it seems to me that medicine suffers not from a dearth of knowledge, but from a burnout epidemic. There’s something about the culture of medical education that pushes us closer to exhaustion and frustration. That is an undertow we must resist.
So put down Notability and go grab drinks with your classmates (they’re like, really cool). Email a professor. Ask friends for good book recommendations. I invite you to join me in a pursuit of “intentional mediocrity” in certain areas, not out of apathy or laziness, but in a deliberate movement away from the undertow to memorize facts, and towards playing the long game of personal growth, character, and well-being. I believe our patients one day will thank us for that.
2. Lean into the process of medical education
This might seem contradictory to the point above, but I think there’s often a distinction between studying and real learning. While there’s always more studying of discrete information to do, learning prioritizes higher level synthesis, clinical correlations, and the ethos of medicine. The things that I am often tempted to skip or ignore in my crunch for time, like doctoring readings, classes at the other grad schools, or optional lunch lectures have often been the most fruitful.
So don’t fear the firehose. Enjoy it, trusting that medical training is a long process designed to teach you the things you missed the first time around. The redundancies are built in for our good, and the material has been selected with purpose. While I have been tempted to cynicism and complaining about the structure or content of my courses, the further along I get, the more I trust the structure of medical education. Everything I’m being taught is an attempt from someone further along to tell me something they wished they had known.
Trust the process to shape not only your mind, but your character and compassion too. I invite you to humbly learn from the communication strategies of ICM. Take notes on the behavioral economics principles of doctoring. Listen to your preceptors as they describe strategies for delivering bad news. And when your classmates are sharing their thoughts on end-of-life care over Zoom, close your other tabs and listen.
Wherever you are, be all there.
Every decision we make moves us closer to or further from the person we want to become, so let’s play the long game of learning, not the short game of information cramming.
3. Don’t let the urgent crowd out the important
The two points above will always be in tension, and in the middle of a busy week, it will be tough to tell which should win out. The best remedy I have found is to, in periods of calm (like before a semester), write out particular goals and priorities that will guide your decisions. These will be easy to write when you can see clearly but become tougher in the chaos of a test week. But if we let those things that feel pressing overtake the long-term things that really matter (like keeping in touch with our families and building meaningful friendships) we’ll simply leave behind a trail of fires we’ve put out rather than a legacy we’ve built.
So, decide what involvement in research, interest groups, and extracurriculars you want while you can still see the opportunity cost. Decide also how much sleep to prioritize and build your budget, your exercise routine, and your personal development goals. When you list all the things you want to do in one place, you’ll likely realize it’s not all realistic, and face the tradeoff of which ones are actually worth pursuing and, more importantly, which ones aren’t. Better to make that decision while clear-minded, rather than have it made for you when the reality of time scarcity hits. A small list of major priorities will grant clarity in the storm and constrain the passive undertow of life.
For my part, I have to prioritize sleep (it drives my physical, mental, emotional, and spiritual well-being) and investing in a non-medical school community (for Christians like me, that means a local church). And I believe you’ll never regret telling friends and family how much you appreciate them… especially if they’re the ones who upload the class Anki cards.
Stress occurs when we don’t have margin (financial margin, grade margin, time margin, etc.) so build margin into your planning. And burnout results primarily from frustration and exhaustion, not simply busyness, so prioritize activities that create “flow” wherever you can.
The value of writing all this down is that it allows the clear-minded version of you to serve the panicked version of you. In the heat of the semester, you’ll forget why you said you wanted to prioritize slow relationships, invest in Philadelphia, or learn the saxophone. You’ll forget why you wanted to come to medical school and how hard you fought to get here. So do yourself a favor and write down why you wanted to come here, why you chose Penn, and why you’ve fought so hard to embrace the high calling of medicine.
Because sure, medical school is hard. But oh, is it worth it.
Chip Chambers is an MS2 at the Perelman School of Medicine.
Image by Tracy Du, an MS2 at the Perelman School of Medicine.
