Med School Confidential Read online

  Why Should I Worry?

  The Top Five Realities About Marrying a Med Student

  How Will Your Med Student Be Spending His or Her Time?

  Applying to school/premed years

  Preclinical training (or the first few years of med school)

  Clinical training in med school

  Internship and residency

  How to Survive Med School as a Spouse, Partner, or Significant Other

  Coping Tips

  Is the End Ever in Sight?

  APPENDIX

  Fundamental References

  Test Prep

  Premed Curriculum and Med-School Applications

  Clinical References

  Finances

  Residency and the Match

  Resources for Family, Friends, and Supporters

  ACKNOWLEDGMENTS

  WHILE ANY AUTHOR would love to claim the finished product as the jewel of their creation alone, the truth is that there were many important contributors to the book you now hold in your hand. First, a thank-you for the invaluable input and insights of our fantastic mentor group. Thank you Ben, Chris, Deb, Pete, Carrie, Adam, and Kate. It is your contributions that have transformed an otherwise unilateral impression of medical school into a broad and comprehensive guide to the experience. We appreciate the time, the effort, and the candor you offered, and are honored to share the authorship with such an august and talented group. Thanks also to Nancy Nelson, former Dean of Student Affairs at the University of Colorado School of Medicine, for her encouraging words, extensive contacts, and sage advice; and to Dr. Andy Perron, Program Director at the Maine Medical Center Residency in Emergency Medicine, for allowing his chief resident to write this book, and for his superb support and encouragement.

  We would also like to thank the many people who contributed to Med School Confidential behind the scenes. First, to our terrific literary agent, Jake Elwell of Wieser & Elwell, who has stood by the Confidential series from the beginning and has helped to nurture and grow it into the well-respected, international platform it has become. Honors three times, Jake, makes you a CB Club Member. Thanks also to Tom Dunne and Pete Wolverton at St. Martin’s Press for seeing the wisdom in turning the success of Law School Confidential into a series.

  On the production side, true thanks go to John Parsley, our editor at St. Martin’s Press, who inherited this project, but whose enthusiasm, responsiveness, and professionalism have kept us on track and made this book his own. John, we’re truly grateful to have had the chance to work with you. Thanks also to Mark Steven Long for an exceptionally good job copyediting and fact-checking.

  Finally, a thank-you to our families for unending patience and support in the face of tremendous pressures and long hours.

  From Rob: To S.D., for seeing me and our family through yet another Confidential entry by so ably and loyally manning the rudder while I continued to insist on fiddling with the sails. Your many contributions to this book, to all of the others, and to the dreams of an aspiring author looking to make good on those dreams will never be forgotten.

  From Dan: To Kim, who shouldered the burden when the teetering tower of residency, research, kids, writing, and life seemed about to topple over. As always you kept our family moving forward and filled me with inspiration to get the job done. Your contribution to the final section of the book has given a voice to the countless spouses who have also weathered the med-school experience and will be inspiration and solace to those who come behind us. Thank you, also, to my father for brandishing the red pen one more time and bringing thirty-five years of teaching experience to bear on our piece, even if it did run a bit over the five-paragraph limit. Your insights, instincts, and insistence on proper punctuation were invaluable.

  FOREWORD

  THE TECHNOLOGY AND organization of American medicine is evolving rapidly and it constitutes not one career path. Medicine provides options for students with diverse interests and personalities. There are some unifying themes: you need an ongoing interest in science, concern for people as individuals, high ethical standards, and a willingness to work as part of a team. These qualities must be present in any physician, whether he or she contemplates a career in primary care, a more narrowly defined clinical specialty, administration, or bench research.

  Your genuine interest and enthusiasm for biological science must persist over an entire career. The advances of the year 2006 will give way to a more advanced understanding and a new vocabulary in just a few years. To maintain your accreditation, state licensure boards demand proof of continuous education efforts. Specialty certification is now limited, in most instances, to a decade before a recertification examination is required. If these challenges are odious, humanitarian motives alone will never be an adequate substitute. Very few of us are really scientifically creative, but you must be excited about the advances appearing each week in the best peerreviewed journals. These advances must impact the care of your patients.

  Science has its limits, though. If you do not see yourself as a laboratory researcher, you must not squander your college years taking highly specialized science courses you will soon forget and probably never use. You must pay more than lip service to a liberal education. Some exposure to subjects like English, economics, political science, history, a foreign language, art, and music can immeasurably enrich your life. You still must do well in the required premedical sciences: general chemistry, organic chemistry, biochemistry, biology, and physics. Be sure to take these subjects at your home college or university or at an institution of equal academic stature, not an inferior school because you fear the grading curve on your own campus.

  All physicians who care for patients must be interested in them as individuals, not bodies with a diagnosis. You must be a competent communicator. Be willing to speak but also be able to listen. You must be sensitive to cultural and educational differences that may color a patient’s perception of their illness and may require you to modify your usual approach.

  High ethical conduct must be engrained in your character. Advances in health care rarely seem to decrease cost. You have an obligation to try to be certain the new technology or drugs are cost-effective, not just something new with marginal benefits. Cost containment and rigid practice guidelines, when based on good clinical data, may save resources of both society and your patient. Everything you do must be tempered by the notion that your first obligation is to your patient and not to enhance your own income, the group’s, or an insurance company’s.

  Health care has become more complex than even a few years ago. The solo practice of medicine is a distant memory for most physicians. You must be comfortable working as an important but rarely omnipotent member of a team of health-care providers, many of whom may not be addressed as doctor.

  As mentioned earlier, not all physicians choose to be involved with largely full-time direct patient care. Research in an academic institution may have strong appeal either in patient-based studies of a new drug or procedure, or at a cellular level. You must always remember that your work must be directed at improving the life of your patients.

  Whatever your ultimate calling in medicine, this thoughtful book will aid you in better understanding the process of medical education and help you find your way.

  —Harold M. Friedman, M.D.

  Associate Professor of Medicine (Emeritus)

  Chair, Admissions Committee,

  Dartmouth Medical School

  PART ONE

  So You Wanna Be a Doctor . . .

  INTRODUCTION

  Is there anyone so wise as to learn

  by the experience of others?

  —VOLTAIRE

  THERE IS, PERHAPS, no more outwardly appealing career than medicine. It is hard to argue with a career choice that allows you to save lives, or at least improve them, every day. Doctors are also well-compensated and enjoy job security largely unparalleled in today’s society. The fact is, the world will always need doctors, and doctors still garner a level of credib
ility and respect in our culture that lawyers, entrepreneurs, and other highly compensated professionals have long since lost.

  So what about medicine? What is it that is drawing you to it?

  Maybe your interest has been triggered by those enduring, romantic perceptions, by a family member who is a physician, by Hollywood’s depiction of doctors, or even by pages from a biology textbook. Somehow you developed the notion that a life in medicine might be just what the doctor ordered. But what would that mean? What does a physician’s life look like?

  How hard is it to become a doctor?

  By picking up this book, you’ve taken a crucial first step, meaning that you’re either interested enough in the idea of medicine as a career to want to explore it further, or that you’ve already committed to the idea and are looking for guidance and perspective. This book can help you on both fronts.

  Together, in the pages of this book, we will embark on a journey of discovery through truly foreign territory. The lexicon will be, at times, arcane and tongue-twisting, the structure, hierarchy, and traditions often seemingly byzantine. Between the covers of this book, though, you will find a detailed map of the world of med school and advice from an elite group of mentors to guide you through the perils and pitfalls of the premed and med-school years. This book contains the wit and wisdom, insight and inspiration to take you from your first musings about medicine as a career through medical school and the beginning of your internship—and everything in between. By reading this book, you will gain invaluable knowledge and perspective about the process, which will enable you to approach medical school with confidence and excitement.

  Let’s begin!

  HOW TO USE THIS BOOK

  THIS BOOK BREAKS the medical education process down into its six component parts, each part representing a major step on the journey to becoming a doctor. This structure allows you to either follow the steps sequentially, if you’re at the beginning of your journey, or to jump right to where you are in the process. Each section of the book contains an overview, discusses the challenges unique to that section, and offers specific guidance about how to survive and thrive in the experience and advance to the next stage of the process. In each section, your team of mentors—people who have all just been through the ups and downs of what you’re about to experience—will highlight the critical aspects of the journey, steer you around the pitfalls, and help you separate what is important from what is not. Spend a moment reviewing their biographies on the next few pages. Your mentors come from diverse backgrounds and very different med-school experiences. By learning from their successes, mistakes, and misadventures, you will make important distinctions and gain insight into what matters and what doesn’t.

  In a moment, we’ll be introducing you, the reader, to your mentoring team—the group of just-graduated med students who will guide you with their advice, wisdom, and anecdotes throughout the following pages. First, though, a bit of advice about how to get the most out of this book. It has something to offer you, whether you are a college student thinking about med school, a working person contemplating a career change, a student already in med school, or the parent/friend/significant other of a med-school student and you’re just trying to understand what your loved one is going through. Determine which of the following situations is most applicable to you, and read on.

  I am a college student thinking about applying to med school/I’m thinking about changing careers and applying to med school

  If your med-school experience has not yet begun, you’ve just stumbled upon a wealth of information and resources that will make your entire experience easier, less stressful, and, we hope, more successful. We suggest that you read this book from cover to cover before you begin the application process (1) to confirm for yourself that you really do want to go to med school, and (2) to get a good overview of the entire experience to help inform your interviews and application essays. Once you’ve familiarized yourself with medschool terminology and gotten a sense of the process, you should then go back and read each of the individual chapters as they become applicable to you.

  I’ve already been admitted to med school, and I’m nervous . . .

  Yeah, well, join the crowd!

  Almost everyone entering med school is nervous about it because of the mystique associated with the experience. You, however, have come to the right place at the right time. Unlike your classmates, who will fumble nervously through the first year not knowing exactly how to proceed, you will have a step-by-step proven plan—a map of the road to success drawn from the experiences of the mentoring team you’re about to meet.

  Take the time between now and your first day of classes to read this book cover to cover. Don’t worry if you don’t understand everything right away. Just familiarize yourself with its content and with some of the basic ideas and concepts it presents. Then, when med school begins, keep this book within arm’s reach and let it be your guide through each month and each year of the experience, steering you safely around the pitfalls and hurdles into which your classmates will stumble. Use it to measure your progress and to keep track of where you are.

  This is your book of wisdom. Let it work for you.

  But I’m already in med school . . . I wish I’d found this book sooner

  Yeah, us, too. The difference between you and us, though, is that at least you can still benefit from this book. We had to learn most of this stuff the hard way!

  The fact is, it’s never too late to start. If you are already in the throes of med school, we still recommend reading the entire book, as there are earlier hints and suggestions on which you can still capitalize. Then simply go to the table of contents, find where you are in your med-school career, and begin in earnest. Read forward to the end of the book to get a feel for what’s to come, and then concentrate on specific chapters as they become applicable to you.

  If you could get help in the middle of an exam, you’d take it, right? So what makes this any different?

  I’m the parent/friend/sibling/significant other of someone going to med school

  Want to give your friend or loved one the best gift you could ever give them at the times they need it most? You have it in your hands. Before you wrap it up, though, you may want to skim it yourself. In it, you’ll soon discover why your med student isn’t returning your phone calls, letters, or e-mails, doesn’t have time to come home to visit, and is frequently tired and cranky when you call. If you are close to a med student, their experience will touch you, too—and the better your understanding of its incessant demands on time and energy, the easier it will be to accept the virtual loss of your loved one for the next eight to ten years. The impact of the stress, the schedule, the financial implications, and the emotional swings of med school is very real. As such, part seven of this book includes a chapter just for you, written by Dr. Bissell’s wife, containing accumulated wisdom from family members and partners to help you see your med student through this challenging process.

  Your job is to be as supportive, understanding, and forgiving as possible, and to place as few demands on your med student as you can. Reading this book will help you to understand why—and also give you some familiarity with the experience they’re having. That said, it’s now time to meet the mentors who will guide you through the next four years and beyond. As you progress through this book, you’ll be able to follow their course, discover and learn from their mistakes, and watch their careers develop before your eyes. You can and should model some of their actions, choices, strategies, and experiences. And you will learn from all of them. You see, at the end of our med-school careers, many of us walked away shaking our heads and muttering to ourselves, “I wish I knew then what I know now.” You are in the unique position to have that wish granted.

  It’s time to get busy!

  THE MED SCHOOL CONFIDENTIAL MENTORS

  CAROLYN COME

  Newton, Massachusetts

  B.A. Cornell University (Government)

  M.D. University of
Vermont Medical School

  Premed: At Cornell, as an undergraduate

  Time off between college and med school: 2 years

  After college, I took a position as a research technician in an immunology lab at Brigham and Women’s Hospital (the same lab I had worked in the summer before my senior year of college). I worked in the lab for two years. My projects involved the use of murine models to explore the relationships between T-cell-mediated immune responses and atherogenesis.

  MCAT prep: Kaplan

  MCAT administrations: 1

  Number of med schools applied to: 20

  Number of times applying to med school: 1

  Residency: Internal Medicine

  Both of my parents are doctors, so growing up I had a lot of exposure to both the rewarding and difficult aspects of being a physician. I was always impressed by my parents’ devotion to and compassion for their patients and their patients’ families. I also saw the affection and regard with which my parents were held by their patients. I think I first thought about becoming a doctor in high school because I liked science, and I thought I would enjoy doing what my parents did. At the same time, I often wondered whether I really wanted to be a doctor or whether it was the only profession I knew much about. While I took all of the requisite premedical courses in college, I chose to major in political science because I loved reading and learning about government and history. After college, I did research in a lab for two years to help me decide whether I wanted to pursue a medical education. My time in the lab increased my interest in medical science and experimentation. Pursuing a medical career offered me a wonderful opportunity to combine my interests in science and working with people.