#26: Intra-class relationships

One word that is used with alarming frequency to describe medical school students is the word "incestuous." In fact, if and when you do matriculate at a medical school, you'll rarely hear the word used more often than in this context. The notable exception to this rule is, of course, West Virginia, but that's just more proof of just how incest-filled med school truly is. However, you'll quickly find out why this word is so frequently used once you get there: like moths to a flame, med students cannot keep their hands off of one another. You will find that medical students pair off quickly and, often, indiscriminately, so it's important to know how to take advantage of this situation (if you desire to do so).

The reasons that medical students fall into the same patterns time and time again are quite simple to understand, when viewed in the proper context. First and foremost, medical students simply don't have many opportunities to go out and socialize with non-med students. This is mostly a consequence of the extreme amount of work they're faced with; time that used to be spent meeting other people now gets taken up studying neural pathways, memorizing cardiac arrhythmias, and learning the mechanisms of action of various neurotransmitters. Simply put, medical students need an outlet. Most of them are young and hormonal, and if they don't have access to people of their choosing, then they will make do with whatever they're given.

However, while much of this behavior can be described as natural, just as much of it is a consequence of sheer stupidity. You'll find that medical students are so desperate to be with someone that they will date people who are completely wrong for them. For example, the following scenario is not uncommon:

You're out one night with a bunch of your friends from medical school who you haven't seen in a while, possibly at a dinner for one of their birthdays. You're making casual talk with them when suddenly you notice that two of your friends are acting more than a little friendly towards one another. At first, you try to remember if the two of them were dating, and you realize that this is a new development. You start recalling your experiences with each of them individually, and you come to the conclusion that these two people are not in any way, shape, or form complimentary to each other. Your mind will struggle to reconcile that knowledge with the information that they are, in fact, dating, and eventually you'll just stop thinking about it because it was never that important in the first place.

When you get to medical school, you will undoubtedly be attracted to someone in your medical class, and will be inclined to date them. It would be unbecoming of me to tell you what to do, but just remember: don't do it. The pros and cons of dating within your class include:

Pros:

• Easy access: It's very easy to meet and spend time with people in your medical class. There are always things going on - house parties, tailgates, holiday parties, etc.
• Quick-forming, intense relationships: One consequence of medical school being so compact and intense is that the students become incredibly close as a result. This same closeness that is found in friendships will also be found in romantic relationships (which, if handled properly, can be a very, very good thing, wink wink nudge nudge).

Cons:

• Too much access: You literally cannot get away from the person. For at least the first two years, you and the person you'll be dating will have almost the exact same schedule, which is suffocating for even the most dependent of individuals.
• Too little privacy: Because medical school class sizes are so small, news travels fast. If something happens in your relationship, you can be sure that most everyone will know about it before you do.
• Messy breakups: It is well known that medical school is like high school - people form cliques, and if you and your significant other break up, people will take sides. The best thing to do in this situation is to get everyone on your side, quickly.
  
  

#25: Parents

If you're considering entering medical school, it's important for you to determine a strategy for dealing with your parents. Simply put, parents seem to have missed the memo letting everyone know that medical school is "challenging"; there is no other way to explain why they are so consistently unsympathetic to their children's needs and struggles. ("Challenging" is the euphemism of choice these days; initially, medical school administrations wanted to use more accurate language, but exhaustive research determined that using words like "pathologically depressing," "psychosis-inducing," and "hell" would not be the most profitable marketing strategy.)

Most people would agree that since medical school prepares you for an occupation in which you will be dealing with life and death on a daily basis, it's important that you take it seriously and approach it with your full, undivided attention. However, this kind of logic is lost on parents. Parents are fragile, emotional creatures who have their own human neuroses and agendas through which they will aggravate you.

Perhaps your parents desperately want you to get your medical degree so they can tell all your relatives about how smart their branch of the family is. Or maybe they've recently developed an anxiety disorder, and can no longer go more than 15 minutes without calling to guilt trip you into making plans to come home. Or, perhaps your parents are partially supporting your way through school, and have become obsessed with making sure their money is being spent wisely.

Those of you with one or both parents as medical doctors may be under the impression that your parents will be more supportive of you than a non-doctor parent would be, seeing as how they once had to go through the same "challenging" educational process as you. However, science has shown that parents who are doctors are actually less likely to be sympathetic to their children's issues once they enter medical school. The reasons for this are not completely understood, although research is continually being done on the subject. Some studies have shown that doctors have been so completely beat down by the medical establishment that they spend most of their free time feeling sorry for themselves; they have no empathy left to expend on their children. Other studies indicate that perhaps there is a correlation between succeeding in medical school and having terrible parenting skills. Nevertheless, the fact remains that children of doctors who are thinking of entering medical school need to be prepared for especially callous behavior on the part of their parents.

Regardless of what your situation is, you need to have a game plan for relieving your parents' tension. Otherwise, you could be looking at four years of near-constant arguments and drama, which is fun on Gossip Girl but frustrating in real life. A few strategies that have proven effective in the past include:

• Ignoring them and dealing exclusively with your more wealthy and understanding relatives: while there are many benefits to this course of action, the most overlooked one is that it enables you to surreptitiously keep tabs on your parents to know what they're up to.
• Complaining about your siblings in order to distract them: this can be a useful maneuver if you find yourself dangerously close to an impending argument.
• Appeasing them through ritual animal sacrifice: note that this may not work if your parents adhere to a monotheistic religion.
• Moving away and changing your name without telling them: the disadvantage to this is that you won't see your parents for at least four years, but the advantage is that you won't see your parents for at least four years.
  
  

#24: The cost of tuition

While most pre-med students can tell you that getting a medical education will be "expensive," they have no real understanding of the magnitude that the word "expensive" actually implies. However, they can tell you that medical school will be expensive because "everyone says that it is." In this sense, they are slightly more evolved than parrots, able to regurgitate key phrases to their superiors in exchange for a few month-old saltines and a bit of yarn (a skill that will be most useful in medical school).

Simply put, most pre-med students have no standard against which to realistically compare the cost of a medical education. On a day-to-day basis, they are concerned with the price of a can of Campbell's condensed tomato soup ($1.65), which isn't really comparable to the cost of four years of tuition at a private medical school ($139,000).

(For those of you playing along at home, the amount of money you would spend on tuition payments for four years of medical school would buy you 84,242 cans of Campbell's condensed soup.)

Making sense of tuition costs is irritating. Tuition costs vary greatly from school to school; there is no standard tuition that all medical schools adhere to. However, many medical schools with similar characteristics can be grouped together, so that general trends emerge. For example, a private medical school will charge around the same amount to all students (regardless of state residency), while a public medical school will charge in-state students massively less than non-residents for attending their school. For completion's sake, here are some figures:

• Average cost of a year of tuition at a public medical school (in-state student): $16,690
• Average cost of a year of tuition at a public medical school (non-resident): $34,900
• Average cost of a year of tuition at a private medical school: $34,749

Of course, these are just generalizations. Medical schools reserve the right to do what they want, so they can buck these trends as they see fit. For example, the University of Colorado (a no-name public medical school) charged non-residents $75,700 for a single year of tuition!

Please notice that these figures do not include anything outside of the base tuition cost. Books, school fees, living costs, prescription drugs, non-prescription drugs, illegal drugs, and health insurance all have associated costs that are entirely separate from the cost of tuition, so having enough money to cover all of those expenses is also important.

All of this has the added benefit of adding another layer of complication onto your decision about which medical school to attend.

However, there are a few things you can do to help lower the cost of tuition:

• Be a minority: Many medical schools have scholarships set aside specifically for minority students, so by fulfilling the criteria for these scholarships, you can make life much, much easier for yourself.
• Have a recently-deceased relative: Medical schools need a certain amount of bodies for dissections for the first year students, and every year, they scramble to meet the number that they need. Medical schools may be flexible in offering some sort of compensation for an anatomical donation. (Note: do not actually do this.)
• Have rich parents: This one is self-explanatory.

Most students, however, will need to take out loans in order to cover the cost of tuition for medical school. If this is you, remember that most doctors make very large sums of cash upon exiting medical school (not including those who go into family medicine), so this mortgaging of your present against your probable future income will generally work out in the end.

#23: Obstinacy

Medical students are one of the most brash and opinionated group of people you will ever meet, probably second only to full-fledged doctors. They love sharing their opinions on anything and everything, even if you don't want to hear them. Especially if you don't want to hear them. And especially if you don't care. If you ever watch a television show with a med student, prepare to have every plot, information, and wardrobe inconsistency identified and dissected at the level of a graduate-degree thesis (complete with bullshit theorizing). The importance of this obstinacy as a survival mechanism cannot be overstated, as it has served them well in their previous 20-plus years of life; pre-med classes are not easy, and this obstinacy is often the only thing driving these students to do well in their classes.

A common misconception is that the majority of medical students are obstinate, which is simply not the case. The reality is that the majority of successful medical students are obstinate (while the rest are cheaters). This is because the more obstinate medical students don't have silly things like guilt and morality nagging at them when they make a mistake or hurt a classmate's feelings, and without these psychological hindrances, they are free to to keep moving forward even when they royally screw things up.

There are a few things med students are especially obstinate about, including liberalism. If you are thinking of going into medical school and you hold any conservative viewpoints at all (e.g., that abortion is wrong), you should prepare to have these views mocked without mercy, especially if you go to a top ranked medical school.

Usually this obstinacy will not cause you too much of a problem, as you will quickly learn to avoid these people in your social circles. However, your classmates' obstinacy can become an issue in small group settings, as you will be forced to sit in the same room with other med students for two hours at a time, with everyone being "encouraged" to share their views on random different inane topics. In order to survive in this setting, always remember that there truly is no one "right" viewpoint, no matter what that annoying bitch says or how loudly she says it. The quieter you are and the more you let things slide, the easier it will be to pack up your things and walk out the door when the small group session is over.

#22: Tests

The entire profession of medicine is obsessed with tests. This is unlike most other professions, which have the common sense of realizing that after an individual makes a certain amount of progress in the field, the job becomes less about bullshit basic knowledge and more about specialized knowledge and people skills. It is true that most professions have qualifying exams of some sort, such as the bar examination for lawyers. However, only medicine forces their practitioners to continually retake exams for the entire working life of a given person, even years after the person has received their medical degree. (As you might expect, masochists tend to do extremely well in this system.)

This process of continuous testing starts with the SAT in high school and continues with the MCAT in college. Many students freak out over these two exams, but in reality, these tests are jokes compared to what you'll have to deal with in medical school and beyond. During the first year of medical school, you can expect to have a quiz or exam every single week. (If you are in a systems-based teaching school, you can also expect to have anatomy lab practicals that coincide with the final exam for each sequence.) Thankfully, second year is a little less vicious in terms of exam frequency. At the end of the second year, all medical students are required to take a massive exam called the USMLE Step 1, which is a comprehensive test of the entirety of the previous two years. The USMLE Step 2 and Step 3 come later on, as well as national shelf exams all through the third and fourth years. However, don't think that the testing stops once you graduate from medical school; board recertification exams must be retaken every seven to ten years!

Ostensibly, this incessant testing occurs for the sake of patient safety. If you force people to refresh their knowledge base in order to pass a recertification exam, you might expect them take better care of their patients by drawing upon that knowledge base later on. The only problem with this sort of thinking is that seven to ten years is more than enough time in which to forget all the stupid minutia that you get tested on. The real test of whether or not a doctor is competent is whether or not they do a good job of managing their patients illnesses on a day-to-day basis, including taking it upon themselves to keep up with emerging trends in medicine. One would imagine that such a doctor would also be able to pass a board certification exam, but apparently it is too much to ask to have the exams be a replica of what doctors actually do on a daily basis. It makes much more sense to ask them to partake in an unnatural, non-intuitive process that tests them on knowledge that is marginally relevant to their ability as a clinician.

If you are considering going into medicine, you should come to terms with the fact that the best years of your life will be spent memorizing and regurgitating vast quantities of information (unless you decide to take some time off before going into medical school). You will basically be a glorified parrot, and your position could be better filled by any kind of PDA. The first point is even more true if you are female, as the longer you wait to have children, the more your uterus will shrink down to nothingness.

#21: Pass-fail grading

Many schools are moving towards a strict pass-fail grading for part or all of the lecture years of medical school, which means that your actual numerical percentage for each sequence is never seen by anyone, and can therefore never count for any kind of future job placement. This is the only criteria worth taking into account when deciding on which medical school to attend. The medical school curriculum is taught at a breakneck speed, and pass-fail grading is the only thing that will allow you to stop backstabbing your classmates and appreciate the material instead. That kid who can't shut up about the research he's doing, your annoying anatomy lab partner, and you (who stays in bed past 1 p.m. every day) are all on the same page for as long as pass-fail grading lasts. Go ahead, take that breather. For once, you're not falling behind.

While medical school will bombard your brain with a ridiculous amount of information, pass-fail grading will remind you that being able to guess 75% of the correct answers on the test is good enough to be a doctor. Since no one will ever see your scores, you might as well use the least amount of effort possible to get through the lecture years, and save that energy for improving your golf game or something.

The only downside to pass-fail grading is that medical schools are starting to use it as an excuse to not improve their curriculum. Why worry about how hard you're pushing your students, how badly classes and events are scheduled, and how poorly information is distributed, when instead you can just say that they should be able to deal with it because everything is pass-fail? Although the giving up of a competent administration for a pass-fail curriculum is more than a fair trade, it would be nice if such a trade never had to be made in the first place.

#20: Student interviews

As mentioned before, there are two kinds of individualized interviews: faculty interviews and student interviews. While faculty interviews are clearly the more important of the two, student interviews should not be completely overlooked. They will not make or break you, but they may help to give you a little push over other, more socially inept applicants. While both types of interviews will basically be run in the same manner, there are a few important differences to be aware of.

First of all, unlike faculty interviewers, student interviewers actually want to be at the interview, and probably won't do things like looking at their watch while conducting the interview. They actually believe they are making a difference, so they enjoy the opportunity to be there. Use this to your advantage. Know that they tend to recommend accepting those interviewees with whom they connect with most, rather than those who are most qualified. Your goal should be to move past the "acquaintance" stage and directly into the "close friend" stage with your student interviewer. Feel out your interviewer's personality, and pander to it copiously. Med schools generally pick the same types of people for their student interviewers, so you should have no problem with this after the first few rounds.

Student interviewers are also much more idealistic than their faculty counterparts. This means that you need to act as if becoming a doctor is the greatest profession on God's green earth, rather than just one of many equally good options. A good way to handle this situation is to specifically mention a few of the negative aspects of the medical profession that you have heard about, and then immediately proceed to downplay and poo-poo them. This will prove to your interviewers that you are just as idealistic as they are and are therefore worthy to enter their medical school. Nothing will boost your value in their eyes more than having unrealistic expectations about what your life as a doctor will be like.

Student interviews are also your opportunity to find out about the more "fun" aspects of medical school, which is really just another opportunity to make student interviewers feel that you will fit in well in their school. Make sure to ask a lot of questions that center around student happiness and well-being, such as:

• What kinds of things do you do students here do for fun?
• What is the hardest aspect of this school?
• What made you decide to come to this school?
• How does this school compare to others, in terms of curriculum structure, administrative involvement, and overall student happiness?
• What are a few things that you would change about your school, if you could?

Remember that asking questions is nothing more than another way to impress your interviewers! Not having questions to ask is not a sign of strength; it is a sign of unpreparedness. Do not make the mistake of thinking that the answers to your questions are relevant in any sense of the word.

#19: Rankings

Medical schools have a love-hate relationship with the U.S. News & World Report rankings. On the one hand, they will tell applying students that rankings don't matter, in order to get the applicants to consider the school over more highly ranked schools. On the other hand, if any department of the medical institution gets ranked well in that magazine, you can be sure that they will shove it in your face and never let you forget it. Going to one of U.S. News's Top Hospitals is like walking into an advertisement for the hospital itself; you will see posters up everywhere telling you how awesome they are, as if that knowledge is somehow going to improve the quality of care that you receive.

Medical school rankings are important to some people (like Asian parents), but it is true that they don't really matter in the grand scheme of things. For example, the reason that U.S. News & World Report always ranks Harvard Medical School and Johns Hopkins School of Medicine so highly is because people are always going to be impressed if you attend medical school there. The people at U.S. News & World Report like to state different factors that they "took into consideration" when ranking schools, but overall the statement of these factors is just their attempt at justifying their own bias in school placement. The placement of any school after Harvard and Johns Hopkins is irrelevant, because in the eyes of residency directors, all these other "good" schools are completely equal to each other.

If you are ever told by a school official how well their school placed on the latest rankings, be sure to ask a lot of questions about how the rankings were derived. Ask for a lot of specifics, such as how much improvement there was in the factor of alumni donations from the previous year. Asking for this kind of detailed information allows you to seem like you possess a wealth of knowledge about the process, which will easily fool most administration officials.

#18: Small groups

As previously mentioned, small group is a problem-based learning environment within the larger framework of the school curriculum. The entire med class will be broken up into these different small groups, so you'll only be working with about ten other classmates of yours. Small group is generally agreed upon to be worthless, for a number of reasons. For one thing, the issues dealt with in small groups are rarely if ever related to the material in lecture. They deal more with the touchy-feely aspects of medical care, like people's opinions on stuff. Since other people's opinions are just as ill-informed and self-serving as your own, there is no way that being forced to hear these opinions will ever benefit you in any way.

However, this in itself would not be a bad thing; in fact, if done properly, it would be a welcome break from the rigors of medical school. The real problem with small group is that the questions you are given to deal with are just plain irrelevant. They are not related to the material you cover in lecture, and they will not improve your abilities as a physician. For example, many of the questions will ask you to look up statistics for prevalences of different diseases, which are completely unrelated to the presentation and treatment of the disease. You will also be asked to look up random health code policies, which won't have any significance to you until you finally get your medical degree and start practicing medicine.

For these reasons, remember not to waste too much time preparing for these sessions; there is always an easy way to fulfill your obligations for any given session. For example, if you are asked to design an interactive project to present information about Munchausen Syndrome by Proxy to the other group members, all you have to do is find a clip of the funeral scene from The Sixth Sense on YouTube, and then have your classmates discuss afterwards. Spending any more than 10 minutes preparing for a given small group session is a complete waste of energy, and a sign that you should work on your time management.

As with anatomy lab, it is quite likely that you will find yourself in a small group with an overly ambitious classmate. Identify who these people are early, then make sure to be the one to delegate tasks whenever you are assigned to work with them. This will require some cognizance on your part, but it will be well worth it if you can keep interactions with them to a minimum. Be sure to be as agreeable as possible in your messages! Nothing gets small group instructors involved more quickly than a few of their students in a heated email exchange.

#17: Taking time off after college

As mentioned previously, there are a few things you should try to put into your application to get med schools to take you seriously, all of which require an obscene amount of work through the first three years of college. If you're close to the end of college and you don't have anything to show for yourself (or if you're close to the beginning of college and don't plan on having anything to show for yourself), you will need to take time off after you graduate and do something drastic to improve your chances of getting accepted. There are a few prescribed things you should stick to when taking time off, because even though there are a lot of ways to spend time off between college and medical school, there are very few that selection committees consider to be "acceptable."

Medical schools will definitely respect time used to do research in a lab, especially if you get published. This is basically the same as doing research during the school year, except that it's more like a nine-to-five job and a lot more is expected of you. Because of both of these reasons, it makes it a lot more difficult to dick around while doing research for a full year. You'll also want to find some kind of grant to fund your time off, like a Fulbright scholarship: don't count on your parents wasting any more money on you just because you couldn't keep up with the rest of your classmates. Finally, make sure to make sure to get a good supply of crystal meth or some other strong stimulants, since research is boring as all hell and it's going to take something stronger than your typical cup of coffee to keep you awake.

Doing volunteer work is another option. There are lots of opportunities in this area, many of which are well advertised. For example, Teach for America enjoys sending out spam emails to college campuses in the hopes of reaching that one person on the planet who hasn't heard of them yet. They'll even go ahead and set up an appointment for you to meet with their recruiters without your consent, so you literally just have to show up in order to get a spot with them. There are also volunteer opportunities that allow people to practice bare-bones medicine in very rural parts of the world, especially in Latin America. It is pretty unethical for people without any medical training whatsoever to perform medical procedures on people from other parts of the world who are too destitute to care, but it still makes selection committees go absolutely cuckoo for Cocoa Puffs when they see an applicant who has these experiences.

Other year-long activities that medical schools consider "worthwhile" include getting other graduate degrees, starting your own business, or being someone famous (e.g., the child of a senator). Note that there are certain things that are absent from this list, like improving yourself as a person, or starting a family. Medical schools consider things like these to be a gigantic waste of everybody's time, especially theirs.

Of course, if no medical school accepts you even after you've taken some time off, you may have to consider alternatives such as a Caribbean medical school or even a D.O. program. Both of these types of schools are known for having lower standards than allopathic medical schools in the United States, so they are a viable possibilities for those of you who are desperate to get into a medical school and won't take no for an answer.

#16: Lecture videos

The lecture video is definitely the greatest thing to happen to lectures in the last 1,000 years. Before, medical students would need to be physically present at lectures in order to get the information needed for any given class. Lectures would commonly start at the ungodly hour of 10 a.m., but more immoral lecturers would start class even earlier than that. Tens to twenties of med students suffered under this system, but thankfully, lecture videos have changed this entire dynamic. Now, having lectures recorded allows the students to decide exactly how late in the day they want to start watching lectures, to rewind the lecture and review pertinent information immediately, and to turn off the lecture as soon as they get sick of listening to lecturers babble on about nothingness. Basically, it takes control away from the lecturers and puts it into the hands of the medical students, and lets them schedule their lecture-watching around more important things like eating and watching baseball.

One of the best things about lecture videos is that you can skip right past any nonsense that might happen in class, something that the poor suckers who actually attend won't be able to do. For example, if a fire alarm goes off (surprisingly common) or if a lecturer goes into a story that has nothing to do with the subject at hand (unsurprisingly common), you can fast-forward right past it. It's really too bad that life doesn't come with this kind of functionality, because your time is too precious for that kind of garbage.

However, the greatest benefit by far that lecture videos have over actually attending lecture is the ability to use add-ons like 2xAV to watch the videos at faster than normal speeds without chipmunk voices, as if all the benefits noted above already weren't enough. 2xAV allows users to watch RealPlayer videos at up to 2.5 times normal speed, which means that a 50 minute lecture can be watched in 20 minutes. While you might be afraid that you won't be retaining all the information when you watch it this quickly, just know that everyone else in your class is watching it at this speed. Remember that it's more important to fit in with your peers than to learn things properly.

Really the only improvement that needs to be made is to expand lecture videos to all parts of the medical school curriculum. Anatomy, for example, would be a much more pleasant experience if you didn't have to actually ever be in a dank, malodorous anatomy lab. Even events like Orientation or Commencement could benefit from being fast-forwarded through - or skipped altogether! Unfortunately, medical school administrations will never let this happen, but it's nice to dream of what could have been.

#15: Recommendations

A recommendation letter can make or break your med school application. A sparkling letter is equivalent to applying as a fifth generation legacy, so you should make sure to get as many as possible (stealing them from other students if necessary). Obviously the easiest way to secure these is to sleep with your professors, but generally speaking, the more mature or more female a professor is, the less likely they are to entertain this possibility. (Note that this is not true if you are in middle school.)

A more realistic way to get a good recommendation letter from a professor is to take a lot of classes with them, like more than five. Make sure to be that annoying kid who asks lots of questions during lecture and needlessly prolongs class for everyone else. It's a surefire way to guarantee that your professor - and everyone else - will never be able to forget you. If you can manage to do this for more than one professor, you should have no problem getting the recommendations you require. You will also be universally loathed by your classmates, which is a small price to pay for something so important.

If you have trouble burying your self-consciousness long enough to enact the previously mentioned tactic, you will need to take more subtle routes to remind your professor of how awesome of a student you were. One thing to do is to make a packet for your professors that has all the information they need in order to write the recommendation. Make sure to include a cover letter, a transcript with your best classes prominently highlighted, and a gift card to their favorite restaurant or department store. Feel free to blatantly lie about your accomplishments in your cover letter; as professors have to deal with upwards of 100 students per semester, it is highly unlikely that they will know anything about you. Finally, people often say to write professors a thank you letter once you've been accepted to a school, but this is entirely unnecessary; since you'll never see these professors again, you are under no obligation to pretend to care about what they think of you any longer.

If you can help it, try to get actual copies of the recommendation letters to see what they say about you. This can be easily accomplished by renting a P.O. Box from the post office for a fake program (e.g., "Tidewater University Summer Scholars Program"), and having your professor send in a recommendation to that P.O. Box for you. This course of action has many benefits, the most obvious of which is that you will be able to find out exactly what your professors will write about you. With this knowledge, you will now have the power to prevent them from backstabbing you in the future.

#14: Medical television shows

Medical students love shows that are set in a medical environment. Grey's Anatomy, House M.D., Scrubs, Nip/Tuck, Doctor Who - the list goes on. Med students swallow them up like Skittles. In fact, it has been documented that fully 75% of the increase in medical school applications over the past three years is directly attributable to the surge in popularity of these shows. If you're new in the television business and you're desperate to create a hit show, all you need to do is take a bunch of old jokes from other hit television shows, and recycle them into the setting of a medical environment. You don't even need to worry about medical accuracy, since the majority of your intended audience will never even know if you make a mistake.

One reason that med students like these shows so much is that they get to live vicariously through them. Real doctors do silly things like take care of patients and fill out paperwork, but doctors on television shows spend most of their time making snarky comments at each other and having lots and lots of sex. Doctors on television also never have to face the consequences of their actions (unless their real-life actor does something stupid). Watching these shows gives medical students a socially acceptable way to fantasize of doing nothing all day except acting as cool as Fonzie and having unnatural amounts of sex with marginally attractive individuals.

Medical students also like these shows because they give the students a chance to show off how much they're learning in school. This does let them impress people occasionally, but mostly it lets them feel good about themselves. For example, if one of the actors mispronounces a phrase like "bilateral hyperplasia of the adrenal zona fasciculata" incorrectly, they will be mocked for no less than fifteen minutes. A really serious instance of medical incorrectness can be milked for conversation fodder for weeks at a time.

Non-med students also watch these shows, but mostly because of the hot actors and actresses (Katherine Heigl, I'm looking at you) and the ridiculous situations the actors are put into. Overall, these shows have better plot elements and character development than other typical shows like Spongebob Squarepants or Friends, so it makes sense that they've attained mainstream popularity.

#13: Problem-based learning

As previously mentioned, some schools try to buck the mold by using a teaching method called "problem-based learning." This entails having students do lots and lots of problems instead of emphasizing lectures. It was developed at a university in Canada, which explains why it sucks so hard.

Problem-based learning is touted by its proponents as being a non-traditional way of teaching, which is a surefire way of knowing that it's not quite as good as the usual method. One big drawback to problem-based learning is that doing problems over and over again becomes really tedious after about 13 seconds. However, the bigger drawback to problem-based learning is that students never actually learn the principles behind the problems that they solve. They become like little monkeys who can apply the right equation to a given problem, but have no deeper understanding than that. When it comes time to study for a national exam such as the USMLE Step 1, which asks questions requiring integration of fundamental concepts in medicine, these students are basically screwed.

Most lecture-based schools include a little bit of problem-based learning in something called "small group." Small group sucks really hard too, but it is only a taste of what problem-based schoolers go through. Every night before they sleep, lecture-based schoolers offer this prayer: "Dear God, please keep me and my family safe. And thank you for not sending me to a problem-based learning school. Amen."

#12: Pre-meds

As soon as you get into a medical school, you can expect every pre-med you have ever known to descend upon you like a hobo on a ham sandwich. They will want to know things like what your MCAT score was, what leadership experiences you have, and how many people you had to sleep with. It is flattering at first, but it quickly becomes irritating because all these people are just using you. If a long lost friend who you haven't thought about in years suddenly contacts you, make sure they are not looking for a copy of your AMCAS application before you let yourself get too excited.

Your pre-med friends will send you long emails with all sorts of information about themselves and ask you what you think their chances of getting into med school are. The best way to approach this situation is always to tell them the same thing: with a little more hard work, they would pretty much be the perfect candidate. Be wary of going into any details in your reply, because the more details you go into, the more likely they are to email you for more information. Also be sure to wait a few hours or even days before you reply so they think you actually read what they wrote. If they do email you again, just tell them that you're a little too busy right now, and ask them to email you again in a few weeks. Pre-meds have a very short attention span, and so they will likely forget that the encounter ever happened.

While it would be easy to get angry at those who contact you, remember that there was once a time when you used to do these same annoying things. Suck it up and at least give them the courtesy of a response before you go back to doing something more important.

#11: Faculty interviews

Interviews are a way for medical schools to separate the normal people from the weirdos. Of course, they have a quota for weirdos that they need to accept, but overall they try to keep this number to a reasonable minimum. The reason they do this is that if anyone asks, they want to be able to talk a lot about diversity and then point to a few key statistics. This is what they like to do with minority applicants as well.

Med school interviews are different at different places. Traditionally, they are conducted by faculty members, although some schools are moving to interviews by medical students as well. If you interview at a school that has both faculty interviews and student interviews, remember that the faculty interviews carry about forty times more weight. Med students are only allowed to interview you so they can say they contributed to the school and feel good about themselves.

Before conducting the interview, faculty members will have read over your application very superficially for things that stand out at them. They will then ask you about these things in the interview. Don't mind that if they had just read the application more carefully, they would already have all the answers to their questions. They are just trying to classify you as either normal or weird based on the way you answer the questions.

Faculty members will also ask you if you have any questions for them, and it is important to prepare with a few:

• What kind of student would do well at this school?
• What has been your best experience here?
• What are the biggest hurdles that most students face?
• What are some mistakes you've seen students make?
• What are some recent changes the school has undergone?

The answers to these questions probably don't matter to you. The goal is to make yourself look good so that the school will accept you.

Remember that it never hurts to be a sycophant. Ask them about all the degrees they have cluttering their walls or about the important and cutting-edge work they do. While these topics have nothing to do with you as an applicant, it will make the faculty members feel good about themselves and report positively about you.

#10: Lectures

The first two years of medical school are the basic science years, during which medical schools attempt to cram as much clinically-relevant basic science information as possible into the brains of their students. Medical schools generally choose from one of two teaching methods for these two years: lectures, or something called "problem-based learning" (to be discussed in another post). The lecture-based teaching method is the more traditional of the two (as it came about in Italy during the Medieval Ages or something), and is therefore the method of choice of most medical schools. So, if you're thinking of going to medical school, it would behoove you to be ready to sit through at least two more years worth of horribly-taught lecture material.

Overall, lectures in med school are run mostly the same way as their college counterparts, although there do exist a few significant differences that you should be aware of. For example, if you decide to matriculate at a school that engages in lecture-based teaching, you'll be happy to know that the first few sequences will start their lectures for the day at fantastic times like 10 a.m. - a nice change from college that should give you plenty of time late in the night to bond with your friends. Another change from college is that many med schools distribute packets containing all of the Powerpoint presentations for a given sequence at the start of that sequence, theoretically giving you all the material you'll need for your exams right from the get-go. A final difference between college and med school is that lectures in med school will usually be scheduled back-to-back, meaning that there will be less dead time in the middle of the day for you to waste.

Things like these will make you feel like your medical school administration really cares about you, and that they want to help you be as happy, efficient, and productive as you could possibly be. Don't be naïve enough to believe this! Lectures during the first few months of med school are only set up in such a humane fashion in order to ease you into the hell that you've entered, and like almost everything else in medical school, these things will only serve to make your life harder in the long run.

For example, you'll quickly notice that as you progress from sequence to sequence, the time at which your medical school lectures begin will slowly creep earlier and earlier; during some sequences, your lectures for the day will even start at the ungodly hour of 8 a.m. (I'm looking at you, second year neurology sequence). While this is a major issue in and of itself, the severity of this problem is compounded by the fact that more of your nights are spent studying because of how dense and complicated the material becomes in these later sequences. Thus, the late start times that you'll enjoy at the beginning of med school do not adequately prepare you for the bulk of how your medical school curriculum will operate, and will only serve to give you a false sense of confidence in your ability to adapt to the demands of your new environment.

The distribution of lecture packets by your med school may also seem to be a welcome improvement over your college experience. This is because your time in lectures during college was probably spent furiously transcribing your professors' words whilst whispering to your classmates about what had actually been said; now, all of that work has [theoretically] already been done for you. However, the fact of the matter is that now that you have the lecturers' Powerpoint slides, they will no longer feel the need to explain things properly because "it's all in the notes." They will also brush you off whenever you ask them to slow down for the same reason: "it's all in the notes." In fact, only the bare minimum is ever in the notes, but a professor who truly knows how to deal with med students will never let a student's wishes supersede his own right to run the lecture however he wants.

(Thus, there is only one way to get a concrete answer out of a lecturer: hitting that critical mass of student questions that a lecturer cannot ignore. Lecturers will try to give you the impression that they are Almighty God and therefore Can Never Do Wrong, but after careful examination it is safe to conclude that this is in fact false. That being said, if enough students ask them questions over and over, it is possible to temporarily pause their steamroller-like behavior.)

Even the back-to-back scheduling of lectures will quickly become a liability, as your days will go from the manageable number of 4 hours of lecture per day to the egregious quantity of 8 hours worth of lectures and labs (again, looking at you, second year neurology sequence). By the time you get halfway through your first year, you'll come to the end of each day wishing that you'd followed your friends who went into i-banking and are now living "meaningless" lives consisting of making boatloads of cash right out of college and drinking themselves into oblivion every weekend.

In fact, the only redeeming quality to all of this is that most med school lectures are not required; in fact, many med schools actually record their lectures and place them online so that the videos can be viewed from anywhere with a solid internet connection. By this token, we come to the final and most important difference between lectures in college and lectures in medical school: almost no one attends lectures in med school. Out of a class of 170 students, a lecturer would be lucky if 30 students showed up (and unlike most of the "facts" in this blog, this one is actually not an exaggeration).

I would imagine that most of the people reading this blog will fall squarely within the 140 people category.

#9: Professionalism

Doctors sometimes do a lot of really stupid shit, like walking into surgery drunk. Medical schools are pretty fed up with this kind of nonsense, so they have become obsessed with teaching their students "professionalism." What this means is that medical schools assume their students are completely clueless when it comes to professional behavior, and treat them like Eliza Doolittle from the play Pygmalion. There is a lot of hand-holding, down-talking, and wrist-slapping involved. This kind of treatment is usually helpful for those students who have been asleep for the last thirty years, or for those who have had the self-esteem portion of their brain surgically removed.

What this also means is that medical schools have zero tolerance when it comes to "unprofessional behavior," and even the slightest mistakes are blown to planetary-sized proportions. For example, forgetting to wear a tie to anything where a patient is present is the equivalent of calling the patient's mother a whore to their face. Even if you have a good reason for not wearing a tie, like being female, even not wearing it once will probably garner you a "Note of Professional Concern" at the least. In fact, the first time you will even hear that a professor has a problem with your behavior is when you receive a such a Note from them. If you find yourself in this situation, your first reaction will probably be that your professors are acting in a hypocritical manner by accusing you of unprofessional behavior when they themselves do not properly express their concerns to you in a respectful, timely, and empathetic manner. However, remember that an important part of professionalism is accepting that your professors can make up rules whenever they feel like it.

Being on time is another big aspect of professionalism. Medical schools like to operate via the maxim of "early is on time, and on time is late", except that this maxim applies differently to medical students and professors. For medical students, the maxim should read: "Early is acceptable, on time is embarrassing." However, for professors and administration officials, the maxim now reads: "Early is pretty close to the time I said I would be there, and on time is up to fifteen minutes past the designated time of arrival." If you keep these principles in mind, you should have no trouble figuring out what you need to do to keep off your med school's shit list.

Mostly medical schools have to worry about all of this professionalism stuff because they know that the field of medicine treats their doctors like crap. In response, doctors turn to things like alcohol and codeine in order to feel less shitty about their lives. Medical schools don't really care if that's how you deal with your issues; they just want to teach you to keep it to yourself and not let it affect the way you treat patients.

#8: Research

Research is a lot like volunteer work because every medical student will have it on their application. Therefore, so should you. However, unlike volunteering, lying about research when you have not done any is more problematic. Since research is more technical than that "touchy-feely volunteer work" stuff, it is harder to pull off having done some when you really haven't. If you want to say you have done some research, it is important for you to be able to back it up with things like talking about how important your research is to all of society and dropping scientific terminology. Otherwise it is best not to mention research at all.

There are two kinds of research: clinical research and basic science research. Clinical research involves a lot of talking to patients and crunching data. It will be pretty easy for you to get a publication out of clinical research because clinical researchers will publish anything.

On the other hand, basic science research involves you spending a lot of time in a dirty old lab, doing a lot of science experiments which fail most of the time. For this reason, it is more difficult to get a publication out of basic science research. Another reason is that most professors in charge of labs are socially inept and have no desire to help you succeed. Even with all these drawbacks, medical schools like seeing basic science on applications more than clinical research because they know that clinical researchers do not actually do any work.

#7: Anatomy lab

Anatomy lab is done differently at different schools, but is always done in the first year of medical school. If you are lucky, your school will do all of anatomy in about two months, and then you will be done with it forever. If you are unlucky, your school will buy into the "systems-based integrative-knowledge" garbage and you will have anatomy labs throughout the year. Fortunately for this second group, having anatomy throughout the year is a good way to There is absolutely no benefit to having anatomy through the whole year, at all, ever. Only bad things will come of having to prolong the end of this experience because no one learns anything from it and it only ends up pissing people off.

Professors like to call anatomy a "rite of passage," which is an accurate description because anatomy lab is basically a legalized form of hazing. The major difference between the two is that there is less free alcohol in anatomy lab. Major things you will notice about the anatomy labs when you first get there are that they are always very cold, and they always smell like death. Ostensibly, the professors need to keep the temperature of the anatomy labs so low for the sake of preserving the cadavers, although they also get the added bonus of doing even one more thing to make medical students as uncomfortable as possible.

Each lab session consists of approximately three hours of pretending that you are finding whatever body parts are on the list. Pretending is important because even though it is a well known fact that nothing in a [dead] body can really be distinguished from anything else, professors like to see that you are hard at work. For this reason, when you are in anatomy lab, it is best to try to leave as early as possible. Set a deadline for giving up, and then try to beat it. Making a game of this helps keep it fun, even after thirty or more lab sessions.

Sometimes, you will find yourself stuck with a lab partner who wants to find every single last thing in the miniscule chance that they will commit something to memory. Partners like these can make sticking to your deadline difficult, but it is best not to lose your cool in this situation. Simply ignore them and make a habit of leaving lab at a specific time every session; they will adapt to your behavior.

Also, do not worry about how these behaviors will affect your score on the final lab practical. Professors love holding review sessions, which are many times more useful than anatomy lab ever is.

#6: The first month

The first month of medical school is a very strange time. All the different cliques haven't formed yet, so people who usually would never give you the time of day are suddenly overly friendly to you. Of course the cliques will eventually form, but until that happens, you can expect your new classmates to do weird things like inviting the entire class to barbeques and house parties. You will probably find this really unnerving, because you really don't want to hang out with the alcoholics but at the same time you don't have a reason not to. Fear not, soon every group will remember how much they don't like the people in the other groups and everything will go back to normal.

Class is also easiest during this first month, so go ahead and allow yourself to have fun. You might as well go out to all the class-wide parties, because you sure as hell won't once school really ramps up. You might as well get your fill of it while you can. Also, make sure to hook up with that cute guy or girl. This is definitely your best chance to do it, because people in unfamiliar situations have an uncanny propensity for making poor decisions.

If you are totally insecure about yourself and want to try hanging out with the cool kids for once in your life, you should try to take advantage of this month.

#5: Volunteer work

Volunteer work is one of those things that you need to have on your medical school application, for a number of reasons. First of all, every other med school applicant will have it on their application. So if you want to be a competitive applicant, it is one of those things you need to have on yours as well. Secondly, not having volunteer work on your application is like directly telling the selection committee that you have always hated poor people and want to deport them all to Mexico. Since this is looked down upon for the most part, it is best to avoid the whole situation in the first place.

You may be under the impression that medical schools like applicants who talk about medically-related volunteer work, but this is not necessarily the case. Medical schools know that most people who have done "medically-related volunteer work" have not done anything more than taking people's heart beats or babysitting sick kids in the hospital's surgical ward.

The easiest way to have volunteer work on your application is to lie about what you've done. The only problem with this method is that if you get asked about what you did in an interview, you will need to be able to talk at length about how much you accomplished and how much it meant to you. If you go decide to take this approach, make sure to rehearse your story so that you know it well and can tell it the same way every time.

Another way to put volunteer work on your application is to volunteer for something small and then exaggerate about how much you did. For example, a two-hour volunteering session can easily become a three-month-long organizing-and-implementing endeavor by picking the right language and spacing out the timeline of events.

However, if you have a lot of time before sending in your application, actually doing a more long-term volunteer project saves you the trouble of having to think of really creative ways to embellish your accomplishments.

#4: Alcohol

Medical students love alcohol. No less than 85% of activities that they partake in have alcohol as a key component, which is probably not that different from most other groups of people. They will use anything as an excuse to get inebriated, including boredom, the end of a sequence, the release of the new Harry Potter movie. If you are thinking of going to medical school, having a hearty love of the bottle and a disregard for the health of your liver is imperative in order to establish yourself in your medical class's social pecking order.

Most potential medical students have already prepared for this situation during college (or high school, for the overachievers). If you fall into this category, congratulations! You are well placed to surround yourself with drinking buddies who you will claim are friends.

However, there are always a few applicants who, for various reasons, do not drink alcohol. This is a straight path to social suicide, so here are a few recommended solutions.

Probably the easiest solution for most is to make up for lost time, and start drinking as soon as possible. Make friends with the alcoholics and follow them to every event they attend (e.g., "Guitar Hero Bar Night Fridays"). When drinking alcohol, go for quantity over quality, as this will help build up both your social standing and tolerance quickly. You should see results within two weeks with this method.

If you don't drink alcohol because of religious restrictions, converting to agnosticism or atheism is your best option. Neither of these religions have any restrictions against anything, so they offer a pretty permanent first step to solving your problem. This method has a secondary mode of action that makes it particularly potent, which is that without the hope of happiness in an afterlife, alcoholism should come fairly easily for you.

Finally, some of you may have moral objections to drinking alcohol. For those of you in this case, your best bet is to consider a different career choice, such as construction, waste management, or teaching. A less popular alternative is nursing (for obvious reasons).

#3: Subject- vs. systems-based teaching

Medical schools like to fight about things with each other. Subject-based teaching vs. systems-based teaching, M.D. vs. D.O. programs, affirmative action vs. racism, etc. The more things that medical schools can argue about, the more types of medical schools there can be. Mostly this allows medical schools to jack up the price of tuition, but rarely, these factors are important to some applicants when deciding on a school.

The distinction between "subject-based teaching" and "systems-based teaching" is confusing to many applicants because the two terms are never properly explained at any point in the application process. "Things not being explained properly" is a recurring theme in medical school and beyond, so those of you planning on going into medicine should be prepared for a lot of it. "Subject-based teaching" and "systems-based teaching" are simply two different ways that medical schools can decide how they want to teach the material. Based on this decision, they then divide up their curriculum accordingly. They like to give these divisions fancy names like "sequences" or "modules", which is done for the sole purpose of making your life a little more confusing. This is another recurring theme in medicine.

Subject-based teaching means that the sequences are based on broad subjects such as anatomy, biochemistry, physiology, and ethics. There is less potential for integration between the different subjects in this form of teaching, so it's good for those of you who survive school by cramming, information-dumping on tests, and then immediately forgetting everything.

Systems-based teaching means that the sequences are based on body systems, i.e., cardiovascular, pulmonary, neurologic, dermatologic, etc. During each sequence, students learn the anatomy, biochemistry, physiology, etc. that is relevant to that system. Because everything is being taught all at once, this form of teaching could potentially do a great job of integrating the material. In practice however, the topics are never integrated properly because the different lectures are taught haphazardly based on the lecturers' availability. Additionally, professors feel less guilty when they ask really nit-picky questions because they assume that at some point you learned everything about the given system. This is a better system for those of you who have already studied medicine.

#2: Applications

Medical schools are always looking to fill their ranks with the best and brightest students available. That's why they sit around in dark rooms and arbitrarily decide on measures of success to apply to applicants. Mostly this consists of drunkenly throwing darts at each other, and then shouting the first thing that comes to mind upon being struck. The final set of agreed-upon measures are kept completely secret, and are not made available to applicants, ever. This is done to keep them from knowing why they did or did not receive an acceptance.

However, the people on medical school selection committees are not very creative, and the set of measures that they finally decide on are generally similar from one application cycle to the next. If you want to have a strong application, it is best to include things that medical schools have a history of drooling over, such as a high MCAT score, volunteer work, leadership positions, and/or having a parent who is a physician. If these are not options for you, you might want to try spending a few years after college doing something a little off the beaten path, such as helping to prevent the spread of nutritional parasites through rural populations in Kyrgyzstan.

Be careful, however. An excess of the above-mentioned factors is known to cause medical schools to preemptively reject applicants for no plausible reason whatsoever. In order to prevent this from happening, you need to present yourself as being both passionate and normal at the same time (unlike Microsoft CEO Steve Ballmer). It may be necessary to place less emphasis on some of your accomplishments in order to create the proper balance that selection committees are looking for. Doing this is a painful process, but it is nowhere as painful as realizing that a school couldn't even be bothered to send you a rejection letter on actual paper and instead sent you your rejection in email format.

Additionally, careful rewordings of simple-sounding phrases and outright hyperbole are important tools to use when selling yourself in your application. Use websites like www.thesaurus.com to find other ways to say what you want to say. For example, if you worked as a janitor for a few months, you might want to use some of these alternative job titles:

• Custodial technician
• Domestic engineer
• Environmental services associate
• Guest service associate
• Industrial floor maintenance sanitation engineer

Finding the perfect synonym to replace an inferior sounding word is always a satisfying feeling, and will fool even the most astute of selection committees without being a complete fabrication.

#1: Medical school is hard

Medical school is hard.

During a typical four-year curriculum, medical students are inundated with literally everything that is known about every major topic in medicine and a small amount of information from a few of the more specialized and more interesting areas of medicine. For testing purposes, medical schools then expect the students to become more proficient with this material than actual practicing doctors. While this is clearly an impossible task for non-android students, a passing grade can be acquired through thoroughly studying old tests for repeated questions.

The sheer volume of information students are expected to learn borders on the absurd. For example, a typical packet of powerpoint-style notes for a four-week long subject can easily reach 600 pages of information, two-thirds of which will be lecturers' piteous attempts at being "hip". Of all the testable material in these packets, everything except the title slide is written in very dense, technical language by someone with upwards of twenty years of experience in their respective field, and every year, more and more material is added as new things are learned. Really, the only people worse off than medical students are each successive class of medical students.

If you are considering entering medical school, there are a few things you can do beforehand to make your life a little easier. Speed reading classes are often useless, but may prove beneficial for some. A faster, easier approach that results in a higher yield is faking a behavioral issue, such as attention deficit disorder. Sympathetic psychiatrists have been known to prescribe medications such as Ritalin liberally.