#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.
  
  

#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.

#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.

#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.

#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."

#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.

#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.

#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.