#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.