Medical School—A Not-So-Quick Walkthrough
Hey humans! Aunt Scripty here. This post is a submission by Brittany, whose Tumblr handle I surprisingly don’t know. This post came through the Submissions Box. If you’re interested, I encourage people to submit articles to appear on the blog! [though it may behoove us both if you message me first, as I have a few posts in-progress and I don’t want us to duplicate efforts]
Anyway, give Brittany some props! This is an awesome post, and I’m CRAZY thankful she wrote in! And now, Brittany, take it away!
Disclaimer: This applies to the American medical system only, and may be biased by the author’s experiences. Also note that this is the process for becoming an MD, not a DO (both MDs and DOs are fully licensed physicians, but DOs have a stronger focus on the musculoskeletal system and their schooling is slightly different).
Disclaimer Part 2: I swear, this was SUPPOSED to be a brief post. Oops.
—4 years of medical school, 2 in the classroom and 2 clinical
—3-5 years of residency depending on what they specialize in. Can be longer if they add subspecialties or fellowships.
The in-depth description:
Getting in (Premed student)
Acceptance to medical school is hard enough to start with. There’s an estimate that 75% of applicants are qualified, but only 50% get in. Your character doesn’t need to major in biology or pre-med, but there are pre-requisites: two semesters each of biology, chemistry, organic chemistry, calculus, and physics, plus a couple biology electives, and I think psych and statistics have been added on since I graduated, but don’t quote me on that. That’s pretty much 2/3 of a science major right there, so you can see why a lot of people just end up with that. During spring of junior year, they’ll take a giant standardized test called the MCAT that covers all of those topics and is notoriously difficult.
Along with the classroom work, they’ll have to get clinical experience—most commonly volunteering, shadowing, or working as a medical scribe, but you can get creative—and usually do a little research of some kind. Med school is hard and being a doctor is harder; they want to know that you’ve got an idea of what you’re getting into. If your character does all that right, they interview with medical schools during the fall of senior year, and hopefully get accepted!
Your first year is classroom based. You get daily lectures on very complicated medical topics, with relatively little patient interaction this year. Schools will include more practical classes as well, including a cadaver dissection, pathology (where you train to look at cells and understand what a healthy vs. diseased one looks like; some schools are old school and have people still work with slides and microscopes, others like mine do it virtually), and standardized patient encounters (where they hire actors to come in and work with us so we can practice histories and physical exams and basically get a baseline on things like “what does a normal lung sounds like?”).
Patient interaction varies from school to school, but generally is pretty low. You can shadow a certain specialty you’re interested in, volunteer in free clinics, join different clubs/interest groups, or do various electives that will focus on teaching certain aspects of patient care (nutrition, medical Spanish, global health, etc.), but you have to go look for them. If I hadn’t done any of that, I would have seen maybe… two patients a month? Most students will branch out with those other opportunities, though.
Similar to MS1 in that you’re still on classroom duty, still not seeing many patients. Typically you learn more sensitive physical exams this year (urological, gynecologic, breast, etc.), and you’re finished with the cadaver dissection, but things are otherwise the same. At the end of your character’s MS2 year, they’ll take their first board exam, called STEP 1. You can take it one time only unless you fail. Low scores or a fail are really frowned on, and can limit the specialty your character goes into, so you can imagine the pressure.
Yay! Your character’s now ready to be let loose on the clinic/hospital!
Boo! This year kicks. your. ass.
This year is all about making your character feel like an idiot putting what your character’s been studying for two years into action. The schedule is broken up into rotations, which are periods of 4-8 weeks where students focus on a specific specialty each time. These courses are: pediatrics, family medicine, psychiatry, ob/gyn, neurology (usually), emergency (sometimes), surgery, and internal medicine. Difficulty varies by rotation, with surgery and ob/gyn being the worst (12 hour days with only one day off a week, max; surgery adds in occasional 24 hour shifts too, just to spice things up). Occasionally you’ll land on a nice one, like psychiatry, with 10 hour days and free weekends.
On a more day-to-day level, third years are usually part of a small medical team that cares for a set of patients. The team consists of an attending (fully licensed physician), residents (physicians who are training in their particular specialty), and medical students (MS3s and MS4s both). MS3s will usually get a small subset of hospital patients they care for every day—take their histories, do their physical exams, list what you think they have, and suggest treatments/tests—but because you’re not licensed, you basically take all that to the attending/resident who hears you out and then says ‘yea’ or ‘nay.’ As the year progresses, hopefully you hear more ‘yeas’ and fewer ‘nays.’
At the end of this year/the beginning of 4th year, there’s another board exam called STEP 2. Half is your typical multiple choice test, with a numeric score—much like STEP 1—while half is a pass/fail practical where you work with standardized patients.
Hopefully by now your character has figured out what they want to specialize in. I can go over specialties in another post if anyone’s curious, but the biggest ones are basically the same as the ones listed as core rotations during the MS3 year. There’s a giant application/interview process that takes up the lion’s share of the summer/fall/winter for interviews with residency. At the end of the process, everyone ranks the residencies they interviewed with from most to least favorite, and at the same time the residencies rank their interviewees from most to least. The whole thing goes into a giant computer algorithm to give as many people as possible as high a choice as possible, and then on the same day of the year, at the same time, MS4s across the country take a deep breath and open envelopes saying where they ‘matched.’
In addition, with those pesky core rotations out of the way, the character has time to take electives that may or may not be applicable to their future specialty—me, I’m going for emergency medicine, so I’m doing several rotations in EM as well as EMS, but I’m also doing a two week course forensics because it sounds awesome.
Otherwise, 4th year is widely known as the ‘take a breath’ year. People get married or have babies during this time, travel, and generally start to act like human beings again. There’s space in your schedule that’s off—it’s generally intended for interviews or studying for STEP 2 if you’re taking it late, but people will use it for anything.
Not going to give too much detail about it, seeing as how your character is technically a doctor at this point, but residency is basically 3-5 years where your character trains in a specialty—yes, they’re physicians, but they don’t know everything about their particular field and need trained. You’re in this weird limbo between student and employee; you make a salary (although a very low one considering the number of hours) and can prescribe medication, perform procedures, etc., but an attending is responsible for you, you still attend a weekly lecture, and you can’t practice independently. To give you an idea of how hard these years are, they recently had to limit things like “don’t make residents work more than 36 hours in a row,” and “don’t put the doctor who graduated med school a month ago in charge of an entire floor of ICU patients for a night with no backup.” Incredibly, some of the old-school attendings think said changes are a bad idea and will produce doctors who are “weak.”
Also, you thought your character was done with standardized tests? You sweet summer child. STEP 3 has to be finished before you can complete residency, and is usually done during intern year. The good side of this is, you’re in a residency now, so as long as you pass, no one cares about the score.
—This is a sample timeline, following your ‘traditional’ student. It’s becoming more and more common for people to take a couple of years off after undergrad and apply for medical school after that. If you want a chance for your character to gain some non-medical life experience (travel, other skill sets, becoming a parent, etc.), this is a good chance for them to do it!
—I’ve been asked by a writer I know in RL how young someone could potentially become a doctor. I think she wanted to put in a prodigy kind of person. The problem with that is that medical schools don’t just look for smarts, they look for maturity—imagine having someone who looks like they can’t drink yet tell you you’ve got a terminal disease, and you can see why. That said, there are a couple of accelerated programs, where I’ve seen people graduate undergrad a year early and go straight into medical school, or where they condense medical school into three whirlwind years because the person’s on track for a specific primary care residency. So if most people graduate medical school at age 26-27, you could have someone out at 25 or maybe 24, but probably no younger. And remember, they’ll still need residency training from there.
—Not gonna lie, medical school is incredibly difficult. That said, I think the best students/doctors are the ones who maintain an outside interest or two, so don’t feel like your character can only have medical skills (*cough*Grey'sAnatomy*cough*) . Give them a few side interests to maintain their spirit.
—I can give more detail about any and all of these if anyone asks; these are supposed to help you understand what your character has had to go through to be a doctor, not be a full detail spiel. I can also do ‘day in the lifes’ if someone’s writing a med student character and wants an accurate description, but let’s be real: most people want to write the master, not the pupil.
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