The Second Year of Medical School

     For the average medical student, the most dreaded year of all four is definitely the second year. This is due to what awaits at the end of it, USMLE Step 1. The United States Medical Licensing Examination is an 8 hour exam that tests you on all the knowledge learned during the first two years of medical school. It is different from the MCAT, in that, if you pass the MCAT, but didn't get the score you wanted you can always take it again. Step 1, however, is an all or nothing deal. You can only take it again only if you failed the first time around, though failing is not an option you want. Your Step 1 score is a measure of your clinical knowledge and it sets a threshold for the residencies you can apply to. The more competitive the specialty you want to practice, the higher your score has to be.

     The second year of medical school is entirely about preparing for this exam. The first year fun is over. And if you thought first year exams were overwhelming, you have no idea how much worse it can get. I am usually an optimistic person, however, this post is going to be more realistic than anything else. If you are looking to read a rainbows-and-puppy-dogs-message about Step 1 you should probably stop reading right now.

     Second year is hard.

     I finally understood why so many current doctors try to discourage pre-meds from going into that profession. This year will test you not just in academics, but in discipline, resiliency, balance, focus, and willingness to make sacrifices for your career. You have to push through the misery and keep your eye on the finish line. Believe that everything will be okay, but study as if everything will go wrong.

     In my medical school, second year exams are taken every three weeks but they test you on a minimum of 90 lecture hours of material. Think about it this way, if say you typical college class is 1 hour 3 times a week, and you take over a period of 5 months, that totals around 60 hours of material spread throughout an entire semester. In medical school you cover more than that over a period of three weeks. Other schools may vary on this, but at USF our second year ends two months earlier than other schools, so the course load per test is heavier.

     Needless to say all you do is study. At the beginning of second year, people are more likely to socialize and still go out maybe once a week for a fun time. However, the closer you get to Step 1, the less this happens as students crawl into their study caves for months.

         People will have many different approaches to balance and studying on this year, but the most important thing is to find out what works for YOU. 

         The most common mistake people do in medical school is compare themselves to their classmates, as if them or their classmates are setting a standard everyone else needs to follow. 

         Many medical students will probably disagree with this last statement, but you will discover for yourself that it is true. Comparing yourself to other in medical school is the easiest way to stress out and drive yourself crazy. You have to remember that each medical class is a collection of the smartest students around the country. While you may be used to being an A-student all your life, now you are grouped with 120 A-students as well. These students have different ambitions, different goals they want to achieve in medicine. So comparing yourself for example, to a students that is striving towards orthopedics while you want to be a pediatrician, is probably not a sane idea. Don't get me wrong, I am not saying that a pediatrician should study less. We all need to have a thorough grasp of medicine. But an ortho candidate may want research experience, consistent 90s on tests and a higher Step score, than what a future peds might want. So find out what you're striving for and what you have to do to get there, and try to compete only against yourself.       

     Even though second year has an insane course load, I discovered this material was much more interesting than in first year. First year focuses on anatomy and physiology; learning what is normal in the human body. Second year focuses on pathology, microbiology, pharmacology; what goes wrong and how to treat it. Every piece of information is clinically relevant and your inherent drive to learn will help you get through your 12 hours of studying a day. Anyone who lacks this inherent drive should probably consider another career path.

     During my second year exams, I never got higher than an 80%. Most of my scores were around 73% +/-4. However, I was focusing more on board relevant material, rather than lecture material. Unfortunately, these don't always overlap and lectures tend to have a lot more information than what we need to know for boards. My school has a pass/fail grading system and my A-student mentality had to adapt to be content with a 73% average. As long as I passed, I was okay. I studied hard every day and the only way to break out of my 73%-rut would be focusing more on lecture and neglecting boards; a price  that did not seem worth the pay. Focusing on boards paid off later when I started official Step 1 studying and my first NBME score indicated I would definitely pass.     

       As an MS1 (medical student year 1), I had the privilege of living with an MS2. I lived with her through her MS2 struggles, which prepared me mentally for second year and also gave me lots of advice in order to succeed in this terrible year. Not everyone has this privilege so I am passing this advice on.The following suggestions below are what worked for me; I can't guarantee that they work for everyone so take them with a grain of salt, and adjust them to your preferences.

     1-Mentally prepare yourself for what is to come. Think of it as sacrificing one year of balance and fun, for the stability of the rest of your life. Get ready to stay in on many nights you want to go out. Get ready to be miserable for a long time, but still suck it up and do your work.

     2- As impossible as this sounds with a 12/hour study day, try to stay balanced. Don't give up everything that makes you happy just to study. If you normally work out every day, continue to do that. If you are passionate about a specific sport, or another hobby, don't take it out of your life.

    3- Spend time with your family and/or significant other. This one goes along the same theme as #3, but it is significant enough to have it's own slot. You will discover there will be many times when your family and/or partner will feel neglected throughout the year. It's not that you don't want to spend time with them, you just can't dedicate the same amount you used to. Communication is the biggest way to overcome a fall out. Try to make them understand what you are going through and how important it is, but still dedicate some time to them on your schedule. This makes them feel appreciated and also fills you with those warm fuzzy feelings that cancel out any bad moods studying has induced.

    4- Find a study partner. Students have different views on this one, as many prefer solitude and confinement while studying, with no distractions. But if you are not one of those people, having someone to study with, to keep you accountable for your work, and to push your academic limits can make a huge difference throughout the year. When looking for a study partner, try looking for someone that is at your same level. I do not recommend studying with some one that is so far ahead that they will intimidate you and stress you out. I also do not recommend finding a friend to waste time with while you're  supposed to be studying. A perfect study partner is one that learns at the same speed as you and strives for the same academic level as you. A friend but also a colleague.

   5- I found that skipping class was a good way to be more efficient with my time. I would go to school at 8ish am. Studied until 5 or 6, then work out and have dinner/cook afterwards. It was the closest way to keep some sort of balance in my life, as opposed to being in lecture for 8 hours of the day to then start studying afterwards. Study hard, but also, study smart.

   6- Plan out your studying. Have both a short-term and a long term plan. The short term will be the one that leads up to each individual group test; while the long-term one will lead up to Step 1 itself. For every school test I made a list of all the lectures I had to cover with all the resources I wanted to use to cover them. I aimed to be done looking at all the material once a few days before the test so I had time to review and memorize little details. The long-term plan started somewhere in December and it included going over First Aid, re-watching Pathoma, and other things I will include in a future blog post.

    7- Be aware that life does not stop while you're in medical school. Friends outside of med school will start graduating, getting married, having kids. Actually, even inside medical school you or your friends might go through these stages. Starting a family makes balance so much harder, and I have the utmost respect for my classmates who did. Your family may have losses, celebrations, or issues that interrupt your schedule and keep things from going according to plan. You will have to adapt to these situations and evolve your focus so much more to be efficient with the time that you are studying.

    8- Do not undermine any particular subject because you feel you won't need it for the specialty you want to go into. Every subject is important to have a thorough understanding of medicine and to do well in your boards. The information you are learning now will potentially save someone's life in the future. You may want to do radiology, for example, and think you don't need to know immunology, but every subject in medicine tends to overlap, and especially if you want to do well in boards to be a good radiology candidate, you can't afford to neglect any subjects.

 I hope this came of help to some of you.Follow my blog if you are interested on my future posts which include Resources for Studying for Step 1, Making a Step 1 Study Plan, How medical school have changed me and many more. Please share with your friends!