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Looking back: What I wish I had known before starting medical school

In this Stanford Medicine Unplugged post, fourth-year medical student, Nathaniel Fleming gives advice to future medical students.

The medical school application cycle is in full swing, and I wish the best of luck to everybody applying. As somebody who was in this position five years ago, I wanted to take this opportunity to reflect on some of the things I wish I had known before I started medical school.

Look beyond the first two years, because the clinical years are the meat of the training.

Many applicants focus mostly on the preclinical curriculum of a school (the first one or two years) when visiting schools and making their decision. Much of this is due to the natural anxiety surrounding the initial transition to med school, as well as the feeling that the clinical years are a long way off. In addition, it can be hard knowing exactly what to ask ("you don't know what you don't know").

However, on a long-term basis, the clinical years of medical school are almost certainly more formative. They will immerse you in the real work environment of medicine, help you decide what specialty to pursue, and, ultimately, prepare you to become a practicing physician. For this reason, it's vital to talk to third- and fourth-year students about their experiences. Some questions to ask us: Which hospitals or clinics are clinical students exposed to? What is the diversity of patients and clinical cases like? How is the quality of the clinical teaching? What have been some of your favorite, and least favorite, experiences on rotations?

Don't underestimate the importance of community and mentorship...

Medical school is a little more complicated than just enrolling in classes and showing up when you're supposed to. Students are thrown numerous curve balls along the way, including taking standardized tests, deciding on a specialty, finding extracurricular opportunities, and navigating a whole host of unwritten cultural rules. For better or for worse, many of the tips, tricks, and advice needed to be successful are simply passed down through word-of-mouth and informal, near-peer mentorship.

The upshot of this is that mentorship -- both the informal type from senior medical students, as well as formal academic advising from faculty -- has an importance that can't be overstated. The best learning environments are cooperative, not competitive; they are ones in which people take care of each other and pay it forward. As such, when visiting schools, do your best to get a sense of the community. Picture yourself working closely with the people you meet, keeping in mind that you will often have to rely on some of those people to be successful!

...But know there is more than one way to achieve your end goal.

The main drawback to relying on word-of-mouth advice is that it can become easy to get caught up in the idea that there is only one "right" way to get through medical school. In reality, every person enters with their own background, interests, strengths, and weaknesses, and each person will therefore have a slightly different way of approaching any experience -- whether it's how to study for a test, or how to pick a research mentor and build a CV. In fact, every single med student I know has gone through multiple periods of trial and error before really feeling comfortable. The great news is that, despite the high stakes involved in medicine, you don't ever need to be "perfect;" rather than getting everything right the first time, it's far more important to come prepared to learn on the fly, gather and incorporate feedback, and give it another try the next time around.

Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category

Nathaniel Fleming is a fourth-year medical student and a native Oregonian. His interests include health policy and clinical research. 

Photo by Norbert von der Groeben

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