Emily Hayward, GS-1 (3rd Year MD/PhD)

Emily has written a really informative piece on the structure and format of classes in medical school. To get an idea of what her schedule was like in the first year of her MD/PhD program, check out the article she wrote on her awesome blog UnABridged! 

How has your approach to learning and/or studying changed since you were an undergrad?

In terms of the mechanistic details of my studying, I wouldn’t say that much has changed. Throughout college, I was able to discern overall what worked for me – for example, whether I preferred notecards and rote memorization, watching videos, and/or making study guides for myself and quizzing myself on them. Once I entered medical school, I reverted to these strategies, and they generally served me well.

However, I think the biggest change has been my perspective and my purpose. In college, I knew exactly what score I needed on each test in order to maintain a high average or to bump my grade up even the tiniest bit. In medical school, my mentality has shifted. I have realized that I am not here to become a better student or test-taker. I am in medical school to become a better physician, and there is so much more to that than obtaining a perfect score. It has been wonderful to really have the chance to dive into material that I know will be important in my clinical practice someday, and to do so in a setting where we can often hear patient experiences with those very illnesses. This has allowed me to avoid studying with a hyper-focus on grades and think more about how the information will impact my future patients or how it relates to a patient whom I’ve already had the pleasure of meeting.

I think this is where I would also give some advice to newer medical students. Medical school is all about taking advantage of the learning opportunities that are congruent with the type of physician you wish to become. Of course, you will eventually need to know every detail of the biochemical pathways or microbiology behind a disease. But if that is the only thing on which you focus during medical school, you are missing some incredible opportunities to learn. The real medical system and real patients aren’t always well encapsulated by our classroom experiences. So yes, you should study.

But you should also spend what you will find to be your very limited time seeking out mentors who can share their own life stories and lessons with you. Volunteer with organizations that help those who face illness or are affected by it in some way. Spend time with families who have loved ones with life-threatening diseases to gain more insight into their world and what they want from their medical care team.

Take those extra few minutes to speak with the patient you were assigned to interview in the hospital – not because you need the knowledge for your grade or your paper, but because you can both learn so much more from each other than that. The patient may find in you a listening ear who is the first person of the day to ask them about how they are feeling beyond his or her vital signs, and you may begin to understand more about the burden of disease that cannot be fully expressed in a textbook or a lecture. Any moment like this can be life-changing for both of you.

Can you give us a brief description of the area surrounding your school and the things you do for fun? What are some things you like and dislike about the city/town you are located in as a student?

Honestly, I would say that my one of my favorite parts of attending UAB is living in Birmingham! I have never been much of a “big city” person. I’m very introverted, and I like to have a safe, quiet space that I can call my own. I’m also not a huge fan of massive traffic, relying on public transport, extremely high rent prices, or the generally quick pace and high pressure of living that is associated with some larger cities. Of course, some of my other friends applying to medical school were the complete opposite – they wanted to attend a school in a big city with a lot of fun attractions, and they prioritized that experience over bigger/cheaper housing, etc. I want to emphasize that both types of personalities are completely valid and reasonable. It is truly all about knowing the type of environment in which you will thrive (near family? North/South? Urban/rural?), and I think it’s important to flesh that out before applying to medical school.

In my case, I knew that I wanted to live in a city that had some of the resources of a major academic center, but that also would allow me to cheaply rent/buy my own place close to campus and drive my car into work every day. Birmingham is perfect for that. MD/PhD students like myself who are in programs funded by the NIH receive a monthly stipend, and that stipend fortunately goes a long way in Birmingham. Many of my peers actually bought their own houses within 10-15 minutes of campus.

I personally decided to rent rather than buy so that I could have some help with the upkeep and because I spent all of my savings applying to medical school (yikes!), so making a down-payment didn’t seem so feasible. I currently rent an entire ~1200 sq ft house by myself with a little fenced in backyard in a safe, quiet, lovely neighborhood about 5 minutes from campus. I couldn’t be happier with my little home. Perhaps the best part of my neighborhood is that two of the other houses across the street from me are owned or rented by students in my MD/PhD program, so we frequently visit each other and hang out. I also know this would be a perfect place to raise a family, if I choose to do so in the years to come (since the dual degree will take around 8 years to complete).

The negatives of Birmingham for some of my peers are that there aren’t many “fun” events, concerts, or things to do. Others don’t like the relative scarcity of housing options in the downtown area that are close enough to campus that you can actually walk to/from class each day. However, again, it is all about knowing what you want in a school (without being too picky, of course, as you do need to apply to a decent number of programs for the best chances of admission!) and looking for a mutual fit.

What resources have been most useful to you in self-learning medical school material or in expanding on material taught in class? Can you briefly describe how you have incorporated them into your learning routine?

Disclaimers: If you are not in medical school yet, please don’t worry about these specific resources! It definitely isn’t necessary to buy them or try to start studying before classes commence. As humans, we can unfortunately only remember so much, and the possibility of burning out too strong to risk if we try to dive in too deep before we’ve really settled into our pattern just yet. So I suppose that truly is my first and most important piece of advice: Don’t worry about getting a “head start” on these resources.

My second big piece of advice here, which I know may seem ironic given the context of this question: Try not to worry too much about the exact resources that everyone else is using. You’ll hear dozens of resource names throughout medical school, and one student will swear by one of them while another student will swear by something else. It is easy to become overloaded with resources, and this ends up being less efficient.

Additionally, please know that your first steps may not involve using standardized resources at all. This was true in my case, especially in those first few weeks/months of medical school. My initial goal was to just understand each lecture, the sometimes complex and overwhelming amount of material, and what my study groove would look like. I played around with whether I should take notes while I watched the recordings, whether I should just listen first and then take notes later, if and how I should use flashcards, etc. I realized that I am actually an auditory learner for my first pass through material; I really need to hear someone explain the information to grasp it. Then once I’ve taken notes and condensed them into my own brief study guides, the best way for me to recall minute details is via rote memorization on flashcards.

Finally, after I fully understood my study strengths and felt the most productive with my time, I started to incorporate resources that covered relevant class material while also emphasizing foundations that would be key for USMLE Step 1. The three major public/popular resources I used during my pre-clinical years were Sketchy (microbiology), Pathoma (pathology), and Boards and Beyond (all subjects).

Sketchy Micro: This was the first major or “boards-specific” resource I used outside of class notes. If your school has a microbiology block, or even if it doesn’t and you just need to learn little bits at a time, I highly recommend this resource. With that being said, it is not for everyone. It works best if you are an auditory and visual learner. Essentially, the videos are typically very brief yet dense (with some being as short as 3-4 minutes!) and will cover one pathogen (bacteria, fungus, virus, etc) at a time. The authors will actually draw out a cartoon/comic as you watch along. Each cartoon has certain symbols that work really well as memory ties. To give a few examples: All gram-positive bacteria have purple/violet shades in the background whereas gram-negative are red. The antibiotic “vancomycin” is represented by a “van” in the background of certain images if it used in the treatment of that condition. This all worked really well for me and even better than rote memorization from flashcards. I could simply visualize the image for that pathogen and that alone would give me information about it that I may otherwise have trouble grouping together. However, again, a few of my friends found this series overwhelming. I recommend giving it a try or two – for some, it is a life-saver!

Pathoma: This was another major resource I ended up using, both during classes (either before a lecture so that I would have some background, or just at the end when I was studying for an exam as a thorough review) and also during step 1 study time. This is a video series that also comes with a condensed, bullet-point printed book version. The whole package costs $120 for a 21-month video subscription and the hard copy of the book, which is a pretty nice deal considering how crucial this material is when it comes to pathology (a major content area for step 1, since you will need to know not just the normal physiology of the organ systems but also the aberrant states and diseases that result). The resource was created by Dr. Husein Sattar, a pathologist and instructor in the SOM at the University of Chicago. Dr. Sattar does a phenomenal job of condensing the very detail-heavy subject of pathology and somehow making it feel simple. He does so in only 35 hours of material, and he still manages to continually re-emphasize not just the facts, but the key principles behind the pathology that will allow you to extrapolate and answer questions beyond just the information he provides.

Boards and Beyond: This is the last resource I would highly recommend, and again, I found it key for both my class studying (before and/or after a corresponding topic was covered by our professors) and my step 1 preparation. B&B costs about $150 for one year of use, or $250 for two years of access to the online videos. While this was a fairly large expense, it was beyond worth it for me. The videos are made by Dr. Jason Ryan, a physician trained in internal medicine and cardiology who teaches at the University of Connecticut SOM. He does an incredible job of being concise yet explaining complex topics in a way that makes them extremely simple and approachable. I find that he is organized in his presentation of materials, and I could watch these videos (and have them make sense!) even without much background information about the organ system at hand. I began to consider this resource “the Pathoma of everything else,” as Pathoma only covers pathology, but the Boards & Beyond videos were similarly short/sweet and useful for really every other discipline. A potential downside, however, is that B&B contains over 120 hours of total material – so this resource is certainly not one that you can just cram for step 1. But if you study it as you go along in your modules, there are no more than 12 hours of lecture for each module (and often more like 4-6 hours), which is fairly easy to factor in to your coursework. Then when step 1 study time comes along, you can simply re-visit the topics that you have forgotten or that give you the most trouble rather than re-watching the whole thing!

Other resources that I have at least glanced include BRS Physiology, which is especially great if you enjoy text-only (again, most of my resources have at least some strong audio component so I did not stick with BRS, but I think this book would be concise and clear for those who prefer text), and for times when I needed an even more basic introduction to something, I would use a simple YouTube video series such as Osmosis.

I actually also liked to use YouTube (free; the price is right!) to look up certain conditions as I learned them, especially in genetics or metabolic biochemical diseases. I found that I could easily remember some of the unique details of the disease from being able to picture specific patients and hear about the challenges of the condition from the families themselves. The videos were also a great reminder of exactly why I was studying what sometimes feels like a mountain of details and diseases in the first place. They tended to be “fun” and special to watch, so it was almost like a study-break even though I was actually reinforcing the material in a clinically meaningful way.

How much/well have you been able to develop clinical skills alongside your classroom work first and second year? What does your institution do to help you develop clinical skills before the clinical years?

At UAB, we have a clinical course that runs alongside our more basic science classes for the first two years. This course is called “Introduction to Clinical Medicine” (ICM). It involves dividing our large class of approximately 180 medical students into groups of just six students, and each group is assigned to a physician preceptor who will oversee our progress over two years. Our clinical course allowed us to learn the physical examinations that accompany each organ module; i.e. as we studied the cardiovascular system in class, we also learned how to examine the heart in clinic or the hospital. We also were able to watch our preceptor perform a full history and physical examination on a patient, or to do so ourselves depending on the week. We also learned the basics of maintaining medical records and presenting patient cases to a clinical care team in a concise, effective way. I really enjoyed having this course during our pre-clinical years because it provided us with so much consistent practice at the skills we would need in our later years. It also gave us the opportunity to learn from watching other students or physicians and to obtain feedback so that we could ideally fix any mistakes we made far before they ever affected a patient.

Additionally, UAB also provided us with volunteer opportunities to improve our clinical skills very early. One of my favorite ways to do this was to volunteer at our student-run clinic, Equal Access Birmingham (EAB), which provides free healthcare for those in Birmingham who are underserved or in need. The clinic is staffed entirely by medical students, plus a physician who oversees the operation and visits each patient alongside us after we make our own initial evaluations. Within my first two weeks of medical school, I was obtaining blood pressure and blood glucose readings, interviewing patients to ascertain the medical issue, and synthesizing all of the information to propose a diagnosis and plan to the physician. This was under close supervision, of course, as patient safety was always our top priority. Yet it was exhilarating to ask the physician volunteering his/her time if I could just “go for it” in terms of presenting patient cases and trying to formulate my own analysis and plan. The physicians who volunteer are usually very willing to teach us and to allow us to learn by trying in a setting where they can still easily manage the patient’s care. I started to grow in my confidence to care for patients within my first year of medical school and continued to improve my clinical skills as time went on, which I think was a great advantage of the design at UAB.

Some of my peers at other institutions do not have a clinical course like our ICM. Instead, they may have a “crash course” that teaches all of the physical examinations and patient care skills needed right before they actually use them on the wards in the beginning of their M3 year. Some of my friends really liked this, as it kept all of the information fresh. Conversely, I found that it was really beneficial to learn physical examination skills slowly during our modules instead of all at once. I felt that this helped me see the relevance of all of the classroom material and understand why I was doing each step of the exam rather than simply going through the motions.

What is one thing you would do differently if you could go back to your undergraduate years or the time between undergrad and medical school?

Don’t take super hard classes senior year during interview season! Although this schedule was fairly unavoidable in my case, it is still one of the biggest things that I wish I could have planned differently. It was very difficult to juggle my hardest course load to date with filling out the 5 billion (OK not really that many, but it sure felt like it!) primary and secondary applications for medical school and also traveling for interviews. I had to make a lot of sacrifices in terms of my coursework, and I had to accept that it sometimes wouldn’t be up to the standard to which I normally held myself.

One of my worst experiences in this regard (so that you all can avoid ending up like me!) was an interview that began with a three-hour flight delay in an airport with poor internet connectivity. I arrived later than anticipated, but I also still had a major school assignment due soon. Since my MD/PhD interview would take multiple days, I knew I needed to submit it that evening. I stayed up until approximately 3am working on my report for school just to get it to a standard that I was even OK with submitting, and then I woke up to prepare for my interview around 5:30 or 6am. Thankfully, I think adrenaline carried me through that first interview day… but to say that I was sleep deprived would be an understatement. I likely didn’t do as well at my coursework or at my interview as I could have if my schedule were less rigid and intense.

Of course, the sacrifices I (and you, if you do end up in this situation) made were worth it, since the entire purpose of taking those courses was to gain admission it to medical school – but it would have been really nice to enjoy senior year and the interview process rather than to be a constant bundle of stress!

Given the number of obstacles we face en route to a career in medicine, everyone at some point feels doubtful of themselves. How has this affected you and what has helped you persevere through these sorts of feelings?

This has always been a big struggle for me, even before I entered medical school! When I applied, I had a noticeable weakness on my application: my MCAT score wasn’t nearly as strong as my GPA or the rest of my credentials, and it was pretty low for fully-funded MD/PhD positions. Yet I still chose to be ambitious with my school list by only applying to NIH-funded MD/PhD programs (MSTP). I was waitlisted at several institutions throughout the course of the application cycle. It took exactly one full year from the day that AMCAS opened until I received the acceptance that led me to where I am today.

In the first few moments of my acceptance to UAB, I felt the sheer joy of finally making it to medical school and seeing my dreams come true. Yet it took only about 1 day before my doubts began to emerge. I started to experience “imposter syndrome,” or feeling as though I was a fraud who did not really deserve my position in medical school. I had put forward only the best parts of myself on my application… what if I wasn’t actually smart enough? What if, once I arrived to campus, people realized that I wasn’t as capable as they may have thought from the “paper” version of me?

When I arrived in Birmingham, I spoke with others in my program. Fortunately, they were amazing and spoke honestly about their feelings, too – and we had all shared many of the same doubts. I recognized that we all have a tendency to look at others (or the image of others that is presented to us) and fill in the gaps in a way that makes us think that they have their lives totally together. We believe their credentials are real but ours are somehow less valid, exaggerated, or faked. Hearing so many people in my program who I view as absolutely brilliant talk about how they have had their own moments of doubt was really humbling and helpful for me.

Another thing that has been crucial for me in the arena of maintaining confidence in my ability to become a successful physician one day has been mentorship. I have been fortunate to find some of the very best mentors in the world in the UAB MSTP (thank you Dr. Lorenz, Randy, and Dr. Van Wagoner). They saw things in me that I didn’t see just yet. When I didn’t quite believe that I was worthy, I reassured myself that my mentors had seen hundreds of students over the years, and that they believed in me – so I only had to believe in their confidence that I could make it. I worked hard so that I could prove them right and begin to see myself through their eyes. It helped to know that I had a safety net to fall back on, that someone believed in me enough to feel that I was worthy of investing in and supporting even through the tough times.

Finally, rather than thinking through all of the theoretical problems I may face, I have tried to just focus on how grateful I am to be in this position and to be on the road towards my dreams. I started making a list of goals for myself for the week or even just for the day. I enjoyed being able to check off boxes as I completed tasks, physically seeing myself making progress and knowing that I was working hard and climbing closer to “making it” – whatever that looks like!

How do you maintain your mental health while balancing school, work, family, and other social obligations?

I am glad this topic is being addressed here because I really can’t overemphasize the importance of this. Overall, I will try to share some of my thoughts about this topic and provide a few tips that have worked well for me.

First, I often advise medical students in the years below me to try to keep school and the rest of your life in separate little compartments when possible, especially when the workload is high. I always tell them that you are a medical student, but you are not only a medical student – you are also a wonderful human being with people who love you and with basic needs (like sleeping and eating!). It is so important to take breaks where your mind is completely free of anything medical-school related, even if it’s just in the form of small study breaks throughout the day. In the less busy times, you can even schedule maybe a few hours in the morning and a couple at night to dedicate to course content, but then you can know that in between those two blocks, your time is yours – hopefully guilt and stress-free! Do something you enjoy, something that reminds you of why you are here, and/or something that just gives your mind a break.

Another highly-related tip is to keep up your hobbies. When there is a lot to study, these are sometimes the first things you might tend to sacrifice – but if at all possible (even if it means bringing an audio lecture with you to the gym, if you really enjoy working out), try to avoid this. As a personal example, one of my hobbies and a core part of my identity is writing. This has always been somewhat of a release for me; I can use it to reflect on my day, to process the good and the bad, and to express parts of myself that otherwise feel a bit hidden. Writing has also helped me develop a sense of identity and flesh out exactly who I want to be as a future physician. Additionally, my writing has provided me with my own little “niche” within my MD/PhD program; it was something I was doing that was a little different than my peers. This helped me feel like instead of competing with them or needing to compare my strengths/weaknesses with theirs, I could take my own path and be comfortable in it.

My biggest piece of advice would be that if you ever feel overwhelmed or are struggling, please just know that you are not alone. In 2016, the Journal of the American Medical Association (JAMA) published a meta-analysis that finally put numbers on the true prevalence of depression and suicidal ideation in medical students. They reported that 27.2% of medical students admitted to having depression or depressive symptoms, and 11.1% at one point had suicidal ideation. I mention these numbers not to scare anyone – if you make it to med school, you really CAN do this – but to comment on a culture that often makes us feel isolated if ever we struggle and that can make It seem like asking for help is a sign of weakness. On the contrary: you are not alone if you experience any of these feelings, and asking for help only indicates your strength and maturity. It is an acknowledgement that you are a human being with human limits, and it is good practice for times in your later career when you will inevitably need help from others.

Overall, I sincerely hope that we can all better understand the importance of our mental health – for ourselves most of all, but also for our patients. Taking care of yourself allows you to be at your best for those around you, for those you are trying to help. Giving yourself permission to get pampered every now and then, to take those breaks as you need them, to find a good support network and to learn on others when the time comes (and to support your friends in return in their times of need)… these things don’t “get in the way” of your medical journey. They make it better, stronger, and more sustainable in the long-term.