6 Unwritten Rules of Medical School

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Everyone talks about studying, clinical rotations, and the more typical things you would expect in medical school. But until you live it, those don’t quite give you the full experience. These are the unwritten and unspoken rules of medical school.

This article is inspired by a video I did on my personal channel, Kevin Jubbal, M.D. That video is a bit more raw and raunchy. If you want something more unfiltered, be sure to check out that video after reading this article. Here, we’ll discuss more extensively the unwritten rules that no one else will tell you.

 

Rule 1 | Don’t Be Whiny

The first rule is a broad general rule, as your medical education and training are going to be lengthy with plenty of reason to complain. You’ll have professors whose competence you question, attendings during your clinical rotations that seem impossible to please, schedule changes that seem to always work against you, and other forms of bad luck.

But no one likes a Debbie Downer, so although there will always be reasons to get irritated or whine about how things are inefficient, unfair, or a waste of time and resources, don’t become the person that’s seemingly always pessimistic. Doing so just brings other people down and makes the already irritating situation become worse than it already is.

Rather, if you’re able to be the person that always finds the silver lining, that can turn negative into positive, you’ll not only win many friends and favors but find yourself much more at peace with the roller coaster ride of medical school.

In line with this, avoid getting defensive or egotistical when your knowledge gaps are pointed out. If you’re wrong or don’t know something, don’t try to explain why. Just appreciate the person who is teaching you something and move on.

 

Rule 2 | Know Clinical Rotation Etiquette

The second rule is to know clinical rotation etiquette before you get to your clinical rotations. And this expands beyond simply knowing that a small towel on the handle of the call room means it’s occupied. Actually, that’s a good one to know to make sure you don’t barge in and wake someone from their few minutes of precious slumber on a busy call night.

First, understand that a big part of your overall grade in any rotation comes down to a subjective evaluation from your residents and attendings. There are pros and cons to this, one of which is that being on your phone is often interpreted as you being distracted and texting, going on social media, or finding dank memes. It is for this reason that I bought an iPad Mini. By using my iPad to look up information, I was more likely to be perceived as being studious and hard-working when using my devices, as opposed to distracted on a phone. The irony here is that just about anything you can do on your phone you can do on your tablet, and vice versa. You could be studious on your phone and be distracted on your tablet, but again the optics of your behavior are important for your clinical evaluation.

Second, don’t be a gunner. When you rotate at clinic or in the hospital, you’ll usually be rotating with one or more other students. You should never, under any circumstance, throw them under the bus. Making others look bad is not only a terrible thing to do that will weigh on your conscience, but your residents and attendings can usually see right through it, and that’s not a good look.

Similarly, consider how your behavior makes others look. If you’re in the operating room or on rounds and the attending asks the resident a question, don’t pipe in with the answer. Sure, it may be impressive that you know something the resident doesn’t, but what’s more salient is that you couldn’t contain yourself to blurt out the answer, thus making the resident look bad. No one wants to work with someone like that. If you are directly asked the question next, it’s of course fine to answer.

When you put energy into looking good, you come across as conceited and you paradoxically look bad. If instead you value others and try to make them look good, you become a likable personality who appreciates others, and that’s the kind of teammate we all want.

Another underappreciated skill is knowing when to ask a question. If it’s something that’s easy to look up, look it up yourself, and don’t waste other peoples’ time or energy answering a simple question. If it’s not easy to look up and it’s a genuine question, don’t be afraid to ask it. However, know when to ask questions. This comes down to social calibration. If things are hitting the fan in the operating room, try to be helpful and let the team handle the situation, and refrain from asking unnecessary questions in moments of acuity or stress.

 

Rule 3 | Don’t Waste Precious Time

The third rule is to appreciate and value the little time you have. It’s normal to feel like there aren’t enough hours in a day, and it’s normal to feel like you’re expected to do an impossible amount of work or studying in too short of a time period.

The value of facing this reality will serve you well for the rest of your life. If you allow it to, it will teach you lifelong lessons in productivity, efficiency, and effectiveness that will make you better-rounded and able to handle more than you thought possible.

I have several articles on efficiency and productivity, so be sure to take a read of them after this piece. What I will emphasize is that while you’re in the hospital or clinic, maximize any downtime you have. There will be moments when you are waiting on the patient to be rolled into the OR, or when you’re waiting on seniors to begin rounding. Never let a moment in the hospital or clinic go wasted. After all, you will not be able to relax and unwind while you’re there, so seize the moment in one of two ways: if you’re feeling mentally sharp, power through some flashcards, practice problems, or quick bursts of studying. If you’re feeling mentally fried, then focus on procedural memory, like practicing your suturing or knot tying.

 

Rule 4 | Finances – Be Mindful of Various Situations

The fourth rule is actually two rules about finances.

First, be mindful that everyone’s financial position is different, and it’s best practice to avoid talking specifics. Some of your medical school classmates will be taking out more loans, others will be taking out less. A surprising number won’t take out any loans at all because their parents are footing the bill. Those who have parental help may feel guilt or receive some resentment from those who have to take out loans. It doesn’t matter what other medical students’ financial situations are. Simply concern yourself with your own finances. And if you’re footing the bill, trust me when I say it’s an incredibly empowering feeling to know you paid your own way through medical school and the feeling you get when you finally pay off your loans is priceless.

Second, physicians are notorious for being terrible with money. Don’t contribute to the stereotype. Educate yourself on some simple financial basics. I recommend the White Coat Investor book for a quick and easy read that will teach you 80% of what you need to know. Countless medical students make poor financial decisions under the premise that since they’re already in six figures of debt, spending another few hundred dollars here or there is just a drop in the bucket.

The truth is that it’s not just a drop in the bucket. In fact, it’s a snowball that rolls faster and grows larger the more you contribute to it due to interest and the compounding effect working against you.

 

Rule 5 | Don’t be Solely Focused on Academics

It’s a common trap medical students fall into – they want to crush their boards, ace their pre-clinical blocks, dominate their clinical rotations, and match into the best residency they can. I get it. I’ve been there.

At one point or another, the students that take this approach become miserable, burn out, and find medical school far more painful than it needs to be. Tying in rule three, it’s not about brute-forcing work at the expense of everything else. Success in medical school comes down to optimizing your time and energy, and that includes high-density fun and relaxation, like spending time with friends or your partner, and of course the three pillars of exercise, nutrition, and sleep.

Some say not to enter a relationship while in medical school, but the reality is that some relationships can immensely help with your resilience and perspective of medical school, and others will be an energy drain and hold you back. I was fortunate in medical school that I dated a fellow medical student who definitely made my life better. But I know others who found that their relationships caused their class performance and mental state to suffer.

 

Rule 6 | View Your Classmates Through a Long-Term Lens

Speaking of relationships, there’s a common saying to not have a bowel movement where you eat. This is said to indicate you shouldn’t date someone where you work or in a small class. The counterpoint to this is that you’ll meet some amazing people you may want to enter a relationship with. The key is to act with integrity so that if you part ways, you can do so on good terms.

Medical school classes are also much smaller than any typical college, and for that reason, you’ll hear about everyone’s business. Gossip is aplenty, and it feels more like high school in this way. Don’t give in to the temptation. Stay out of the gossip and drama and stay in your lane. You’ll thank me later when things implode and become a distraction from the little time you already have.

If you view your fellow classmates through a long-term lens, meaning that you want to be on good terms with everyone, and for a long period of time, you’ll find yourself avoiding many faux pas, like asking others what score they got on a quiz or test. Doing so has very little upside for you but a substantial downside– after all, you already know the class average and max scores, but there is a high probability to make someone else uncomfortable.

When you view medical school and your classmates through this perspective, it’s natural to look out for one another and want the best for each other. After all, you’re all in it together, and challenging times can be great sources of strength and bringing us closer, but only if you let it.

 

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