You Just Got into Medical School. Now What?

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Congratulations, you just got accepted to medical school! The hardest part is now behind you, or so you thought. Here’s what to expect and what to do next to make the most of your next 4 years as a medical student.

Dr. Jubbal, MedSchoolInsiders.com.

If you’ve ever wondered how to navigate the medical school process to position yourself for a strong residency position, you’ve come to the right place.

After receiving your acceptance and prior to your medical school orientation, you’ll have several months of free time. The gunners amongst you may be tempted to get a head start on studying or otherwise prepare themselves to get a leg up. I advise against this. There is little you can do leading up to your first day that will make a meaningful difference in your success. Enjoy and cherish the break and slow pace of life while you still can, as you won’t get another opportunity like this for quite some time.

 

Preclinical Years

Your first two years of medical school are your preclinical years, where you’re attending class and small group sessions to learn physiology, anatomy, pathophysiology, and the basics of the various organ systems.

Your first few months will be an adjustment period. It doesn’t matter how well you performed in undergrad – medical school will be different. During this time, focus on getting your study fundamentals in order. Succeeding and thriving in medical school can only happen once you have a foundation of strong study strategies and are dialed in with your efficiency and productivity habits. You’ll need to be able to sustain a relatively high intensity for the next 4 years.

Many schools have pass/fail grading during the preclinical years, which usually means you can just study for the boards and you’ll end up passing your classes too. However, note that some pass/fail schools still have internal rankings across all four years that they do keep track of. This will be codified in your dean’s letter when you’re submitting your residency application. And if your school has an AOA chapter, which is a medical school honor society, figure out whether they factor in preclinical grades or not. Getting into AOA will definitely help your residency application. If your school is graded, either with letter grades or honors/pass/fail, there will generally be more pressure to bring your A-game.

As you get acclimated, now is the time to begin seeking out exposure to the various specialties you are considering. The sooner you can narrow down and pinpoint which single-specialty you want to pursue, the sooner you can focus your efforts on finding a mentor in that field, securing publications, and getting involved with relevant extracurriculars.

It’s ok not to know, and many students won’t finalize their decision until their third year. But if you’re able to figure this out sooner, you will be at an advantage.

At most medical schools, you’ll have a summer break between your first and second years. This is likely the last summer vacation of your life, so enjoy it. At the same time, use this as an opportunity to do something useful. Most students opt to pursue research in a field of interest, and with roughly 10 weeks dedicated to full-time research, you should be able to secure a publication, or at least an abstract and presentation. It generally takes a few months to secure one of these positions, so start looking no later than March, but ideally a little sooner.

In your second year of medical school, the intensity will be dialed up compared to your first year. The main reason for this is USMLE Step 1, the most heavily weighted and dreaded exam of a medical student’s life. At most medical schools, you’ll take USMLE Step 1 at the end of your second year, right before starting third year. However, there are a few schools that have students take Step 1 during their third year.

However in 2022, Step 1 will be pass/fail, and as a result, there will be far less stress and anxiety surrounding it. While that will give you welcome breathing room as a second-year medical student, it’s kicking the can down the road and you’ll likely experience greater pressure to perform well on USMLE Step 2CK. It’s still best practice to apply yourself and perform reasonably well on Step 1. After all, many of the concepts tested here will be further built upon and assessed in future tests, such as your shelf exams and Step 2CK. However, since Step 1 won’t be graded, now is an opportunity to reallocate some extra time and energy to other factors that will move the needle on your application – namely, research.

 

Clinical Years

Your third and fourth years of medical school are your clinical years, where you’re spending most of your time learning in the hospital, clinic, and operating room.

Third-year for most students is a rough but welcome transition. You’re finally in the hospital and are one large step closer to becoming a doctor. You’ll be rotating in various required specialties, such as internal medicine, surgery, pediatrics, obstetrics and gynecology, neurology, psychiatry, and more.

If you’ve narrowed down your intended specialty by the end of your second year, you can use that to your advantage to strategically schedule your third-year rotations. At the very least, you hopefully have a vague idea of things you’re drawn to, like patient population, such as adult versus pediatrics, or how procedural you want to be, such as surgical or non-surgical. You usually don’t want to do your target specialty first, since your first few months of third year are a transition period and you won’t be as likely to impress your preceptors. Don’t save it for the end either, as this may interfere with your away rotation scheduling or compromise your Step 2CK studying.

Third-year is considered the longest and most intense year in medical school. Not only are you studying for written tests in the form of shelf exams for every rotation, but you’ll also be assessed by your various attendings on a subjective level. Your overall grade in a given rotation is a reflection of your combined performance on your shelf exam and your clinical evaluations.

Your clinical rotations will be graded, usually in some form of Honors/Pass/Fail or Honors/High Pass/Pass/Fail. Your performance on these third-year rotations will be far more important and far more weighted on your residency application compared to your preclinical grades.

Towards the end of your third year, you should have figured out which specialty you’re applying to. At this time, you’ll begin applying through the Visiting Student Application Service, or VSAS, to secure sub-internship positions at various programs across the country in your desired specialty. The end of third year is also the time most students take USMLE Step 2CK, although others opt to take this later during their fourth year.

In your fourth year of medical school, you know how to handle your clinical rotations, but you’ll now need to work extra hard at your away rotations to impress. Knocking it out of the park will help you secure a strong letter of recommendation, make a positive impression to hopefully receive an interview invitation, and ultimately rank well. At some away rotations, programs won’t invite you for a formal interview, but will instead have an interview at the end of the rotation, thus saving you a trip during your residency application cycle.

In most specialties, letters of recommendation are ranked by program directors as one the most important factors in assessing your residency candidacy. You should receive several letters as a fourth year, including from mentors at your home program as well as attendings in your away rotations. However, letters are something you should be mindful of throughout your medical school career. Work hard and impress your PI from your summer research between first and second year. Impress your attendings during your third year clerkships, particularly for rotations in your intended specialty. And of course, knock it out of the park in your sub-internships as a fourth year.

Not all away rotations and sub-internships are created equal. Depending on your specialty, this can be the most trying and intense time of medical school, or it can be comparatively chill. My colleagues in internal medicine and emergency medicine described straightforward rotations that were sometimes even easier than some third year clerkships. But those in surgery were often “tested” by the institution to see how hard they could work and if 100 hour work weeks would shake them.

As a fourth year, you’ll still have a few electives and mandatory rotations at your home program, but you’ll overall have much more flexibility and even dedicated research months which are much more relaxed. Your residency application will be submitted in September, and you’ll want to take a few months during summer to prepare your personal statement and other parts of your application.

Between October to February, you’ll attend interviews at residency programs across the country. At the end of February, you’ll submit your rank list, and a month later, in March, your fate will be sealed on Match Day.

 

Additional Considerations

There are a few other considerations to keep in mind if you want to set yourself up for a smooth and successful medical school career.

First, do not get in trouble or have any professional marks against you. This will be reported on your residency application and will hinder your chances of matching at a top program. We have helped a number of students overcome such marks and match into very strong programs, but it required a great deal of effort, finessing, story telling, and networking.

Second, be careful with extracurriculars. There’s a steel opportunity cost to your time in medical school, and time spent on one activity takes away time from something else that could be higher yield. Being a secretary or treasurer of some student group isn’t going to mean anything on your residency application. On the other hand, if you’re able to start a meaningful advocacy initiative or organization, certain specialties may look favorably upon this.

Additionally, certain specialties will see certain activities or side hustles as a liability. This is most prominent in surgical specialties, which are more old school in thinking and don’t want you to be distracted. After all, surgical residency is extremely demanding and they are concerned any draws outside of surgery will compromise your ability to be a top-performing surgeon. Other specialties may be more or less understanding, but I still recommend avoiding talking up or highlighting any activities that could possibly draw negative attention. While it may be awesome you have 50k followers on Instagram, there will be some faculty who look down on this. It’s one of those things from a risk assessment perspective that’s more likely to hurt than help.

Third, research, as it relates to your residency application, is a game, and you can play the game to win. Even if you’re uncertain about your specialty, get involved with research early, learn to play the game, and pump out papers and abstracts. It will help you, regardless of which specialty you apply into. I’m working on creating a research course that will teach you how I secured 65 publications, abstracts, and presentations, and what systems you can use to also crank out research with ease. If you’re interested, sign up for my weekly newsletter, link in the description.

And lastly, I found credit card churning immensely valuable when I was applying to residency. I’m glad one of my classmates turned me onto it, because it allowed me to save several thousands of dollars on flights and hotels when interviewing at 20 different programs all across the nation. It’s something that takes time. I started 2 years prior to my first residency interview, and that gave me enough runway to accumulate hundreds of thousands of points. Even after medical school and residency, it’s a hobby I’m still involved in because it continues to provide immense value.

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