College vs. Medical School – Comparison on Content, Exams, Time, Finances

  To become a fully trained and practicing doctor in the United States, one must go through 4 years of college, then 4 years of medical school, and then 3-7 years of residency. Let’s go over college and medical school and see how they compare.
College/University Medical School
– Prerequisites are constant
– Slower rate going over material
– Difficulty depends on major
– Everyone studies the same material
– Fast pace (“drinking from a fire hydrant”)
– Mostly NOT conceptually difficult
– A’s all the way (4.0 GPA)
– Your GPA is heavily weighed in your application
– Many schools are Pass/Fail during pre-clerkship years
– More control and flexibility over schedule
– Fewer hours spent studying or in the classroom
– More opportunity for extracurriculars, exercise, etc.
– Everyone takes the same classes
– Fixed schedule
– More time spent studying
– More time spent in the classroom or hospital
Class Exams
– Multiple exams, sometimes on the same day
– Less content on each exam
– Higher frequency of exams
– Fewer exams, no traditional finals week
– More content per exam
Standardized Tests – MCAT (230 questions over 6 hours and 15 minutes)
– USMLE Step 1 (280 questions over 7 hours)
– USMLE Step 2CK (318 questions over 8 hours)
– USMLE Step 2CS (12 patient encounters over 8 hours)
Cost/Finances – $25,000/year to $50,900/year on average – $60,000/year or more on average

1) Material

Let’s begin with the material you will be learning and studying.
In college, you have control over what you want to study in terms of your major, however you must complete a set of prerequisites in order to apply to medical school. These include one year of biology, physics, English, general chemistry, and organic chemistry. Overall, however, the difficulty and amount of material you need to learn is highly dependent on your major. I majored in Neuroscience, which was fun for me as it proved to be conceptually challenging, relying less on rote memorization and more on critical thinking. There was also a good amount of overlap between the prerequisites for my major and for medical school. You could, however, major in anything you want, such as English, or biochemistry, or political science, as long as you complete the medical school prerequisites.
In medical school, you mostly learn about one thing: medicine (surprise!). That means no more physics, at least in the traditional sense, or organic chemistry. The difficulty of the material in college will mostly depend on your major, but in medical school, everyone is learning the same things. The surprising truth is that the material in medical school isn’t that difficult. The challenging part of medical school is the amount of information and the pace at which you need to learn it. As they say, learning in medical school is like drinking water from a fire hydrant.

2) Grading

College is highly competitive, where your GPA and MCAT score will be heavily weighted in your medical school application. As a result of the competitive nature, pre-med culture in university is usually cut-throat, stressful, and less collaborative.
Many medical schools, on the other hand, are transitioning to Pass/Fail grading during the first two years. Medical students are already stressed as is, and this is a welcome change to ease the tension. Reducing the pressure to outperform your fellow classmates definitely helps students relax. Overall, Pass/Fail grading helps cultivate a more collaborative atmosphere between students.

3) Schedule & Time

As you progress from college to medical school, you will have less flexibility with your time and increased demands on your time.
In college, you have some control over your course schedule. Whether you’re a night owl or an early bird, you can customize your course schedule to your liking. In the first two years of college, you should complete most of your medical school prerequisites. In the last two, you’ll work on your upper division courses that are specific to your major.
In medical school, your courses are fixed for the first two years. You don’t choose your own schedule. Everyone has lecture together, usually starting at 8AM, and you’re all in the same classes for the most part. Everyone has anatomy. Everyone has histology, pathology, and small group sessions, usually at the same time.
During the second two years of medical school, you begin your clerkships, where your daily schedule is highly variable and dependent on the service you’re on. Congratulations, you’re now mostly out of the classroom and in the hospital treating patients! This is what you came to medical school for – to work in the hospital as part of the medical team, whether that’s in surgery, medicine, psychiatry, OBGYN, emergency medicine, neurology, or pediatrics. These are your general core rotations that you complete in your third year, and during your fourth year you have more flexibility over what rotations you take. Generally you will complete sub-internships in your future specialty of choice. I personally did multiple sub-internships in plastic surgery.

4) Class Exams

College tests are straightforward with quarters or semesters. There’s a period of midterms and then finals week. It’s not uncommon to have multiple exams in a couple days, or sometimes multiple exams in the same day.
Medical schools usually don’t follow this pattern. Many medical schools teach material in “blocks”, which are shorter than a traditional quarter or semester. Blocks may or may not have exams in the middle, and they always have a final exam. For example, a school may have a cardiology block, or a biostatistics block.
Medical schools also have “threads”, which are longitudinal classes on subjects such as professionalism or the practice of medicine, which run longer than quarters or semesters, and have tests sprinkled throughout the year.
Overall, this translates to fewer tests in medical school. Exams are also not stacked up within a short period of time. However, this also means that each test covers much more content than a college exam.

5) Standardized Tests

If you thought the MCAT was the biggest and baddest test you’d ever take, think again. The MCAT consists of 230 questions over 6 hours and 15 minutes.
Medical students have to take the USMLE, or United States Medical Licensing Exam. There are three Steps, the first two of which are taken in medical school. Step 1 consists of 280 questions over 7 hours, and Step 2 consists of 318 items over 8 hours.

6) Cost and Finances

The cost of college and medical school are fairly similar. In both, you must pay tuition and cover your living expenses. According to the College Board, a moderate college budget for an in-state public college is approximately $25,000 per year, and for private college it’s approximately $50,900. According to the AAMC, each year of medical school, including tuition, fees, and health insurance, comes out to approximately $60,000 per year, with private schools slightly more expensive than public schools on average.
For most, covering these expenses comes down to student loans. Generally speaking, federal and school-offered loans are superior to private loans. The former generally have lower interest rates, longer periods of deferment, and overall more favorable terms.
If your parents are able and willing to help you front the cost of college or medical school, be very grateful! That’s very generous of them and it will make your life much much easier. For most of us, myself included, that may not be a possibility. I fronted the cost of both college and medical school entirely on my own. However, I was fortunate in that I received sizable scholarships and grants which helped to reduce my overall loan burden. I’ll be going over how to finance college and medical school, including how to secure such scholarships and grants in more detail in a future post.

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