How to become a doctor
“......... if you get offered an interview, there is a chair in that school’s first-year medical school class with your name on it. Based on your performance in the interview, you will either claim it or give it away.” - Quinn Capers IV, MD, The Ohio State University College of Medicine’s Associate Dean for Admissions
In order to qualify as a doctor, you will be required to be disciplined and commit to a lifelong career of self-education and development. One of the key things to understand is what a life in medicine actually involves. The years of training, time commitment, concentration, and stress are factors to consider before you decide to embark on a medical career. As well as these facts, you should also be aware of how medicine, as an academic subject and career field, has changed over the last few decades.
In the late 20th century, medicine was a didactic lecture and tutorial based system, the advent of problem-based learning and case based sessions have radically altered the way that students study and revise the topic of medicine. Make sure you are aware of which of these methods your university employs. Some older universities still focus on the didactic method, but most offer a mix of the two approaches.
Before Medical School
Not everyone who applies to medical school gets accepted. In order to maximize your chances of winning a place to study medicine, you need to ensure your application is as competitive as possible. This includes:
- writing an excellent personal statement/essay
- obtaining a strong set of academic results
- have letters of recommendation from appropriate sources
- take part in numerous extracurricular, volunteering, and charity activities
- performing undergraduate research (according to some advisors and committee members)
In order to do well at school you must always strive to achieve your best in terms of your grades. This includes things like homework, projects, coursework, and examinations. At school age, it is very easy to forget the importance of exams such as GCSEs, A levels, international baccalaureate, etc.. The grades you achieve in these topics will form an enormous component of whether you get a place to study medicine. One should not take their knowledge for granted, as examinations can always go worse than we expect. Preparation through studying and taking practice exams seriously is one way to help ensure success in exams.
Writing an excellent personal statement/essay is dependent upon writing as many drafts as you can. It is surprisingly common for candidates to make simple spelling or grammar mistakes in the personal statements they send with their applications. Don’t be the one to make these errors, as some universities reject applications with spelling errors outright! You should make sure you are making a point with every single sentence you write. A lot of candidates write about what medicine is about, or what they did on their work experience. These sections of their personal statements should be kept very brief, and the main focus of each and every sentence should be why you deserve a place to study medicine. Not why medicine is great, or what you did for two weeks in a local hospital. These points should only be used to frame sentences that you can then fill in with what you learnt, what you can contribute, your excellent achievements, etc. You are ultimately selling yourself as a candidate.
Medicine is a career that requires a good work life balance. The stresses of the job are much more difficult to handle when you have little else but work in your life. As a result, medical schools will be looking preferentially for candidates who have a demonstrated a clear ability to balance their lives between work and extracurricular activities. Examples of these include sports, playing a musical instrument, doing volunteering or charity work. However, be careful in your choices. One of the favorite questions of a committee is about extracurricular activities, it can be during the application process or during the interview. For instance, if you love to surf and it is your favorite activity, how you unwind and stay healthy, why would you want to relocate to a mountainous area with no access to the ocean? Where as the candidate the bikes or runs seems more transplantable. You might think, well I will just give up surfing for 4+ years, the committee knows better. They want you to be the right fit and be happy in their program. Just some thoughts to consider when putting in your favorite extracurricular activities.
It is essential that you read about what specifications the universities you are applying for require. This includes academic requirements, extracurricular expectations, and general requirements for applicants. If you have submitted a strong enough application you will be invited for interview. These interviews are usually designed to get an understanding of what you are like as a person, why you want to study medicine, and what you could contribute to the university. It is important to do your reading and be clear about the course structure at the university, as well as the unique features of the institution i.e.:. they may offer cadaveric dissection as part of the university curriculum, they may have a unique area of research that the university is proud of, they may have a sports team that does well in a particular tournament. If you do your 'homework' and ask those who are at, or who have been at that university to study medicine, your interview will be looked on much more favourably. In short, do your research, be prepared, and be interested in joining their team.
In the interview itself, ensure you arrive smart and well dressed. Make sure you arrive well in advance of time and are as calm and collected as possible on the day that you can be. Nervousness is normal, it is part of the process. It does become an issue when you are finding yourself unable to concentrate, on edge, unable to focus, and generally unable to perform well at interview. Practice talking to others, especially strangers. You must remember, the interviewers on the day will be strangers. This is a daily practice in medicine, you have to speak to perfect strangers about sometimes very personal health issues. Getting a part time job with plenty of customer interaction could be an excellent preparation.
Make sure you have practiced answering the basic questions asked at interview. These are:
- Why do you want to do medicine?
- Why not study nursing instead?
- What steps have you taken to understand what a career in medicine involves?
- Why do you want to study at this university?
- What can you contribute to this university outside of medicine?
- What experiences have you had, that make you want to study medicine?
If you have a somewhat prepared answer (be careful not to sound robotic, it must sound authentic), then it will eliminate a large amount of nervousness you will have on the day. Preparing thoroughly will make your life a lot easier.
Crucially, you must remember to do the basics right. This includes being well dressed, meeting everyone’s eyes as soon as you walk into the room, and sitting up straight. This means you should not slouch, or lean forwards in your chair. You shouldn’t tap your hands nervously, or clap them into a fist due to stress. Please make sure you don’t wear any brightly colored clothing, like purple socks or a yellow jumper. Stick to smart dark colours and you won’t go wrong. Make sure you dress professionally. This means especially for women, no large jewelry, or copious bangles, or necklaces about your person. A wrist watch only is okay. Personal hygiene and grooming must also be taken into account, nothing makes an interview more uncomfortable that someone wearing too much cologne or having forgotten to brush their teeth. If you choose to chew gum, get rid of it before the interview.
The Preclinical years
These years are focused on gaining an understanding of human physiology and anatomy. Your examinations will focus on the biochemical underpinnings of the basic physiology of the human body.
One thing to be aware of is the sheer amount of new words you will be expected to understand and know the meaning of. Throughout the years at medical school, the number of words you will learn is equivalent to learning a new language. Do not be daunted by this little fact, as the understanding and knowledge of basic physiological processes will build over a great deal of time. In the long term, almost all final year students gain an excellent appreciation of the physiology of the entire human body, as well as the anatomy.
The process of learning physiology takes years to develop. Everyone learns differently, so you should know the best way of learning that works for you. Do not assume that what works for others may work for you. Mechanisms of learning include the following (although it has become increasingly apparent that the idea of different learning styles is a myth):
Visual - These learners tend to gain the most from images, pictorial and diagrammatic representation. If you are a visual learner, you find picturing things in your head to be very beneficial. If you have a clear enough memory, you will be able to visualize precise details of diagrams and flowcharts during your examinations themselves.
Auditory - These learners benefit from listening to a lecture, or an explanation. Students may benefit from listening to lectures to consolidate knowledge. Some students benefit from recording themselves reading areas of revision material. This gives them the additional benefit of consolidating their knowledge in an additional way.
Audiovisual - This style of learner benefits most from combined audiovisual learning are common. It is likely that you will benefit greatly from combined auditory and visual learning mechanisms. The reality of daily medical learning, is a combination of both visual and auditory resources.
Note taking - At medical school note taking is an art, it needs to be practiced to become perfect (yes, you can improve it!). At the beginning, your fear of failure and enthusiasm will cause you to write far too much. You have to become adept at note taking, this means not writing excessively, but rather concisely. The key is taking down the information that is essential, that is precise, and that is useful. If the information is interesting but not essential you should not take it down. If the information is not precise and is a complex or waffling, you may do better to jot down the topic then read it later from a textbook or internet resource, such as Kenhub. If the information is not useful then don’t waste your time writing it down! Remember you have a finite amount of energy to put into your work both academic and personal, so use it carefully, and work purposely.
This is a topic that comes easier to some than others. Some people find it very easy to attend a lecture and remember the content. The majority of students, however, need to consolidate their knowledge by repeating, reorganizing, and thus relearning things they might have known. This practice takes your previous knowledge and allows new information to be coupled with it.
The best ways to revise information varies among individuals. An effective technique is promoting understanding of each topic. If you understand a topic, you can apply the principles you learn to any question in the exams. This has to be combined with a certain degree of memorization i.e.: drug names, effects, and side effects. However, the principles of understanding will carry you far in your medical school examinations.
Some people benefit from highlighting words in their notes. If that is effective for you than do it, just don't ‘over’ do it. Others may benefit from repetition and rewriting to consolidate and solidify knowledge.
Anatomy is a different animal to learn compared to physiology. There is simply nowhere to hide when it comes to anatomy. You either know the name of the structure or you don’t. You either know the innervation or you don’t. You either know the function of the organ or you don’t. In this regard, anatomy learning is a lot more to do with memorization and recall than it is to do with physiology learning which is applying concepts.
Make sure you are fully aware of the format of anatomy exams at your university. Some university will be using cadaveric and prosection-based anatomy. Others will be using written questions based on diagrams and models. If the exam is prosection based, then learning anatomy is best done in the dissecting room, where you can visually record things in your mind’s eye, and which will make recalling the structures a lot easier at a later date. Get to know the lab instructor and ask them to help demo structures, i.e.: how would you display pes anserinus?
If your anatomy knowledge will be assessed by written questions, then you may require a deeper knowledge of anatomy and can’t rely on your visual memory as much. In addition, watching videos, or using interactive content can be incredibly useful for learning anatomy. Kenhub offers excellent resources for this. Other video atlases such as Acland’s video atlas are also very highly recommended. Taking notes in anatomy can be useful for salient and specific structures i.e.: nerve plexus, as well as muscle origins and insertions. Note taking forms a much smaller part of the learning process with anatomy than it does with physiology for most people. Another way of cementing your knowledge of anatomy is doing online quizzes. They will help you consolidate knowledge and make remembering the facts a lot easier.
The Clinical years
These years are aimed at gaining knowledge and a thorough understanding of a range of conditions, as well as developing high quality clinical skills. Understanding conditions requires more than a superficial understanding of a disease, definition, and treatment. There is a thorough mechanism by which you should learn each of these diseases. Over the course of these years you will likely be required to learn hundreds of diseases.
For every condition listed in your list of learning objectives, or your curriculum outline, you should know the following minimum facts: signs and symptoms (S/S), diagnosis (Dx), and management (Tx). This should be the pattern by which you learn every single disease. Learning other elements of a disease are also very useful, especially in exams, where critical thinking can give you an edge. These areas include pathophysiology, risk factors, aetiology, genetics, classification, prognosis, complications, and follow up. Having this deeper bank of knowledge for each disease will put you in a very strong position to approach the examinations. In practical terms however, you may not have the time to fulfill the full quota of elements for each disease. Focus on the first three elements I mentioned: S/S, Dx, and Tx then build in the other elements as you go along. If you are quickly approaching exams, then narrow your learning regimen to these three topics only to maximize yield and exam effectiveness.
Clinical Skills and knowledge
Clinical examinations (also known as OSCEs- Objective Structured Clinical Exams) are often the most challenging of exams, as you are: on the spot, expected to know how to examine proficiently, expected to communicate proficiently, expected to maximize the amount of marks you get. It is understandable to feel nervous, and depending on your medical school, you may be expected to sit these exams in our preclinical years as well.
The key to doing well in an OSCE is remaining calm. It is ok to feel nervous, but this should not be hindering you from talking and performing well. When you approach each station, ensure you read the full station and use all the time you are allocated for this. There are no prizes for rushing through the station, in fact there are marks to be lost if you find yourself with time at the end of the station and nothing else to say. Think about follow up questions you could ask and think about what else may be relevant to your examination.
In terms of your examinations, there is simply no substitute for practice. Your examinations should be second nature to you and you shouldn’t be having to second guess the sequence of steps you are taking. The same principle goes for history taking. You will learn a firm foundation, most likely in your third year.
This foundation is:
- presenting complaint - This is a one sentence summary of what has brought the patient into hospital/clinic.
- history of presenting complaint - You should spend the majority of your time on this part of the history. This is where you establish the onset, duration, and progression of the presenting complaint. You must also establish any associated symptoms, such as nausea, vomiting, or diarrhea. Remember to screen for systemic disorder i.e.: tuberculosis or cancer, then ask about night sweats and weight loss.
- past medical history of the patient - Ask about heart disease, lung disease, cancers, and previous surgeries. Screen for other major diseases such as diabetes, high blood pressure, and strokes, If these are relevant to the history.
- drug history - Establish what medication they are on and what they have been on in the past. Ask about over the counter medications and vitamins/supplements. Some herbal treatments can contain dangerous chemicals, especially if purchased over the internet or another unreliable source. There also might be interactions which would be a contraindication.
- family history - Ask about siblings, parents, cousins, aunts, uncles, grandmothers, and grandfathers. You should ask specifically about the disease that may be linked to the presenting complaint. For example, the patient may have presented with weight loss and bone pain, in which case you should ask about family cancer history. Also, ask about pregnancy, past or present, no matter the level of discomfort.
- social history - This includes asking if the patient smokes, drinks, or takes any recreational drugs. Also how the disease is impacting them and their relationships, affecting their work, and if they are having any financial problems because of their illness. This section of the history may come much earlier if you feel the patient's primary concern is the impact of the disease on their life, and not just the primary illness.
As you go through medical school you will learn about the specific elements of each history in each area i.e.: a falls history, a hearing loss history, etc. These skills are best picked up on placement in these specialty areas and practicing on real patients who actually have the diseases you have been reading about. There is simply no substitute for this method of learning.
Final year is usually regarded as an assistantship in a range of core specialties. These include surgery, medicine, emergency medicine, and general practice. You will be undertaking many of the duties of a junior house officer and as a result will be expected to be proficient in all areas of medicine. At this stage you will be expected to essentially be a doctor. You will just need to sit for finals and your last few exams. At this point you should have a mastery of clinical skills and knowledge, and working at putting these skills into practice. Your professionalism should be at an impeccable standard throughout medical school but this year is where it is especially important.