Becoming a doctor
Becoming a doctor is the ambition of a lifetime, and one that requires years of hard work and dedication. It’s cliché, but true! Before you go any further, you need to be sure that medicine is the right career for you. Some people will have a unique reason for their interest in studying medicine e.g. an experience they had as a child, or an illness they suffer from. In order to separate yourself from the crowd, you need to celebrate this reason, and be aware of its role in driving you towards this career.
On the other hand, it is very common for many candidates to be applying for medicine purely for academic reasons. They were gifted at school, and they want to challenge themselves in a difficult degree. This approach can certainly lead to an excellent clinician, but also presents significant pitfalls. Medicine is about so much more than being clever. You have to visualize and practice medicine as both a science AND an art.
In this article we are going to discuss the basic steps undertaken to become a doctor. The path to an MBBS/MD/MBBCh degree is variable, and students can take one of the various paths. The main themes that will be discussed aim to clarify the requirements for success during the various phases of your medical school and pre medical school career.
Before Medical school
The art of medicine is a topic that has been discussed since the time of Hippocrates. As well as having the clinical knowledge to prescribe the right medication or the surgical skills to repair a bleeding vessel, a doctor must be able to communicate with compassion, care, and common sense. If you are not interested in improving a person’s quality of life and helping them, then medicine is very unlikely to be for you. Always remember, there is a world of potential jobs out there, and there is certainly no shame in being honest about what your main goals and passions are in life.
Being at school or college gives you the opportunity to excel both academically and personally. Being gifted academically will give you a strong foundation for a future in medicine. In this realm, there is simply no substitute for hard work. You do not need to be an Einstein, but you do need to be performing well in the vast majority of your subjects, with strong grades. This includes good proficiency in basic subjects like Physics, Mathematics, Chemistry, and English, at both GCSE and A level (in the United Kingdom). The international Baccalaureate also requires you to perform to a very high standard. Whatever exam board, or country you are studying in, you need to excel to the best of your ability and be motivated to succeed academically.
If, however, despite your hard work you are really struggling with your grades, or you chose non-medical subjects for A level, or have only recently decided to come to medicine, this is not necessarily the end of the road. Many universities offer a year 0, where they will bring you up to speed in the science subjects, e.g. Biology, Chemistry and Mathematics. At times, you’ll be asked to reapply to the medical program using the grades obtained from year 0.
This also extends to those who are from disadvantaged backgrounds, or went to poor secondary schools. Many universities make allowances in your grades if you have a background like this. If either of these apply to you, the importance remains in doing your research. There are many paths into a medical degree, which you are encouraged to explore thoroughly. Sometimes, despite your best efforts, finding a place to study medicine may seem impossible. If you are certain that medicine is the career you want, then don’t give up! You can always do another degree and apply as a graduate. A career in a field allied to medicine is also an option, such as a physician’s associate, a healthcare scientist, or a biomedical scientist. Sometimes you may not know you enjoy something until you explore other options!
As well as your academic career, it is imperative that you develop a good range of extracurricular activities and hobbies. This may be playing sports for your school team, or local team. This could also be charity work or volunteering. Anything that involves communication with a range of people and a large number of people from the general public will do e.g. a cashier at a shop, or a coffee shop barista. This will improve your communication skills and get you used to speaking to a variety of strangers with ease. This is what medicine is about. Speaking to people you may not know very well, and making them feel comfortable and reassured enough to discuss their health concerns.
Any opportunities at school or outside of school that take on leadership responsibilities are highly recommended. The same advice is encouraged for teamwork activities. Play in a team, work in a team at work, sing in a choir or play in an orchestra. All of these are examples of things that will demonstrate your abilities to work well in a cohesive teamwork structure and demonstrate your leadership skills when they are required.
If you choose to do a bachelor’s degree before you apply to study medicine (as is the compulsory system in the US), then you will have a different pathway to your degree. In the United Kingdom this will be in the form of a graduate degree. This is an accelerated four-year degree that compresses the preclinical years into one. Your first year will be a lot more stressful than that of an undergraduate. You will essentially be expected to learn years worth of undergraduate knowledge in one year.
Application for a place on graduate courses is understandably competitive, with many students choosing medicine at a later stage. Motivations for choosing medicine at a later stage in life will almost always vary, and each candidate will be unique. Previous employment will also have a significant bearing on one’s practice at medical school, with experience in the areas of teamwork, leadership, organisation, and others of utmost importance.
How to get into medicine and being successful at interview are discussed in other articles, so discussed further will be what your time at medical school will involve.
The Preclinical years
The initial years of medical school are spent learning the physiology underpinning the human body and it’s normal functioning. The teaching you will be exposed to will teach you the normal functioning of the body and its systems, and will also introduce you to the abnormal function of the human body. This will most likely be covering the major diseases that affect the human population i.e. diabetes, heart failure, myocardial infarctions (heart attacks), stroke, chest infections, urinary tract infections, etc. The majority of the teaching you will receive is generally focused on the topics mentioned above.
It is likely that the main focus of your examinations will be on your knowledge of these areas of academic understanding. The clinical side of your knowledge (patient history taking and examinations) will be something that will be in its early stages. This is not the case with all universities, some of whom may place a heavier emphasis on your clinical acumen at an earlier stage. The key is to know what works for you. If you are a visual learner, then utilise that fact, but don’t limit yourself to it. Read lecture slides, draw diagrams, and brainstorm topics. Learn with other visual learners.
If you are an auditory learner, then listening to lecture recordings may be helpful for you. Another point I would make, is to not neglect online resources. The internet has millions of websites dedicated to offering high quality information on physiology, anatomy, and clinical conditions. You can use YouTube, Google, and any other search engine or online platform to cement your understanding with reputable sources. That is the key to being successful at medical school, understanding. Memorization also plays a key role, and there are some things that you will simply have to memorize before understanding them. For example, the brachial plexus; you need to memorize all the name of the branches and their relative location before knowing what part of the arm each branch will innervate. There is no replacement for understanding a topic. If you understand something, you can apply those principles to any topic. You will be more capable of thinking on your feet and answer questions that require you to think laterally (outside the box) during your examinations.
The Clinical years
The later years of medical school involve the learning of clinical science and medicine in the way we traditionally think of it i.e. symptoms, investigations, examinations, and management. You will be expected to learn a large amount of information and this will certainly be the most challenging part of medical school. These years of medical school are largely comprised of regular hospital based placements and clinical contact with patients. Students will be encouraged to clerk patients (take a thorough clinical history, formulate a diagnostic and management plan, etc). This is incredibly beneficial, as each patient offers another learning opportunity. This could be in the form of a condition you are unfamiliar with, or a medication you have not yet heard of. By interacting with patients, your communication skills will remain of a high quality. This will prepare you for your examinations, where you are likely to be asked to take a clinical history from a patient and gain an understanding of their condition.
Patients are the eternal fountain of clinical knowledge, so do not try and learn everything from your textbooks. You will obviously need to read both widely and thoroughly, as well as see how these conditions impact every day patients. Make an effort to see how these conditions are managed on hospital wards and clinics.
Another point to make is the importance of intellectual curiosity. You will get out of learning experiences what you put in. It is very easy to follow a ward round and learn nothing, or sit in a clinic for four hours and learn little. If you ask questions, show interest and behave professionally, it is truly amazing how much you can learn in the duration of a few hours.
A technique that you are encouraged to use during medical school is reading about the conditions you see in patients you meet on the ward or in clinic. This has the effect of cementing your knowledge, and rather than learning the empty facts about a disease, allow you to associate the information with a person. This information therefore becomes easier to remember and utilise.
In the later clinical years, your focus should be on perfecting the skills you have already developed. You may know the steps of a cardiovascular exam, but do you know the precise sequence? Are you able to put the patient at ease while you perform the examination? These are points of refinement that will improve your marks in examinations, and separate you from the bulk of your academic year. Do not neglect your clinical skills. Work on both your levels of knowledge, and your ability to communicate and establish a good history. Both are required to become a good doctor, so work on both equally.
Some doctors choose to do a higher degree such as a Master’s or a PhD. This is particularly beneficial if they are pursuing an academic career. It is also a positive if considering a career in surgery or hospital medicine. It may give you the edge in a certain area when you apply for a competitive job. This is certainly not a compulsory part of a medical career, and the options will become much more tangible once you qualify.