This is a wonderful letter to all graduating medical students from Steven L. Kanter, MD, editor in chief of Academic Medicine.
“Remember that you take with you such an amazing gift to offer to society. Some of you will advance our understanding of medicine by discovering new knowledge, some of you will ensure our future by teaching others, and some of you will attend to the very meaning of life, one patient at a time.”
I’ve had several new college graduates ask me what they should do this summer to prepare for medical school. It’s easy – don’t worry about it! There is no studying or preparation that will improve how you do. Seriously, you’ve been accepted and you will do fine. I know you are anxious, but I can absolutely guarantee you don’t need to study anything to get ready! That being said, I do have some advice about what to do this summer:
Take a vacation (or two or three…).
Develop (or strengthen) an exercise habit.
If you don’t know how to cook, learn.
If you are reading this because you are preparing to start medical school – welcome! You are now part of one of the most noble professions in the world. You are no longer just a student, you are part of a profession… as of now.
Medical school is a wonderful, but at times difficult experience. As you start this fantastic journey, there are a few “rules” I think might help:
1. You can drink from a fire hydrant, but you’ll need to learn how.
The amount of information you are going to be exposed to in medical school is logarithmically more than you had to learn in college. It really is like being asked to drink from a fire hydrant. You are going to have to study more, study better and actually use the time in class to learn. (more posts to follow with concrete tips on how to do this.) But – here’s the good news. You’ll be able to do it. Everyone who has gone through this has thought at various times that a) everyone here is smarter than I am, b) the admissions committee must have made a mistake and I’m not really supposed to be here and c) there is absolutely no way to read all of this material. And… we all discover that a) we are just as smart as everyone else (sometimes in different ways, but all effective) b) nobody made a mistake – we really are supposed to be here and c) you have to change the way you study, but you really can learn this much material.
2. Make your bed.
You wanted to become a doctor for a myriad of reasons, but one of them was surely because service to others is important for you. Therefore, you are already primed to sacrifice a lot of your needs for other people. Sacrifice is part of the culture of medicine. But, it’s like a Starling curve… a little sacrifice makes you better, but too much makes you ineffective. Doctors are notorious for this; we forget that if we don’t take care of ourselves, we really can’t take care of others. “Make your bed” is a simple rule (and action) which helps you remember that you need to take care of your environment, your fitness, your nutrition and your spiritual wellbeing as you are learning how to become a physician.
3. Act like a doctor.
We (all practicing physicians) see you as a doctor already. I know this is a really hard concept for first year medical students, but it’s absolutely true. You have started your apprenticeship and, unless you are one of the very, very few who change their mind, you will have an MD after your name in 4 years. With all of the joys and privileges that come with this role, there are a few responsibilities to start thinking about as well. Start thinking about your decisions, words and actions in this context. You’ll learn a lot of specific details about professional behavior as your apprenticeship goes on, like protecting patient confidentiality, peer review, etc., but the core values of professionalism start when you enter the profession, which is now.
4. Kindness matters.
It is remarkable how our paths in medicine cross over and over again. The person sitting next to you on the first day of medical school may be someone who will be an intern with you in 4 years or who will refer you patients 10 years from now. You and your classmates will be going through classes together (like you did in college), but this is different. You are starting your professional life together as well. The camaraderie that results is a gift and is also very important personally and professionally. Don’t blow off the class events. Don’t stay home to study instead of going to class. Go out of your way to meet everyone in your class and really get to know them. Cultivate and nurture these important friendships.
5. Enjoy the journey
The first year or two of medical school may, at times, seem like an obstacle course you have to “get through” to get to the “real stuff”. The basic science curriculum is not a rite of passage! It turns out that even the “trivia” (or at least that’s what it will seem like) is important. You are learning a new vocabulary… a new language. If you don’t learn the breadth and depth of this new language, when it comes time to apply it to patient care you won’t be “fluent”.
You are about to embark on a life changing (and fulfilling) journey. This journey is a privilege and it is very, very special. Take a few minutes everyday to write down the events of the day. The first time you hear a murmur in a heart will be just that – the first time. Take a minute to record what that was like. You are going to have a lot to process as you start studying anatomy – more than just the names of the structure. “Talking” about it in a journal is a great way to make the transition we all make in the anatomy lab. There are also going to be some hilarious stories and events that you’ll forget if you don’t write them down. When you look at them later, you’ll be glad you recorded them. Recording these moments doesn’t have to be by writing. If you are an artist, you may want to use drawings. Photos of your classmates (and some of those humorous moments) will become a treasure in the future as well. (but remember the professionalism rule!)
There is no question that there are many people who have integrated exercise into their daily routine so successfully that they don’t even think about it. It becomes part of their day, just like brushing their teeth, or putting on their pants in the morning. But even though it seems like the majority of people around you are in this category, it’s just not true. There are the real exceptions – like the guy who gets up at 4 every morning (even if he went to sleep at 2) to run. If you have never been an “athlete” you may feel really intimidated by these people. .
The benefits of exercise during your training can’t be overestimated.
Consistency, not intensity is the key
One of the biggest mistakes you can make is to view working out as something that you do as an activity “outside” of your day. A 45 minute work out, plus the time to get to the gym, plus showering and changing can easily take an hour and a half. For many residents, that kind of time commitment is a luxury they can’t afford. So, we have great intentions to get to the gym 3 times a week… and next thing you know, a month has gone by with no trips to the gym at all. One of the ways to improve consistency is to have a list of a variety of things to choose from. Although it’s expensive in most cities, a gym membership will help. See if it can’t be part of your holiday “wish list” for your family. The other thing that should be on that list, by the way, is a maid once a week to do your laundry and clean your house. Unless, of course, you want to use housecleaning as one of your calorie burning activities!
It’s a skill, and there are teachers
Most people know about cardiovascular training and have probably run, swam, or biked at some point in their life. The nice thing about running, swimming and biking is that everyone can do them, often at any time of the day, and it doesn’t take a lot of money, or a gym membership to do. But there are other options for cardiovascular fitness that you can explore – spinning classes, martial arts training, aerobics classes – when these are offered at gyms, there will always be a teacher to help you learn.
Even though the emphasis is often on cardiovascular training alone, fitness is a composite of cardiovascular, strength and flexibility training. If you’ve never participated in team sports, and haven’t had a reason to be in a gym, there is a good chance you don’t know the basics about weight training. You are not alone, and it’s normal to feel a bit intimidated. You can find a fellow resident to show you, but, often they haven’t learned proper form, either. It’s better to have a pro show you. If you join a gym, there are several options. Many gyms have circuit classes using free weights – which is a great combination of cardiovascular and strength training. There are also personal trainers. Although you probably won’t want to spend the money for a trainer on a regular basis, you can hire one for 2 or 3 sessions to teach you about each of the machines, and help you plan a workout routine or two.
Unfortunately, morning is usually the best time to work out
There are a few people who, no matter how tired they are can get to the gym, or go for a run after work. If your day started at 5 or 6 and is ending after 5 or 6 (or 7 or 8 or…), most people are just too tired and the call of the couch is too strong to go workout. In general, the most consistent exercisers usually get it done first thing in the morning. For most medical students morning will usually work. As you enter your residency, you are going to have to be more flexible.
Different days = different workouts
Call days are tough… and, for exercise, the day after call is the toughest of all. The key here is consistency. On the post-call day, don’t plan for long workout at the gym, but do plan for a 20 minute brisk walk when you get home. If there is a way to have someone cover you for 30 minutes before morning rounds, go for an early morning run outside, or climb the stairs in the hospital for 20 minutes. Don’t forget to plan in a day or two of rest, every week. It’s tempting to use the post-call day for your recovery and that may be the best thing some weeks. However, recovery from call is easier if it includes some working out.
Food is fuel. It’s also solice if you are stressed, and face it – it’s fun to eat. Other professions that deal with stress and physical labor have learned the lesson about not paying attention to nutrition. The culture of medicine demands a “selflessness” that borders on the absurd. It is often a badge of honor that you can go all day without eating. But, when you consider the consequences of such behavior, it is really crazy. There is no benefit to the patients, and clear harm to the doctor.
Eat often and eat well
When you are physically and intellectually busy (an average day on call in the hospital) you need to plan to eat every 3-4 hours. In general, you will have one “meal” (i.e lunch) in the middle of the day and two snacks. It’s not always going to possible to stop for lunch at lunchtime, but you should be able to find 10 minutes at some point in between 11 and 4 to eat a meal. Different rotations have different demands, and you can certainly take this into account when planning your meals. A peanut butter and jelly sandwich on whole wheat requires no preparation, and no refrigeration (it can even go in the pocket of your white coat). Alternatively, buy a loaf of whole wheat bread every week, and put the bread, a jar of peanut butter and a jar of jelly in your locker. It takes 2 minutes to make a sandwich to put into your pocket on the way to a conference or a brief break. Bring leftovers from the previous night’s dinner to reheat and have for lunch. You need to plan to include fruits and vegetables as part of every meal and your snacks. Buy a bag of apples once a week and put them in your locker.. and then make sure you eat the entire bag every week. The snacks don’t need to be elaborate, but you do need to watch the clock and eat them – even if you are not hungry!
Examples of easy snacks for the hospital