Life As a Medical Student

Hello hello.

Whether you are a premed interested in what your future may look like in medical school or you’ve recently been accepted, finding out what a day in the life of a medical student looks like is often something searched. It is usually difficult to find, and for good reason! Every school, curriculum, and student is different. Making a “day in the life” of student hard to capture.

I am going to be honest here: I was not usually on top of my shit as a student. Despite what the medical school youtubers show you and what the over-achieving instagramers say, most people are not on top of studying or have it together in medical school. It is completely common to be far behind, too tired to finish, or often run out of time in the day to do what you need to do.

Because of this, I spent a lot of time NOT going to class, learning at my own pace, and sleeping. Majority of my classes were not mandatory in person, and they were recorded so we could in essence “re-watch” them later. What that really meant was most students didn’t go to class and just watched them later on their own time.

Year 1:

Year 1 is all about that learning curve. In case you haven’t read a previous post, I went to a school that was known to have a difficult curriculum. They also had block scheduling, and the curriculum taught the “normal” first year and the “abnormal” second year. So that meant first year you would have anatomy, physiology, biochem, immunology, histology, and embryology for each section. The second year was mostly pathology and pharmacology. So you would have GI 1 in first year covering the basics, and GI 2 going over disease and pathology. They would definitely throw in common diseases to be tested on in first year though; they make great test questions. The idea was that you would have the ability to see it twice; as more repetitions = more likely to get into your brain.

Because the school was proud to have a “tough curriculum”, it also meant that you did a lot of self learning. I won’t go too into details, but you would have your lectures/reference books, but a lot of it was not easily put together for you. You did have to hunt to find important information. First year did hand you a bit more, but by the time you got to second year you did a lot more hunting…

It definitely made it frustrating as a student as most of us wanted to spend them time just learning and understanding what we needed to know, but it is what it is.

I wrote a lot of blocks on my classes in first year. But a schedule typically looked like this:

  • Class from 8 am to noon most days of the week. Occasionally we would have lectures in the afternoon, but most of the time we didn’t.
  • Lab usually from 1-4 on 2 or 3 of the days in the week. First year would have PCM, OS, and anatomy labs to fit in during the week depending on the block course you were in. OS and anatomy labs were 2 hours, PCM was only 1 hour.
  • Any additional time spent off was in the lab or studying for your courses.

This meant that you either had to pre-read/review lectures before class and try to learn a chunk of it during class, or do most of your reviewing  later in the evening. I am more of an evening person, so most of my studying occurred at night.

For most labs, you did not have to prep. But for some you did. This obviously took up some of your review time to make sure you were prepared. There were a lot of long nights and most of my weekends were spent trying to catch up simply because of this. As time went on, I stopped going to class to sleep in or try to start studying and just went to campus for labs. For anatomy, you spent most of your time trying to dig and find your structures, but you didn’t learn them well until they were cleaned out and you were able to see them and their relationship in the body. If I would have prepped more before going into lab, I probably would have gotten more out of it.

Our school has something called Mediasite, which is where our recorded lectures would be. They would show up as soon as the in person class was finished. We could speed up or slow down the lectures, so you could get through lectures pretty quickly if you wanted. Other schools I know utilize just voiced over powerpoints, which you cannot fast forward through…

And that was how my first year went. A lot of lectures, doing questions, trying to learn the anatomy, etc. There were some classes that I utilized a lot of additional resources besides my notes, and some where I didn’t need to utilize much. Because I had previously had plenty of exposure to the subjects taught, I knew how to study for them and how to approach them. It was just learning how to accept, study, and understand the large amounts of material in a much smaller amount of time.

Overall I would study an average of 10-12 hours a day first year.

No, I didn’t really work out. 

Yes, I had a lot of anxiety and there was a lot of stress burrito-ing happening and cuddles with my kitty. 

Year 2:

Honestly, more of the same. Except the focus was on pharm and path. I utilized Robbins path and pathoma the most, in order to help me understand and organize the material better. But honestly, you just have to see the material many times in order to understand path.

We didn’t have anatomy second year, so our only labs were OS and PCM. Most of the important skills we actually learned in first year; so a lot of it was review or integrated with some fine tuning. Since we had exposure to how they tested for different scenarios for both courses in first year, it wasn’t as stressful second year.

For our schedule, it was similar:

  • Classes 8-12 (or less depending on the day)
  • and lab/simulations about 2-3 days out of the week. We rotated in smaller groups for more things, so the schedule would look more hectic than it was.

Again, I chose to sleep in during the morning and get a later start to classes/studying than go to class. I simply didn’t learn in class. And if I did go, I could only pay attention for about an hour before I needed to switch. Plus, a lot of our path/pharm lectures were flown through simply because there was so much material and not enough time to teach it.

I’d say I utilized more outside resources consistently for second year, such as Truelearn for questions, or sketchy/pathoma for help with path understanding. So instead of multiple books, youtube, paid resources, etc, I just used the same 1-3 sources. First Aid can also be utilized as well to help organize your thoughts for path.

Then towards the end of the year you start gearing up for boards and dedicated. See my other posts for that information.

Overall, I would study maybe 6-8 hours a day consistently for second year. Partly because I was burned out, and partly because I would avoid my duties due to stress. It is what it is.

No, I still didn’t work out. I did hang out with friends more though. We would call it “study group” but only about 1/2 the time was spent studying… 

Year 3:

Well, I’m just starting so I don’t have much to offer yet!

But my site is doing what they call the “2+2” method. It is where we are in clinic for 2 weeks and then off for 2 weeks. But when we are on, we are on. In my first rotation this meant I was on straight for 14 days. Anything that was on call that my provider called me for meant I needed to be there. It was a bit exhausting by the end. I didn’t really get a “day off” until my 14 days were done. 

I know in the future, my schedule could be any combination of weeks on/off. It just so happened that my first rotation was one off, two on, one off. Because of this program, we have more work to do than our classmates. We all have some online work to do (and by we I mean my class as a whole), but my site has more additional projects that count towards our grade. This includes case presentations, powerpoints, standardized patients, and virtual reality. 

On my weeks off, it would usually consist of doing the work assigned for a grade, flash cards, and practice questions. 

For my first rotation, my scheduled looked like this:

  • 6am Rounding: As a student I would go before clinic started. I would usually run into my attending as I was finishing up so I could present. Then we would go see the patients from there. If I finished beforehand, I would look up the first few patients in clinic for the day so I had their information handy if I was sent in to see them.
  • Clinic from 7am-4pm (which always ran late).
  • I was on call the whole time, so if anything next door on the floor was called in, I would leave clinic to go be with the attending that was dealing with that. Sometimes it was the attending I was with, sometimes it wasn’t. Weirdly, I was usually with the attending in clinic that was on call that day. So it worked out in my favor. So if a baby was about to be born, we would leave clinic and go deliver and come back.
  • Some days we would have scheduled surgeries mid-day. So usually over lunch?
  • After clinic, we would visit patients on the floor. Usually started sometime after 5 pm. We would check in with any mom’s that needed to be delivered, or anything that was admitted while we were in clinic.
  • I would usually leave anywhere around 6-7 pm. 
  • On the weekends I would be there from 6/7am-7pm. I think there was one night where a case went haywire and we were there pretty late. 
  • This was a mix of inpatient and outpatient.

And that was mostly how my first rotation went. I only had enough time to shower, make food, and eat before passing out during the 2 weeks I was on. And since it was my first rotation, I hadn’t learned how to work in studying yet and hadn’t gotten used to the physical exhaustion yet. Hopefully my next rotation I will be better with this!

All I know is my next rotation is peds. I’m off the first two weeks and on the last two. I believe this rotation is just inpatient, so I’m expecting to be doing regularly scheduled 12 hour hospital shifts, but will let you know!

Cheers!

 

Scribe Series: HPI Practice Case 3

Hey all,

I’m back with some more HPI practice! This will be text practice; I’m not technologically fancy enough to do a voiceover. These cases are long, so I will do 1 per post. Let me know if you find this helpful in the comments below!

Also, here is a drive worksheet you can use. Feel free to make a copy of it or print it out so you can work through this on your own. I will not be giving edit access out simply to allow others to come across a blank worksheet. Worksheet here.

Diarrhea

Here are the list of complaints given to you in no particular order.

  • 27 y/o M
  • Diarrhea, having several episodes a day
  • Watery, not much mucus. No blood.
  • Stomach hurts all over. 
  • Some nausea and vomiting. Vomited 2 times.
  • Symptoms started 3 days ago. 
  • Having abdominal cramps that seem to get better after going to the bathroom. Cramps and pain are a 6/10. 
  • He’s been taking pepto bismol with slight relief of cramps and diarrhea. He hasn’t been eating much as he just gets sick when he does. 
  • He doesn’t have a thermometer at home to take his temperature. 
  • He was travelling recently before he got sick.

Task 1: Can you pick out the elements of this HPI?

Age/Sex
Chief Complaint
Onset
Location
Duration
Characteristic
Alleviating factors
Aggravating factors
Associated Symptoms
Radiation
Timing
Severity
(anything else you can add at the bottom of your paragraph).

Answer:

Age/Sex: 27 y/o M
CC: Diarrhea
Onset: 3 days ago
Location: Abdomen
Duration: episodic. Having several episodes a day.
Characteristic: watery, no mucous or blood.
Alleviating factors: going to the bathroom to relieve himself. pepto bismol. Not eating.
Aggravating factors: eating
Associated symptoms: abdominal pain and cramping. Nausea and vomiting x2.
Radiation: None.
Severity: 6/10
Everything else: He recently travelled prior to symptoms seeming to start.

Task 2: Write an HPI!

Write an HPI so that your order, flow and story makes sense. Use medical terminology as if you were writing this in a chart. The blessing is this is text, and you aren’t converting it from what you are hearing down into text form.

My version of this HPI:

Patient is a 27 y/o M presenting with 3 days of diarrhea. It is watery, but no mucous or blood noted. He is experiencing several episodes a day with associated cramps and generalized abdominal pain rated a 6/10. This improves briefly with bowel movements. Patient is also experiencing nausea and has had vomiting x2 since onset. He has been taking pepto bismol and not eating as much with some improvement in symptoms. Of note, he was recently traveling before symptoms started.

Bonus!

On exam, he appears uncomfortable. HR is 103, RR is 18, Temp is 99.7’F, BP is 115/87. Conjunctiva are pink. Mucous membranes are slightly dry. Heart is slightly tachycardia, but regular rhythm. No murmurs, rubs, or gallops. Pulses equal and bilateral to upper and lower extremities. Abdomen: Generalized tenderness without rebound or guarding. Hyperactive bowel sounds noted. in all four quadrants. Negative Murphy’s and McBurney’s sign. The remainder of exam is non-contributory.

Labs show a slightly elevated white count. But normal hemoglobin. Slightly elevated hematocrit. BMP shows a slightly elevated BUN and creatinine, but still within normal range. Negative liver panel. Stool studies were sent off and are pending.

Task 3: Can you guess what happened?

Now this is just for funsies as I certainly didn’t give you all of the clues or everything that I would order for this patient. You also wouldn’t be asked to do this as a scribe! But just for fun, what do you think this patient has?

Answer:

I was going for a viral gastroenteritis here. There are lots of different presentations for this and it could be viral or bacterial. This is a very common thing to get in the winter (viral) and popular in the summer at cookouts (bacterial). You see this frequently in both outpatient clinics, urgent cares, and ER’s. Since this one is likely viral from his recent travel, he will probably get some fluids and some anti-emetics and left to ride it out. The biggest concern with diarrhea is dehydration. Depending on someones baseline of hydration will depend on how much diarrhea will cause dehydration to that patient.

So our diagnoses (or Assessment!) is as follows:

  1. Diarrhea, likely viral.
  2. Gastroenteritis, likely viral.
  3. Mild dehydration.

Hopefully you enjoyed this practice HPI post! Let me know if this helped in the comments below.

Cheers!