In January, a group of researchers at the A.T. Still University-Kirksville (Missouri) College of Osteopathic Medicine (ATSU-KCOM) set out to explore the question, “After your first semester of medical school, is this what you expected?” We wanted to examine the discrepancies between students’ visions for their time in medical school and their real-world experiences.
Osteopathic medical education has a long-standing history of educating holistic and well-versed physicians. Like trainees in any health profession, medical students must overcome a variety of obstacles and hurdles before they are granted the title of osteopathic physician. A few of these challenges include course load intensity, academic rigor, time management, family obligations and self-motivation.
Students typically enter medical school with a rough understanding of the trials ahead and their possible effects on their emotional, physical and psychological well-being. However, until students are fully immersed in medical school, they can’t fully comprehend what the experience will be like.
We focused on first-year medical students for two reasons. Among all medical students, first-years are likely the least cynical and most pure. They’ve yet to be exposed to the grueling schedule of second year, board examinations or the frustrations of everyday patient care. Having just begun the path to their dream career, they are still optimistic. Also, their original impressions are fresher in their minds.
To research our topic both qualitatively and quantitatively, we conducted a shorter survey, which 168 ATSU-KCOM first-years completed, as well as 30-minute semi-structured interviews, which 18 students agreed to participate in. For confidentiality purposes, we retained no identifiable information about the students.
More than three-quarters of students who responded to the brief survey said that overall, medical school matched their expectations. However, only about half of students said the way the curriculum is presented lined up with what they envisioned. Slightly more students—60%—said that the lopsided work-life balance of medical school was what they expected, a result we didn’t find surprising because the process of getting into medical school typically prepares candidates for its intensity. And about 9 out of 10 respondents said if they had the chance to start over, they would still pick medicine as their career.
Course load and curriculum
We were intrigued by the fact that so many students said they would choose medicine again—particularly because a number of recent articles have detailed a rise in physician burnout and dissatisfaction in recent years.
All the students we interviewed acknowledged that they expected medical school to be difficult. However, most of them noted that the strains of medical school were more taxing than they imagined, and they made comments echoing this student’s: “I always knew medical school would be difficult, just not this difficult.”
Many of the students we interviewed reported that the overwhelming amount of material made them feel mentally, emotionally and physically exhausted. They noted that the information itself wasn’t the main challenge, but the amount of it along with the required speed of acquisition tripped them up. One student stated that medical school is like “being in a circus—a constant juggling of acts.”
Most of the students we talked to said they also expected first year to be more clinically oriented. They were hoping for a “tool box” of skills that would help them provide their patients with the most comprehensive care. They anticipated their classes to be more hands-on and tactile. Instead, they found their courses were more lecture-based and similar to the undergrad format. They would sit in class and listen to a professor, then go home and study from books.
Considering that many students found medical school to be more grueling than they imagined, we weren’t surprised that when asked about the balance between life and medical school, most students we interviewed chuckled and responded, “What life? Medical school is my life.”
Many students said they had a hard time explaining the rigors of medical school to their nonmedical family members and friends. They said medical school caused strain in their relationships. Their social interactions became rather limited, they said, and usually revolved around the new friends they made within their class. Many said they had a hard time relating to people who weren’t spending their days studying science, anatomy and osteopathic manipulative medicine. Several students expressed guilt at not being able to spend more time with their family. They felt as if they were “missing out” and “disappointing” those they love most.
Despite their complaints about work-life balance, nearly 60% of the brief survey respondents reported that they found a way to balance their outside life with medical school. Many students are involved in clubs, sports, music and other extracurricular activities. And while they may be under time constraints, they are still devoted parents, siblings and children. Medical students make sacrifices not only for their careers, but also for those who suffer alongside them as they commit to the hard work required to become osteopathic physicians.
A jury of your peers
While medical students often struggle to find time for their families, they typically spend a lot of time with one another, studying or in lectures. Most students we interviewed spoke highly of their fellow classmates. They praised their cohesiveness and willingness to help each other out.
“It’s like being in an army,” one student said. “We’re all working together during this really tough experience.”
Every interviewee stated that they expected a high degree of integrity, maturity and professionalism from their peers. Yet several students compared medical school to “being back in high school.” They noted the presence of social cliques, the spreading of rumors and an egocentric focus from some of their classmates.
In addition, students found that their peers partied more than they’d been expecting. Some students used words such as “excessive” to describe alcohol usage, though one was quick to note that the heavy drinking wasn’t limited to ATSU-KCOM.
“I have friends attending medical schools all over the country,” he said. “It’s not only here, it’s happening everywhere.”
We were surprised by these reports because physicians are responsible for promoting healthy lifestyle habits. The increase in drinking may be due to the high degree of stress that medical students are exposed to on a day-to-day basis.
Considering that medical students who abuse substances may one day become impaired physicians, we suggest further research on substance use among medical students.
Many students also said they were surprised by their peers’ behaviors in the academic realm. Several noted that while they expected their classmates to be more involved in extracurricular activities and community service, they found that more students than anticipated displayed a single-minded focus on academics.
Willing to sacrifice
Whether they throw themselves into academics or embrace extracurriculars, all medical students spend several years preparing for a career in medicine. Some volunteer in the community, while others take on leadership opportunities, go above and beyond in their courses or conduct research. Most students know from a fairly early age that they want to pursue medicine.
“This is what I’ve wanted to do since I was 4,” one student said. “I’ve worked super hard to get where I’m at and I’m going to continue doing that to make sure I [become a physician].”
The journey of becoming a physician—and completing medical school—is long and often wrought with obstacles. Mental and physical fatigue, long hours, emotional frustration, delayed gratification: All medical students will become familiar with these challenges as they take on the responsibilities necessary to become physicians. Most of the students we spoke to are willing to accept these short-term trade-offs to accomplish their goals.
“The benefits in the end will be so fantastic, and doing what I’m passionate about is more important than current enjoyment,” noted a student.
In the end, altruism and enthusiasm for medicine appear to outweigh the day-to-day hardships faced by medical students.
“It’s important to keep moving forward and get past the speed bumps,” another student said. “They slow you down a little bit, but get you to where you want to go.”
Editor’s note: This post was written by Jessica Lapinski, OMS III, Amanda Schoenfuss, OMS III, and McKenzie Tate, OMS I, of ATSU-KCOM, and Patricia Sexton, MS, DHEd, the school’s associate dean for curriculum.