21 Things I wish I knew before starting medical school - A Clinical Years Student's Perspective.

This is an homage to my preclinical years (which I will miss) and to turning 21: A list of 21 things that I wish I knew before I started medical school.

I compiled these for my 18-year-old self just beginning medical school, but may this serve whoever reads this advice and something to reflect on, whether you are going through medical school at the moment, or are about to begin. I have a lot to say, so feel free to read the points and their elaborations to your liking.

(Before you read further, please keep in mind that I am currently in a direct-entry 5-year MBBS program that I commenced right after completing high school. Therefore, this is more applicable to those in the same position as I was in 3 years ago)

When you truly care about something you won't like it all of the time. It will make you angry, feel hurt, and push you away in ways you wish it wouldn't. Knowing if this is something you want to continue vs let go of may be tough, but an important decision you'll have to make. Although I would have never predicted a pandemic would strip away almost half of my preclinical years from campus, I know for many this ongoing situation has definitely made us rethink our decision and desire to continue in healthcare after having seen so much and observing others endure what they've had to. Just because you enter something for the end goal does not mean you have to love the journey. Just learn from it. That's the least you can do for yourself.

We tend to be more close-minded than we think. Truly. At a young age, we believe that if something isn't 'serving' us we should let go of it, "cut if off". This thinking will be harmful to you when it comes to pursuing opportunities.

The biggest lie you are told is that you have to pursue what your passion lies in. I appreciate Julia Weunch's way of describing this as the 'worst career advice' in Forbes. The idea of 'following your passion' assumes you only have one passion in life when in reality people are dynamic and so multi-faceted. It assumes you will stay the same forever when in reality life hits us with so many opportunities and situations, and we are bound to evolve. It assumes we've always known what we wanted to do and will do anything to follow through with our 'dream job'. Being passionate doesn't mean being good at it, and this idea of having to be passionate about what you want to pursue is so full of privilege that a lot of us don't realize we have so much of and most others do not.

If like me, you enter medical school right after completing high school, you are going to be going through medical education during the biggest mental developmental changes of your life. This isn't meant to be scary. It just means that you will absorb a lot more than you think and your ways of thinking will be greatly shaped around your experiences here. You will probably end up regretting this degree pathway.

Hating your degree does not mean you shouldn't complete it.

No one is saying you have to become a clinician, but you always have that option if it's what you end up wanting. Your passion may not lie in treating patients first-hand. It may not even be sitting in a lab trying to figure out how a person died the way they did, regardless of how 'cool' forensics sounds. It may not be in researching a cure for pancreatic cancer (a majority of students I know hate the idea of doing research. That doesn't mean you're not meant for this profession)

Your passion may lie in content creation and business. It may lie in policy-making, public speaking, or education. It may lie in 'influencing' (or whatever it is us millennials and Gen Z are doing nowadays). These are to name very few. Your medical degree can help you excel in all these areas, believe it or not. It depends entirely on how you choose to view it, what suits you, and how you decide to use your platform. You are not bound to one pathway. Use your knowledge to maneuver yourself through countless opportunities that may present themselves to you, not to hold yourself back.

I will quickly reiterate: If like me, you enter medical school right after completing high school, you are going to be going through medical education during the biggest mental/emotional developmental changes of your life.

You will be surrounded by so many different types of people. My high school's graduating class size was only 108 students, all of us similar in our outlooks on ambition and pursuing future goals, but very different in how we interacted with each other and went about situations. I will forever be thankful for having grown in such an environment because I got to meet and expose myself to many different personalities, intentions, and goals. In college, it's a similar feeling but on steroids. Although I was born and raised in Riyadh, starting college here meant overcoming a huge culture shock. It meant learning that I grew up in a very different Riyadh than a lot of my peers.

Developmental changes: your higher functions start to come into play and certain personality traits become concrete. Therefore, you are exposed to a plethora of ways in which others communicate, handle difficult situations, and treat others in the same, higher, or lower positions than them. It'll truly open your mind to how many ways people can help you and try to put you down. Most times, it's subtle.

Experiencing what you do at the same time as working towards obtaining your medical degree will never be easy, but it will be the best learning experience you will ever have. This is the only 'information you will ever be able to apply to all aspects of your life where you have to effectively communicate: everything. Take everything in your stride. Situations present themselves not to drag you down, but for you to learn.

It's a confusing and maybe unfortunate truth but will make sense very quickly once you start. I say 'unfortunate' because taking advice from authority figures, and taking it very literally on top of that will sometimes backfire on you. Remember _ things:

1. Your doctors and professors are from different generations. They are not always aware of what is best for a student in your time and age.

2. They have gone through what you have gone through, and are prone to their own subjectivity. What they tell you can be incredibly valuable. Other times, it can be very closed-minded.

3. Doctors and professors will tell you how to effectively approach academics (after all, they are not teaching in this environment). When you are having difficulty with something, approach a senior first, and demand advice, which leads me to the next thing I wish I knew earlier:

It's self-explanatory. Your seniors have gone what you have gone through, in a similar timeframe. They know the ins and outs of what you don't yet. They know the most helpful resources for what you want to know more about. They know which doctors to approach for what. They know what you're going through academically, mentally, and emotionally. Many of them just went through it a few months, weeks, or minutes ago.

3rd year (the last year of preclinical) was my most mentally taxing year yet. Every opportunity I got, I would talk to a senior about it and ask if what I was feeling was normal and if they had any advice. I went to a few TAs as well, and a couple of professors who di. You can guess where I got my most valuable advice and consolation from.

Naive little first-year Eman, you will no longer romanticize specialties that require you to come in at 4 am and perform hours upon hours of life-saving procedures (you never know, maybe clinical years may change your mind again). This is just speaking career-choice-wise.

Your appearance of yourself and your life to other people will no longer be of importance to you like it once was (be honest with yourself: you do care about this more than you let on). You will realize that your career isn't your life's purpose, but your career can help you live your life's purpose. Your purpose may change. The way you spend time alone will change, and the way you spend time with your friends will also change. Surround yourself with people whose values align with yours, who push you out of your comfort zone in a healthy way, and encourage you to be kind and more curious. Your capacity for malalignment with your values will greatly decrease, and your sense of responsibility and ability to realize your greater role in society will greatly increase. For some, this will come earlier. For others, this will come later. Be patient and understanding, and don't push away those you think don't have 'anything to offer you', and don't keep those who 'have something to offer you' so close to you. It's an incredibly selfish, limiting, and possibly harmful way of thinking. Everything is not what it seems.

This point ties in with #3, where I wish I had known that I would learn A LOT. I would have also liked to know that it is IMPORTANT as long as you see the importance in it. Subconsciously, you will pick up on more communication cues that were not apparent to you before. You will learn to ask for what you want in the most effective way and without apology. You will learn to make the most of the little you may have at the moment. You will learn what is disposable and what is necessary. You will no longer doubt your ability in certain things but will start to in other things. That's because you're growing.

After all, this degree is primarily making you a doctor. A good doctor can take something 2-dimensional, and see its 3 dimensions. An excellent doctor can teach that to those who follow in their footsteps. Interact. Read and record what interests you and how you felt reading it. Do things out of your comfort zone. It doesn't feel important at the moment, but you will thank yourself and also be able to make your progress tangible. You only learn from an opportunity if you spot an opportunity to learn. Your experiences outside of your lectures are what will make this true for you. Not your university curriculum.

They didn't study for that exam? Lies. They likely just want to protect their self-image in case they perform poorly.

They've gone through 2 passes of each lecture coming in the exam? Cool. Do they remember anything though?

They have opportunities waiting for them while you don't really have anything set up or ready? No problem. Your time will come.

(I myself am guilty of having done the first one early on, but it's genuinely admirable if you put in the hard work. What is wrong in admitting you studied for your certificate/degree???)

Don't let others' way of speaking about experiences dictate how you start to recount yours. You will be made promises many times, and you will be disappointed many times. People who inflate their own selves are the ones at a loss at the end of the day. You may fall into this habit or trap as well. Try to recognize it as soon as you can, and stay around friends who are not afraid to call you out on it. It's necessary for you to move forward in a way you can be proud of yourself. Stand by your word and you will notice how much lighter and at peace, you feel with your experience in medical school.

Failure is different for every individual. For some, this may be failing a block, getting a grade below what they were expecting or needed, or missing out on important opportunities for professional growth. For others, it may be failing an entire year and rethinking their major (Don't overthink it). Whatever the experience is, this will provide you mentally with what you need to maneuver yourself in the best way possible for you.

If you keep doing well, you will never realize room for improvement. Also, your journey will be very boring.

One thing to remember is: things will not go your way a majority of the time, and that is a good thing. You will realize how much more beneficial the outcome is than you anticipated.

We have a tendency to inflate things in our life. In your first year especially, you'll think everything is a big deal. When you convince yourself that something is a big deal, you'll then convince yourself that it's hard when in reality, it actually as simple as the most overly-confident person will admit (they may be lying to themselves, but it's truly not as difficult and as big of a deal as it seems in the moment). This is a natural response to encountering so many new things at once. You'll likely also hear:

"Wow, you're becoming a doctor? Med school must be so difficult"

"Biology is so difficult I don't know how you do it."

"You didn't start studying yet? You have a lot to catch up on"

"You all are in a very competitive institution. Keep that in mind. You are the creme de la creme"

The last one is my favorite from all the ones I heard. I heard it on my 2nd day of medical school. Hearing these things can give you a greater sense of self-importance and convince you that what you're going through is more difficult than it actually is, and you will end up sabotaging yourself.

I like the way Ali Abdaal says it about his experience at Cambridge: 'Ask yourself: How hard should this be? How hard can it be?' and in the words of Tim Ferris: Ask yourself: 'What would this look like if it were easy?'

A great misconception is that in medical school you have no time for anything else. Besides rotations, lecture hours, and attendance requirements in your institution, you are in complete control of your time. Divide your time actively. Somethings I wish I practiced in my first year that I know for a fact would have helped me are:

1. Write down 10 priorities from most to least important. Yes, write them down. Seeing them will help you.

2. Learn to say no to what you know is not a priority.

3. Set aside a certain time (i.e. 4:00pm to 5:30 for Gym) for activities you like. This will allow you to set a scheduled study time in which you will feel more productive, and allow you to destress by doing something you like without the guilt of 'oh I didn't study'. (I'm fond of athletics but did not allow myself to feel that way in 1st year because, back to point #10, I convinced myself medicine was harder and more time-consuming than it is (a majority of people do) and mentally beat myself)

4. Realizing that you know more than you think

5. Focusing on practice questions rather than rereading material to save me time in studying

Keep what is special to you close to you.

They're just grades. Your scores are not everything. Your scores and grades alone are not what will land you in the residency of your choice, or the career position of your choice. They may play a role depending on where you choose to apply and prioritize, but will not be the deciding factor of your success as a physician or anything for that matter. Many people will try to convince you that you are not doing enough. That's their own projection of what they think they should be achieving for themselves in order to do well. I will talk more about this when I am actually in a position to talk about this first hand when in pursuit of a job. How many opportunities are presented to you is not always in your immediate control. How you perform on your third-year preclinical university exams will not determine how well you will do in your board exams nor will it be given a second thought by many employers. Tying back to points #8 and #10, keep in mind that your progress is different from others' progress. There is no one right way to go about this.

Becoming an attending at a big institution and university hospital always seems to be the be-all and end-all outcome when you enter medical school. This can't be farther from the truth. Either you end up working with a huge name in a top hospital, or you're mediocre.

What's wrong with mediocrity anyway?

Actually what I want to ask is: why is what you consider mediocre, mediocre in your eyes?

Do NOT let it get to your head. You're on a completely different path. This thinking usually stems from one or more of the following (these are my observations, feel free disagree and/or share yours with me):

1. You're not happy with your major

2. You lack confidence/are insecure in your ability to get to where you want to.

3. You've been comparing yourself subconsciously to those people from before.

Who said they will have a career they love and you won't? What ensures that they will be wealthier than you? Why do you care so much about their life in comparison to yours? Keep your head up and keep looking forward. It does not matter at all. AT ALL.

Lateral thinking is a term that was first coined by Edward de Bono in 1967. Yes, science is very logical. However, you are not only going to be dealing with science as a doctor. You are dealing with many difficult and brand-new situations. You will be dealing with many different types of people. Sometimes, the logical approach (vertical approach) may not be the best one, and a non-traditional approach may benefit you or other people more (lateral approach). When you take suggestions, think about new ways in which to get things done when it comes to studying, in extracurricular team meetings, and when something goes wrong.

Your classmates are your resources, and you are theirs. They are not your competition, and you are not theirs. When you realize this, you will realize how much better you feel in academics, and how much stronger of a student you will become. You will also realize how pleasurable it is to work with different personalities and allow yourself to learn invaluable things. It is highly likely that none of you will even be competing for the exact same opportunities post-grad. You are all working towards the same thing, and it's not an easy journey. Make this a good experience for yourself and others, and help each other out. What good will a false sense of competition give you? As cliche as this may sound, compete with yourself only.

This is not meant to be the same as point #13. This is to do with you comparing yourself to your classmates/peers/colleagues:

1. They are getting excellent scores and you are not meeting your own standards.

2. They have more leadership positions than you and you start to beat yourself up and therefore sabotage your own progress.

3. They have access to more resources and therefore will be better than you, in your eyes.

4. They seem to be really good at balancing a social life with medical school, and you seem to be struggling.

5. They're so talented outside of medicine and you feel you have nothing else to offer.

None of the above is ever true, by the way. You have absolutely everything you NEED to succeed. You don't necessarily have everything you want. Just open your eyes.

Choose to focus on your strengths over your weaknesses, and choose to see your weaknesses as areas you're excited to improve on.

I really don't think I can elaborate greatly on this point. It's something you will come to learn on your own. Everyone's observations are very different, and their perceptions of people are very subjective. Me sharing mine will only fit into this description, so all I will say is: Wait and see what I mean, but don't forget that everyone has their own experiences that shape their judgment.

I think it's safe to say that the pandemic has shown us a great example of this. More times than desirable, patients forgo doctors' advice and act on what they think is the best decision for their health. This is incredibly frustrating to see, to say the least. You will encounter heaps of people with this mentality and more than you would like in your own family. As much as empathy may be genetically determined, it is also a learned behavior, along with compassion and effective communication.

Some are in it for their families, others for the science, and others for the money. It doesn't matter. You're here, they're here, you're all deserving of the opportunities that are equally presented to you. It is natural to think you are more deserving of certain opportunities over others in the same position as you, but avoid doing this for the sake of your mental health and practice humility. It's so much easier said than done. However, this leads me to my next point where you may feel that:

Financial struggles

Exams

Lost Opportunities

Scores

Losing people you care deeply for

Having to do other people's part.

Having to prioritize what you feel is not your responsibility.

Becoming the collateral damage of someone else's careless actions.

These are to name a few. You're not alone, and you may feel that you don't deserve any of this. You don't, but stop focusing on these aspects. It is what it is. Focus on what's in your control and make that the best of what it can be, and try your best to let go of everything else. Take everything in stride and as an opportunity for growth. You are not a victim. The last thing you want to do is believe you are one. Don't ruin your own life by thinking that. Recognize that it's not the situation you want to be in, cry, complain about it, then move on or create a different game plan. There's no one single way any of this is meant to go.

And I don't mean this in a derogatory or degrading way. Your wants, needs, and health are important. Your progress towards your goals is important. I mean point #21 in different aspects:

1. Medical School: You are one of hundreds of thousands of medical students globally all working towards the same goals. They all want to realize their dreams the way you do. Do not let your position at any point get to your head and do not think you have the most important task in the world (look back at point #10). When you do that, you only create room for anxiety and stress.

2. Generally: You want to do something but think you will be judged for it. I promise you, no one cares as much as you think. Everyone is concerned about themselves, you should just be concerned about yourself as well. If they have time to care about your life negatively or judge you, they're too bored or insecure about certain aspects of their own life. It's not personal. Moreover, more people are friendlier and more helpful than you first anticipate.

Whatever happens throughout, I urge you to ask yourself the following questions especially when things feel difficult:

Have faith in yourself, remember to hold yourself accountable, and keep an open mind. This is a reminder to myself as well. You are far more capable of doing what you think you can't do than you think.