Letters to my fresher self
We asked six final year students to send a letter back in time
Dealing with stress
Emma Firth, foundation year 1 doctor, St James’s University Hospital, Leeds firstname.lastname@example.org
Congratulations, you’ve made it through A levels, UCAS, UKCAT, and medical school interviews! Unfortunately, unless you’re secretly superman/woman, undertaking a medical degree and a career in medicine may sometimes feel even more stressful than the application process itself. In my years at university I suffered much anxiety—some justified, some needless—juggling work, homesickness, relationships, money, and health. Initially I feared that feeling faint in surgery would be a big problem, and that I wouldn’t be able to cope with the sheer amount of information to be learnt. Friends of mine struggled with dissection, face to face evaluations, confidence with clinical skills, and encounters with disease and death. But having lived through the experience, what advice would I give to myself as a fresher now?
Keep a balanced approach
Being organised and putting work in early pays off and saves last minute hair pulling; however, don’t aim to work 24/7! Sleep and eat well, exercise, see friends, and relax, and you’ll be more productive overall. Losing sleep, not eating properly, and irritability are all signs of stress—look out for this in yourself and others. Avoid the temptations of alcohol, drugs, or other risk taking behaviours. I found joining medical societies and activities outside the bubble of medical school really valuable and a lifeline during stressful times.
Learn from others
It can be confusing and frustrating when you see classmates apparently breeze through life but you feel you’re struggling to keep up. My advice? Talk to your friends—often they’re finding it tough too. Alternatively they may have found better ways to manage their stress, which you could try out.
Nurture your self confidence
With work, try and focus on doing the best you can, and don’t get distracted by other people’s performances or claims. Medicine can be competitive, but remember you’ve all earned the right to be there. Garnishing your CV with presentations, publications, or prizes can be rewarding, but isn’t essential, and shouldn’t be at the expense of your health and wellbeing.
Know where to find help
Friends and family are often a good starting point, providing a shoulder to cry on or a listening ear. Personal tutors and counselling services are available though university. You can also talk to your GP or self refer to IAPT (increasing access to psychological therapies). The NHS Choices website provides practical tips on stress management, and MoodGym (https://moodgym.anu.edu.au/welcome/new/splash) offers free online exercises to help with anxiety or depression.
Over your next years at university, keep in mind these four nuggets of advice. Remember that thousands have gone through it before you and survived! Good luck and enjoy it; it’s an amazing part of your life!
Making the most of lectures
Emma Rourke, foundation year 1 doctor, Royal Surrey County Hospital email@example.com
It’s roughly 8 am and you have a full day of lectures ahead. Still in bed, you can hear the rain beating down on the window. Your non-medic housemates aren’t due into their lectures until at least 1 pm and may even find time to bake scones before you get home. You’re wishing you hadn’t stayed up until 4 am watching US reality TV shows . . .
Well, you’d better get out of bed—you can’t expect to get the most out of your lectures if you never turn up! Attending lectures provides opportunities to ask questions of expert lecturers directly, or of your colleagues, and it also ensures you don’t miss out on social invitations. Although there may be occasions when you don’t gain much from a lecture—whether you’re tired, unwell, or just sat next to someone who fancies a mid-lecture chat—on the whole they are a positive learning experience. Some universities provide a recap service, where you can watch recorded lectures again. This is useful to reinforce learning and a valuable fallback if you’ve missed something.
Find out what works for you
No matter how keen you are, there will always be lecturers who are less inspiring than others. Remember lectures are only part of the learning process, and there’s often a lot to be said for going to the library alone or with a group, to work through the subject at your own pace. Finding a group who you can work well with, who aren’t necessarily your closest friends, will benefit your learning and expand your social circle.
Whether or not to take notes is a personal choice. I scribble furiously as it’s how I learn best, but equally have friends who claim to have never written notes. Ultimately, we were all successful in exams. You need to find what works for you.
You’ll never know everything
The study skills required to succeed in medicine differ from those of A levels. Medical textbooks can run to thousands of pages, and it’s often argued that they’re out of date before they’re even published. You’ll find you’re encouraged to read journal articles to augment your learning. Don’t get too worried about needing to know absolutely everything, though. Exams exist to prove you’ll be a safe and competent junior doctor, not a professor of molecular pharmacology. Read for interest—you came into medicine knowing it offered, and even demanded of you, constant learning and development, but use lecture notes and course handbooks to inform the depth of knowledge expected for exams. Additionally, revision guides do exist, and can be very helpful for presenting essential knowledge concisely.
At times it can seem an insurmountable task, but you’ve got this far. Have confidence in your ability to learn, and don’t be afraid to ask for support from the university if you need it—that’s what they’re there for. Very best of luck.
Managing your workload
Emilie Green, foundation year 1 doctor, Whipps Cross University Hospital, North East Thames Foundation School firstname.lastname@example.org
Marathon, not a sprint
On my first day at medical school, a lecturer shared a nugget of information with my year group that has only recently made perfect sense: “Medicine is a marathon, not a sprint.”
During the first few years I could not see the light at the end of the tunnel but instead concentrated on immediate deadlines, such as end of year exams and ongoing coursework projects. I think this step by step approach is essential to some degree if you are to jump through all the hoops of medical school and maintain your sanity. Patience is definitely a virtue, and if you constantly focused on the end result you would feel as exhausted as if you had completed a whole marathon at sprint pace!
Study little and often
I would advocate a “little and often” approach to studying. Cramming is of course possible but is neither enjoyable nor useful for a career in medicine and lifelong learning. The sooner you establish a daily routine that involves a balance of work and play, the better, even if your textbook is open for half an hour a day.
Rather than waiting until a month before the exam to cram the basics, working steadily throughout the year will enable you to acquire a firm foundation of knowledge and also random jewels of information that set you apart from the rest of your year group. If you are keen on excelling in exams, particularly in terms of the ranking system that haunts many medical students, this is the way to study.
Look it up!
Most medical courses are likened to a spiral: there is considerable repetition of certain topics, and more detail is progressively added to your basic foundation of knowledge. If you see something that you are not familiar with, look it up. It will take five minutes at most and will be cemented in your mind the next time you come across it.
Everyone is different
Everyone has different study habits, so take the time to find your own method in all the madness; it will be invaluable in subsequent years.
Enjoy your free time and don’t worry!
Don’t feel guilty about sleeping or watching rubbish television for a few hours; you’ll be more productive after a good rest. Most importantly, don’t panic about becoming a doctor—by the end of medical school you will be chomping at the bit to start work. The course is so long for a reason!
Dealing with competition
Rhys Davies, final year medical student, Imperial College London email@example.com
Hello young fresher! You may not know me but I am your future self, aged with what I hope is wisdom. Before you dive enthusiastically into lectures on the Kreb’s cycle, I’d like to share with you some advice on a cornerstone of medical education: competition.
Ranking is not everything
It is a fact that medical students are inherently competitive, and with constant examination and assessment there is plenty of scope for healthy competition. You are all big fish of little secondary education ponds. In medical school, some will continue to excel while everyone else trails out behind them. Some people will try to convince you that academic deciles and UKFPO points are everything and that every other student is striving after every point. These statements are not true.
Your colleagues are not your enemies
There is more to medical school than simply competition. If John Donne had been a medical student he would have said that no man is an islet of Langerhans. The students around you are not your enemy. They are your future colleagues, first as students on the ward and then as junior doctors. You will need them and they will need you.
Problem based learning cases are fuelled by cooperation. Firms in hospital are a team effort. Revisions for practical exams such as the OSCEs depend on other students who will let you talk at and examine them at length. You will do best in these endeavours if you try to get along and support your peers.
There will be students who do not share this view. They may brag about how many hours they study or the lecture slides they have acquired from the lecturer that they keep to themselves. They may hoard the best textbooks or the cushiest spot in the library. They may not tell you about bedside teaching with the registrar. To them, you are their competition.
Do not let them worry you. Their learning style should not affect your learning. Doctors, who used to be medical students themselves, can recognise these students and often are not fond of them either. If you focus on working with students who can support you to learn together, you can ignore these “gunners.”
You may already have your heart set on a foundation job that requires 99 FPAS points. But no matter where you go after medical school, you will still be a doctor, working with your colleagues to care for the sick. Everything else is small print.
Richard Scott Pye, foundation year 1 doctor, Glasgow Royal Infirmary firstname.lastname@example.org
I’m graduating tomorrow. You’ve barely finished high school and 2013 doubtless feels a world away, but university goes by surprisingly quickly. It’s important to make the most of your time there, and I’m not referring to the academic side of things: it’s life outside of medical school that matters most. I’d like to offer some advice on this, your personal life, using the glorious power of hindsight. Knowing you as I know myself, you’ll put this in a drawer and forget all that’s written, but it’s worth a shot. Here goes!
Morning is the best part of the day; stop sleeping in until noon. You’ll meet friends in the strangest of places, so visit such places regularly. Be open to all new experiences, the opera included. You might not be sporty, but go to the gym every now and again. An overdraft is not free money. The checked shirt will make a huge comeback (who knew?); embrace this, although recognise when it’s over. Travel at every opportunity, but don’t attempt motor biking in Thailand (seriously). As Rihanna will sing, you’ll find love in a hopeless place: a dodgy nightclub on Great Western Road—not the romantic encounter you’d imagined, but those only happen in films. Call nana more often than twice yearly; it really makes her day. And learn to boil an egg; it’s not as hard as you think!
Don’t freak about getting a “B” grade; you’ll come to regard them highly. Read fiction whenever you can. Beware of self diagnosis; you’ll always discover a fatal illness. Remember that some people aren’t medical students or doctors; regaling an auntie with gruesome tales of human dissection is not a good idea. Even with fellow students, talk about something other than medical school—remember all those old hobbies? In a blind panic about the sparseness of your CV, don’t join the medical school’s Haematopathology Appreciation Society; join something you’re really interested in, and preferably unrelated to medicine.
That’s all for now. I’m hoping to hear from Richard (aged 30) about the next six years, but otherwise I’ll need to go it alone—perhaps that’s part of the fun? Give my love to 2007, and do get a haircut—you look scruffy.
The extracurricular side of medical school
Sidra Maqsood, foundation year 1 doctor, Lincoln County Hospital email@example.com
This morning I received an uninspiring email, coldly confirming my university graduation and thereby officially marking the unnerving but happy end to five years of medical school. Aided by this most apt of timing and the resultant overabundance of nostalgia, I write with the hope that this will be of use to you when you stand at the precipice of “fresherdom,” about to delve into the murky trove of medical education.
Don’t let medicine kill your imagination
I’ll start by recalling a blunt comment from a friend during a conversation about the variety of creative forays we indulged in before medical school: “Medicine killed my imagination.” The response was a collective, cool nod in solemn, passive agreement. While nodding along, I noted a sharp, shrill shiver of alarm that has stayed with me. The acceptance and frequent self venerating acknowledgment of the way that medicine seeps into every aspect of our lives is a truth held up by the majority of clinicians. The small minority who persevere with their creative interests and hobbies and maintain the practice of medicine to the same extent as any other job have lifestyles that are coveted or scorned, usually in equal measure.
It saddens me to think that the time and effort spent on carefully honing our skills in various extracurricular activities that then decorated our university applications so well become merely a fondly remembered anecdote once we start medical school. In reality, this is actually the ideal time to establish and perfect a healthy work-life balance, a delicate but precious concept that undoubtedly becomes more valuable as you progress through your career.
Develop transferrable skills
Ideally, indulge in an extracurricular pursuit that enables the development of important transferrable skills, such as manual dexterity and hand-eye coordination, while also providing a welcome reprieve from medicine. Additionally, I would recommend making the most of the location of your university. Bigger cities offer obvious attractions, but venture out of the usual inner city student haunts and explore the surrounding countryside. There are stunning scenes of nature all over the UK, just waiting to be plastered over your Facebook wall.
I wholeheartedly encourage the cultivation of a hobby alongside the demands of stressful academia and work. All things considered, after five years at medical school you will want to have absorbed, experienced, and achieved much more than just a degree.
Provenance and peer review: Commissioned; not externally peer reviewed.
Cite this as: Student BMJ 2013;21:f4532