What Medical Students Do in Preclinical Years

I am sweating and my stomach cramped, my feet is cold and I could feel my head spinning. Then I sit on the same chair I’ve been sitting on for the last several years, looking around me and taking a deep breath. I see my friends, my closest friends in medical school who have been through the hills and valleys with me in the last three and a half years. Fourteen of us are scattered in the right side of the room, mumbling sentences only medical professionals will understand. Our pulse are definitely tachycardia and our breath tachypnea, our face mimics people with a lots of concern and fear, a face we had at least once for every six months.

We are having our OSCE exam (Objective Structured Clinical Examination), a final exam for all of the medical skills we learned in the last six months. We practice almost one hundred skills in our years of medical school, some of them are simple (such as physical examination, measuring blood pressure, cranial nerves examination, etc.) but most of the skills we will have to perform in our final OSCE is rather complex.

Think of installing a catheter in patient with difficulty to pee, first we have to do ask permission and answer patient’s questions regarding the procedure, examine the genitalia to make sure everything is normal and catheter could be inserted (5 minutes). Then we differentiate the tools that are sterile and could be touched only using sterile gloves (2 minutes). Once we touch the wrong tools, we have to change the gloves and change the tools as well to avoid infection on the patient (extra 1 minutes if you are fast in changing sterile gloves, we have another procedure in using the gloves). We give lubricant to the catheter and insert it to the patient’s genitalia, slowly and we inflate the balloon (1 minutes if the patient is cooperating). When its over we educate the patients to not pull the catheter and notified the doctor if they feel something is wrong (I’m not sure if I have time for this). Imagine doing all that in ten minutes, perfectly.

In OSCE, you have to at least attain 80% of the checklist points in all stations to pass the exam. But there’s a catch, once you do a sterile procedure in an unsterile way, you failed all the other station as well. Failing OSCE cost you $40 and six months to have remedial, if you fail in the last semester OSCE, that means you are wasting 3 months in home (because you can’t continue to the clinical phase). Usually 80% of medical students pass semi-annual OSCE in my university, most of us trained in the provided class and repeat the procedure several times until we are fluent. One week before the exam, my friends and I will study together in group and train using simple tools (because we can’t bring the mannequin and equipment outside the university). In OSCE it doesn’t matter how smart you are, even students with 3.5 GPA could fail. What matters is your hands skill in doing the procedure, the capability to memorise procedure correctly, and having a good attitude towards the patients and doctor in charge.

That was OSCE, an examination we have every six months, so the stress usually only come one or two weeks before the exam. We have another annual exam called SOCA (Student Oral Case Analysis) where we are presented with a case and we have to explain what the case is about, why the patient is having signs and symptoms like that, and how it correlates. For example if the patient is having a fever, we have to explain that bacteria caught inside our bloodstream by macrophage and initiate the excretion of inflammatory molecules such as TNF alpha, IL-1, IL-6. That was one symptoms pathophysiology, usually there is four to six symptoms in one case. Then we analyse what diagnostic procedure we want to do, X-Ray, CT-scan, MRI, lumbar puncture, serology testing, etc. What are we expecting the results will be and the conclusion. Once we have the diagnosis, the doctor usually asked us what is the proper treatment. Give him drugs? Drugs for which symptoms? An antipyretic for the fever, but which is better between Paracetamol and Ibuprofen? And perhaps antibiotic for the bacteria that causes the disease, floroquinolones or macrolides? What will the interaction between the drugs given, will it be dangerous for the patients? Hundreds of disease learned means we will screw up and confused between the diagnosis, but few doctors are kind and understand our frustration.

To me and some friends, OSCE and SOCA are the hardest challenge in medical school, a frustrating and exhausting exam that needs extra-ordinary preparation. Of course we have harder exam, which called OSCA (a combination of both OSCE and SOCA), but I believe no words can explain the frustration we had in the preparation and you won’t understand it either (no offence). Having funny-collaborative friends is the only things that makes medical school bearable. Without supports from my friends when times are tough, I doubt I will be here to share with you this post.

When I got in medical school in July 2011, I was grouped with eleven other students. There were lots of tasks and we have to stay over midnight, even not sleeping to finish our duty the next day. We were strangers back then, but we manage to get it through together. Our senior’s in the orientation still stick with us today, we have dinner together every six months, and we ask for his guidance whenever we are lost. Our group expands to fourteen people in the next three months and it stays that way. We sit together every Monday to Friday, sometimes Saturday as well for the last 3.5 years. Our class changes, but we always sit together, 14 of us in the same position. We talked a lot even during lectures (oops) and teachers are aware of it, but we are too idiotic to change and we got shouted at few times in the past.

As our routine, we have class, Problem Based Learning (PBL), Skills Lab, laboratory, and discussion. We have 7 cycles each year, each cycle takes 5-6 weeks. We have mid-cycle exam in the third week and end-test in the fifth or sixth week. For the smart students, preparation for each test took at least four days and for people like me, the average (but slightly above average ) it took a week. That means 1.5 weeks stress-free, one week stressed, 1.5 weeks stress-free, one week stressed. And the cycle repeated until holiday come. Before holiday we have OSCE (usually one week after the last cycle ends), and OSCA every June (one week after OSCE or two weeks after the last cycle ends).

The material in medical school gets interesting with time, first you will study biochemistry, physic, genetic, and other abstract details. As you progressed to higher level, you learn physiology or how your body works. For example, you learn how food and water are ingested, absorbed, and excreted inside your bodies in a wonderful details. Then you learn about disease, how it affect your normal body and how drugs could help stabilise your body to the normal state. I remember being stressed as hell in my first six months of medical school, I ate less, sleep less, and study more which made me depressed even more.  I think I was in the wrong place and imagine how easy my life would be if I choose to learn business instead, but I wasn’t alone because half of my friends felt the same. We rationalise our choice, talking to each other about our concern and decided to walk the path together.

Anatomy class gets the most attention for first year medical school, we get to touch cadaver (mutilated bodies) and dissect it into parts. We learn the names of muscle (hundreds of them), nerves, artery, veins, bones, and other body parts. After anatomy we also learn histology, the small parts of our bodies that could be seen only with microscope (think of eye, ears, skin, etc.).

There are 24 cycles in my university, they are:
– First semester: Learning skills, Biomedical Science 1, Biomedical Science 2
– Second semester: Biomedical Science 3, Life Cycle, Humaniora, Public Health
– Third semester: Allergy and Immunology, Infection, Research Method
– Fourth semester: Neoplasma, Haematology, Respiration, Cardiovascular
– Fifth semester: Gastrointestinal, Neuromuculoskeletal, Psychiatry
– Sixth semester: Urogenital, Reproduction, Endocrine, Sensing Organs
– Seventh semester: Medico-legal, Entrepreneurship in medicine, Emergency medicine

Apart from having to study for the cycle’s exam, OSCE, SOCA, we also have to make a research paper as a terms to graduate. This is the job many students didn’t like and suffer, some of them delay their research to the last year and still unable to finish it. It took generally 9 months to a year to start and finish the research, lots of my friend started late and have to be late in entering clinical phase. I pass the pre-clinical years with GPA 3.36 and am satisfied with it, my early target is 3.30. One thing I have to be proud of is the fact that I never had any remedial in any cycle, a request my mother made to me when I enter medical school. My mother told me she doesn’t ask for high grade, but to always pass the exam without having to take a remedial and I did just that. To me, remedial is a waste as well. If you could pass an exam the first time by studying harder and longer, why do you have to study twice with twice the frustration?

Last week I did my final exam I told you earlier in this post called OSCA, a comprehensive exam of knowledge and clinical skills about all diseases we have learned so far. Medical school is separated into two phase, pre-clinical years and clinical years. Passing OSCA means I and my friends could enter the next phase (clinical years) where we will learn cases in real life settings inside hospital. From two hundreds medical students, one hundred and twenty are able to continue our learning in higher settings. The rest of course would join us soon as they finish their research or pass their previously failed OSCE or OSCA. Keep the good work fellas!

I wouldn’t lie, medical school is hard. If you are thinking about getting in medical school, don’t think how you will pass all of this. Think about why…. Think about all the people you will someday help, but also think of how your incompetencies could cost someone life’s. Then you will study hard and study with determination.

Here’s some tips from my experience in pre-clinical years:
– Read self improvement books and increase your self esteem, it will help you to deal with the challenges ahead.
– Make a plan of where you vision yourself to be in the next 5, 10, 15 years and make a time-table according your target.
– Help your friends when they need it (not when they want it). Making a wide connection is important, but having a deep connection is more important.
– Review the lecture you had everyday for at least 30 minutes.
– Study before you have to, it will decrease the amount to stress you encountered.
– Know your reason getting in medical school, “why” will always be stronger than “how”
– Having fun in the process of studying instead of wishing for good results.
– Having one good friend is better than one good score
– Don’t kill yourself

If you have any concern, question, or anything to share about medical school I would be glad to answer!

DP

DP

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About agent909

Kevin Yulianto is a private trader and equity portfolio manager with over 4 years of experience. He was born in Jakarta at July 18th 1994, graduated with Bachelor of Medicine Degree from Atma Jaya Catholic University of Indonesia in 2015 and is expected to receive Master of Management Degree from Binus Business School in 2017. Currently he is pursuing his professional certification in the CFA and FRM program, in which he passed level 1 for both program in 2016. Kevin is an avid traveler and photographer, with a record of 32 countries visited in 2016. He is a freelance contributor at Getty Image and is running two website in his spare time, journeyman.live and idxstockwatch.wordpress.com.
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9 Responses to What Medical Students Do in Preclinical Years

  1. A nice insider’s view of medical school. Sounds a little like nursing school, only much more in depth and longer!

    • agent909 says:

      Yes, it is. I’ve been studying with nurses as well lately, they focus more on the skills like inserting catheter, IV line, and general assessment while we learn more about the disease and diagnostic procedure. Thank you for reading!

  2. Pingback: Too Early to Rise | Keyboard Pizza

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  4. Another nice tip to survive: have a blog 😉 It helps a lot with expressing yourself and exploring other fields!

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  6. what a wonderful insight into medical school, also well written, and articulated. I wish you the best of luck with all of your studies! Blessings!

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