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Why You’re Struggling in Med School

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15 Reasons Med School is So Brutal

Med School is hard. There’s no way to sugarcoat it. You’re responsible for retaining a huge amount of information at a breakneck speed. And there’s a chance the way you’ve studied your whole life is not getting you as far as it used to. Because no one teaches smart students the best ways to study. That’s why we created the STATMed Study Skills Class. During this 10-day class, we help you learn study methods, time management, and how to handle everything med school throws at you. 

Check out the video below to understand what makes med school so hard and uncover proven study strategies for med students. 

If any of this sounds familiar, we can help. Contact us to learn more!

Transcript

Ryan Orwig: 15 reasons why med school can be so hard for some of us.

Getting through the first few years of med school can be an absolutely brutal experience. This is true for a certain subset of med students. But they’re usually hidden and feel like they’re all alone. They’re suffering in silence and certainly not posting about their struggles on social media or wearing a tee-shirt saying, “hey I was valedictorian in high school and now I’m getting wiped out by med school.” They don’t know what’s happening or how to fix it.

So today we’re gonna talk about 15 of the main reasons that I’ve collected over the years explaining why med school can be so hard for some students. Solutions can come later.

First, we need to understand the problem with study-related issues before we can fix the problem. Number one is simply that med school is not built right. Let’s call it what it is. It’s cumbersome, it’s brutal, it’s inhumane. The fact that everyone agrees that it is like drinking out of a fire hose is insane. So if you feel like you’re drowning, that makes sense.

We can’t fix the system. So at STATMed, we believe we have to start with methodology. With equipping students with the tools to manage the main problem with med school design. Which leads us to problem number two: there’s so much, so fast coming at you all the time, and you’re required to know all of it. We call this the speed, volume, density equation. So then it becomes a matter of how best to receive, organize, code, and retrieve all of this information.

And that leads us to problem number three. And that’s the simple fact that no one teaches smart students how to study. Study methodology matters more for some students than others. But the majority of my students were academic superstars before they ran into the wall that is med school or boards. Nothing’s a problem until it’s a problem though. And no one is intervening and teaching robust skills to our highly intelligent, highly motivated students. This is a cultural problem. So what happens when our smart students get to med school? They rely on old low-yield study methods. And if these work, then this lecture doesn’t apply to you. But a lot of our students will relate to this. Old methods that just aren’t good enough, include rereading, recopying, reviewing. Underlining/highlighting as they read, maybe watching and re-watching videos passively. It’s logical to think, well, these things worked in the past, so I just need to do more of them. It’s logical. But for a lot of our students, we need to replace these low-yield methods with high-yield methods. So I sort of equate this to a lifeboat. So let’s say we have a lifeboat and the life boat holds three people. And if we put three people on the boat, they’re going to be fine. The boat represents yourself, your study skills, every skill has a threshold and a capacity. Now what happens if we overload that capacity? Well, let’s say we put two more people in the life boat. Now we’re saving more people. But unfortunately now the capacity of the lifeboat has been surpassed — sorry this gets really morbid, really fast — the lifeboat sinks. You’ve overloaded the capacity of the lifeboat. Now the skill has lost its validity. This is where we see problems arise with certain med students. They’re taking old skills and then they’re overloading those skills because they worked in the past. And then they’re capsizing; they’re sinking. The threshold has been surpassed. And then they don’t know where to go from there.

Number five: what works for one student won’t necessarily work for another student. It’s logical to look at what someone else is doing and say, I want to do that too. Especially if that student seems like they are about as smart as you, and maybe they’re doing it in a way where they have a lot more free time, or it doesn’t seem like they’re struggling. But not all students are built the same. Different students need different skills. I think it’s just important that we sort of embrace this and understand this.

Number six: cramming. One of the main skills that gets overloaded. One of those lifeboats skills that gets overloaded really quickly is this idea of cramming. So a lot of struggling med students will come to me and sort of guiltily confess like, “I gotta be honest, in undergrad I crammed. I was a crammer. I studied really hard for one or two days before the test then really took it easy for the next two weeks, had a great life, had all kinds of fun, but then the other tests would come and I’d cram. I graduated with a 3.9, I’m sorry.” It’s like, don’t apologize. The system allowed for that to happen. This is a methodology, a philosophy that many people embrace and they succeed with it. It’s fine, so you ask a med student, “Well, why aren’t you doing it now?” And they’ll just look at you with like hollow eyes and say, “Are you crazy? There’s no way.” Why? Because of the speed volume density equation. There’s just too much information. You’re accountable for all of it. So the boat will sink when you try to rely on cramming. So we need to learn better methods to study deliberately and effectively and efficiently every day across the spectrum.

Number seven is sort of the opposite of this. So maybe somebody wasn’t a crammer before. Maybe instead, they spent way more time than their peers to get great grades. And you ask them, “Why don’t you do this anymore in med school?” And they look at you horrified and they say, “Are you crazy? There is no extra time. I can’t spend more time than my peers because all of our time is accounted for.” And they’re right. This again, speaks to a need for methods that are more effective and efficient.

But I think another huge issue students face is finding the right intervention at the right time. So let me illustrate that here, using a somewhat elaborate metaphor. So just humor me. So we have our med student, his boat represents his study methods, if the methods are good, they keep them afloat. The river here, pushing them along, represents being enrolled in classes. This is a critical real-world variable that has to be factored in. The river never stops just like the pressure of being in med school never lets up. So in scenario one, there are no leaks in his boat. He just keeps going down the river. Good for him. This accounts for a large percent of med students. I’m not talking to those folks now. In scenario two, the boat here, it springs a few leaks. This definitely happens to a lot of med students, but these leaks can be fixed midstream still in the river, still in classes, maybe you fix the leak yourself. Maybe you figure out how to stop within the confines of the speed, volume, density equation. Maybe you find the right resource, the right tip, the right advice. Maybe your school’s learning specialist can give you the right tools to plug the hole in your boat. If that’s the case, this is great, and you keep on going down the river.

But in scenario three, sometimes the boat has too many leaks. You can’t fix mid-stream, even with the help of others. And when this happens, the boat sinks. And then we have scenario four. Yes you have a lot of leaks. There are too many leaks to fix mid-stream, but instead of sinking, we pull the boat out of the river and fix it on dry land. Meaning we rebuild the whole process while not enrolled in classes. So this is what happens between semesters or on a leave or something like that. At STATMed, this is how we intervene. We rebuild the boat, the study skills, on dry land in the STATMed class. And then when you’re back in the water, you are good to go for the rest of your career.

Another reason med school can be so hard is an over reliance on outside variables. These might include finding the right study group or study partner. World-class professor, great curriculum. If you have these and they work, great. But ultimately we have to have the tools to succeed autonomously.

Number 10 is the trap of familiarity. Old study methods reinforce familiarity, which in other academic arenas might be exactly what is needed, but at this level, how does robust familiarity treat you on test day? I’ll tell you how. It’s just enough to frustrate, just enough to narrow down to two or three options and say, “I know it’s one of these, but I don’t know which one.” We have to get out of the habit of reviewing, which entrenches familiarity, and instead engage in retrieval practice.

Another big pitfall is the illusion of productivity, which includes things like rearranging your notes, converting PowerPoint to Word, searching for the best review videos, maybe watching videos or passively rereading your notes. They all give the illusion of productivity, but they’re not. It’s like planning to work out, but not actually doing the workout.

Number 12 is the challenge of lecture. Some students feel crushed by the lecture experience. A common extreme description would be: I go to a lecture all morning or all day. I try to hang on in each one, but eventually I get lost and distracted. Then by the time I’m done with lecture, I’m exhausted, I’m frustrated and I feel like I’m starting from scratch. For others it might be less extreme, but inefficient nonetheless. Why can some people sit there and absorb so much information in lecture and really be ahead, whereas others are sitting there and they actually come out behind? My theory on this is that there are two types of learners. So we have the dual-track and the single-track brain. So with the dual-track, they’re rolling with two tracks that run at the same time. The first track subconsciously builds the framework to decipher and house incoming information. So it’s building the architecture, that’ll hold the information, the organizational hierarchy. Whereas the second track starts placing the details in their proper place within the framework as learning happens. These people benefit from lecture. They benefit from bottom up learning like Anki decks. The single track learner however, only has one track and they have to choose. Are they going to build the organizational hierarchy or are they gonna deal with detail as well? After the first test, they’re gonna worry about details. And that’s the wrong approach.

So think about it like a closet. A single track brain basically has no shelving units and they’re just sitting in lecture or going through decks of flashcards or Anki. And they’re just jamming everything haphazardly into the closet and then trying to sort it out later. Whereas the dual tracker, this person with two tracks, they’re going to simultaneously build the framework, the shelving unit and the labels that go on the shelves on the one track and at the same time, they’re going to be going through and putting the details in where they belong during lecture, during reading, building out through Anki decks, whatever it might be. So this is sort of how that dual tracker works. And you can see the brutal distinction here between the single tracker brain and the dual tracker brain. For the single tracker, they’re just jamming it there and hoping they can find it later. That is not good for long-term memory. It’s not good for retrieval. It’s not good for application. Even if it’s in the closet, if you can’t find it, what good is it? And obviously it’s inefficient. So how does that translate into a lecture-based learning experience? Well, the single tracker will sit there at lecture, and as the information is being disseminated, it’s all just a flush line of bullet points. They can’t see what the main topics are and the subtopics. They might not be able to see the distinctions between it. They’re just coming out with this flush list of random terms and not building organizational hierarchical relationships. And that makes it a lot harder.

Whereas the duel tracker can sit there at lecture, and as she is streaming and receiving the information, she’s building out a hierarchal understanding along with putting the details where they belong. So the intervention here is to learn a strategy where a single tracker can emulate a dual tracker. This is a complex skill. I can’t disseminate that in a 20-minute video. It takes a few days, and that’s sort of one of the core skills we teach in our stat class.

So another issue is the idea of tips and one-size-fits-all advice. This includes things like preview or pre-read before lecture or before reading. I’ve never seen this taught in an effective way. If you can do something to extract framework, great. Anything else is probably a waste of time. Concept maps, this falls under the category of recopying notes in a fancy way. That’s going to facilitate review instead of retrieval practice. Again, if any of these things work for you, that’s great. But I’m talking to the people where these things are not working. Anki decks again are one of the most popular things we hear about in med school today. It’s great for the bottom-up dual track learner. Usually terrible if you are a single tracker and you need to learn from the big picture inward.

Making a schedule. A lot of people will sort of use that as a way to passive aggressively accuse you of not working hard enough. A lot of people make a schedule, then fall off the schedule, and then they’re like, well, I’m a bad person. They don’t make a schedule for a week. Then they make another one. It’s not a way to optimize yourself. I think time management is a critical piece of success in med school, but just making a schedule, usually isn’t enough.

Get a tutor, if a tutor works, that’s great. But a lot of my students will tell me I don’t need a tutor because it’s not that any single concept is that hard. The problem is managing the speed, volume, density equation. The idea of finding the right resource, the right video series, the right skill — very difficult while you’re midstream. Methodology does matter, resources can matter of course, but if we’re spending that time, chasing that instead of actually building knowledge, then we are in that illusion of productivity. And just don’t feel like what works for others should work for you. I think that’s a myth that needs to be shattered.

So number 14 is dealing with this idea of time management and workflow issues. And time management can come from the very top, just broad management of your time within a theme or a block. It can come down to your weekly schedule. It can come down to when you’re studying. Are you starting on time? What’s happening during study? Maybe like time management big picture is not a problem, but the issue is more about getting more bang for your buck, every time you sit down to study. That ties into study methodology. It’s hard to really address time, for me, without redesigning study methodology on the other end. But this other piece that people don’t talk about enough and think about enough is the absolute importance of workflow generation. The ability for the student to generate work flow to externally and explicitly track what has been done and what’s not been done. How to break large tasks into smaller tasks. How to skip things that are less urgent, less important. Workflow is a key skill. But again, that ties into time management and study skills. So if you’re just sitting down and putting your head down and ploughing through, that could be where the problem is.

And that brings us to number 15: test-taking problems. But we need to define this. A bad test day outcome does not mean necessarily that it’s a test-taking issue from my point of view. Just because you studied a lot and did poorly on a med school exam, a board exam, an NBME, it doesn’t mean it’s a test-taking issue. If the problem is you can’t recall the information, then this is a test-prep issue, a study-based issue. And that ties into everything we’ve talked about so far. But if it is translational issue where you’re not taking the stuff you know, and you’re not plugging into the design of the question properly, and you’re making misreads misinterpretations, you’re twisting clues, you’re rounding clues down, you’re narrowing down to two and liking A, and talking yourself out of A and going to B, and you know less about B. These are test-taking issues. We can absolutely predict the types of issues bad test takers make and therefore fix them. But it’s important, especially in the first two years of med school, that we understand the sort of difference between a study-based issue and a test-based issue.

So in conclusion, not all med students are the same and thus should not be treated the same. A certain subset will struggle based on predictable patterns. Therefore, we can build and teach strategies to offset these issues. And you can, of course, build your own solutions based off of these problems. We have to understand problems first before we can solve them. You can explore our website and our YouTube channel, where we talk about some of these solutions in varying depth, or you can take our STATMed class, where we pull your boat to the side of the river and completely rebuild your study system. Feel free to contact us to chat so we can hear your story, answer your questions and see if STATMed can help. Thanks for watching.