What to Expect in your First Year of Medical School (in Canada)
When I started medical school, I barely knew anyone in medicine. I was connected with two student mentors a year ahead of me and a friend in pharmacy had given me the number of one of his friends in medicine. However, I did not know any of these people very well and did not know enough about medical school to even ask all the necessary questions to feel prepared for the start of medical school. Once I started, it felt like everyone knew someone, either a family member or a close friend, who told them everything about what to expect for each year of the program. I always felt like I was hearing information third hand from other students and still felt blind-sided by a lot of things in my first year. Therefore, the purpose of this post to highlight some important things you should know about first year medical school. I attend school in Saskatchewan so some of this information might not be particularly applicable if you are attending a different school, however, I believe the basic structure of each year is the same within Canada.
Your First Week: This week can be incredibly overwhelming. Try not to get stressed out by all the information they give you at orientation (also orientation lasts 2-3 days and is sometimes boring, sometimes exciting, and sometimes stressful. They provide lunch on some of the days and you get some nice medical school swag such as backpacks, water bottles, stickers, etc.). You will meet a lot of people with interesting personalities in your first week and you may not mesh well with everyone. Some people will brag about their achievements a lot or tell you about this and that family member of theirs who is a well-renowned physician. Just take things braggy people say with a grain of salt. Everyone struggles in medical school whether or not they let on to this fact. Some people are just more honest with their struggles.
Another part of your first week is all the welcome activities that are organized by the second year medical students. As a rather introverted and socially timid person, I did not enjoy having to attend an event every single night of the week. However, I think it was an important experience to bond with the other students. I found out later on in the semester that medical school is incredibly cliquey. It was almost like being in high school again. Find a group within your first few days and try to stick with it. Be nice and friendly to absolutely everyone, but it feels very lonely if you didn’t find a solidified group within your first few days (or weeks) at medical school. There are several reasons why you should find a group: 1) you will need to form academic groups for the anatomy lab anyway and you don’t want to be running around last minute trying to awkwardly fit into other people’s groups 2) you help each other study, do assignments, and sometimes even work together as a group for quizzes 3) it is helpful to know other people who somehow magically know what will be on exams; or possibly they are just very good at guessing this. At the very least, having several friends to bounce ideas off of about what will be on the exams means you will have a better chance at hitting on the right topics. 4) You will have to practice clinical skills on each other. The main point you should take from that list is, you cannot survive medical school without other medical school friends.
The one event that you will feel forced into is the infamous Tuesday Night celebration. Your medical school likely has some variation on this night. All the second years will chant at you “FIRST RULE OF TUESDAY NIGHT IS WE NEVER TALK ABOUT TUESDAY NIGHT!”. Also, it really is nearly mandatory. Just go. I actually cried before going because I already felt so stressed out about the amount of stuff we already had to do in our first week and felt like I should be preparing for that instead of going to some sort of party. Also, I really don’t like loud crazy parties. It is just not something I enjoy. Don’t get me wrong, I love being social and will often host dinner parties and movie nights with my friends, but this felt a bit too crazy. Keep in mind, this was already my fifth year of university and I felt way past the frat party scene. One thing I really must emphasize is that Tuesday Night is a crazy wild party like nothing you have ever experienced (at least, nothing I had ever experienced). It is your initiation into medicine, so basically the second years dress you up in crazy embarrassing costumes including diapers and sparkly unibrows and send you out in big vans to various party locations (oh and they also write dentistry and “I love dent” on your back to preserve the good name of medical students…). You drink lots (either you or your friends will get messy drunk) and play lots of fun party games. We were given a challenge scavenger hunt where we had to complete certain tasks to gather points for the teams we were assigned to. Additionally, we were promised prizes for winning the scavenger hunt which never materialized… ahem (-insert shifty eyes expression here-). One poor medical student shaved both their eyebrows for this scavenger hunt- that’s dedication, man. Don’t do anything you don’t feel comfortable doing, but do relax and have fun. Once again, go to this! It is one of the few things you really shouldn’t miss when you start school. Having to go to class the next morning will suck though.
Student groups and extra-curricular responsibilities: you should pick a maximum of two extra-curricular responsibilities otherwise you will be way too busy. I applied right away to be the first year representative of the psychiatry student interest group and that was basically it (I was shooting to be president the following year though so I really wanted to be dedicated to this group). Some other people go after more prestigious roles with the medical student associations, but I was not overly interested in any of these positions. You have to be very organized to take on one of those positions as you are acting as a type of administrator/intermediary between the students and faculty. The busiest people are often the year reps because they have to advocate for all the students who have issues throughout the year. For example, I had to leave in the middle of a week to see my grandma who was hospitalized in a small town. I talked to my student reps quickly and they advocated to get me the week off to spend with my grandma.
Onto the academic aspects of first year: the first semester will be different than the other pre-clerkship semesters (you are considered pre-clerkship for your first two years and then for years 3 and 4 you are considered to be in your clerkship because in those years you are actually on the hospital wards for the majority of your days). In first semester you are loaded with a bunch of “basic” science knowledge and it doesn’t always transfer over directly to your other years. The information you will receive is often much more detailed than you will need once you start learning the medical sciences. You will take massive exams in first semester that are comprised of four subjects on one exam (PHEA- physiology, histology, embryology, and anatomy) and five subjects (MIP- Microbiology, immunology, pharmacy, genetics, and pathology) on the other. You’ll be assigned to a group of 5-6 students and given a cadaver to dissect. The things you should be prepared for during this lab: 1) you will need to burn (Exaggeration note: probably just throw them out) your designated lab clothes at the end of the semester because it will be so covered in blood and bodily fluids 2) you really, really, really need goggles and boxes of nitrile disposable gloves 3) you only need 2 or 3 (maximum) dissection kits 4) using a bone saw is really cool 5) the cadaver lab will smell really bad, but you will get used to it. 6) get an anatomy book that you are willing to use in the lab and then throwaway after (it too will get smeared in blood). 7) You may get grossed out and be turned off from eating meat for awhile. 8) your cadaver will mould and it will be gross 9) you will have to rotate in your group checking the cadaver daily for mould- which there is very little you can do to prevent anyway. During the first semester you will also learn a bunch of basic physical exam techniques that will be reiterated over and over again in the successive semesters.
Second semester is where you actually start learning “Medical School Stuff”. You will have your first taste of actual medical sciences. The usual order of subjects in first semester is Hematology, respirology, cardiology, and gastrointestinal. Basically what you learn for each subject, is the physiology of the system, a bit of histology, embryology, and pharmacology, and then a lot of pathologies, how to identify them, and how to treat them. It is very important to know what tests you need to run to identify pathologies and the subsequent treatments. This is largely what you will be tested on (also, this is the most practically useful information). There are usually 1 or 2 midterms for each module and a final exam. Each module runs 4-6 weeks, so you are writing exams almost weekly. You will also have assignments in some of your other courses. Clinical skills class will get harder in this semester and you will be expected to be able to form differentials, order tests, and suggest treatments in a bunch of hypothetical cases. Always be very prepared for your clinical sessions and try to find out in advance what the topics will be and make notes on it. Even if you have not formally learned the material in class, you will still be expected to know it for clinical skills cases. This means you need to look things up on your own and make notes to use in the session. Another aspect of second semester is large group cases that you will have to complete with your classmates. Your peers sometimes mark the assignments you complete in these sessions. Sometimes you get nice classmates and sometimes you get people on a power trip who won’t mark your answer correct unless you used the exact wording the session head used when he/she read the answer out.
Exams are always hard, so you should be preparing as far in advance as possible. The students who do the best on exams are generally those that review their notes to some extent every night. Don’t stress too much about bad grades though. You will still likely be an excellent doctor even if you just get that passing grade of a 70 (which in my opinion is still a decent grade because some of those exams will be incredibly hard).
You will have several options for what to do during your summer. Try to get some sort of research experience before the end of medical school but it doesn’t have to be in the form of a Dean’s Project. Whatever it is though, try for a publication. Some people really enjoyed the Making the Links Program which involves travelling to a northern community for a few weeks during the summer of your first year and then travelling out of country the following year. Try to do something with your summers as your extra-curricular activities are more important when it comes to applying for residencies. However, still make sure you are taking a break and relaxing. Research can be stressful, but also rewarding.
My three departing messages are: 1) stay calm and don’t sweat it if you fail an exam or two 2) continually remember why you want to be a doctor as this will keep you motivated 3) work hard but also take time for yourself to do fun things without guilt.