Geoffrey Talmon, BS, MD


October 30, 2006


In the early years of medical school, I was motivated to learn more and more about medicine, and I can say that I have a passion for medicine. After a few years, however, I started to feel discouraged, and there are signs that I'm losing interest. Part of the problem is that I've discovered that I can't remember much from what I studied earlier, and I have not been doing well on exams. What can I do now?

Response From the Expert

Geoffrey Talmon, BS, MD 
Chief Resident, Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska



The problem that you describe is actually not that uncommon. In fact, I went through a very similar "crisis of faith" during the latter part of my medical education. It is an issue that many of my colleagues had, and one that I still see in medical students rotating through our service. So take heart, you are most definitely not alone.

First of all, it is important to remember how medical school is organized. Medicine is one of the few professions that has such a large dichotomy between different levels of training. The first 2 years are usually spent in an environment very similar to college (attending lectures, studying for tests, and taking examinations). You quickly learn to memorize and digest huge amounts of information, flowcharts, criteria, etc.

In July of your third year, the game changes. Rather than being asked to name a disease entity and regurgitate a wealth of related facts, now you are required to start from the end with the clinical presentation or lab abnormality and work to the diagnosis. This paradigm shift takes a great deal of mental adjustment. Further, the strong didactic environment to which you may have become acclimated is no longer present. Many rotations require self-study or clinical experience to glean the required knowledge for examinations. At the same time, the student is the low man on the totem pole, commonly relegated to "scut work" or standing in the back of a pack of white coats on rounds. This makes taking ownership of cases (with the attendant responsibility and practical experience) much more difficult.

The transition to this new learning scheme can be rough. It can be harder to retain information learned on rounds or in impromptu teaching sessions with attendings than it was to master information presented in organized lectures. This can translate to poor performance on exams and may leave students feeling inadequate and frustrated. I went through a similar period, as my third- and fourth-year grades were not as high as those in my first and second years. Although I loved the study of medicine, I wondered if this change meant that I did not have the tools to succeed as a physician.

It is very easy to get caught up in the mechanics of being a medical student and lose sight of the reason you are there to begin with. The fourth year is filled with many distractors (graduation, the USMLE [United States Medical Licensing Examination], residency applications), complicated by late nights on call, crabby residents, and less-than-understanding attendings. All of these things have a tendency to make enthusiasm wane.

My advice is this: First, keep in mind that what you are experiencing is not rare and in no way means that you do not have the ability to be a good doctor, or that you do not have the discipline to continue. Although you feel as though you are having a difficult time remembering facts, keep in mind that you will be exposed to the most important information multiple if not dozens of times. As a pathologist, I am in a field where the depth and breadth of required knowledge can be quite intimidating, but even in our training, this repetition occurs. I guarantee that you will come across and retain what you need. Next, remember that medical school is a finite period of time that serves 2 main purposes: to give you basic information to pass the boards, and to help you choose a specialty. If these things happen, you will have succeeded.

In my own experience, when I felt as if I was losing interest or enthusiasm, I thought back to why I applied to medical school in the first place and why I wanted to be a physician. I reread my medical school application personal statement and talked to family members who had helped foster my career choice. Often, these simple acts put my goals into sharper relief and reminded me of the "big picture." I also got a boost when I finally chose my specialty. I became reinvested in my remaining rotations, as it seemed that I had more of a focus and direction. Additionally, I was able to tailor my schedule to services that I felt were more applicable, and I found a faculty mentor who gave me advice and served as a sounding board for many of the issues that I have previously discussed.

In the end, don't lose hope. Remind yourself of why you began the journey. If you haven't done so yet, narrow down your choice of specialties and optimize your remaining schedule if possible. Faculty mentors can help you with these tasks and provide you with valuable counsel.


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