For many of us, medical school is the first step in a distant dream. Much like any dream, there is a sense of naivety in our expectations, and a blank space of unawareness and unpreparedness that the creativity of our mind fills to generate a psychical experience worth noting. But when we wake to the stark reality that those conceived expectations are, in fact, unrealistic, this dream can become a nightmare. 

And so, as I stand on the precipice of my medical school journey, and stare onward into the seemingly endless abyss of a medical career, it is tempting to glance back at the comfortable mainland of medical school, and reminisce on the journey that led me here. I do so in the hope that you can fill these dreams with a sense of pragmatic expectation and find the beauty in what could otherwise be seen as a terrifying awakening of medical school. And so: Here. We. Go.

1.              The Top 10% Paradox.

As you gracefully glide over pre-medical application hurdles, you begin to separate away from the pack of people you once compared yourself to. You isolate yourself in a society of high achiever’s – the top 10%. And now, where you once felt beholden to, and rightfully dignified by, your achievements, it is easy to feel dwarfed by the might of your peers. Where you once sat upon your throne of intellectual prowess, you find yourself humbled by the stature of your cohort. All of this bestows a sense of insignificance, of non-achievement, the fear of failure; and as our diagnostic minds ruminate, we boil it down to the ultimate self-diagnosis: a mild to moderate case of Imposter Syndrome.

But do not fret my capable and deserving friends! You are here because you belong here; trust the process – it was long and arduous for a reason. Just because you have narrowed your comparator group to a cohort of individuals that define excellence, does not mean that you yourself do not define the very same principle. Remember this, as it will be challenged. As your average marks change, as the effort you have to impart increases, as you feel yourself lost for answers where they once were abundant, and as those around you seem to find them in the places you already searched— remember that every one of you deserves to be here. Whilst you may stumble and fall in one area, you will rise in glory in another. Most importantly, remember your sense of worth. It is not dependent on the group of individuals you surround yourself with. It is dependent on one thing, and one thing only: you.

 2.              The Pursuit of Happy-ness

Swedish psychologist, Anders Ericsson, from his research on expertise, asserted that an expert undergoes 10,000 hours of training. The expert doctor therefore would require 2,500 hours of training per year (for a 4-year degree). In a 36-week course, that’s 69 hours a week, or 10 hours a day.

Medical school trains you to be a doctor, but not an expert doctor. Expertise takes years, training programs, examinations and placements. The irony is that if you managed 10 hours a day for 4 years, you could still not call yourself an “expert doctor” – because that is not the outcome of medical school.

The goal of medical school should be to create a safe doctor, and whilst some assessments seem to forget this motive, your goal as a student should be to become a safe doctor.

As high achievers, we are driven to excellence, and to the limits of perfection. When the bar is set so high, this drives the demand to dedicate everything (and more) into this pursuit. But at what cost? An unbalanced and unrealistic pursuit of perfection, can come to the detriment of our health and safety. Knowledge is accumulated disproportionately to the effort contributed and does not neatly account for personal growth in this equation. 

Do the work, and then do some more (you are in medicine after all) but recognise your limits. If you studied 1,000 hours a year (4 hours a day for 36 weeks) an extra 25% more of your already given time would translate to an extra 250 hours. What is worth more: 10 marks, or 250 hours to live? I’ve seen friends throw entire lives away dedicated to the academic pursuit of that one point, on that one lecture, in that one block, 12 weeks ago. I myself may have wandered down that road more times than I care to admit. And every time I have walked away with the same regret. What more could I have got, than that one, meaningless mark?

3.              Okay: The Strongest Two-Syllable Word

Medicine is tough. But life is tougher. If I had to redo the last four years and choose between experiencing the hardships of medicine, or the hardships of my personal life, I would choose those of medicine— riding a unicycle, whilst on fire.

However, this doesn’t undermine the accumulative effect that the stress of medicine contributes to the stress of life. It is one of the many juggling acts we aim to master in our journey of resilience. But that doesn’t mean we must do it alone.

The concept of “being okay” is important. Why? Because it sets a minimal threshold at an appropriate level. If we set the bar at “being great”, we would constantly be dousing mental fires. If we set the bar at “coping”, we may miss the opportunity to be proactive and preventative. Being “okay” sits somewhere in the middle. Whilst it will be drilled into you over the course of your medical career, it can take a while to see the validity behind this notion, and it often reaches many of us too late.

Exercise your intuitive mind – if something seems amiss, have a low threshold to instigate your measure of “okay-ness”. Practice first by asking yourself. Reflect on your stressors and stresses. Understand them, empathise with them, and develop your arsenal of stress management. 

And then turn your scope to check in on others. In a culture in its rebirth stages of accepting imperfection, your efforts may be brushed off 99 times out of 100. But there will be one to open up, and it will be worth it. And the validity of “being okay” will be abundantly clear.

4.              Identify a Mentor

As someone new to the experience, there is nothing wrong with not having all the answers. Everyone has been in that boat at some point in time. As you progress through your career a long-term mentor will be invaluable, but this is inessential at a junior level - mentors provide insight and advice but this capacity is not reserved solely for advisors of enduring life choices. 

A mentor can be transient, so long as they are relevant for that point in your life. Relevance in mentorship is important. As a first year, seeking advice from a liver transplant consultant is like trying to squeeze lemon juice from life’s apple tree: you’ll get something, but it sure wasn’t what you were after. You go into a conversation hoping to hear about study planning and balancing your life, and end up leaving knowing how to do a complicated closing of a surgery you haven’t even heard of - it’s not supportive, it’s confusing. 

The best thing you can do is learn, and from those who have recently departed that very boat you have found yourself in. It is important to seek a mentor for the insight they possess, not the title they hold. An individual that understands you and the mindset of your current position, is far more valuable than the field expert of a career you may or may not possess 10 years in the future. This does not exclude experts of certain fields, the condition of mentorship is dependent on the mentor’s ability to understand you. My greatest mentor is from a field I would never dream of pursuing, but their ability to relate to me, fostered a relationship I knew I could rely on. For me, mentorship became about principles of decision making and troubleshooting, rather than training programs and networking. 

This is an important nature of mentoring to realise, as it precludes the need to seek mentors. A mentor can, and should, be an individual you stumble upon - one that you can relate to. If you come across that connection, latch on it, don’t let it pass you by because that person is not in the field of medicine you see yourself in.

5.              Be Micro-Ambitious

As dreamers and schemers, we make decisions 8-10 years in advance in the pursuit of a goal immortalised in our minds as a “life worth living”. The problem with setting our minds so far in the future, however, is that we forget to take note of the present. Every action is validated for its contribution to the end goal, but we fail to see its merit in being an ‘end’ itself. This serves to paradoxically deter our future motivation – as we slowly chip away at the mountain of our career, a focus on how far there is to go, renders the prospect of continuation daunting. 

Be aware of the hurdles you have overcome along this journey, the dints you have made, and celebrate them. Reserving recognition for your accomplishments is not a purely maternal characteristic. We all need to be the mothers of our own lives and place our accomplishments on the fridge. Note that recognition of your wins does not need to be demonstrative - the validity of your accomplishment does not stem from the recognition of others, but from yourself. But celebrate. 

These wins will provide your sustenance for the harsh cold winter months of long study hours, endless assessments and unpaid placements. Divide this long journey into small, manageable segments: championships are won by winning games first. Direct your efforts to tests, to submissions, to OSCEs and to clinical tasks. But take note of your progress, learn from it, and relish in your growth.

6.              Opportunity Lies in Disguise

Entering this degree requires a strong predilection for following the path we have paved out for ourselves. We put so much effort into paving it, the late nights, the long days, and the constant stress about which foot to put where, that we become individuals driven by the goal in the distance. Whilst our goals and ambitions are directive, such preconceived notions can often serve as the masks of limitless potential. 

We become so focussed on events panning out the way we think they should, or falsely believe they must, that we often miss the opportunity masked as an “inconvenience”. Part of adopting a ‘growth mindset’ is meeting the path of supposed resistance with the attitude that this path will serve your growth. And often the path of resistance is the path less travelled, and the one open to opportunities untrodden.

At the beginning of this ramble, which is now a short story in length , I noted that the dream of medicine can often be wiped away to reveal a stark reality. I want to be very clear – this reality itself is beautiful. It is the instinctive reaction to the fear of change that misrepresents the said reality and frightens us. Rather, I hope to give you some insight into the nature of the path you have set out on.

Reach for the stars, by all means, but do not make these stars your entire existence. Whilst setting foot on the moon is an achievement worth noting, one must imagine that the view of Earth from the shuttle must have been something to marvel at itself.

Do not mistake this as an encouragement of mediocrity, or an acceptance of passivity. There is nothing mediocre or passive about you.

But that has nothing to do with medicine.

You existed prior to medicine, and this newfound drive, albeit enticing, is not absolute nor all encapsulating. Dedicate yourself to the pursuit, but do not live for the process. Focus on what is in front of your nose. Seek help. Be the help. And leap at every opportunity. But do so on the proviso that you step back, rest, reflect, and give yourself permission to enjoy this moment. 

Because before you know it, the next stage of the journey is ahead of you. And all of this, this wondrous and incredible experience, will all be behind you sooner than you know.

You’ll all be doctors. That is the bar you will all achieve irrespective of everything else. But what sort of medical student, will you have been?

That is up to you.