Book Review: So You Got Into Medical School….Now What?

Newly minted orthopod Daniel Paull MD’s So You Got Into Medical School….Now What? came out last year. The book attempts to be a one-stop shop of medical school advice with a big focus on how to study. I bet the idea of a detailed how-to guide for medical school seems compelling to a lot of people (particularly the anxious type A variety), but I find it odd how specific authors and various internet people attempt to be for study advice given how variable the coursework and grading are for the basic sciences nationwide.

Chapter 1 (“Conceptual Learning and Detail Worrying”) is 7% of the book, extremely dry, and could be summarized by saying medical school is hard, there is a lot of information to learn, and given that, you should try to really understand material and not cram. I’d argue that the argument that studying over time leads to better long-term retention over cramming requires no argument at all. It’s self-evident. Even people who cram (and I’m one of them) know that it is a test taking strategy of procrastination/weakness and not a good method for truly learning the material or preventing self-hatred and sabotage.

Paull also advocates strongly for reviewing the material before lecture. Conversely, many students would argue that avoiding lectures altogether when possible is a more time-efficient solution. His discussion of anatomy is pretty old school without any discussion of how anatomy instruction has changed at many institutions around the country (with many schools placing a greater emphasis on prosections, virtual dissections, etc instead of lots and lots of hours in the lab).

I did really like one bit of counterintuitive advice: keeping a study schedule can help you prevent the feeling that you should always be studying more. The schedule as a means to say “you’ve done enough” sounds like a great idea! Everyone needs balance.1

When it comes to specific test advice like Step 1, he again focuses on the idea of the magical schedule (without supplying an example himself). He doesn’t mention anything specific about book recommendations, question banks, or any recommendations on how to structure your review. I wonder if he avoids mentioning any books by name so that his book doesn’t become outdated? Either way, all the conceptual writing about studying then falls short without any specific advice when it might count. Paull falls prey to thinking his own specific experiences and school set-up are totally generalizable (because they’re not). His take:

Review books and question banks are equally important in preparing for the Step 1, and just about every study schedule will dictate the use of both.

Again, the best approach is to ask upperclass students which materials they found most helpful. Usually you’ll get a consensus on this.

Which is a huge cop-out! You’re the upper classman in this context! People are reading the book because they want your thoughts! If there is really a “consensus,” then give it. You ask enough people, especially completionists, and you won’t get a consensus. In reality, ask enough people and you’ll eventually get a list of more good/reasonable resources than you can handle. (I’d also personally argue that the question banks are generally more important than books in preparing for Step 1, but that’s just my take.)

Regarding shelf exams:

Another mistake students make is not reading the books they select in their entirety; too often students rely entirely on practice questions. Despite their usefulness, practice questions often do not cover all the necessary details of a topic and are designed simply to test the base of knowledge you will gain from books.

Agree that you need to read the entire book, but I’ve never met anyone who really relied too much on practice questions; I have however met a lot of people who haven’t done enough.

Regarding clerkship evaluations:

The subjective component can comprise up to 50 percent of your clerkship grade.

Up to but not more than? Really? 50% of your grade from evaluations is the maximum cut off nationwide?

Regarding Step 2 CK:

In fact, most medical schools simply require students to take this test before graduation.
On average, students study for two to three weeks for the Step 2 CK
Second, find someone who did well on the Step 2 CK and ask how that person studied.

The appeal to authority fallacy is really a terrible way to live your life. Many (most? who knows?) schools require Step 2 CK long before graduation, and more importantly, a growing number of programs require passage before ranking.

Regarding Step 2 CS:

Most nonnative English speakers will have a more-than-sufficient clinical skill set to pass those aspects of the test, but the spoken English proficiency section can be a challenge.

The data don’t necessarily demonstrate that. Spoken English Proficiency (SEP) is the least likely cause of failure in all groups (US and IMG). International students (which doesn’t distinguish between native and non-native English speakers) fail ICE > CIS > SEP, the same order as US students. I wrote about this here (with actual data).

Regarding The Match:

A personal statement won’t make or break your application.

A great personal statement can only “make” an application in extreme circumstances, but truly terrible personal statements absolutely can and do break applications.

Either way, if an institution doesn’t have a majority of residency positions filled by people who rotated there (this includes students from the program’s home institution), consider that a bad sign.

This is highly field-dependent. Small surgical subspecialities like Ortho and Urology differ greatly from typically larger residencies like Medicine or even Radiology.

Anyway, you get the idea.

Ultimately, the book falls prey to the obvious limitation: Paull is a single author who hasn’t made a huge effort to see how his medical school experience might differ from other students across the country.2 The general advice is reasonable but not mandatable. Study hard but not too hard, over time instead of overtime. The specific advice is occasionally way too narrow,. and of course, the whole thing is mostly common sense. That’s the nature of these things.

Overall: If it would make you feel better to have a solid road-map of medical school to keep you grounded, give it a spin (especially if you have a free trial or subscription to Kindle Unlimited, making it free to read). I know that during med school I was always wanting to know more about what happened next and felt that the class meeting that discussed it was inevitably further away than I wanted. If you want specific advice though, you’ll still have to (and should) look elsewhere.

Leave a Comment.