The Disillusioned Medical Student

I struggled during my first two years of medical school in the University of the Philippines (UP). This I can say only in retrospect, not because of a lack of awareness at that time, but more so because I refused to acknowledge how I felt. I thought I was OK. I wanted to believe I was OK. Many years later, as a doctor and teacher at the same medical school, I can say I wasn’t.

Our class was among the first to use exam answer sheets that a scanning machine could check automatically. Whereas it would take weeks to release the results of a manually corrected exam, the waiting time was reduced to a few days, a week at the most with this new system. As soon as word got out that the scores of the last lecture or laboratory exam had been released, first year medical students, in their lab gowns stained with bodily fluids and reeking of formalin, would make their way from Calderon Hall’s dissection laboratory to the Department of Anatomy’s computer room one floor below, and huddle in front of the few working desktop computers.

The results were tabulated in an Excel file and displayed using our codenames (Mine was sphenethmoid, a tribute to frog anatomy), arranged from highest to lowest. For the top ten students in each exam, however, the names were always revealed. Even before you could manage to squeeze into the front of the pack, high fives, congratulations, and “Libre naman diyan!” would already echo in the room, and the names of the top-performing students floated in conversations for the rest of the afternoon. In first year, you always celebrated these triumphs.

Except for one exam towards the end of the semester, in which I got the top 9 spot, I was far from stellar in anatomy. In one exam, I almost failed. Each time I silently hoped that one of my friends would be among the first to look at exam scores and get back to me with good news, but I only ended up disappointed for failing to meet expectations. Always, I waited for the crowd to dissipate before checking how I did.

I was the topnotcher of the INTARMED program*, and yet when our class of 40 students was joined by 120 more, mostly honor graduates from UP Diliman and UP Manila, I felt that I could not keep up.Β I would not say this openly though; it would be utterly insensitive to my other classmates who tip-toed on the passing mark. Only INTARMED friends who knew me well enough could decipher my facial expression and offer words of consolation or frank advice. Sometimes both.

Outcome was only rarely proportional to effort. For the most part, this was the root of my disillusionment early on in medical school.Β I envied my classmates who could memorize lecture transcriptions, find time to read the preferred textbooks for each subject, and subsequently earn top marks. I could not figure out what I was doing wrong. I was putting in long hours but hardly getting the results that I wanted.

This cycle of hard work, anticipation, and frustration would drag on for two years. I struggled most in anatomy, histology, and pathology, subjects that relied heavily on rote learning. Even biochemistry, whose pathways I relished as a pre-med student, mutated into a fanged creature that I could not tame with my clipboard and study lamp.

I was not comfortable with just passing, and the straightforward reason: I could not risk losing my academic scholarship that required a 2.0 general weighted average at the end of each year. Admittedly, and I now laugh at this, underperforming also bruised my ego.

I had a more profound, idealistic reason, though: I was afraid I was not learning enough. Even though I passed my exams, not much information was retained afterward, and I felt this was tantamount to shortchanging my future patients. The countless nights spent studying could be endured, but this nagging feeling of inadequacy was much more difficult to bear, like the frayed edges of your white uniform, or the whisper of doubt that you hear just after inserting the eartips of your stethoscope.

Several weeks ago, a UP medical student’s rancid post went viral in Facebook. It was strongly worded, urging aspiring doctors, “HUWAG NA KAYO MAG-UP MED” (Don’t go to UP College of Medicine) because of “tremendous amount of stress” and “rampant crab mentality and neurotic ambition to get the perfect grades,” at one point even calling the national university’s medical school a “hellhole.”

This is what disillusionment does. And this happens not just in UP. I say this as a teacher and a blogger who has had the chance to speak to and interact with medical students from all over the country.

If I could talk to this person and my first year self, this is what I would tell both:

At the start of medical school, we get fixated on this concept of a medical student who excels in academics, finds time for worthwhile extracurricular activities, has an active social life, is well-loved by everyone, and seems right on track to becoming a successful physician.

The perfect medical student does not exist. Even the best and the brightest have moments of solitude, when they doubt their ability to heal a patient.

Nobody goes through medical school unscathed. Take care of yourself and each other. You need that part of you that is kind and empathetic to remain intact at the end of all this. What we have is an imperfect system. It may be necessary to study to pass, but it is more important to study to learn.

When doubt and disillusionment enfold you during the most difficult of days, I hope you find fortitude in your why. Remember the person you were at the beginning, and focus on the doctor you aspire to be at the end. Realize that all the hard work you put in now is just because one day, you would want to be of service to others as a physician.

For me, things got better in third year, when I began to see patients in the clinics regularly. It all started to make sense, and I saw how information I used to just memorize could be life-changing, even life-saving at the right moment. I continued to hold myself to a high standard, but I let go and stopped comparing with everybody else.

During Otorhinolaryngology (i.e., Ear Nose Throat or ENT) rotation in internship, I saw one of my classmates lingering at her patient’s bedside after work hours. She was holding up a magic slate and showing her patient how to use the writing device. Later, I would find out that her patient was scheduled for total laryngectomy. In this operation, the larynx or voice box is removed completely and a patient would lose voice permanently. The magic slate was my classmate’s gift.

Medical school is never just about grades.

*INTARMED students only take two years of pre-med subjects mostly at the College of Arts and Sciences in Padre Faura, before going into four years of medical school proper at the College of Medicine in Pedro Gil and one year of internship in Philippine General Hospital.

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50 comments

  1. As a less than stellar medical student struggling to be worth her salt, it becomes so hard to see beyond the grades sometimes. But somehow, no matter what happens I still want to continue. I feel like sometimes I might be crazy, as the uncertainty and sacrifices mount up as time goes by, I start to question if this is for me.

    I’ll be saving this post doc, we all need to see beyond. Thank you.

    • Hi Syrlc, it gets better. Trust me on this. For as long as you do your best, you should be fine. πŸ™‚

  2. Edwin Soliman

    Hi Doc Roni – are you also teaching at UERM? My daughter will start her med school there this August. By the way, she didn’t see that viral fb post. Hehe..

    Regards,

    Edwin Soliman

    • No Sir, I only teach in UP and occasionally in Ateneo. I do teach sa board review where I get students from all over, so maybe in 5 years she will be my student. πŸ™‚

  3. Definitely one of the fave posts here! Thanks doc πŸ™‚

  4. I really enjoyed this blog entry Dr. Roni. I’ve been so destitute during my 1st year in med school after losing a parent, and getting poor grades. I never thought about quitting and just trudged on. What kept me pushing was the grand goal that I’ll one day go back to my community, serve, and become a barrio doctor. Now, I am incoming intern at PGH come July πŸ™‚ It’s true, at the end of the day, those who stayed are the ones who win.

  5. i love, love reading your writings…. you are genuine by admitting your limitations although we know how well respected you are in your field. PS: yeay, so glad you are back and writing again

    • As I said at the very beginning, I can say these things only in retrospect. Thanks for reading Ninette!

  6. Gabby R. Batuigas

    Hi sir ronnie!
    First of all, I would like to thank you for the stress-free lecture on Biochemistry when I was still reviewing for my board exam. Really, your the best! Converting Biochem into story telling. I could hardly believe that I was enjoying studying Biochem during that time. Hehehe…
    Thanks a lot! Always be a blessing to others doc!

    • You’re welcome Gabby! Long delayed, but congratulations! I hope you are finding satisfaction in your chosen field. πŸ™‚

  7. Med school will never be easy and sometimes, it becomes emotionally draining. You start to question yourself if you’re doing the right thing or what. You know you can only give it your best shot. Pero minsan, kahit ‘yong “best shot” mo eh parang kulang pa rin talaga. Nakakaiyak na pero busy pa masyado kaya sige pa rin sa pagkayod.

    Saved this post (along with other words of wisdom from you; hugot inspirasyon).?
    Thank you for this, Doc. Keep inspiring aspiring doctors. God bless!

    • Yes, always your best shot. The problem sets in when people get used to the comfort of just passing, and never strive to be better. Thank you Auie!

      • Kahit kasi passing grades eh ang hirap na pong abutin Doc. But personally, I also share the same sentiments of how uncomfortable it is to just pass (of course you are grateful naman pero parang kulang and the scholarship reason also), or the feeling na inadequate ‘yong napag-aralan mo. Maybe also because I am in a class of brilliant minds, but I don’t compare myself to anyone pero you can’t help worrying about grades. Gaya nga po ng sabi n’yo, huwag maging mediocre. Still, I know I’ll be re-reading this post to boost the fighting spirit within. Hehe.. Thank you po ulit.

        • Yes Auie, never mediocre. Thanks again for reading, and I hope you never lose that fire to keep fighting. It will be worth it in the end. πŸ™‚

  8. manupulative ex-med stude

    Hi sir. I was once tutee yours way back when yiu were a peer tutor at LRC. ? Its never about grades. I went on to study Medicine in Intramuros. Graduated with honors and topped the board exam. And I share the same sutuation as yours. Struggling to start a practice. It nice being appreciated for your academic skill. But grades is not everything. Reality will hit you right in the face after residency. That is what happened to me. ?

  9. Raissa Guldam

    “Medical school is not just about grades.”

    Huhu. Thank you doc for this inspiring article. I promise to do better this LU4. ^_^!

  10. Hi sir! Thank you for this. I experienced the same in the med school. Always wanting to get the best grades and forgetting the essence of what we are being taught. But being in the hospital will really open our minds with reality. That patients appreciate compassion more than the awards or the unos written in our TOR. It’s not that we should not strive to be the best but we should not forget why we do in the first place. To give the best quality of care to our patients. πŸ™‚
    P.S. Never got the chance to thank you for giving us an awesome Biochem review in Topnotch. It was my favorite subject in med school but I never thought it could get any more fun. Thank you sir! Hope that I can do the same and teach med students in the future as well. All the best to you sir!

    • Hi Split Ends! You’re welcome. Teaching is fun, it’s my way of paying it forward. There are several medical schools looking for teachers, I’m sure you’ll find your niche. πŸ™‚

  11. Hi doc, totally agree with your last statement!!!!

  12. Hi doc! I was inspired by your post. I am a first year medical student but recently i just failed in biochem and anatomy. Hoping i would pass my remeds and be better by 2nd year! I really struggled my way through 1st year. 1st failure definitely shapes you. Thank you for this!

  13. Hi! I am not in the health science field but this post resonated with what I am feeling right now. I am currently reviewing for the Mech Eng Licensure exams and I am experiencing this anxiety of being not good enough even though my weekly exam scores are better than most of my classmates. I am afraid of not performing well on the actual exam, and afraid of not retaining the information in my brain. It’s driving me crazy.

    Thanks for this post. It actually made me feel better. πŸ™‚

  14. Thank you po for this inspiring and encouraging post, sir! Needed it for internship πŸ™‚

  15. Doc Ronibats, idol ka talaga namin!

  16. Thank you for this post!! I definitely needed something like this to remind myself why I started and what I would want to be remembered as in the future. I am a second year student at DLSHSI and I just failed Internal Medicine so I have to repeat the subject alone for an entire year, and the thought alone scares me!! But this post helped alleviate some of my fears. You’re an inspiration!

  17. Hi sir πŸ™‚ i might not be a medical student yet, but your words truly ignited that fire within me to study not just for the sake of striving to be an excellent student but to learn because of that desire to help and heal patients once becoming a doctor. I will surely treasure this once I enter med school and hopefully I’ll never lose grasp of it along the way. I’m currently a Bs Biology student and just thinking about Biochem, Human Ana and Human Physio intimidates me already since I’m just an average student striving her way to cope up these heavy subjects. But I won’t give up! I just have to face them one day at a time and do my best. I truly hope to meet you one day. Do you also teach at ASMPH since you also do in the Ateneo? πŸ™‚

  18. Truly inspiring doc. ?? As an incoming 3rd yr med student, I absolutely feel like I just “passed” my subjects w/o really retaining anything. Its very discouraging. Im thankful for passing though. Sometimes I just wish I could repeat those lectures, listen again and study properly. Were all in survival mode, sana malampasan namin ang pagiging kabisote. Hope I’ll be able to pick up the pieces as I go through the coming years. Thank you again doc!

    • You still have lots of time to catch up. I think most of what I use in practice, I learned 3rd year onwards. And then you just go back to basic sciences when you review for the boards. πŸ™‚

  19. Your blog makes me happy, Doc. I know you’ve heardβ€”read this a lot of times but your story is really inspiring. I hope I could be like you. Ang baba ko naman po yata kumpara sa inyo hahaha

  20. It is truly inspiring doctor. I am always inspired by your posts that I am in the process of starting my own blog. I wish I could also inspire others the way that you have inspired me to do my best, not only because I have to, but because my patients deserve nothing less than quality care and service.

    I will be starting my internship this July. If I were to ask for an advice on PGIship, what would it be?

    πŸ™‚

  21. The disillusionment came at a full force last year in clerkship and i took an LOA. This year, its still the same feeling of severe inadequacy and “bobo feels,” afraid of making mistakes. Seriously about to raise the white flag and move on.

    • Hi Paul, if you really want this, then sit down and think hard why things are not working out for you. Try to be objective and deal with things one at a time. Hang in there.

  22. I remember my first year in med school…I rant, I cry, but at the end of the day I would go back to my study table, I open my book and study again. It’s like a life cycle of microorganisms or sometimes a love and hate relationship, you would always go back and do it again.hehe.. Thank you, Doc Ron for this inspiring blog. Hoping for more inspiring stories soon. ?

  23. Hi doc! Any advice for us aspiring med students? I’m currently in Grade 12 and I’m really really pressured right now because of acads and college applications. I also applied for the INTARMED program. Also, thank you for inspiring us doc! πŸ™‚

    • Don’t feel the pressure just yet. Have fun and do your best in academics and extracurricular activities. Study very well for the UPCAT! All the best!

  24. One of the reason why I started blogging is to touch lives as what you have did to me. Thank you doc for the inspiration, for this.

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Names, dates, and events may have been changed to protect the identity of patients. The stories are not meant to provide medical advice for specific illnesses. The author neither accepts online consults nor gives medical advice online. Please consult your trusted physician.