from Podcast Medical School with Dr. Moss
First, welcome to Medical School!! Each and every one of you deserves to be here. I know the imposter syndrome will set in at some point during your medical career (if it hasn’t already).
Second, to introduce myself, my name is Stephanie Moss, MD, a current PGY-1 Psychiatry Resident and a 2024 MD graduate from Rush in Chicago l. I took a “Leave of Absence” from medical school between my 2nd and 3rd year for medical and mental health healing, and continued USMLE Step 1 studying. I am married with two dogs, and I am now a year behind my husband, Dr. Jonah Moss, who is an Intern in his Neurology Residency.
I wanted to share some advice about some pertinent topics that people rarely talk about, but desperately needs to be documented. To note, this information is specific to my medical school, but many schools have similar resources and procedures. So book mark and save this for when you need it in the future!
Each TITLE is linked to a larger blog post with a LOT more information. This is just a sneak peak of 6 taboos in medical school.
Please SHARE so all medical students can receive information regarding these taboo topics.
2. Challenges with Academics & Imposter Syndrome
3. Failing Quizzes, Exams, Courses, & STEP1/2
4. Accommodations - physical & mental health disabilities
5. Taking a Leave of Absence (LOA)
6. Finances in Medical School
I’m going to start with mental health because if you are human, you have a mind, and will struggle at some point in dealing with your mental health. In medicine, we frequently over emphasize the body’s physical health because we can physically conceptualize it through physiology, anatomy, chemistry, pathology, etc. However, we cannot put thoughts and emotions on a slide and look under it on a microscope.
Rarely do academic medical school curriculums emphasize mental health as a pertinent portion of an individuals’ health. Though I am not here to talk that, I’m here to talk about about our mental health as future health care providers.
As medical students we are immediately thrown into the deep end of the pool where we must learn to swim, if not suffer the consequences. In a short period of time we are given countless medical diagnosis, physiological and biochemical pathways, medications and their mechanisms of action that we must learn how to quickly “drink from a fire hose.” We are then frequently tested, graded, and judged on our intellect based on how quickly we are able to spit out and regurgitate information we most recently learned.
As you see below through the rest of the taboos, there are multiple types of struggles medical students experience that inertly impact their mental health. I want to emphasize in this number one taboo that YOU ARE NOT ALONE! Everyone is struggling with their mental health whether or not they are in a place where they are able to acknowledge or recognize it.
This is all a part of being human.
There will be moments when we notice our mental struggles. Sometimes they come out as emotions which can become overwhelming, especially if we have been pushing them down for so long in order to focus on our academics or patient care.
These emotions can become so severe and poor out as anger, sadness, frustration, or even as apathy. In this last emotion one might consider giving up on medicine or even our life. I want to say that it is normal to have these thoughts and emotions, even though the might scare you. You are not a bad person for thinking these things. You are just under a lot of pressure and your body is reacting in response.
However, if these emotions are not addressed then they can become overwhelming and one might start acting out on these emotions.
Once you feel yourself coming up with a specific plan or these emotions become so severe that it is all you can think about PLEASE TELL SOMEONE. This can be a friend, peer, teacher, parent, 988 or 911
This is the time where you must be brave and ask for help one more time. I know it is very hard to ask for help. Trust me, I know, especially coming from a traumatic background, where I didn’t know I had anyone to ask for help.
Know that right now you do have someone, whether if that’s me or someone else.
You have a purpose in this world.
There is at least one person who cares and believes in you.
If you would like to read more about this specific topic click on this blog post I wrote: "The Call of the Void- Suicide Ideation"
Also check out the mental health collection where are you can find support groups, books, podcasts, and more resources to continue to work on your mental health.
2. Challenges with Academics & Imposter Syndrome:
According to the AAMC, in 2021-2022 cycle 62,443 individuals applied to medical school for just around 22,000 positions in the US. This means that 35% were accepted.
In 2021, 11,576 pre-medical students applied to Rush Medical College in Chicago. Out of those interviewed and selected only around 152 began Rush as an M1 (first year) this year. That means only 1.3% were selected. If you are one of these 1%, CONGRATULATIONS!
Keep this 1% number close to your heart because there will be times (more than you can count) where you will feel stupid, unworthy, dazed, etc. This will happen because you are now in a group of individuals who are part of the 1%. DO NOT get worked up when you do not get the "top" grade. It will always be a bell curve, be happy if you get an "average" or "mean" score because that is it, it is the average of the 1% of your class. If your school is in the Pass/Fail System (Thank you Rush!!!) then ALL YOU NEED IS TO PASS! That means that at the end of the academic block all your grades will be added together and you have to get above the designated "pass" number, usually above 70%.
If you are struggling to understand something, so is at least 50% of your classmates! Reach out and ask for help from your own classmates, upper classmates, and professors. Each school usually has a FREE tutoring service so ask your academic advising team early! Don't wait till you fail an exam. But if you do fail - IT IS OK - go to #2 Failing Quizzes, Exams, and Courses
There are SO MANY RESOURCES out there! Take a deep breath, you might use a couple during one block, and a completly other on a different block. You will get your groove eventually. Usually you have to pay for them unless your school is awesome and buys some for you. Expect to spend at least $3,000 to pay for resources for all 4 years.
Most common resources (click each for direct links):
Learning all Subjects: Boards & Beyond, Osmosis, AMBOSS, OnlineMedEd (25% off multi-month with code: medpsycmoss25)
Histology: Histology Guide (free)
Memorize with Pictures (Biochem, Micro, Pathology, Pharmacology): Sketchy Medical, Pixorize, Picmonic (20% off with link)
Anatomy: University of Michigan Pictures (free)
Cardiology: UMich Heart Sounds (free)
Quizzing YourSelf: Anki (free)
Dermatology: DermNet (free)
Psychiatry: NowYouKnow-Psych (20% off with code: medpsycmoss)
Click for 20% off Picmonic
I hate that word, "failing." That just means you didn't score the minimum that the school put in place (usually 70% is a PASS). If you received below a 70% on a quiz or exam it is ok! It usually won't have a huge impact on your overall course/block grade. Sometimes you have to meet with an advisor after you score lower than 70% to make sure you have the right resources (see above).
Check out #3 Accommodations.
If you score below 70% or "Fail" a Summative/Final Exam, first YOU WILL BE OK! From my experience talking to other medical students, at least a quarter of medical students fail a course at least once in their medical school career.
At my school, first they will have you meet with the Academic Advisor to plan when you can study and retake the exam during your next time off (winter, spring, summer break, or dedicated). Make sure you plan 1-2 weeks to study just for the exam when you are not in another block.Most schools provide free tutoring and extra support to make sure you pass during the retake. When the retake date comes, and you still don't feel ready, contact your academic advisor and ask for more time! YOU DESERVE TO DO YOUR BEST! If you retake the exam and Pass, then on your "report card" it shows that you Passed (the fail is removed), and no one will ever know! (Again my school specific). However, if you failed the retake or more than just the final exam sometimes they the school will make you retake the entire class (but that is rare).
If you fail more than 2 Courses, then (at my school) when you retake the 2nd exam and Pass, then the second grade on your report card will say you failed once and then passed. If you Fail a second Retake Exam, or fail more than they might have you retake the entire semester or year which might require you to take a Leave of Absence (LOA) from medical school. See #4 Leave of Absence and MedPsycMoss Blog Post "How one’s identity can be shaped through life's traumas, struggles, and failures"
NBME Step1 board Exam: Usually you must TAKE and PASS this exam between the 2nd and 3rd year of Medical School (some schools after your 3rd year). Every school is a bit different on their requirements, resources, and expectations.
Again, this is what was at my school:
At the beginning of our M2 year we were provided UWorld to start studying. Some people used the question bank at the same time we were learning the specific subject in class. Others would do 10-40 questions a day. Others would ignore it until "Dedicated."
In the Spring of our M2 year we were given the First Aid Step 1 book and provided 2 months of "Dedicated" study time where we were supposed to study and take Step1. At my school there is specialized tutoring services and extra NBME practice exam vouchers BUT YOU NEED TO ASK for them.
However, if you failed any of the previous courses (above) you were also expected to retake an exam during this dedicated time, which shortens your Step1 prep by at least 2 weeks.
At my school there is an opportunity to ask for an extension of time to study for Step 1. One option is using the first month of M3 Clerkships (May) as your 4 week elective. However, if you don't take it during this time, you fail, or need more time you will have to take a Leave of Absence. See #4 LOA
If you Fail Step 1 (this year the "Passing score" is 196) you have the opportunity to study and retake Step 1 again for a second time. However, each school is different on how many times they will allow you to fail before sending you in front of the Medical School Board to offer you the opportunity to take it a 3rd or 4th time before dismissal from medical school. The AAMC only allows you to retake the Step1 exam 6 times.
IF YOU ARE NOT SCORING ABOVE PASS ON MORE THAN 2 PRACTICE EXAMS DO NOT TAKE IT - EXTEND TEST DATE! From experience and conversation with many other medical students who have failed, it is better to extend your exam date than fail the exam.
Read more about Failing Step 1 from the AAMC: "No, a Step 1 failure won’t doom your medical career"
"In 2017, 72% of U.S. MD applicants (including both U.S. MD seniors and prior graduates) who failed Step 1 on the first attempt went on to a residency, compared to 94% of applicants who passed on the first attempt."
"However, we know from longitudinal data that within six years after graduation from medical school, more than 99% of all graduates have records of graduate medical education training and/or are in practice in the United States."
This means that at least 6% of medical students fail Step 1, and if you keep trying and graduate you will get into residency!!
I matched into my top specialty and program with 2 Step 1 failures!! I also know people in my class who have matched with failures into IM and FM!
Read my Article on Doximity: "I Failed Step 1 by 1 Point"
Check out my blog post - "Lessons Learned from Failing STEP1: A Comprehensive Guide "
4. Accommodations- physical & mental health disabilities
All medical schools and exams are required to have some sort of accommodations and accessibility available. However, not all schools value this or spread the word that they exist. I unfortunately, found out I could apply to receive accommodations after over 2 years of medical school, failing 2 courses, and failing my STEP1 Exam.
If you struggle with any of the following things (non-inclusive), consider talking to your School's Accommodations Representative:
Not finishing quizzes or exams in given time (have to skip over questions and would benefit for an additional 5+ more minutes)
Needing to take a bathroom, water, medication, snack break during an exam and not given break time
Suffering from Testing Anxiety
Have a diagnosed physical, medical, or mental health disability
Have a diagnosed learning disability
Have a mental health condition that impacts your focus while in class or taking an exam (ADHD, Anxiety, Depression, PTSD, etc)
Have medical or mental health condition where you need time off for therapy or medical appointments
If you are breast feeding
If you need time in private to do medical care (ex: injections)
If you need a quieter room with less people during exams
If you need to sit in a chair during rounds or can't stand for longer than 30+ minutes at a time.
If you have an acute injury or illness that will impact your academics longer than 1 week
Need time off during the day for medical appointments, medications, self care during clinicals
In the "Medical School Graduation Questionnaire 2020 All Schools Summary Report" (see below) by the AAMC 7.6% of medical student graduates self reported that they suffered from a disability.
Of those who stated they did have a disability and requested accommodations only 2.9% were denied by their school. Therefore, the worst thing they say is no.
You can read more about my experience receiving accommodations:
KevinMD: "Requesting disability accommodations in medical school"
"Living with Chronic Medical Conditions as a Clinical Medical Student"
"Requesting Disabilities Accommodations in Medical School"
Even if you don't need or receive accommodations, everyone needs time to take care of their health.
Read through my MedPsycMoss Resources on Mental Health and Resources on Dealing with Trauma
Read MedPsycMoss Blog Post on "Call of the Void- Suicide Ideation" -
Each year in the U.S., roughly 300 - 400 physicians die by suicide - do not be one of these statistics. Call 988 if you start thinking about a plan to commit suicide.
Check out Docs with Disabilities Videos on How to Request Disability Accommodation
Check out MedPsycMoss Disability Resources for being a student with disability
5. Taking a Leave of Absence (LOA):
There are two types of Leave of Absence in Medical School: Academic or Personal When one takes a LOA from medical school, one must sign a piece of paper from administration check marking one of these two options:
An Academic LOA is when the school decides you must take a leave because you have failed to many courses, have to retake a year course, or have to retake a board exam. This is seen not as favorably by residencies (so I have been told).
A Personal LOA can be for any reason and it is because you choose to take the leave. It can be because of family obligations, health concerns, research, or just needing a break. You do not need to explain why to the school, but will need to explain what you spent your time doing during this time in your Residency Application and Interview.
Things to consider when taking an LOA:
How will you finance the months off? You are not allowed to take out Federal Student loans when you are on LOA
How will you finance Health Insurance? Some schools allow you to remain on the same plan but you will need to pay out of pocket. Our insurance cost us around $4,000 for 9 months off of school.
Does your school provide you continued access to academic study spaces and tutoring services? My school does when individuals are on LOA.
Do you qualify for any financial aid assistance through city, state, or federal programs?
Are there any current or previous students at your school who took an LOA and can provide advice? We have created a GroupMe for Medical Students in our school with around 20 students who have been on or are currently on an LOA- reach out to Stephanie
Read some of my Blog Posts on my experience going through LOA:
"The Decision Whether to Extend my Leave of Absence (LOA) from Medical School"
"How one’s identity can be shaped through life's traumas, struggles, and failures"
Considerations Before Taking a Leave of Absence from Medical School
**More personal examples in blog post The Financial Realities of Being a Medical Student in a Lower SES**
30% of medical students take out 0% of loans. Who is paying Tuition and Living? Usually Family.
33% of medical students came in with outstanding undergraduate and pre-medicine student loans
In 2020, the median amount of total scholarships over 4 years that graduating medical students reported receiving was $25,000
21.1% of 2020 graduating medical students had non-educational student loan debt (78.9% had $0)
Just to apply to medical school costs around an average $10,000 (credit cards anyone?)
"In 2020, 11% of graduating medical students had between $300,000 and $400,000 in medical school debt, nearly 3% had between $400,000 and $500,000, and about 1% had more than half a million dollars in debt." - My husband and I combined will have almost a million...
See list of Costs of Every Medical Schools here
Average Cost of Tuition per Year: $54,698
Average Cost of Tuition for 4 years: $218,792
Total Living Expenses Allocated for 4 years: $29,000 x 4 = $116,000
Total Loans Taken Out for 4 years: $218,792 + $116,000 = $334,792
Don't get me started on compounded interest... article to come!
Average Cost of "Living Expenses Loans" per Rush Website in Chicago in 2023
Monthly Living Allowance: $2,450
Rent, utilities, etc. = $1,457 per month
Transportation (car repairs, insurance, registration, gas, etc) = $380 per month
Miscellaneous (food, entertainment, moving expenses, clothing, medical care, pet food, etc.) = $201 per month
Educational Resources & Exam fees (left over) = $412 per month
For the 10 months you are in classes you are given: $29,000/year (yes not given money for holiday and summer breaks)
A single medical student who takes out 100% of loans for living expenses without any parental financial $$$ support is at around 250% of the Federal Poverty Level Annual Income
Did you know that medical school disproportionately affects students from low-income communities and underrepresented students of color/race in medicine because they have less financial assistance from family to subsidize their medical education and living expenses?
Automatically, we were expected to pay for academic resources that were not covered under our tuition. Many students ended up purchasing the majority or all of these resources once they realized their peers were receiving benefit or an advantage. These resources for the first two pre-clinical years included Sketchy ($800), Pixorize ($400), Boards&Beyond($400), Amboss($500), Pathoma ($120), Complete Anatomy ($150), and a First Aid book ($50). In total, the cost of unexpected academic resources would be $2,4020 per student. Of course there were ways for some students to acquire some of these resources without paying, but technically that is against the code of conduct.
When it came to academic success, some students paid for private tutors especially for the board exams. Since I was experiencing academic struggles and consistently scored in the lower percentiles, I was provided tutoring by my school for “free” by a student in the upper level classes.
Financial resources we have used and highly recommend:
One can increase the $$$ of living allowance you receive for computer/tablet purchases (once), flights home (2 times per year), and medical costs (contacts, copays, medicines, etc). Each school has their own form to fill out so contact your financial Aid Department. As an example, Rush's Request to Increase Loans can be found here
Food stamps (SNAP) Application if you have NO family financial support or external income is under 250
Food Banks and More Food Support
LasagnaLove: Make or receive a huge Lasagna from someone in the community
Chicago Utilities Support
WIC Application: If you or your partner is pregnant or having a young child
Is there anything else you would like to know?
If so send me a message and can contact me here. I hope you consider signing up for my monthly emails where I share educational virtual events, trauma-informed resources, and more blog posts.