Post-Graduate Series Part Three (and a half): Medical School

"Post-Graduate Series Part Three (and a half): Medical School", June 2008

In my previous article on medical school, I outlined the application process. This article explains what one would actually do in medical school. That is just as important as the whole application

process and deciding if you really would like to be a doctor.
As I mentioned, medical schools in Ontario are all very different. The first way they differ is in terms of teaching style. Some have a very didactic approach while others are based on Problem-Based Learning (Mac is really big on it, as it was developed here. We do a lot of PBL group work in all faculties at McMaster, so you should be used to it). This is how your first two years of medical school are spent, so you need to be comfortable with how you are taught in order to do well. At Western for example, half of the day is spent in lecture while the other half is most often spent working in small groups.

In your first and second year at medical school (or your first sixteen months if you’re thinking about going to the McMaster medical school) you will be doing in-class learning. This is not necessarily all spent in a lecture hall like our years as undergraduates. There is some (or a lot) of self-directed learning. At certain times for example, you will be taught the clinical skills needed for your third year clerkship. During this time, you have an opportunity to contact other physicians, and do what are known as observerships. This is when you shadow a doctor and see what it is they actually do. These allow you to apply the book knowledge you acquired in your first two years. In addition, the more observerships you do with the same doctor, the more likely you will have freedom to work with patients. Mind you, you must be competent in order to do so!
Your third year is spent in a clerkship position. Your clerkship is spent on wards, working and interacting with patients and really learning medicine. Medicine is much more than just learning in the classroom, you must also have good social skills in order to interact with your patients. Each school has a different way of organizing their clerkships, and your best bet for understanding how they work is to talk to people who are in their third year or above. Some schools make you do your mandatory rotations first, and then you can choose your electives. This allows you to experience the different wards and get an understanding for where you’d like to focus your attention. Western’s medical school uses this method. Other schools mix in the elective clerkships with the mandatory ones, which makes it much harder to know what you will enjoy. Another thing to consider with your clerkship is how involved you will be. Some doctors only allow you to stand and watch, while others want you to be the first person on the scene. Finding a hands-on clerkship is advisable as it is the one that lets you learn the most.

As a clerk you will be working on the wards, doing intake histories, helping to diagnose patients, and deciding treatment plans. You are essentially doing everything a doctor does. The difference is that you always have a senior doctor to report to, and they are the one who is signing off on your orders. So if they don’t agree on your choice, you will not be permitted to choose that method of treatment.


In your fourth year you will continue doing much of the same as you did in third year. You will be working on the wards, and trying to focus on the areas you are most interested in. At the same time, you will be filling out your applications for residency. Your residency occurs after you have obtained your M.D. degree, but is pivotal for you to be able to practice in your field of interest.
In terms of cost, medical school is very expensive. Tuition for medical school is approximately $17 000 a year, and it is estimated that students will spend nearly double that amount. At the same time, due to the demands of the program, it is nearly impossible for medical students to keep a part-time job. As such, they are forced to rely on loans to finance their education. This has long-term consequences for students, and many leave medical school with debt exceeding $100 0000. This causes students to go into sub-specialty practices that offer more money rather than first-line practices that are lower on the pay scale. It can be scary (to say the least) to think about being in that much debt, and it is definitely something that needs to be considered. Furthermore, some people get into medicine for the wrong reasons: they think that in being a doctor they will immediately be making a large salary. Thus, they go into the highest paying speciality just to make money and not because they enjoy what they are doing.
The following is a list of general content of the first two years at Western’s Medical school:

• Introduction to medicine (general biochemistry, psychology, anatomy, etc.)
• Musculoskeletal
• Respiratory and ENT
• Cardiology
• Hematology and oncology
• Infection and immunity
• Dermatology
• Endocrinology
• GI system
• GU system (genito-urinary)
• Reproductive health
• Neurology, Eye and Ear
• Psychology
• Emergency
• Community health which includes ethics, ecosystem health, health care systems and epidemiology

And small groups covering:

• Clinical skills
• Patient interviewing (including breaking bad news to patients)
• Patient centered discussions (i.e. what resources does the community have, what obstacles will we face in interacting with patients, etc.)

Other schools cover the same material but do it in a different way. They will usually break the material into anatomical systems. For example, they will cover the thorax, which includes covering all of the organs in the thorax. From there they would move up to the abdomen and so on.

Remember what I have mentioned about medical school here is more important than getting accepted. If you don’t like what you’re doing than please don’t continue! Also remember that each school values different things and you need to find the one that has the best fit for you.

A special thanks to Bourke Tillmann for all of his help with this article.