What I Wish I Had Known as a Medical Student

Looking back on medical school, foundation training and GP training, there are a few things I wish someone had sat me down and told me.

1. Enjoy the Journey

Medical school feels long when you're in it.

Exams, placements, portfolios and revision can make it feel like it will never end.

The truth is that it goes by surprisingly quickly.

Work hard, but don't forget to enjoy the experience, build friendships, and make memories along the way.

2. First Two Years - Focus on the non-clinical and learn OSCE history/examination like checklists

In the early years, focus on understanding the core sciences and learning the common clinical checklists.

History taking, examinations and communication skills will become the foundations upon which everything else is built.

The sooner these become second nature, the easier your clinical years will be.

3. During Clinical Years, Focus on How Patients Present

Patients do not walk into clinic and tell you they have coeliac disease, heart failure or hyperthyroidism.

They present with symptoms.

  • “Doctor, I have been feeling so tired over the last year and its got worse in the last month, I dont know whats causing it”

  • “Well to be honest I have had a little bit of chest discomfort”

  • “I have been feeling so breathless doctor, I cannot even walk up the stairs like I once used too!”

One of the biggest shifts in medical school is learning to think from the presentation rather than the diagnosis.

This is one of the reasons The Med Den exists.

4. Build Illness Scripts

One of the most powerful learning tools is developing illness scripts.

An illness script is your mental model of a condition.

For each important diagnosis ask yourself:

  • How does it typically present?

  • What are the key symptoms?

  • What are the important risk factors?

  • What makes it more or less likely?

  • What must not be missed?

Initially, focus on:

  • Cancer diagnoses also known as 2-week-wait referrals (2ww)

  • Emergencies

The management is often straightforward.

Suspected cancer usually requires referral and investigation.

Emergencies usually start with: ABCDE assessment and calling for help.

Recognising the condition is often harder than managing it.

5. Work on Your Communication

Medicine is a people profession.

Knowledge matters, but communication matters too.

Pay attention to:

  • How you ask questions

  • How you explain information

  • How you build rapport

  • How you listen

Watch clinicians whose communication you admire and learn from them.

Good communication can make an average consultation good, and poor communication can make an excellent clinical decision feel unsatisfactory.

6. Use Question Banks Early

One thing I wish I had done earlier was use question banks consistently from the start of my clinical years.

Question banks help you identify knowledge gaps, reinforce learning, and, perhaps most importantly, teach you how conditions present in real clinical scenarios.

Resources such as Passmedicine are excellent for this and were a major part of my own learning.

However, avoid using question banks simply to memorise answers.

Instead, ask yourself:

  • Why is this the correct answer?

  • How would this patient present in real life?

  • What clues pointed towards this diagnosis?

  • What other diagnoses would I need to consider?

Used properly, question banks are not just revision tools. They are powerful clinical reasoning tools.

My recommendation would be to start using a question bank from the beginning of your clinical years, focus on the placement you are in and continue using it consistently throughout medical school.

7. See Patients and Practise With Colleagues

Medicine is learned through patients.

Textbooks can teach you what a murmur sounds like or what clubbing looks like, but patients teach you what these findings actually look and feel like in real life.

Whenever possible:

  • See patients

  • Take histories

  • Perform examinations

  • Observe experienced clinicians

Read the notes after seeing the patients to see if what you found had been noted. How do those with more experience document their findings? Speak with colleagues if possible to see what they had found.

At the same time, practise with your colleagues. Healthy classmates are excellent for learning what "normal" looks like.

Practise cardiovascular, respiratory, abdominal and neurological examinations on each other until the sequence becomes second nature.

The same applies to history taking.

Find a small group of motivated friends and regularly practise common presentations together:

  • Chest pain

  • Breathlessness

  • Fatigue

  • Headache

  • Abdominal pain

The students who improve most are rarely those who spend all their time reading. They are usually the ones who combine reading with repeated practice.

Remember: You learn what normal looks like from your colleagues. You learn what abnormal looks like from your patients.

A Final Thought

Your goal is not to memorise every disease.

Your goal is to develop a safe and structured approach to patients.

Learn how conditions present.

Build illness scripts.

Communicate well.

Stay curious.

The knowledge will come with time.

Happy learning,

Dr Shabir