To the Class of 2023

To the Class of 2023,

Congratulations! You have already accomplished what less than 0.3% of the US population has by being accepted to medical school. Even though you have not yet begun your clinical careers, you have each spent an immense amount of time, effort, energy, and significant financial investment just to be sitting in those coveted seats in the small auditorium.

When you received your letters of acceptance, you likely experienced a feeling of euphoria. Step one of becoming a doctor, check. This marked your first real measure of progress since you realized your desire to pursue medicine. Some of you came alone, straight from your shining undergraduate institutions. Others came with families, sometimes balancing night classes, second degrees, and multiple jobs just to make it to this point. Some of you have dreamed of this moment since you were a child, perhaps influenced by friends and family members in the profession. Others of you may have taken a longer route, experiencing the triumphs and tragedies of other professions before answering the call of medicine, yet all of you are now united in this noble pursuit of the care of your fellow man.

So again, I say to you: Congratulations. When I was in your shoes, I felt like an imposter (and despite reaching the hallowed ground of 4th year, sometimes I still feel like one)! Yet, each of you are here for the right reasons. You all possess the intelligence, perseverance, raw grit and determination, and the foresight and wisdom to plan and attain long term goals. Each and every one of you is capable of becoming an excellent physician. You are not here by mistake, and you did not trick anyone into letting you in. The admissions department sees more applications than you can imagine, and they are masters at seeing through trickery and ruses. I promise, you did not fool anyone into letting you be here. You each bring a vital and slightly different component to your class and to our school. Like the multitude of colors on a tapestry, each of you is vital to its vibrancy as a whole.

I hope you will allow me a brief moment to share with you some advice. Medical school will change you. You will find yourself leaving a different person from when you first began. I hope you will allow a 4th year’s musings to help prepare you for the journey ahead. Each piece of my advice represents something I wish I had been told 4 years ago. When you sit in my place, you will likely each have your own list of things you wish you had known. This is a part of growth, and I would encourage each of you to reflect on this 4 years from now.

Rely on those who have gone before you, but be willing to learn from those who come after you.

Medical school is hard. You will be amazed at how beneficial your relationships with your upper classmates will be in the years to come. Invest in the Big Sibling program at Quillen. It is worth more than its weight in gold. Over your 4 years, your questions may change, but they will always increase. You will find yourself asking less and less about how to pass a course, and more about how to be a great physician. I know it sounds far off, but you will begin to wrap your mind around the science of medicine, and you will begin to realize the depth and breadth of the art of medicine. Even within your 4 short years here, you will likely find yourself beginning this mental transition. This is a mark of the maturing physician in training. Shortly, you will be asked to impart your own wisdom on the classes below you. You will likely find great satisfaction in providing this sought-after advice. You will realize just how much you have learned in the process and will be both humbled and empowered.

Rely on your classmates.

For many of you, this will be one of the most difficult things. You are all accustomed to being the most intellectual person in any given room. You were all likely top of your high school class, top of your college class, and some of you may have even been highly successful in other occupational endeavors. In any group project, you were likely the leader (and for the true Type A’s, you may have even done the whole project yourself). You may have even disliked group projects and preferred individual effort. Yet, medical school is a different ballgame. Some of you will certainly be capable of surviving without the help of others, but you will significantly miss out on the process. You will find these new classmates of yours to all be uniquely qualified and intimately invested in your education. Study together. Learn from each other. Teach each other. Interact with the material together. Get to know each other outside of school, if at all possible. Enjoy life together. It makes the journey so much more bearable.

Everyone fails a test.

For some of you, this will be a first. Perhaps in a previous incarnation you vaguely remember making an 82 on a test in your elementary art class. Yet, the reality of medical school is there is far too much information and not nearly enough time to master it all. Even the most capable among you will fall victim to this at one point or another. You will have too many tests in a given time period. A brother, sister, or close friend will pick the worst possible weekend to get married. You will develop the worst cold of your life the day before your final shelf exam. You may lose someone close to you. Despite the unyielding demands of medical school, life goes on, and it will result in a low test grade. In that moment, you will fear the truth is finally revealed: you are an imposter in the system. Fight this. Everyone will fail (or nearly fail) a test. You are not alone. You are only human despite medical education’s need for you to be super-human. When you do fail, learn from your mistakes. Understand the reason for your failure. Was it due to lack of time? Were there circumstances outside of your control? Did you struggle to understand the material? Where possible, learn and make adjustments. Seek help. Everyone needs help at some point in medical school— if not with the intellectual material, then with the constant and draining emotional demands. Talk to Phil.

Each season of medical school has a time and season.

Your first year will be consumed by material at a pace you could never have imagined before. You will constantly be worrying about mastering the deluge of information and regurgitating it on test days. Never forget though that the point of medical education is to provide patient care, not to pass a series of tests. Master the basics of studying your first year. Discover how you study best. Try new ways of studying. Enjoy the course material as much as you can. Try to make some of the seemingly esoteric material meaningful to you in some way. Your second year will be consumed by the impossible balancing act of institutional tests and preparation for Step 1. Remember though, it is only for a time and a season. Like the hundreds of students who have gone before you, you too will survive this. Your third year will be filled with a whole different kind of learning: the real world. C.S Lewis once said, “Experience: that most brutal of teachers. But you learn, my God do you learn.” Nothing compares to the wards. You will find it both immensely rewarding and immeasurably stressful to now be a contributing member of patient care. You will have rotations you love and rotations you dread. In every situation, make a resolution to yourself to learn as much as possible— not for yourself but for your future patients. You owe it to them. In many ways, your 4th year is like a return to first year. It is stressful but rewarding. You will grow more on your away rotations than you ever thought possible as you further dive into your desired field of study. You will meet many new people on the rotation and interview trail, some of whom you may even work alongside in residency in the years to come. Through it all, embrace the process. It is far from perfect, but it does have much to offer.

Get in the clinics early.

So much medical education happens in the clinics and wards. Network with the physicians and providers in the area of medicine you see yourself pursuing. This is essential if you are seeking a specific specialty. The Tri-cities area is full of academic and community physicians who are more than glad to open their doors to medical students. Take advantage of these opportunities. You will be amazed at what you will get to do with many of these providers. I still remember the exhilarating feeling in my 3rd year when a community orthopedic surgeon walked out of the operating room and let me finish closing the incision and bandage the patient by myself. These mentoring physicians will be an invaluable resource throughout your time at Quillen. They will teach you, guide you, and provide an immeasurable amount of advice to you. They will write your letters of recommendation. They will celebrate and ask about your away rotations. They will be your cheerleaders as you seek a specific field. Find them: ask your classmates for recommendations and be a part of interest groups that invite community physicians to speak. Work with them as much as possible (summers are a great time to do this).

You can bring about change, so don’t wait on someone else to do it!

Like every other institution, Quillen is not perfect. During your time here, you will doubtlessly notice problems. Medical students are notorious complainers. In part, this is due to your excellent ability to identify problems (a skill that will serve you well during your clinical practice). But, don’t fail to address the problems you see. You will often have potential solutions in mind. Make your voice heard. Problem solving is integral to all aspects of medicine, and the same applies to medical education. Where you are uniquely qualified and equipped to better our school, do so! Don’t expect anyone else to do it for you. And, you don’t need to be an elected official to bring about change. There are many avenues and outlets for your voice to be heard. If you think an outlet doesn’t exist for the suggestion you have, make your own! There will be a strong temptation to complain about the shortcomings of Quillen, yet I would encourage each of you to be proactive and seek change. You will be surprised at what you can accomplish and how receptive the leadership at Quillen is to well-thought out solutions.

P.S. Identifying, addressing, and solving institutional problems looks great on your resume, and is an invaluable talking point on your interviews.

You will lose classmates, and it will hurt.

The small, intimate class size at Quillen makes these losses so much greater. Some will leave due to circumstances outside their control. Life can be brutal, and no one is spared indefinitely. Some will struggle and fall under the emotional burden of medicine, which is far more than anyone should shoulder alone. Others will be unable to cope with the monumental amount of information. Support each other. Where possible, maintain the friendships forged in the trenches. No one escapes unscathed from medical school. Each person in your class is unique, vibrant, and irreplaceable, and the loss of even a few classmates will affect you deeply. Cling tightly to each other and help each other. No one else truly understands the burden of medical education like you all will together. Lean and rely on each other every step of the way.

Stay grounded, and don’t forget the things that matter.

Despite the massive maw of medical education, remember who you were before. Medicine changes everyone, but don’t forget the things that make you uniquely you. You will have less time for hobbies, but don’t forget to take time doing the things that bring you a sense of fulfillment. Don’t neglect your friends and family. They want to be a part of your life. Take the time to explain to them what medical school is like. Attempt to share your experience with them. They will appreciate it more than you can know. Play with your kids and volunteer with the organizations that get you fired up. Spend time outside whenever possible. Go on trips; go to weddings. Travel. Learn new skills. Don’t let medicine chew you up and spit you out a dull, boring, bitter shell of what you once were.

You are the future. Day by day, you are becoming competent, capable, and caring physicians. You each have the ability to provide for, influence, serve, and heal thousands of your fellow man. Never forget your responsibility or your ultimate duty.

I look forward to meeting you, to teaching and learning from you, and to one day, practicing alongside of each of you. I wish you all blessings upon your journey.

-Steven Irmeger, M4