I have found myself in the rather unusual situation of trying to do well in British and American medical school exams simultaneously, while also attending my placements. The size of the workload is something I wouldn't wish on anyone but it has taught me lessons that I believe are more broadly applicable to all medical students, particularly around trying to get the most out of each hour of my day, dealing with stress and my attempts to make my learning relevant to real world clinical practice.

Studying for the United States Medical Licensing Examination (USMLE) opens a British medical student up to a breadth of medicine that they would otherwise not experience. The cost is the requirement of thousands of hours of studying on top of placement and that puts a large amount of pressure on a student.

On a typical day I would return from placement and work into the evening on material I knew I wouldn't need to use on placement, material most doctors just don't know. That was the standard the exam demanded and to be honest I found that thrilling. The material was fascinating, I was deeply interested in it and I found that the more I worked at it the easier it all became, the more links I could make throughout specialties.

A large piece of advice I would give any student is find a way to enjoy and appreciate the content for what it is - it will make you want to sit down and study on a beautiful day when your friends are outside.

Americans are lucky in that they have two or three designated textbooks for the whole of medical school; the obvious resources are there if the student just wants to follow the path set out. In Britain there are hundreds of books and resources and it's the student's job to figure it out for themselves.

I avoided all the stress of studying by having my key resources, and only those resources. I have only opened three books in the whole of medical school, they are my bibles and they contain all the information I feel I will ever need until my specialist training. I very much found that fewer voices tell a clearer message in that respect, so my advice would be to pick great resources and be cautious about using anything else or you risk unnecessary confusion and stress.

The question is then: how can one translate their academic knowledge into clinical practice? I did it by going into a placement where there is really very little weight on examinable detail. I remember feeling nervous on my first day of A&E. This was a placement heavily centred around clinical knowledge and technique, aspects I was less comfortable with. Ironically the more exam preparation I did, the more out of my depth I became for real-world doctoring.

…find a way to enjoy and appreciate the content for what it is - it will make you want to sit down and study…

I came to view medicine and medical school as having two sides, the academic detail and the clinical experience. It was impossible to give sufficient time to both and because my exams came earlier I ended up with a large knowledge base with little useful clinical ability.

Although of course studying well can prove useful on the wards, the reality is that huge portions of information, painstakingly memorised, felt irrelevant. The challenge we face as medical students is how to marry the academic with the clinical – how to make the time in the library useful on the wards.

I found it useful to study the clinical material relevant to both the exam and the placement before it got underway, then during the placement I could spend time on the more bare-bones science. That way I could feel at least somewhat prepared for placement whilst still meeting my academic requirements. It is important to bear in mind though that just because you learn about something in a book, it doesn't mean you will need that knowledge on the wards - and that's okay!

Doctors will tell you it's important not to get disheartened, because all that work serves to make you a more interesting doctor who is genuinely excited by medicine. It's not about which protein does what where, but training yourself to have good habits and a healthy attitude to hard work. Passion for the library translates to passion for the material and a healthier, more sustainable relationship with the job.

I have spent thousands of hours studying by myself, yet not every hour made me a better doctor in real life. Simple things such as getting used to talking to patients, basic jobs and protocol can't be learned out of a book. Having both the American and British exams after two years of medical school meant I had little useful patient contact in that time, and I left my placement as soon as I could get away with it to go back to the library, which is just what the USMLE demands - total commitment.

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It's important, however, to bear in mind that that is only one piece of the puzzle. Learning how to care for a patient, to empathise and communicate with them, requires just as much commitment, but this is learned on the ward and not in the library. So, we are often left with two competing sides of a coin; academic study and clinical experience. While they may seem like mutually exclusive ideas it is our responsibility to find a way to excel in both. After all, both are just as important as each other.

I found that the academic side fuelled a desire to put learned detail into practice clinically, and seeing something interesting on the wards made me want to go and put it into academic context. In that way, although they form very different parts of the life of a medical student, they can never be separated. Both are required to make significant progress and both are required to build a level of self-confidence that facilitates enjoyment.


This article was correct at publication on 01/11/2018. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

Oliver Ralph

Oliver Ralph is a final year graduate medical student at St George's hospital. Prior to medicine he studied for four years at Oxford University for a master's in biochemistry before taking his place on the graduate MBBS4 medical program. When not studying he is a keen musician and singer. His hope is to take up a surgical residency post in the USA in two years' time and he has been taking the American exams alongside the British ones. The views expressed here are his own.

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