Six Taboos of Medical School: What I Wish Someone Had Told Me
From the Podcast "Medical School With Dr. Moss"
First, welcome to medical school!
Each and every one of you deserves to be here.
At some point during your medical career, imposter syndrome will probably set in—if it hasn't already.
My name is Stephanie Moss, MD. I am a Psychiatry Resident and a 2024 graduate of Rush Medical College in Chicago.
During medical school, I took a Leave of Absence between my second and third years for physical and mental health recovery while continuing to prepare for USMLE Step 1.
I wanted to share advice about several important parts of medical school that students often struggle with but rarely openly discuss.
Much of this information comes from my personal experience at my own medical school. Every school has different policies, resources, grading systems, accommodation procedures, and Leave of Absence requirements, so make sure you understand the policies at YOUR institution.
Bookmark this post for when you need it later.
Each title below connects to a larger blog post with much more information.
This is just a sneak peek into six taboos of medical school.
Please SHARE this with other medical students who might need these resources.
The Six Medical School Taboos
1. Mental Health
2. Academic Challenges & Imposter Syndrome
3. Failing Quizzes, Exams, Courses, & USMLE Step 1/2
4. Disability Accommodations & Accessibility
5. Taking a Leave of Absence (LOA)
6. Finances in Medical School
Taboo #1: Mental Health in Medical School
I'm starting with mental health because if you are human, you have a mind—and at some point, you will struggle with your mental health.
Medicine frequently emphasizes physical health because we can conceptualize it through physiology, anatomy, chemistry, pathology, imaging, and laboratory values.
Thoughts and emotions are harder to visualize.
We cannot simply place them on a slide and look at them under a microscope.
Yet the mental health of medical students and physicians is incredibly important.
Medical School Can Feel Like Being Thrown Into the Deep End
As medical students, we are immediately thrown into an environment where we must rapidly learn enormous amounts of information.
In a short period of time, we are expected to understand countless diagnoses, physiological pathways, biochemical pathways, medications, mechanisms of action, clinical presentations, and treatment algorithms.
It often feels like trying to "drink from a fire hose."
Then we are repeatedly tested, graded, and evaluated based on how quickly we can learn, retain, and apply that information.
That pressure can affect anyone.
YOU ARE NOT ALONE
Many of the struggles discussed throughout this post can directly affect mental health.
Academic challenges, financial stress, illness, disability, board examinations, relationship stress, and uncertainty about the future can all accumulate.
I want to emphasize:
YOU ARE NOT ALONE.
People may not always openly discuss what they are experiencing.
That does not mean they are not struggling.
This is part of being human.
When Emotions Become Overwhelming
Sometimes emotional distress shows up as sadness, anxiety, frustration, anger, irritability, exhaustion, or even apathy.
If we repeatedly push our emotions aside so that we can continue studying or caring for patients, eventually those feelings may become difficult to ignore.
Sometimes people begin wondering whether they want to continue medicine.
In more severe situations, someone may begin wondering whether they want to continue living.
Those thoughts deserve support.
Ask for Help Before You Reach a Crisis
If you begin developing thoughts about harming yourself, especially if you are developing a specific plan or feel that the thoughts are becoming difficult to control:
PLEASE TELL SOMEONE.
That person might be a friend, classmate, faculty member, therapist, physician, family member, mentor, or another person you trust.
You can also call or text 988 in the United States for the Suicide & Crisis Lifeline.
If there is an immediate emergency, call 911 or go to the nearest emergency department.
Asking for help can be incredibly difficult.
I know.
But you deserve support.
You have value outside of your academic performance.
More Mental Health Resources
Read my blog post:
"The Call of the Void — Suicidal Ideation"
Also check out my Mental Health Collection for support groups, books, podcasts, trauma-informed resources, and additional tools for supporting your mental health.
Taboo #2: Academic Challenges & Imposter Syndrome
Getting into medical school is HARD.
Once you arrive, however, you are suddenly surrounded by a classroom full of people who were also successful students.
That creates a completely different comparison group.
You may have spent years being one of the strongest students in your class.
Then suddenly:
Everyone was one of the strongest students in THEIR class.
You Do Not Need to Be the Top Student
There will be moments when you feel stupid, unworthy, behind, confused, or convinced that everyone else understands the material better than you.
Remember:
You were accepted for a reason.
If your medical school uses Pass/Fail grading, learn to become comfortable with passing.
You do NOT need to receive the highest score on every examination.
An "average" score in medical school is still the average among an incredibly accomplished group of students.
Ask for Academic Help EARLY
If you are struggling with material, chances are other students are struggling too.
Reach out to classmates, upperclassmen, professors, academic advisors, tutors, and mentors.
Many schools have free tutoring or academic-support programs.
ASK ABOUT THEM.
Do not wait until after you fail an examination to find out what resources were available to you.
Medical School Study Resources
There are SO MANY resources available.
You do not need all of them.
Different resources may work better during different blocks.
Common resources include Boards & Beyond, Osmosis, AMBOSS, OnlineMedEd, Histology Guide, Sketchy Medical, Pixorize, Picmonic, University of Michigan Anatomy resources, UMich Heart Sounds, Anki, DermNet, Pathoma, and specialty-specific resources.
Some are free.
Others can become extremely expensive.
Your school may provide subscriptions, so always ask before purchasing everything yourself.
Taboo #3: Failing Quizzes, Exams, Courses, & STEP
I hate the word:
"Failing."
In most situations, it simply means you did not reach the minimum score established by your school or testing organization on that attempt.
It does NOT automatically mean you are unintelligent or incapable of becoming a physician.
Q: What Happens if You Fail a Quiz or Exam?
At many schools, one failed quiz or exam does not automatically mean you failed the entire course.
Your school may require you to meet with an academic advisor to review:
Your study strategy, available resources, tutoring, testing difficulties, health concerns, or other factors affecting your performance.
Use that meeting.
Ask for help.
Q: What Happens if You Fail a Final or Summative Exam?
This varies substantially by school.
At my medical school, students could sometimes remediate an examination during a school break or another designated period.
That might require setting aside one or two weeks specifically for remediation.
Students may also receive tutoring and additional academic support.
If your remediation date arrives and you genuinely are not prepared:
Talk with your academic advisor.
Ask about your options.
Do not simply assume you must take the examination because a date was initially selected.
Repeated Academic Failures Can Have Larger Consequences
Depending on your school, repeated course failures may eventually require:
Additional remediation, repeating a course, repeating a semester, repeating a year, meeting with an academic board, or taking a Leave of Absence.
Again:
KNOW YOUR SCHOOL'S POLICIES.
Do not assume that what happened at my school will be identical at yours.
USMLE Step 1
Historically, many medical students have taken Step 1 around the transition between preclinical and clinical training, although exact timing differs by school.
At my medical school, students received UWorld during M2 and later entered a dedicated Step 1 study period.
Some students used UWorld throughout M2.
Others waited until dedicated.
My school also had additional tutoring and NBME practice-exam resources available—but students often needed to ASK for them.
Do Not Take Step Simply Because the Calendar Says You Should
One of the biggest lessons I learned after failing Step 1 twice was:
Your PRACTICE SCORES need to demonstrate that you are ready.
If you are not consistently passing multiple practice examinations, seriously discuss delaying the examination with your academic advisors.
Extending your study period may create logistical challenges.
But failing the examination can create much larger ones.
I Failed Step 1 Twice and Still Matched
I ultimately matched into my top specialty despite two Step 1 failures.
I also know other medical students who successfully matched after academic and board-exam setbacks.
A board failure can absolutely make residency applications more difficult.
But:
More difficult does NOT mean impossible.
Read my Doximity article:
"I Failed Step 1 by 1 Point"
Also see:
"Lessons Learned From Failing Step 1: A Comprehensive Guide"
Taboo #4: Disability Accommodations & Accessibility
Medical schools and standardized testing organizations have processes for requesting disability accommodations.
Unfortunately, students may not always know these resources exist.
I did not learn that I could apply for accommodations until after more than two years of medical school, academic struggles, and a Step 1 failure.
That experience completely changed how I thought about accessibility.
Q: Should I Talk to My School About Accommodations?
Consider contacting your school's disability or accommodations office if you experience functional difficulties such as:
Not finishing examinations within the allotted time, needing medically necessary breaks, significant testing anxiety related to a diagnosed condition, physical or mental health disabilities, learning disabilities, ADHD, anxiety, depression, PTSD, difficulty focusing during examinations, needing time for therapy or medical appointments, lactation needs, needing privacy for medications or injections, requiring a lower-distraction testing environment, difficulty standing for prolonged periods, an injury or illness affecting academics, or other disability-related barriers.
That list is NOT exhaustive.
You do not need to diagnose yourself.
Talk with the appropriate accessibility professional about your circumstances.
Accommodations Are About Access
Potential accommodations vary depending on the individual's functional limitations.
They might involve additional testing time, additional break time, a reduced-distraction environment, seating modifications, schedule flexibility, access to medical care, or other individualized supports.
Receiving accommodations does not mean someone has an unfair advantage.
The purpose is ACCESS.
My Disability Accommodation Resources
You can read more about my experience in:
KevinMD: "Requesting Disability Accommodations in Medical School"
"Living With Chronic Medical Conditions as a Clinical Medical Student"
"Requesting Disability Accommodations in Medical School"
Also check out Docs With Disabilities resources and my MedPsychMoss Disability Resources.
Taking Care of Your Health Matters Even Without Formal Accommodations
Even if you do not identify as disabled or never receive formal accommodations:
You still need time to take care of your health.
Medical students are human beings.
You still need sleep, food, healthcare, therapy, medication, relationships, movement, rest, and recovery.
Ignoring those needs does not make you a stronger physician.
Taboo #5: Taking a Leave of Absence From Medical School
A Leave of Absence can occur for many different reasons.
The terminology varies by medical school.
At my institution, leaves were generally categorized based on whether the school required/recommended the leave or whether the student voluntarily requested it.
Always review YOUR school's current policy.
School-Required or Academic Leave
A school may require or strongly recommend a leave because of circumstances such as:
Repeated academic failures, needing to repeat significant coursework, additional board-exam preparation, or other academic progression requirements.
Residency programs may ask about interruptions or extensions in medical education, so understand how your leave will appear in your academic records.
Personal or Voluntary Leave
Students may voluntarily take time away for:
Physical health, mental health, disability, family responsibilities, burnout, research, professional opportunities, board preparation, or simply needing additional time.
You may later need to explain an extension or interruption in your medical education during residency applications.
That does not mean you need to disclose every private medical detail.
Q: What Should You Consider Before Taking an LOA?
Before taking a Leave of Absence, consider:
How will you pay for living expenses?
What happens to your student loans?
How will you maintain health insurance?
Will you retain access to campus, tutoring, libraries, and academic resources?
Do you qualify for local, state, or federal assistance?
Will you need to work?
Will you need to move?
Are there students at your school who previously took an LOA?
How will you emotionally handle watching your classmates continue without you?
What will you need before you are ready to return?
These issues can matter just as much as the academic reason for taking time away.
Find Other Students Who Have Taken an LOA
One of the most helpful things I did was connect with other students who had also taken time away.
At my medical school, we eventually created a GroupMe for students who were currently on or had previously taken a Leave of Absence.
Knowing other people had experienced similar challenges dramatically reduced the isolation.
More About My Leave of Absence
Read:
"The Decision Whether to Extend My Leave of Absence 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"
Taboo #6: The Financial Reality of Medical School
Money is one of the least openly discussed parts of medical education.
Students enter medical school from dramatically different financial backgrounds.
Some students receive substantial family support.
Others are entirely dependent on loans.
Some enter with undergraduate debt.
Others begin medical school debt-free.
Those differences affect the medical school experience.
Medical School Costs More Than Tuition
Tuition is only one part of the expense.
Students may also need to pay for housing, utilities, transportation, food, health insurance, medical care, clothing, board examinations, residency applications, travel, technology, study resources, licensing requirements, and moving expenses.
Those costs accumulate quickly.
The Hidden Cost of Academic Resources
Students are often expected to purchase educational resources outside their tuition.
These may include Sketchy, Pixorize, Boards & Beyond, AMBOSS, Pathoma, Complete Anatomy, First Aid, UWorld, Anki-related tools, question banks, tutoring, and other specialty resources.
Not every student can simply place hundreds or thousands of dollars of educational resources on a credit card.
That creates another inequity within medical education.
Paying for Tutoring
Some students also pay privately for tutoring, especially for board examinations.
Because I experienced academic difficulties and repeatedly scored in lower percentiles, my medical school eventually provided upper-level student tutoring at no additional cost to me.
Again:
ASK what your school offers before assuming you need to pay privately.
Medical School Financial Resources to Ask About
Contact your Financial Aid Office and ask whether your Cost of Attendance or living allowance can be adjusted for eligible expenses.
Depending on your school and circumstances, this may include expenses such as:
Computer or tablet purchases, required educational costs, medical expenses, insurance costs, transportation, or certain travel expenses.
Every school has different policies.
ASK.
Other Financial Resources
Depending on eligibility and location, students may also explore SNAP, food banks, community food programs, utility assistance, WIC for eligible pregnant/postpartum individuals and young children, local nonprofit organizations, and other community support programs.
Examples I have used or recommended include food banks, Lasagna Love, utility-assistance programs, and other local resources.
Eligibility requirements vary, so check current guidelines.
Socioeconomic Status Affects Medical Education
Medical education does not financially affect every student equally.
Students from lower-income families may have less ability to rely on parents for:
Tuition, rent, emergencies, food, board-exam expenses, tutoring, technology, application fees, or unexpected healthcare costs.
That can affect academic performance and wellbeing.
It is incredibly difficult to study for an examination while simultaneously worrying about whether you can afford rent or groceries.
These are not separate problems.
They are part of the educational environment.
Your Financial Struggles Are Not a Personal Failure
If you need loans, food assistance, financial aid, community resources, or employment to survive medical school:
That does not mean you don't belong.
Medical school was built around assumptions that do not reflect every student's financial circumstances.
Use the resources available to you.
Ask questions.
Talk to Financial Aid.
Talk to upperclassmen.
And do not be ashamed of needing support.
Final Thoughts: Medical School Is Hard Enough Without Silence
Mental health, academic struggles, exam failures, disabilities, Leaves of Absence, and financial insecurity are all real parts of medical education.
Yet students often experience them quietly because everyone else appears to be succeeding.
Remember:
You are usually only seeing the parts of people's lives they choose to show you.
The student sitting beside you may also be struggling.
The upperclassman you admire may have remediated an examination.
The resident teaching you may have needed accommodations.
The physician you respect may have taken a Leave of Absence.
And the person who appears completely confident may still experience imposter syndrome.
Medical training does not require perfection.
Ask for help.
Use your resources.
Take care of your health.
And remember:
YOU DESERVE TO BE HERE.
More Resources From Dr. Moss
Check out my blog posts, "Medical School With Dr. Moss" content, and "Life as a Patient-Doctor" Podcast for more information about medical education, disability, mental health, academic challenges, residency applications, and the hidden curriculum of medicine.
If there is another medical school topic you want me to discuss, send me a message.
You can also sign up for my monthly newsletter for educational events, trauma-informed resources, new blog posts, and other medical education resources.
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