During my gap years, I didn’t have an issue sitting down and studying every day. That level of discipline made me feel like I was getting closer to my dream. The hard part was feeling like I was stuck, while everyone else was moving on with their lives.

My friends from college bought their first houses, got real jobs, and got married. I lived in a basement and worked two minimum wage jobs for clinical exposure and a publication. Everything felt like a ball and chain, while my peers were getting a first-class ticket to the rest of their lives.

I worked as a physical therapy technician for three years. The pay was low and didn’t require my degree, but it got me experience working directly with patients. That was enough.

I was having Chipotle on my lunch break one day, and a guy I had gone to high school with walked in. He and a group of other erudite-looking dudes walked in wearing their button-downs and sunglasses. I looked down at my uniform, a polo and brown pants, and felt inferior. What’s more, I could see the optimism in the way they walked. They had it figured out, and they knew it.

I felt ridiculous. Like I was stuck in first, making a feeble attempt to roll my clunker uphill.

I kept working, and you already know that it paid off. That’s not the point. I want you to know that I have a deep, intimate knowledge of comparison mindset.

That comparison is even worse during gap years, my friends. Think about it. In undergrad, you technically have a job that’s directed at your goal. You can say the same about med school and residency. You’re on the train.

Those years are the absolute worst for comparison mindset.

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Nuggets of Advice

If I could go back and talk to my stressed-out 22-year-old self, I would have a few words of wisdom to give him:

1. Enjoy this time while you have it. It will be another 8 years before you finish, so fill this time with things that make you happy.

2. Keep at the things that fill your cup. For me, that was drawing, playing guitar, and learning new languages. I wish I had kept those hobbies through residency, but they withered away while I focused most of my energy on learning and working.

3. Start meditating and doing yoga. Now. If I had started a mindfulness practice before getting to med school, I might have circumvented the panic attacks that landed me a psych diagnosis and a few urgent care visits.

In Closing

It’s cliché, but do the things that build you up in this time, while you still have it. Build a healthy inner narrative. Strengthen your body. Eat well. Find a spiritual practice. Those things will make you stronger in the present and will make you impervious to comparison. They’ll even give you a deeper reserve for the hard years that lie ahead.

Best of luck, everyone. If this resonated, please subscribe and share it with a friend who could use it. If you’re struggling, please don’t hesitate to reach out with questions. I read every message.

Cheers,

Dr. Joe Klaus

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Welcome back to the Pre-Med Foundation, where we’ll explore the common psychological challenges of striving to become a physician. Last week, we discussed a mindset shift for those of you feeling out of place in a healthcare setting. This week, we’ll go over some practical tips on standing out while you shadow physicians. Cheers!

Shadowing is essential for every pre-med. I don’t just mean for your application, either. You need to see as much as possible before making one of the biggest decisions of your life. I like to think that picking a specialty is up there with choosing a spouse.

Med school will put you through the big ones: Family, Internal Med, Surgery, Psych, Neuro, Peds, and OB. Many students complain that they don’t get to see enough before making the big decision. Shadowing will get you the exposure that you need before the heat is on.

How to Stand Out as a Shadow

As an attending, I’ve had a number of students shadow me in the operating room. It’s wonderful to see their eyes light up when they witness their first induction, intubation, or spinal injection.

For many, it’s also their first in-person experience seeing a surgeon delicately traverse a patient’s anatomy. It really is magical, and it brings me back to what it was like when I was doing the shadowing myself.

There are things that make certain students stand out, and there are little things I know that make others feel out of place. I’ve been there — and not too terribly long ago, either.

My hope is to foster the habits that will make your shadowing experience productive and memorable, while creating space for the things you might be too embarrassed to ask about.

If you're a pre-med navigating the path to medicine, The Pre-Med Foundation was made for you. Subscribe below. Every piece is free and has been written from the other side of the journey.

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Move from “I Don’t Know Anything” to “I’m Curious About Everything”

This is an important mindset shift for any stage of your career. The first is a posture of defeat. The second is one of engagement.

Some call this the mindset of a five-year-old. A five-year-old is curious about everything, and shamelessly asks questions. You’re not expected to know how to intubate or read an EKG on day one. But wouldn’t you like to learn about it during your time with us?

As a shadow in the OR, your curiosity is the most visible thing that we can see of you. That curiosity is also contagious. Ask thoughtful questions when the moment is right. Notice things. Wonder out loud. The students who stand out aren’t the ones with the most knowledge; they’re the ones who are most alive to what’s happening around them.

Set The Tone Before You Even Walk in The Door

Before your shadowing begins, send your supervisor a short note outlining what you hope to gain from the experience. Think of it as making your own syllabus.

Ask them which diagnoses and procedures are key to their specialty so you can get a real picture of what they do. Frame it as a checklist of experiences. It gives your supervisor a tangible way to engage with your learning, and it gives you both a satisfying sense of progress as you move through it. Who doesn’t love the feeling of checking something off?

If you’re considering asking this clinician for a letter of recommendation, it’s a good idea to say that up front. If your request is made in writing, along with a wish list of clinical scenarios, even better. This will save you the pressured, last-minute request on the last day of your rotation. It will also prompt the clinician to consider what they might include in their letter during your time together.

Maintain Situational Awareness.

The clinical environment moves fast and has its own unspoken rhythm. Pay attention to where people are standing, when it’s appropriate to speak, and when silence is the right call. In the OR especially, there are moments of high focus where even a well-intentioned question is poorly timed. Knowing when to engage and when to observe will serve you for the rest of your career. And for the love of all that is holy, please don’t touch anything sterile. You don’t want to be the reason a scrub tech has to open a new surgical kit.

Ask How You Can Contribute.

This is less common, but you could ask if there are small tasks or research presentations that you can help with. You won’t always get a task, but asking changes how people perceive you.

I like to assign students an interesting medical problem to research. Perhaps a molecular/genetic problem that’s closer to their undergrad-level understanding so they can relate it to the real-world practice of anesthesia.

Build Your Own Database, One Day at a Time

Every day, pick one or two clinical scenarios, procedures, or diagnoses that came up and study them at home. Write them down somewhere. Over the course of a shadowing experience, you’ll accumulate a personal database of real cases that no textbook can replicate. When it comes time to write your personal statement or sit in an interview, you’ll have a reservoir of specific, vivid experiences to draw from.

In Closing

Shadowing isn’t just about logging hours. It’s your first real look at what a life in medicine actually feels like. Do as much of it as possible, and see as many specialties as you can.

In an upcoming article, we’ll create a system of self-inquiry that you can carry with you as you explore each specialty.

The Pre-Med Foundation is a weekly newsletter meant to help you navigate the stress of becoming a doctor. If you found this helpful, subscribe below, and the next article will land in your inbox.

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Welcome back to the Pre-Med Foundation, where we’ll explore the common psychological challenges of striving to become a physician. Last week, we discussed a foundational mindset: having faith in your vision. This week, we’ll discuss imposter syndrome as it applies to shadowing and just being new to the healthcare system. Cheers!

Introduction

The first days in a hospital can feel like arriving in a foreign country. All of life’s challenges that were so neatly tucked away come to greet you face-to-face. Medical jargon, hospital beds, and tubes coming from every orifice. Code blues. Intimidating nurses and doctors.

You quickly realize that there’s very little you can do to help, though you wish that you could.

If no one in your family has ever worn a white coat, that feeling is even more significant. There’s an edge of pride and panic. One of, “I’ll make my family proud,” and, “What the heck am I even doing here?”

A quick story to illustrate my point. My freshman year of high school, I tried out for the soccer team. Another kid pulled me aside and made it clear: the rest of them had been playing their whole lives. I was out of place, and he wanted me to know it.

Nobody ever said that to me in medicine. Not once. And yet, I felt it constantly.

Pre-Med Imposter Syndrome

Trying to break into the medical field can be frustrating as a pre-med. Your classmates studying for their RNs are given clinical rotations, while you study organic chemistry and molecular biology. Your clinical exposure is up to you, and it can feel daunting to even get your foot in the door.

You wear an inner title of future doctor, but in the clinical environment you have no training to help. It’s a tough dichotomy of seeing your future self saving lives while your current self stands on the sidelines.

Having clear responsibilities can help. That includes those of you working as scribes, MA’s, and paramedics. But what about the shadows? When your role is just to observe, it’s easy to feel like you don’t belong.

If you can relate to feeling out of place at your dream job, keep reading. The Pre-Med Foundation will tackle topics like this every week. Subscribe, and the next reflection will land in your inbox.

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It’s All About Resistance

In the early stages, the inner narrative tends to confuse unfamiliarity with not belonging. Even worse, we can start to believe that we look inadequate to everyone else. This is called internal resistance, where you do not fully accept what you are.

Once you can fully accept that you’re new and don’t know the answers to the attending’s questions on rounds, you’ll start to feel more comfortable in your own skin.

Remember this. Every attending was once a nervous pre-med standing in the corner, hoping not to be in the way. Every surgeon who operates with calm precision once had no clue where the IVC was.

A Three-Step Mindset Adjustment

1. Stop Trying to Impress

When I shadowed doctors, I worried constantly about standing out. It was exhausting. What I needed to understand was that my job was not to be impressive.

The purpose of shadowing is to learn. To see enough of medicine that you can picture yourself doing it. The knowledge, skills, and confidence come later. Once you shed that inner need to impress, you’ll start to relax. You can be yourself.

2. Lean Into Your Curiosity

If learning is your priority, then you cannot fail at being new. Your curiosity and interest are your most valuable assets.

When students shadow me in the OR, I love when they have questions about the job, medicine, and surgery. It’s fun to engage with a student who’s genuinely interested.

3. Accept Where You Are

The gap between where you are now and the physician you’d like to become is at least 7 years long. If you spend the entire time wishing you were finished, you’ll lose the value of the early stages: undifferentiated potential.

As a pre-med, you have time and energy. You can get exposure to every field without the pressure of having to choose a specialty for the match. You can be open without the early stages of burnout. The inner visionary can freely choose the specialty that makes your heart sing.

In Closing

Being new to the medical field can be intimidating. We’ve seen that most of the discomfort of being new comes from expecting more of yourself than you can realistically give as a pre-med.

You don’t need to know the various parts of human anatomy and physiology to stand out. Stay curious and engaged, and see where this journey leads you.

If this found you at the right moment, share it with someone who needs to hear it. And if you want more of the honest and unglamorous parts of the journey, subscribe below.

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On my first day of college, I had zero clue what would go on my application in three years. I walked in with a kind of naive optimism and the thought that I could just study hard and get in.

I didn’t know how to build a good application. I wasn’t accumulating publications before I could legally rent a car. Up to that point, I had worked as a landscaper and a grocery store clerk. Looking around at the other pre-meds, I felt like a mule next to a field of thoroughbreds. What was I to do?

For a long time, I assumed the other students had some hidden advantage that I lacked. Better schools. Better mentors. Better opportunities. Better connections.

Many of them certainly did.

The Numbers Game

As you already know, med school admissions are rigid and unromantic. There are boxes to check: good grades, a solid MCAT score, clinical exposure, volunteer work, and letters of recommendation. The formula isn’t a secret.

For me, there was a much more important factor that I needed to integrate first. I had to believe I belonged in medicine before having any validation.

The Pre-Med Foundation is for aspiring physicians who know the checklist by heart, but still struggle with uncertainty. If that's you, subscribe below. Every piece is free.

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My First Go

Fast forward to the end of my junior year. Based on my GPA and MCAT, most would have considered my belief that I could get into med school to be delusional. My advisor expressed her concerns, but I forged ahead anyway.

I applied to 15 DO schools, hoping they’d take me on a personality basis. I did have a compelling personal statement, but the reality was that no one bothered reading it with such low numbers.

I wasn’t getting in, and I knew it.

I had friends who also did poorly on the MCAT. It was such a humbling experience that some of them gave up. That never occurred to me as an option. I would try again.

Faith Without Evidence

Rejection was my wake-up call. During my gap years, I worked two jobs, took an MCAT prep course, published an article, and volunteered at Shock Trauma. My surroundings showed me a basement apartment and a life on hold. My vision showed me something else entirely.

Every single day, I envisioned myself making diagnoses, performing procedures, and saving lives. At some point while I was studying for the MCAT, I grew completely certain that my vision would become a reality. My commitment and effort had finally caught up with my vision. That certainty dropped into my heart. I stopped worrying about the test. I stopped perseverating over which experiences to list.

My MCAT score went up by 50%. That should give you an idea of how low it was to begin with. I rolled the dice again, this time applying to both MD and DO schools. I received my first interview offer at my desk in the research lab. My heart felt like it would erupt. I fell to my knees and thanked God. I would later be accepted to an MD school. The rest is written in my other newsletter, Medical Mindsets.

Who This Is For

If you’re scrolling through Student Doctor Network for validation, this is for you. After working with many pre-medical students, I have found several common worries. It’s never the workload. It’s usually about the uncertainty, comparison, and doubt. This mindset is a good place to start.

Having faith in your vision is the cornerstone.

From there, we’ll continue to build the foundation, one mindset or lesson at a time.

Next up in The Pre-Med Foundation: why feeling like an outsider doesn’t mean you don’t belong.

This is the first post in The Pre-Med Foundation, a newsletter intended for pre-medical students who feel overwhelmed by comparison, anxiety, and uncertainty. I’ve been there, and I hope these articles will help you on your journey.

-Dr. Joe Klaus

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