For most of this site’s readers, first year of med school is well in the past. You’ve moved on from the monotony of books and PowerPoints to the revelation of actual cases. You see the subtle connections between text and reality, develop pattern recognition, and learn how medicine actually works. If you entered medical school expecting to heal the world, your perspective these days is probably a bit more cynical. But no matter how distant those pre-clinical years may seem, you have an absolutely massive bank of anatomy, physiology, and pathophysiology knowledge. You worked hard to get where you are, and you’re a better healthcare provider for it.
Then there are those of us who come to med school not from college, but from other medical fields: often nursing and EMS. In our prior careers, we skipped the basic science of the pre-clinical years and…just kinda started doin’ stuff. In med school I’m given mounds of information to understand and memorize but am barely allowed to touch an actual patient; as a paramedic I was given six months of quasi-formal education before being expected to run a cardiac arrest, in a dark alley, while being nipped at by a gaggle of ferocious Chihuahuas.
For myself and many others, med school is a big step back followed by a colossal step forward. As a paramedic, I made decisions I won’t make again until well into residency. I’ve developed a good recognition of sick and not-sick, can make a couple diagnoses from the door, and know that medicine is a massive gray area. I’ve saved lives, but harmed a couple too. I’ve worked under some really great doctors, but also remember the time I had to walk a panicked attending through an RSI, or the time I had to convince a senior resident my patient was, indeed, suicidal (she came into the ER after taking an entire bottle of amitriptyline a week later). If EMS taught me anything at all it’s to trust my gut.
As a medical student, this skepticism has given me a bit of an independent streak. I often find myself straying from the curriculum, redefining what’s important to my eventual practice and what isn’t, and thinking about what patients—rather than their karyotypes—might actually look like given different pathologies. When we spend hours discussing pseudomembranous colitis but just minutes clarifying somatic vs visceral abdominal pain, I reprioritize. When I should be learning immunohistochemical markers, I’m instead buried in an EM text. On one hand, this probably isn’t great for my Step 1 prep. On the other, I think it’s best to correct my often-flawed autodidactic learnings from my paramedic days before they become set in too deep.
If med school has taught me anything, it’s how little I know. There’s definitely danger in learning medicine through naught but patient presentations and FOAMed. Eye-opening though these may be, clinical pearls can’t supplant knowledge of basic physiology. And, as paramedic education often neglects this foundation, it’s hard to know what information truly is important. You can’t find the answer if you don’t know to ask the question. As a former provider of sorts, discovering this startling knowledge gap gives me a drive to improve prehospital training and patient follow-up throughout my career. But as a medical student, I realize how privileged I am to have cared for and learned from so many patients before starting school. Approaching medicine with actual clinical context keeps me invested in my education, and reminds me that med school is, indeed, where I want to be. It’s a chance, I hope, to earn the trust that I used to take for granted.
MS2, University of Vermont College of Medicine
Paramedic, Denver Health and Hospital Authority