Greg Kirschen, Ph.D., returned to 
medical school earlier this year and is currently on his last clerkship block. Today he shares some of his pearls of wisdom from his trek through the MSTP over the years, aspects he found helpful during his transition back to medical school, and some information on what to expect on the last leg of the MSTP race. Greg received his Ph.D. in Molecular and Cellular Pharmacology researching with Shaoyu Gu, Ph.D. who is part of the Department of Neurobiology & Behavior.
How did you get back into the clinical/medical school mindset towards the end of your Ph.D.?
“I think it’s important to dust off some of your old study materials toward the end (last 3-6 months) of your PhD to get in the mindset. The biggest adjustment will be changing from reading journal articles and doing lab work to having to live, breathe, and study medicine constantly. Getting a head start by skimming through First Aid, buying UWorld for Step 2 and trying to do a few questions every few days (maybe 10 Q’s at a time, just to get back into it) could be helpful.”
How did you know it was the right time to go back to medical school?
“Someone once told me a joke:
When you start your PhD, you think your PI is a god. You’re ready to graduate once you realize your PI is an idiot.
While this is obviously sarcastic, I think there’s a seed of wisdom in it. Once you’re able to think critically on the level of your PI, design experiments that test your own independently generated hypotheses, interpret your data in a meaningful way and be able to communicate it intelligibly, you’re probably getting close to ready to graduate. This should hopefully correlate to a certain level of productivity in the lab (i.e. at least one first-author manuscript that is at least submitted, if not in revision or accepted). There’s always more you can learn while in lab, but there comes a certain point when you realize you’re reaching the peak of what your dissertation work can do for you in terms of scientific growth, and that’s the time to start to talk to your thesis committee about graduation.”
What mentors or people around you helped with this transition?
“In my opinion, the best people to help you with the transition are the ones who just did it, that is to say, the people one class ahead of you. I had a “big sib” who I would meet with a few times a year to find out how things were going, what advice they had for me for the next stage, and what I should be doing to prepare for it. “
How did you go about choosing which clinical clerkship to start with?
“I think it’s probably a good idea to not start on the clerkship you think you might apply for, but honestly even if you do you’ll probably still be fine. I personally put what I thought I was interested in second, and it worked out well- by the time I was in my second rotation I felt pretty much on the same level as my classmates in terms of being an MS3.”
Did you use any specific resources during graduate school to keep fresh with medical knowledge?
“If you’re into podcasts—Emergency Medicine Cases by Dr. Anton Helman & The Curbsiders.
If you’re into journals—JAMA or NEJM (especially the clinical challenges).
If you’re into review books—First Aid, Case Files or Pretest for individual subjects.”
Did you engage in any medical activities during graduate school to keep connected to medical school/the medical community?
“I volunteered sporadically at SBHOME, which I thought was very helpful in keeping up my H&P skills which are easily lost during the grad school phase. I also went in about 1 weekend every couple of months to the hospital to work on the floors in a couple of the specialties I thought I’d be interested in. This worked out well because by the time I hit 3rd year, a lot of the residents and some of the attendings already knew me, which I felt put me at an advantage.”
How did you handle entering a new medical school class that you didn’t start with? Was it strange not knowing anyone in the class, exciting, or did already know people in the class?
“Luckily, the class I entered is awesome, very welcoming, easy to get along with, eager to help with catching up and sharing resources. Hopefully you’ll have the same experience. I was talking to one of my friends in the class I re-joined, and I said something like, ‘I remember back in my med school class…’ and I was quickly corrected— ‘Greg, this is your med school class.’”
What was the easiest thing to adjust to going back to the wards?
“Giving topic presentations (e.g. on rounds, for resident report) and researching the primary literature. The PhD prepares you well for this given the innumerable presentations we have to give and the experience we have in literature review and summarize it clearly and accurately.”
What was the hardest thing to adjust to going back to the wards?
“Being a med student again- having to wake up early, constantly study, and adjust to different attendings with different sets of expectations nearly every week. After working with the same handful of people for 4 years, now you’re working with new people every week.”
What similarities or differences did you look for in clinical mentors versus research mentors when you transitioned back to medical school?
“Patient, invested in our education, the type of person who you want to be like when you grow up!”
Has there been activities that were important enough to you during graduate school that you felt important to keep up upon going back to medical school? If so, how did you manage and what advice would you suggest keeping important activities in your life during clerkships?
“Exercise—I somehow manage to do it nearly every single day even in MS3. As an MS3, you get to pick 1 activity that you can continue to juggle alongside clerkships. Choose wisely.”
How did you manage to adjust to taking shelf exams (after presumably not taking written exams for years during graduate school)?
“Having taken Step 1 is a huge advantage, even though it feels like eons ago. The fact that we have the endurance and experience that comes from studying for and taking Step 1 makes Shelf exams not so bad, especially after your 1st one, for which you may be a little rusty.”
Did you have an idea of a specialty you wanted to go into before returning to medical school? If so, how did this come about and what were things you did to foster this during graduate school?
“I wasn’t sure, but I had an idea. I think it’s a good idea to shadow or get involved in some side project in the department you’re interested in, if you know at this point. If you don’t know, that’s totally fine. A lot of people change their minds during 3rd year.”
Any advice on the med school to grad school transition?
“Make sure you find a PI you get along with and who has your best interests at heart. That’s more important than the topic of your dissertation.”
How do you think getting the Ph.D. has helped you in the clinic and why is it important to you?
“Being older than your cohort of med students, and probably older than some of your residents, you have a certain amount of perspective and you tend to see ways that you can help as part of the treatment team that others will not.”
Have you ever found yourself having to explain to a patient or an attending why you got a Ph.D. or why it was important to you?
“No, usually they’re either impressed and want to hear about what you did, or indifferent. They might expect you to be able to rattle off drugs and receptor names or biochemical pathways which you likely won’t be able to do.”
Are there any good books you would recommend before going back to medical school?
“Still Alice by Lisa Genova, When Breath Becomes Air by Paul Kalanithi, and Brain on Fire by Susannah Cahalan.”
Are there any good movies you would recommend before going back to medical school?
“TV shows- Mystery Diagnosis, Untold Stories of the ER, and Animal Inside Me. Some of the cases from these will really stick in your brain, and when you see them on the floors, you’ll know what’s going on.”
What has been the most inspiring thing for you since going back to medical school?
“Getting to work with patients every day. It’s amazing.”
What would you say to students a few years younger than you, looking ahead on what to expect?
“Expect to work hard, expect that the knowledge you broke your back to obtain years ago is still in there, but you’ll have to brush off the cobwebs a lot. Expect to learn twice as much during MS3 year as you did during the first two years of med school. Expect to be tired after a long day in the hospital or the clinic. Expect to start feeling like a physician once you realize you can apply your medical knowledge to the patient in front of you and listen to them, support them, and counsel them in their time of need.”