There are three major transitions that a typical medical student will go through on their way toward independent practice: (1) from the pre-clinical, largely didactic portion of medical school to the clinical years, (2) from medical student to resident in a specialty of interest, and (3) from resident to fully-fledged independent practitioner. While there will be individual differences, each transition represents a test of merit, medical acumen, and sheer endurance.

“Each of these transitions can be a highly demanding stage within a medical career and all are characterized by numerous challenging novelties ranging from unknown tasks in a new role with its accompanying responsibilities, to a new context and unfamiliar colleagues.” (From Transitions in Medical Education)

Advice on how to position oneself while going through these transitions is abundant. For the student in a dual MD/PhD or Medical Scientist Training Program, however, there are additional transitions that aren’t often addressed.

Below are the major transition points that I identified for myself as I have gone through my own training and bits of advice that I found helpful.

1. Starting medical school as an MD/PhD student

You are at the starting line of a 7+ year marathon. Your mindset is not unlike your fellow MD-only classmates; however, you know you need to find your PhD field-of-study.

What you are missing: broad medical knowledge

At this point, you do not have a strong fund of medical knowledge. You might not know what constitutes a truly interesting research question.

What you have on your side: purposeful curiosity

Maybe you have an idea of what you want to work on for your PhD training, or maybe you don’t (and that’s ok). What you have, however, is a drive to dig deep into the topics that you are learning about.

Advice: pay attention to what excites you most

Do not fear. By the end of your first year of medical school, you will close a significant portion of that knowledge gap. Identify your research interests by identifying what area of study draws you in. Confirm your research interests by seeking out appropriate mentors and identifying a project to work on that truly excites you.

2. Medical School to Graduate School

You found a lab to live in, you have an idea of what you want to do, and you are excited for some intellectual freedom.

What you are missing: momentum

You got the hang of medical school, you attained the grades you wanted, and you did well on Step 1. Sorry, none of that matters.

What you have on your side: time

Three to five years is a long time.

Advice: be unrelenting, work long hours

Three to five years will pass quickly. Formulate a plan early, and apply for grants. Grant writing early (and often, if required) is crucial because it forces you to be timeline-oriented. It’s ok if you do not receive funding — take the opportunity to refine your plan. Recognize that you will have new ideas and that your plan will change often (or things will simply not play out as expected). The way to counteract this is to consistently put in effort.

3. Graduate School to Medical School

You got your PhD and are exhausted from the intellectual grind. You might even be looking forward to having someone else set your schedule again.

What you are missing: broad medical knowledge

Use it or lose it. You spent your time as a graduate student thankful that you could focus on one area of inquiry that excited you. Each rotation during your clinical years may represent an area of knowledge that you lost.

What you have on your side: work experience, maturity

You can handle stress and respond to criticism (after all, you survived your thesis defense). You learned how to be independent when required.

Advice: you did it once, you can do it again

Fake it til’ you make it. You might not remember what the HACEK organisms are, but you know how to study and digest information. Your knowledge-base will come back, just be patient.

4. Medical School to Residency

You made it, you got your MD. The transition from medical student to being “the doctor” is very binary. One minute you have no responsibility, the next you are on the front lines and responsible for patient care.

What you are missing: specific medical knowledge

You were at the top of your game; you got your PhD and were deemed an expert in your field of study. You made it to residency and now you are at the bottom of the totem pole again. You have near-zero practical knowledge of what it means to be responsible for patient care.

What you have on your side: experience starting from scratch

Déjà vu. You started from the bottom in graduate school and you made it out with consistent, hard work.

Advice: embrace your ineptitude; the learning curve of practical knowledge is steep

Ask “what if” questions, ask for help when needed, be the self-starter that you know you are. Be humble; your PhD might lend you some nuggets of expertise here and there, but it does not lend you authority.

5. Special Considerations

When your former classmate is your boss

The first friends you made in medical have waved goodbye as they proceeded along their career paths. Your junior resident, senior resident, or even your attending may be an old pal. These scenarios will happen with some frequency. Do not abuse the special treatment that may be offered to you. Instead, recognize that this relationship represents an opportunity to learn from someone in a lower-stress environment.

When the kids seem sharper than you

Age is just a number, but you might find yourself surrounded by senior colleagues that are your generational-juniors. The lines of hierarchy may appear to blur at times, but never forget that these individuals know more than you at every stage of your training. They are your life-line, and not vice-versa.

In summary, work hard and go with the flow. In grad school, be timeline-oriented. Be self-aware, and understand that rigorous scientific inquiry will provide for you a unique skillset. Use your maturity to your advantage and always be humble.

David Kurland, MD, PhD was born and raised in Baltimore, MD and is currently a PGY-1 resident in the Department of Neurosurgery at the NYU School of Medicine in Manhattan. You can connect with him on Twitter and Instagram.