Planning

Pre-Med Timeline: Year by Year

What the Wisest Students Knew Before You Did

Sitting in the library on a random September Tuesday is a pre-med freshman, who makes the simple decision to figure out the serious stuff later. Four years is a long time. The pre-med isn't lazy or careless, just doing exactly what human beings have always done with time that feels indefinite: spending it as though someone will give more.

The oldest wisdom in the world is about the assumption that there is time later. But later never happens. The "later" of today will become the present, and today will become the past, but later will still be later.

Thousands of students have walked this road before you and left notes in the margins. They post on Reddit, late at night, after something has gone wrong. And the pattern in those posts is the wisdom of the ages. In the late-night moments of regret, many realized the real timeline had started two years before they thought it did.

The most common regret in premed communities is not "I studied the wrong things." It is "I protected my GPA too late." The second most common is "I had no plan when junior year arrived."

We did a TOPmed thing, we analyzed over 1000 Reddit and SDN posts looking for regrets. We call them the Threads of Regret. There is a speech that Charlie Munger gave in 1986, the contents of which were simply brilliant. Munger laid out a step-by-step guide to have a miserable life. This speech inspired the question of what would guarantee a pre-med student to be miserable/not make it, and further the analysis.

286 posts said the same thing: protect the GPA early and do not let activities crowd out the thing that is hardest to rebuild, GPA. The dominant answer, repeated across years and cycles and schools, by students who had already learned the hard way.

The ancient teachers called this something like wisdom: the knowledge of seasons, of right timing, of what belongs to each moment. The Teacher told me: there is a time for every purpose under heaven. A time to plant. A time to build. The students who made it understood, perhaps without naming it, that each year of college is its own season with its own work. Miss the season, and the harvest shifts.

Freshman Year: The Foundation Nobody Wants to Hear About

You are being asked to do something deeply counterintuitive: Not do a lot, but you have done nothing, and you need to do things.

Your GPA is most vulnerable right now, when you feel the least pressure. The research, the clinical hours, the relationships with professors, the letters of recommendation: none of them exists, or matter yet. Everything has its own time. And the students who later write the regret threads on Reddit had the same feeling you do right now. They felt fine because they hadn't realized or experienced yet what was to come.

The best freshman year should not be the most impressive on paper. You're not trying to win a Nobel prize for your freshman year. What you need is a firm foundation that's durable and a simple plan. In practical terms: strong grades, early contact with a pre-health advisor, one activity you can sustain for years*, and a simple record of what you are doing. The moments that will become your essays are happening now, and you will not remember them unless you write them down.

The simple plan that you need as a freshman needs to include: Planning your classes, a minimum GPA (median of your desired school), when you will take your MCAT, what you are going to do for clinical work, what you are going to do for volunteer work, and what you are going to do for research. And these don't need to be meticulous plans; you need to think about it and figure out what you like, but always leave room to be amazed.

Threads of Regret wished they had kept records of their experiences. Keep a record of your experiences, because years later, it will be nearly impossible to remember when, with whom, and the moments that actually build stories.

Do few things. Do them well. That is the whole secret of freshman year.

*(It's fine to be in multiple clubs, you could register for 100s, you don't have to go to any of those meetings, you can be on their emailing list and don't even have to read the emails. As you pick clubs, you want to ask 3 questions in order of importance from most to least: 1) Can I serve others through this organization? 2) Am I willing to do the work? 3) Can I grow my responsibilities?) (I recommend everyone's first activity to be heavily service-based.)

Sophomore Year: When Curiosity Must Become a Plan

Sophomore year begins the day after you finish freshman year. The Sophomore summer is a very special summer. This is the time to work at a clinical job, you could be a CNA, Laboratory Assistant, Patient Transport, etc. You could also research and get a research internship at your Uni or another through different national programs. This summer must, must, must include shadowing* a Physician or 3, as much as you can get. As you are involved, remember to record what you did, when and with whom. If you don't, to your surprise, the medical school application asks all of that.

When class time swings around, do 2 things: refine your plan and execute. You should have a general plan; now you need to start cutting portions out and adding new portions in. An involvement is not what you thought; drop it and pivot. A class is requiring more work than you thought, and the org you joined also needs your time, tell the truth and protect your GPA. This is the year to take a decent amount of your coursework, deepen your involvement, and move up the org food chain.

The spring semester is important; this is when you think about the upcoming summer. Various research, medical or other internship applications open and close in this window. So figure out what you want to do, apply for it, and do it if you get it; if not, pivot.

For a successful Sophomore year, remember: It's okay to drop things or add. Keep refining, keep growing.

*(When you shadow remember HIPAA. Don't do dumb things, dress well, smile. Don't touch things; this is so you don't ruin sterile fields. Ask the doctor questions. If the doctor allows you to talk to the patient, shake hands, smile, introduce yourself, and remember it's not that deep, just have a simple conversation.)

Junior Year: Where Hidden Problems Stop Being Hidden

Junior year is the great reckoning.

The students who planned simple and executed well will have a good Junior year. The students who intended to get organized later are now in a different kind of conversation with themselves, because junior year is when a rushed MCAT, a weak transcript, and an underdeveloped application can all arrive at the same time.

The Threads of Regret cry: If you have low clinical involvement, lack of research, and lack of meaningful volunteer roles (they say meaningful and not many, important point to keep in mind), you can't catch up. If you started pre-med as a freshman and waited until junior year to start building these lanes (WHY!?) while also protecting your GPA, studying for the MCAT, and managing everything else, it's going to be near impossible. Many discover that they need a gap year. A gap year is perfectly fine; it's the new normal. About 75% of pre-meds take at least one gap year. So if you struggle with the thought of a gap year, remember you will not care after a 30-to 40-year-long career if you took a gap year. Be ready, not reckless!

If you have been planning since your freshman year, this is when you get into a groove. Add one new thing if you want, but you have established everything in your sophomore year, so just keep doing it. If you want to start medical school right after uni, you need to take your MCAT soon, we're talking the spring of your junior year, the MCAT window is open January-September. Applications open at the beginning of May, and submission opens in early June. Applying earlier is better, but you need to be ready; the best way to balance those two things is to start earlier.

Todo for Junior year:

Protect your GPA
Study for MCAT
Start thinking about why you wanted to be a doctor
In February, put your thoughts into words
Work on the application
3 months before applying, ask for Letters of Recommendation
Take your MCAT
Apply
Take the PREview or CASPER*
Do Secondaries quickly

*(The PREview and CASPER are required by some schools; check if any of your schools require them. If they do, you will have to take it. They are ethical and cultural competency tests. Don't stress too much, but practice a bit. PREview is multiple choice. CASPER has a video recording of you answering questions.)

Senior Year: Learning Whether It Added Up

Senior year is fun; it's your last year of undergrad. Remember to finish your classwork strong. If you are in the application process: submit secondaries, prepare for your interviews. No matter the outcome, enjoy your time, spend it with family and friends. Continue your activities; you shouldn't start any new ones, and if/when you get your acceptance, dance! You made it!

The Threads of Regret have said applying in their senior year is manageable but chaotic, especially when secondary applications and interview weekends stack against coursework. One post described tracking fifteen interview weekends in a single semester. There is a secret to this…

The secrets are:

Do your primary application early.
Do your secondaries quickly and well; you can even start before you get secondaries.
Interview prep before you even get invited for an interview.
When invited for an Interview, schedule for the earliest day possible.

All of the above happens if you planned and executed.

Gap Year: What the Wisest Students Eventually Say About It

A beautiful secret lies in the Threads of Regret: most people who took gap years describe them as clarifying, not defeating. They are full of relief. Students describe the extra year as the "first time the whole process felt sane", the first time they could study the MCAT without simultaneously protecting their GPA, building experiences, writing primary essays, and drafting secondaries. This sounds nice, and the reality is that some of the best doctors in the world had gap years.

The AAMC itself treats gap years as normal. Their timeline recommends seeking meaningful medical work or education during them. A gap year is a part of the journey, and for many students, it is the right one, and a fun one.

The Summary That Took a Thousand Students to Learn

The ultimate lesson by the Threads of Regret is to plan simple and execute well.

In Munger fashion, if you want to miserably fail getting into medical school:

Have no plan. It's best to navigate the dark without light.
Forget your GPA exist, especially from freshman year until junior year.
Remember that when you fall, don't get up. It's the end.
Be involved in every activity ever.
Track nothing, keep no record of anything, and forget what you did.
Study for your MCAT without a plan.
Apply right before the window closes.
Do your secondaries right before they are due.
Just wing the interviews.
Ingest a lot of chemical substances (alcohol and drugs).

The teacher is right. There is a time for every purpose. The students who arrived at medical school had usually understood that the time to begin was always earlier than it felt, and the time to rush was never.