September 17, 2025
Written By
Michael Minh Le
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Four years of classes, rotations, exams, and somehow still finding time to be a human being. Everyone talks about how hard it is to get into medical school, but what about once you actually get in?
This blog gives you a clear picture of what that journey looks like on the inside. You’ll get a year-by-year breakdown of the medical school timeline: the format, what you’ll learn, what exams to prepare for, how your priorities shift every single year, and more.
And if you’re still not sure what it takes to get into med school to begin with, don’t just guess. At Premed Catalyst, we created a free resource that provides unlimited access to 8 real AMCAS that earned acceptances to top medical schools like UCLA and UCI. See what made these applicants stand out so you can avoid being average.
Get the free resource here.
Welcome to MS1: the year you trade your “premed” identity for your first white coat. It feels surreal until it doesn’t. One minute you’re standing at your white coat ceremony beaming with pride, and the next, you’re buried under lecture slides, unsure what just hit you.
This year is often called a baptism by fire because everything feels new: the language, the expectations, the pace. It’s not just the sheer amount of material. It’s learning how to process it quickly, while adjusting to a new role and a new way of thinking.
Here's what this year actually looks like.
Whether you’re at an MD or DO school, MS1 is mostly classroom-based. Heavy lectures, anatomy labs, and dissections dominate your schedule. Some schools run case-based learning, others are systems-based.
The format varies, but the rigor is universal. If you’re a DO student, Osteopathic Manipulative Medicine (OMM) lab is a regular part of your curriculum starting day one.
This year lays the groundwork. You’ll cover anatomy, physiology, biochemistry, embryology, and often get an early taste of pathology. You’re not treating patients yet. You’re learning the language of medicine. The acronyms, the pathways, the “normal” before you learn the “abnormal.” It's foundational, not glamorous, but essential.
Expect in-house block exams every few weeks, anatomy practicals, and occasional NBME-style assessments (especially at MD schools). There are no board exams yet, but make no mistake, you’re laying the foundation for Step 1 or COMLEX 1 starting now, the first licensing exams taken in MS2. They’re massive, full-day tests covering the basic sciences and their clinical applications.
Your first job: figure out how you learn. Whether that’s Anki, Boards resources like First Aid or Sketchy, or old-school notetaking, build a system now that you can refine later.
Explore interest groups, clubs, and research opportunities, but don’t overcommit. And be intentional about your summer. Plan something productive, whether it’s shadowing, research, or just strategic rest.
You will feel overwhelmed. Period.
That’s normal. You’re not behind. You’re just adjusting. Forget perfection and focus on momentum. No one expects you to become a fully independent doctor in year one.
If MS1 is the fire, MS2 is the pressure cooker. You’re still in the classroom, but now every lecture feels like it’s whispering one phrase in your ear: “Step 1 is coming.” This is the final preclinical year. It’s the last time you’ll sit in lectures before you’re tossed into hospitals and clinics.
Let’s break down more of what you can expect.
MS2 still lives in the classroom, but with more clinical focus. Think fewer lectures, more problem-solving, more small groups, and more simulated patient interactions.
DO students continue with regular OMM labs and are now preparing in full for COMLEX Level 1. For both MD and DO students, this is where the “pre” in preclinical starts to fade, and clinical thinking begins to take center stage.
This year is pathology, pharmacology, microbiology, and immunology — the heavy hitters of clinical reasoning. You’ll start to understand not just what goes wrong in the body, but why, how, and what to do about it.
This is the year you learn to think like a board question writer: "What’s the diagnosis?" "What’s the next best step?" Everything is building toward Step 1 or COMLEX 1.
If you’re an MD student, the big milestone is the USMLE Step 1. It’s now pass/fail, but programs still use it as a marker of how prepared and disciplined you are, especially when deciding who to interview.
If you’re a DO student, you’ll take COMLEX Level 1, a full-day exam structured similarly but with extra emphasis on osteopathic principles and OMM. Many DO students also sit for USMLE Step 1 to stay competitive for residency programs that are more familiar with that exam.
On top of that, most schools design their final exams to mimic board-style questions. That means even your in-house tests feel like practice boards, forcing you to think clinically rather than just recall facts. By the time spring hits, your schedule is dominated by UWorld blocks, Pathoma, Sketchy, Anki reviews, and practice exams. Board prep essentially becomes your second full-time job.
Your top priority is preparing for boards. By January, you should be layering in serious board prep — daily UWorld questions, dedicated time with First Aid, Pathoma, Sketchy, or your chosen resources. If you wait until April to start, you’ll be trying to learn hundreds of diseases, drugs, and mechanisms under crushing time pressure.
Plan your dedicated study period now and block it out like sacred time. And yes, start organizing your third-year schedule too.
Tunnel vision is real this year. Burnout creeps in when your identity becomes your UWorld stats or NBME practice scores.
You don’t survive MS2 with willpower. You survive it with systems. Structure your days, schedule breaks, automate decisions. It’s a hard year, but it’s also the last one before you step into the real world of medicine. Keep going. You’re almost there.
This is it: the moment you leave the classroom and step into hospitals, scrubs on, badge clipped, pager buzzing. MS3 is where you finally feel like a real medical student. You’re on your feet, six days a week, rotating through every corner of medicine. It’s thrilling, exhausting, and at times deeply humbling. But this is where you learn what medicine actually looks like.
MS3 is clinical rotations, full stop.
You're in hospitals and clinics six days a week. Mornings are spent pre-rounding, writing notes, presenting to attendings, and checking on your patients. Afternoons are consults, procedures, and teaching.
Evenings? That’s when you hit the books again to study for Shelf or COMAT exams, depending on your track. These are the standardized tests that cap off each core rotation — NBME Shelf exams for MD students and COMAT exams for DO students. Both are national, multiple-choice tests designed to make sure you’ve learned the key knowledge for that specialty (medicine, surgery, peds, psych, etc.).
You’re assigned to a team, and yes, you might even get your own pager. You’re part of the healthcare machine now.
This is your crash course in real-world medicine. You’ll rotate through Internal Medicine, Surgery, OB/GYN, Psychiatry, Pediatrics, Neurology, Family Medicine, and often Emergency Medicine. You’ll learn how doctors make decisions, lead under pressure, and manage complex patients. You’ll also start to figure out what you’re drawn to and what you’re definitely not.
Each core rotation ends with a major exam. MD students take Shelf exams, written by NBME. DO students take COMATs, and many begin preparing for COMLEX Level 2-CE and 2-PE. These exams test what you’re expected to have learned clinically, which means your nights and weekends are spent balancing real patient care with relentless studying.
Now’s the time to start thinking seriously about your specialty. Who inspires you? Which rotations energize you? Start identifying mentors and collecting strong evaluations and letters of recommendation. These will matter a lot in MS4.
And don't wait too long to start Step 2 CK / COMLEX 2 prep. With Step 1 being pass/fail, more weight is shifting toward the next board scores.
You will feel like a burden at first. That’s normal. You’ll fumble your presentations, forget to check labs, and maybe even get scolded by a resident who’s had no sleep. The key is this: keep showing up. Ask questions, take feedback seriously, and help the team in small but meaningful ways. No one expects you to be perfect. But they do expect humility, curiosity, and growth.
You’ve made it to the final year. But don’t let the lighter schedule fool you. MS4 is less about endurance and more about execution. This is the year everything counts.
The application, the interviews, the way you show up on rotations. You’ve spent three years building your knowledge; now you’re being evaluated on how well you use it. You’re not just a student anymore. You’re a professional in training, auditioning for your future team.
MS4 brings more flexibility: electives, Sub-Internships (Sub-Is), and away rotations at hospitals where you may want to match for residency. You finally have some control over your schedule, but with that freedom comes pressure. Every interaction, every eval, every impression could impact your residency placement.
This is where you hone your craft. On your Sub-I, you’ll be expected to manage patients with more independence. You’ll write orders, call consults, and follow cases like you’re the intern. Whether you’re headed into surgery, psych, or peds, this is your chance to sharpen skills in your target specialty. And while you’re mastering clinical tasks, you’ll also develop the real differentiators: communication, reliability, and resilience under pressure.
If you haven’t already taken it, Step 2 CK (for MDs) or COMLEX Level 2-CE / 2-PE (for DOs) is the big exam this year. Step 2 CK now carries more weight in residency decisions, so don’t brush it off.
There are no more Shelf exams, but in their place: interviews, application stress, and months of waiting. It’s a different kind of test now.
Everything revolves around the Electronic Residency Application Service. The application opens in September, and interviews run from October through January. Your rank list is due in February, and Match Day is in March. If all goes well, you’ll start residency on July 1.
In the meantime? Crush your Sub-Is, secure strong letters, stay organized with interview logistics, and don’t forget to take care of yourself. This year is a mental marathon.
This is the transition from student to colleague. The gap between MS3 and MS4 isn’t knowledge. It’s ownership. How you show up now matters. Patients, residents, attendings — they’re watching. Don’t coast.
Finish strong, stay grounded, and remember: you’re not preparing to be a med student anymore. You’re preparing to be someone’s doctor.
Medical school is hard, but so is getting in.
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