Surviving Your First Year of Med School: A Guide to Preliminary Surgery

Understanding Your Path: First Year of Med School and the Preliminary Surgery Track

The title of this article combines two milestones that often get blurred together: the first year of medical school (M1) and the idea of a preliminary surgery year. In reality, these are different phases:

• First year medical school (M1): Your initial preclinical year focused on basic sciences, anatomy, physiology, early clinical skills.
• Preliminary surgery year / prelim surgery residency: A PGY-1 internship in surgery after graduation from medical school, often one year only, used as a stepping stone to other specialties (like anesthesia, radiology, or neurology) or as a bridge to a categorical surgery position.

Why talk about them together?

Because if you’re even remotely considering a preliminary surgery residency later, the way you approach and survive your M1 year will shape:

• Your competitiveness
• Your resilience
• Your professional habits
• Your understanding of whether surgery (even prelim) fits you

This guide will focus on surviving first year of med school with a clear eye toward students who:

• Are interested in surgery, but not sure if they’ll do a full categorical general surgery path
• May ultimately pursue a preliminary surgery year as part of their training journey
• Want concrete M1 tips that set them up for both academic success now and residency success later

We’ll walk through how to thrive academically, build surgical exposure early, safeguard your mental health, and position yourself for a strong application to surgery or a prelim surgery residency when the time comes.

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Building a Strong Academic Foundation in M1

If you’re aiming for anything in the surgical space—even a prelim surgery residency—your first year medical school performance matters more than you might think. Even with pass/fail grading at many schools, your knowledge base, study habits, and USMLE preparation all begin here.

1. Know What “Success” Actually Means in M1

Surviving medical school is not about getting the highest possible score on every exam. For a surgery-oriented student, “success” in M1 usually involves:

• Consistently passing your courses with solid understanding
• Mastering core systems that matter for surgery: anatomy, physiology, pathology
• Building Step 1–relevant knowledge (even now that it’s pass/fail, programs still care about performance patterns and Step 2)
• Learning efficient, sustainable study habits you can maintain in M2 and beyond
• Beginning to understand the culture of surgery, without burning out trying to “be a surgeon” on day one

Ask yourself: “What do I want my M1 self to hand off to my future intern self?”
The answer should be: a solid brain, sustainable habits, and no major burnout or academic red flags.

2. Choosing Study Resources Strategically

M1 is where resource overload starts. You do not need every book or app. For surgery-minded students, focus on:

Core resources for preclinical success

• Lecture materials + syllabus: Still your primary source for exams.
• Anki (spaced repetition): Especially for:
  • Anatomy (nerves, vessels, muscles, spaces)
  • Pharmacology basics
  • Physiology and pathophysiology concepts
• A high-yield reference like:
  • Boards and Beyond (if your school uses USMLE-style integration)
  • Pathoma (once pathology begins)
  • A concise physiology or anatomy textbook you actually like

Surgery-relevant extras (optional, not mandatory in M1)

• A clinically oriented anatomy text (e.g., Moore’s Clinically Oriented Anatomy) for a deeper surgical understanding of structures.
• Occasional review of surgical anatomy videos (YouTube or institutional resources) to tie structures to OR relevance.

Actionable approach:

• Pick one primary video resource, one Anki deck strategy, your school materials, and stick with them for at least a block.
• Avoid constantly switching because “someone else said this is better.” Stability beats trendy.

3. Proven Study Framework for M1

Think of your week with three repeating cycles:

1. Pre-class preview (15–30 min per lecture)

   • Skim slides or notes.
   • Identify 2–3 big questions you want the lecture to answer.
   • This primes your brain, especially important for dense topics like neuroanatomy.

2. Active engagement during lecture

   • Take minimal notes—focus on:
     • What the lecturer emphasizes
     • What they say “you must know”
     • Real-world clinical examples (often tested)
   • If lectures aren’t mandatory and you study better alone, consider:
     • Watching at 1.25–1.5x speed later
     • But don’t fall more than 48 hours behind.

3. Post-lecture consolidation (same day if possible)

   • Do 15–25 Anki cards related to that material.
   • Write or sketch one-page summaries for complex topics (e.g., coagulation cascades, cardiac cycle).
   • Do 5–10 relevant practice questions 2–3 times per week (if your curriculum supports it).

This structure makes surviving medical school more predictable and reduces last-minute cram panic before block exams.

4. Early USMLE Mindset (Without Obsessing)

Even if Step 1 is pass/fail, the habits you form in M1 set you up for:

• Efficient Step 1 review in M2
• Strong Step 2 performance (which now carries more weight)

Actionable M1 tips for boards:

• Once per week, do:
  • 5–10 USMLE-style questions on topics you’ve already covered.
  • Focus on learning from explanations, not your score.
• Maintain discipline with Anki for:
  • Biochemistry pathways
  • Immunology basics
  • Microbiology frameworks

You are not trying to “crush boards” in M1—you are trying to build fluency with question styles and strengthen recall.

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Gaining Surgical Exposure Early (Without Overcommitting)

If you’re considering a prelim surgery residency or surgery-adjacent specialty, M1 is an ideal time to explore without yet having your entire identity tied to surgery.

1. Understanding the Role of a Preliminary Surgery Year

A preliminary surgery year is:

• A non-categorical PGY-1 surgical internship
• Often done by:
  • Future anesthesiologists, radiologists, ophthalmologists, etc., who match into advanced positions requiring a prelim year
  • Applicants reapplying to a different specialty who need solid clinical experience
  • Candidates hoping to convert into a categorical surgery slot later

Why this matters in M1:

• Knowing this path exists can relieve pressure. You don’t have to commit now to five years of categorical general surgery.
• It helps shape decisions about:
  • Research (surgical vs general)
  • Mentorship (surgical vs medicine vs undecided)
  • How strongly you pursue surgical experiences.

2. Low-Risk Ways to Explore Surgery in M1

You do not need to live in the OR in M1, but structured exposure is valuable.

Examples of sustainable exploration:

• Surgical interest group:
  • Attend talks on “A Day in the Life of a Surgery Resident” or “What is a Preliminary Surgery Year?”
  • Participate in basic suturing workshops.
• Shadowing:
  • 1 half-day every 2–4 weeks in the OR with:
    • General surgeons
    • Trauma/acute care surgery
    • Surgical subspecialties (orthopedic, ENT, vascular)
• Anatomy lab with a surgical mindset:
  • When dissecting, think: “How would a surgeon approach this region?”
  • Ask anatomy faculty or visiting surgeons to explain clinical correlations.

Signs surgery may fit you:

• You’re energized by controlled chaos and time pressure.
• You enjoy working with your hands and visual-spatial tasks.
• You like clear, immediate feedback and are okay with hierarchy.
• You’re willing to tolerate long hours if the work feels meaningful.

None of this is a contract. M1 is a trial period.

3. Building Relationships with Surgeons Early

Your future letters of recommendation—even if for a prelim surgery residency—come from people who know you. Start planting seeds now.

Action steps:

• Identify one approachable surgeon through:
  • Surgical interest group events
  • Anatomy guest lecturers
  • Shadowing opportunities
• Send a short, respectful email:
  • Thank them for their talk or letting you shadow.
  • Express interest in learning about their career path.
  • Ask if you can meet for a brief 15–20 minute chat about their journey and any advice for an M1.

In that conversation:

• Ask how they chose surgery.
• Ask what they look for in good medical students and interns.
• Mention you’re exploring surgery and trying to build good habits in M1.

You’re not asking for a letter. You’re building long-term mentorship.

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Time Management, Systems, and Habits That Prevent Burnout

Surviving medical school—especially first year—depends heavily on your systems, not just your willpower. This becomes even more crucial if you ultimately choose a path that includes a preliminary surgery year, where the hours and expectations are intense.

1. Design Your Ideal Week (Then Adapt Realistically)

Instead of “trying harder,” create a template week and adjust:

Sample M1 surgery-curious weekly template

• Monday–Friday

  • 8:00–12:00: Class or lecture review
  • 12:00–1:00: Lunch + short walk
  • 1:00–3:00: Focused study (Anki + summary notes)
  • 3:00–4:00: Break, errands, or gym
  • 4:00–6:00: Practice questions or small group review
  • 6:00 onward: Dinner + personal time

• One afternoon every 2–4 weeks

  • OR shadowing or surgical interest group event

• Saturday

  • 3–5 hours of review of the week’s material
  • Catch up on any missed lectures

• Sunday

  • Light review only (1–2 hours)
  • Plan the upcoming week
  • Real rest (social time, hobbies, sleep)

This kind of routine echoes what you’ll need in a prelim surgery residency: structured work blocks, limited wasted time, intentional rest.

2. Protecting Sleep and Physical Health

If you picture a future intern year in surgery—prelim or categorical—you may be tempted to “train” yourself now by sacrificing sleep. That’s a mistake in M1.

Non-negotiables for first year medical school:

• Aim for 7–8 hours of sleep most nights.
• Move your body 3–4 times per week:
  • Even 20–30 minutes of walking, cycling, or simple strength training matters.
• Eat regular, balanced meals:
  • Eat something with protein at least twice a day.
  • Minimize the number of nights you replace dinner with only caffeine.

These habits are not luxuries—they are performance enhancers. The work of surviving medical school and later a prelim surgery residency is cognitive endurance; your body is the engine.

3. Avoid the Comparison Trap

M1 is where imposter syndrome thrives. Some classmates will:

• Use 10 different board resources
• Finish all lectures 2 weeks ahead
• Publicly talk about surgical research they’ve already started

This can become toxic quickly.

Reframe:

• Your job is to become a safe, competent future doctor.
• Programs value reliability, professionalism, and teachability as much as raw scores.
• Plenty of outstanding residents had average-looking M1 transcripts but superb patterns of improvement and clinical performance.

Ask weekly:

• Did I show up consistently?
• Did I learn something deeply, not just shallowly memorize it?
• Am I moving toward sustainable habits I could carry into intern year?

If the answer is yes, you’re on the right track.

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Mental Health, Resilience, and Knowing When to Ask for Help

The transition to first year medical school is psychologically intense. Add the identity pressures of thinking about surgery or a preliminary surgery residency, and it’s easy to feel overwhelmed.

1. Recognizing Normal Stress vs Concerning Distress

Common and normal in M1:

• Occasional anxiety before exams
• Feeling behind sometimes
• Wondering if you chose the right career
• Being tired during anatomy or heavy content blocks

More concerning signs:

• Persistent sleep disruption (insomnia or oversleeping)
• Loss of interest in things you previously enjoyed
• Worsening mood most days for >2 weeks
• Thoughts of self-harm or feeling that people would be better off without you
• Using alcohol or substances to cope with academic pressure

Surviving medical school means evolving from “I can handle it alone” to “I can recognize when I need help.”

2. Building a Support Network Early

You don’t need dozens of close friends, but you do need:

• 1–2 people in your class you can study and vent with.
• Someone outside of medicine (family, partner, old friend) who grounds you.
• Access to mental health support if needed:
  • Campus counseling
  • Student wellness center
  • Physician/trainee-specific mental health groups if available

Remember: surgical culture is changing. Good programs—including those with prelim surgery slots—are increasingly aware of burnout and value trainees who know how to seek help appropriately.

3. Allowing Your Interests to Evolve

You might start M1 thinking, “I’m 100% doing general surgery,” and end up choosing anesthesia with a preliminary surgery year. Or vice versa.

Give yourself permission to:

• Explore medicine, pediatrics, emergency medicine, radiology, etc.
• Admit if the lifestyle of surgery doesn’t match your long-term priorities.
• Stay open to partial surgical paths (e.g., prelim year followed by another advanced specialty, or surgical subspecialties with different call structures).

You are not “failing surgery” if you redirect. You’re practicing the clinical skill of reassessment on your own career.

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Positioning Yourself for Future Surgical or Prelim Surgery Opportunities

While M1 is not primarily about building a CV, some early steps can make you more competitive if you later decide to apply to prelim surgery residency or categorical surgery.

1. Academic Trajectory Matters More Than Perfection

Programs look at:

• Evidence you can handle a medical school curriculum
• Improvement across years (especially if M1 was rough but M2–M3 are strong)
• Step 2 CK performance
• For prelim surgery: reliability, work ethic, and fit with surgical workflow

What you can do in M1:

• Avoid course failures or professionalism concerns whenever possible.
• If you struggle:
  • Talk to your dean or academic support early.
  • Document your efforts to remediate and improve.
• Reflect on why you struggled (time management, health, learning disability, etc.) and address causes now, not in M4.

2. Research and Extracurriculars: Quality Over Volume

If you’re surgery-curious, research can help—but it does not need to fully define your M1.

Good M1 options:

• Joining a longitudinal research project with:
  • A surgeon
  • A surgical subspecialist
  • Or even a non-surgical physician if that’s where opportunity exists

Prioritize:

• A mentor who is responsive and supportive.
• Projects that have a realistic chance of:
  • Abstract/poster presentations
  • Potential publications down the line

Examples:

• Retrospective chart review on outcomes after a specific surgical intervention.
• Quality improvement projects in perioperative care.
• Educational research related to teaching procedural skills.

For those likely to pursue a prelim surgery year before another specialty, research in your ultimate specialty (e.g., radiology, anesthesiology) is also very valuable.

3. Professionalism and Reputation: Your Invisible CV

From M1 on, your professional behavior is quietly observed:

• Do you show up on time to small groups and labs?
• Are you respectful to staff, nurses, and classmates?
• Do you own your mistakes honestly?

Surgeons—and program directors for prelim surgery residency positions—value:

• Reliability
• Humility
• Team-mindedness
• Emotional stability under stress

M1 is a low-risk environment to practice:

• Admitting when you don’t know something
• Handling feedback without becoming defensive
• Balancing confidence with respect for hierarchy

Think of it as rehearsal for intern year, where those traits are under constant scrutiny.

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FAQs: Surviving M1 With a Future in Preliminary Surgery in Mind

1. Do I need to decide on surgery or a preliminary surgery year during first year medical school?
No. Use M1 to explore broadly. Get some exposure to surgery, but also rotate through other interest groups and shadow different specialties. A clear decision is more realistic around late M2 or during clinical rotations in M3. M1’s role is to build a strong academic and personal foundation, not to lock in your entire career.

2. How much surgical shadowing should I do in M1 if I’m interested in surgery or prelim surgery?
A reasonable target is one half-day every 2–4 weeks during lighter blocks, and less (or none) during heavy exam periods. That’s enough to build familiarity and relationships without harming your coursework. Remember: consistent exam performance and solid knowledge matter more at this stage than maximum OR time.

3. Does my M1 performance affect my chances of getting a prelim surgery residency later?
Indirectly, yes. Many schools have pass/fail, but patterns of performance, remediation needs, and your overall trajectory influence how advisors and deans describe you in MSPE letters. Strong M1 habits make M2 and Step 2 CK more manageable, and those later metrics are very important for both categorical and preliminary positions in surgery.

4. What if I struggle in first year—does that mean I can’t match into surgical fields or get a prelim surgery spot?
Not necessarily. Many successful residents had rocky starts in M1. What matters is:

• How quickly you recognize and address problems
• Whether there is clear upward trajectory in later years
• How you perform clinically and on Step 2 CK
  If you struggle, seek help early—academic support services, mentors, mental health resources. Programs respect applicants who have faced difficulty, learned from it, and improved.

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Surviving first year of med school while exploring surgery and keeping a preliminary surgery year on your radar is entirely achievable—if you approach M1 with structure, honesty, and flexibility. Focus on consistent learning, sustainable habits, and authentic exploration. The rest—whether you end up in categorical surgery, a prelim surgery residency leading to another specialty, or something entirely different—will build on the foundation you lay this year.