I write this blog in order to prepare premedical students for the road ahead. I want you to understand common obstacles facing medical students so you can be better prepared to overcome them. Medical training is akin to a roller coaster pulling you through the highest of highs and the lowest of lows. On the one hand, medical school is extremely challenging but rest assured, it is very tough to get dismissed from medical school. Plain and simple, most U.S. medical schools are extremely supportive and want you to succeed.

Students often get many chances to prove themselves before they are booted out of medical school. Despite this, the four-year graduation rate for MD students dropped from 96 percent in the 1990s to 81 percent in the 2009-2010 matriculating class. So, what is causing students to drop-out you ask? Here are five reasons why students drop out of medical school.

1. Unprepared or overconfident. No matter who you are, medical school comes with a steep learning curve. You can never be fully prepared for medical school but simply being prepared is good enough. Being underprepared or overconfident can be dangerous. By unprepared, I am not referring to academic challenges. Those who have made it this far have already proven they are academically gifted enough to succeed. Some students who struggle are unprepared in their expectations of medical school. A student who is easily distracted should not reside an hour away from school next to a nightclub. Do not tempt yourself like that. Students should not expect to sleep-in daily or be regulars at happy hour. One thing that sets unprepared and overconfident students apart is their failure to gather crucial information. Often times, these were students who were overly arrogant and felt that by asking questions they would show a sign of weakness. While other students know the big exam was moved to a different lecture hall, Mr./Ms. Unprepared will show up to the wrong hall and miss the exam.

As soon as that “acceptance” letter arrives in the mail, students should begin searching for housing, planning finances, understanding the curriculum and networking with other students. You don’t want to be dealing with these while med school has already started.

2. Family stress. A close friend of mine battled with this daily in medical school. Her husband was not very happy that she was studying late into the evenings. It saddened her terribly that she missed her daughter’s first day at school and then her dance recital. These things took a toll on her, and by our 3rd block, she called it quits. To this day, she still looks back and wonders “what if” she had stuck through and became a doctor but in the end, she feels she made the best decision at that time. There are others who unfortunately have loved ones fall sick during their schooling. Life is very unpredictable, and sometimes the decision to take a break makes sense, but hopefully, one will hang tough or return when they are ready.

When you get that “acceptance” letter, make sure to begin preparing your friends, significant other and family on what they can expect from you over the next four years.

3. Burned bridges. Be very careful with what you say and how you treat others (especially around a medical campus and on the internet). You can never judge a book by its cover. If you do, that book just may make life miserable for you. I still remember a buddy of mine who had a firecracker personality. I played basketball with this guy a few times a week. Let’s just say I witnessed a number of altercations between him and other medical students on the court. What many of the first-year students did not know was that this guy was a chief resident and in a few years, rose to a very high position in the medical school. When students make mistakes or perform poorly in medical school, a committee typically presides over their case. It would be very unfortunate if one of those committee members is someone that student has burned bridges with. In today’s global age, the medical community is tighter than ever. Therefore, there are only a few degrees of separation between everyone.

Once you get that acceptance letter make sure you stay on your best behavior. Remember, that person you are talking to could be your upper resident, faculty, or boss one day. Here is a hint for you during your interview trail. Be friendly to everyone because you do not know who you are engaging and who is watching you. While I took premeds on their interview tours, I made sure to speak to the dean about the students who I found to be friendly and especially those who were courteous with the nurses and the cleaning staff. Those to me were the team players.

4. Illness. This is one of the saddest reasons to say goodbye to a classmate. It feels as though everyone expects medical students and physicians to be supermen and superwomen. Well, it’s not so when it comes to being sick. As med students, you are exposed to many unique bugs. Med school also has a way of turning students into transient hypochondriacs as they learn about the pathophysiology behind diseases. Stressors may push susceptible individuals towards depression and substance abuse. In fact, a recent study showed that 27.2 percent of medical students had depression or symptoms of it and 15.7 percent sought psychiatric treatment. Schools are doing more these days to address this problem, but students must be bold enough to seek help before it gets too late.

Once you get that acceptance letter to medical school, make sure you see your doctor and do your best to get a clean health bill of health or learn coping strategies to deal with stress and adversity. Never be afraid to seek help.

5. Wrong career choice. Believe it or not, after spending years as a premed and matriculating into medical schools some students realize medicine is just not for them. Our first day dissecting cadavers in anatomy proved to be too much for a classmate of mine. She fainted and eventually gained consciousness only to see a room full of students and professors surrounding her. This unfortunately shook and discouraged her drive to become a doctor but I believe she eventually gained enough courage to rejoin us. A very intelligent friend of mine left med school to obtain his PhD as he thought he could touch more lives through his research. Yet another friend of mine completed her medical school, residency, and GI fellowship only to leave a very promising academic career at a well-known institution to become a beautician. She felt medicine was more a dream of her parents and not something she was truly passionate about.

When you get accepted to medical school, do a lot of soul searching and make sure this is what you really want to do.

“Dr. Daniel” is an endocrinologist who blogs at PreMed StAR.

Image credit: Shutterstock.com