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Medical student Chuka Onuh and orthopedic surgery resident Ogechukwu Onuh discuss their article, “A sibling’s guide to surviving medical school.” They share lessons learned as siblings navigating medical training, focusing on the critical need to be intentional with time and avoid the “illusion of productivity.” Chuka and Ogechukwu emphasize that study habits must be adaptable (like switching from Anki to practice questions for USMLE exams) and that students must learn to advocate for themselves. The conversation also explores the biggest challenge of the medical school journey: protecting your identity outside the white coat, prioritizing relationships, and building resilience to avoid burnout. Learn the habits and mindset shifts necessary to survive medical school with your sense of self intact.

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Transcript

Kevin Pho: Hi. Welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome medical student Chuka Onuh and orthopedic surgery resident Ogechukwu Onuh. Together, they co-wrote the KevinMD article, “A Sibling’s Guide to Surviving Medical School.” Everybody, welcome to the show.

Chuka Onuh: Thank you so much for having us.

Ogechukwu Onuh: Thank you.

Kevin Pho: All right. I am just going to ask each of you to briefly share your story and journey. Then we will jump right into that article. Chuka, why don’t you go first?

Chuka Onuh: Well, again, thank you so much for having us. My name is Chuka. I am a medical student here in Chicago, Illinois. I am excited to be able to talk about this article I had the pleasure of writing with my sister. Forgive me if I drop an occasional “y’all.” You will know I am from the South. Thank you again.

Kevin Pho: Oge, why don’t you briefly share yours?

Ogechukwu Onuh: Absolutely. I am an orthopedic surgery resident in Madison. I was a humanities major, spent time in NYC for medical school, and found myself back in the Midwest. As Chuka said, we call Nashville our home area. I had a very atypical, non-traditional process in medical school, but I learned a lot along the way. That kind of helped us to drive this article.

Kevin Pho: Both of you wrote this article, of course, “A Sibling’s Guide to Surviving Medical School.” Now, for those who did not get a chance to read it, Chuka, why don’t you summarize the article?

Chuka Onuh: The article really was, as Oge said, fortuitous. It stemmed from a couch conversation. She was visiting me in Chicago, and we were talking. We asked: “What do we wish people had told us before we started this journey?” As we wrote it, we broke it down into three categories. We thought about looking at time and priorities. Then we started looking at what it means to be academically successful and have resilience. Then also, how do you think about who you are and whose you are regarding the identity and community aspect of this journey.

With that, we talked about time and priorities. Every yes to something is a no to something else. Be strategic with your time. Regarding academic success and resilience, we are talking about being dynamic. Sometimes it is not about doing what you want to do but what is required and necessary in the season that you find yourself in. In that last section, we talked about how we invest in who we are. When we take off our medical student badge, take off that white coat, and take off that nice embroidered Patagonia, are we making sure that we invest just as much in who we are in bringing ourselves to medicine as we do to the profession?

Kevin Pho: I am certainly familiar with the pre-medical and medical school process. My daughter is an undergraduate pre-medical student. Chuka, now that you are in medical school, what is something that surprised you in medical school that you wish you had known as you were applying?

Chuka Onuh: I think something that I wish I had known is that medicine is such a privilege to be in as a career, but also that medicine has to prove as much to me as I give to it. It is not a unidirectional relationship but bidirectional. I think that is something that can often be missed as a pre-med. We are doing whatever it takes to get into medical school. You are thinking: “I want to be part of the profession. I am going to give everything I have to it.” Those are good things, but we must also recognize that medicine should be excited to have us as a part of it. Being in medical school and seeing physician and resident burnout, that is a mature mindset to have.

Kevin Pho: Oge, now that you have finished medical school and you are an orthopedic surgery resident, tell us what kind of tips that you wish you had known when you first started medical school that you could share with perhaps our medical school audience.

Ogechukwu Onuh: Yes. This also stemmed from why I was really excited about this article. I always tell my friends that medicine can have a pattern of drawing in what I call my “A plus B equals C” applicants. You got the grades, you have the interest, you love the science, and then A plus B equals C. You ended up at the top of your class. I love research. The biggest surprise and also what I learned in finishing medical school is the privilege of being able to see people’s paths. When you meet everyone as an MS1, you think a person is going to do this or that. Then at the end, you realize some outcomes are predictable. However, you also see that some people did even more successfully than you would anticipate.

All this is summarized by the fact that sometimes what we consider the traditional A plus B equals C process is not the only way to be successful and sometimes not even the best way to be successful in medical school. I think the biggest tip is self-preservation. Also, one time a friend who was a little older in medical school said to trust your process. At the time, I was like: “This trust the process never really served me.” I do not think I am an A plus B equals C person. However, definitely trust your process. Do not shell out who you are. Echoing what Chuka said, it is a bidirectional relationship. Of course, you need to do the tasks that need to be done to the best of your capabilities. You must also realize that there are a lot of various pathways that can lead to really interesting and successful careers that may not be as platformed in what we consider coming in as naive MS1s in the beginning of our medical school journey. Definitely keep your passions and keep the grind, but also remember that you do not have to be what they show in the movies.

Kevin Pho: Oge, you mentioned those words, self-preservation. On this podcast and on my site, we talk about physician burnout a lot, but I know burnout also is becoming increasingly prevalent in medical school as well. So tell us exactly what you mean by self-preservation, some of the challenges that threaten self-preservation, and some techniques that you would recommend medical students take to preserve that.

Ogechukwu Onuh: I would definitely be a liar if I said that I came in as an MS1 knowing already how to do self-preservation. This has been a longitudinal process, and it is one that I took throughout medical school and am still learning now as a junior resident. The biggest things come sometimes with experience as life happens, whether that is from friends, family, or unforeseen circumstances. Sometimes it took close ones going through that to realize self-preservation. I define self-preservation as who I want to be at the end of the process, not just during the beginning. I think one mentor said: “Medicine is what we do, but it does not have to be who we are.”

Of course, it depends on what you find as your passion. Some people say: “I am medicine. I wake up and I am excited for the new research.” Some people say: “I am very good at my job, but I also think I best serve my patients doing my hobbies and seeing my family.” Self-preservation stems from realizing that medicine is what we do. We have pride in our work, but it does not have to be your only identity. It is about this longitudinal relationship throughout training and working. When you are stressed in the beginning of your training, what do you do? What did you do before you were a medical student that you would like to preserve? Say you did not have to try to fit 28 hours of work into 24 hours. Is that working out? Is it having set time points? Some people say: “I treat studying like a job, nine to five.” I try to make this so that at the end of the day, I have tasks and things that I enjoy. Also, realize that those hobbies and passions can be integrated into your work in medicine to find a different kind of appreciation and energy. It does not always have to be draining. Those are kinds of things that I learned along the way.

Kevin Pho: Chuka, you are at a prestigious medical school. What are you seeing from your vantage point regarding burnout among your peers, and what are some of the things that you are seeing them doing or doing yourself to help prevent burnout?

Chuka Onuh: I think within this new generation of medical students, COVID really allowed people to mature very quickly. A lot of my classmates and peers are really engaging in this bidirectional relationship with medicine. I was just talking to one of my friends yesterday while grabbing coffee. He was telling me he was on a surgery rotation, and they were gracious enough to let him go early. He said: “All right. That was for me. How do I invest this time? Okay, I am going to go make sure I go work out.” I think that is a value that students are unapologetic about. I think there is also a maturation of the medical education system in allowing students to do that. You talk to young attendings, or even people who are middle-aged attendings, and that was not always the process.

I see a lot of my friends finding and investing in their passions outside even during medical school. Even from the medical school admissions side, a lot of admissions people are asking: “How do you manage stress?” That is a very important question. Even the pre-meds who are listening to this need to be ready to have an answer for that question. Even when I was going through the interview process, I thought: “Oh, that is a good question.” I said: “I watch Netflix and work out.” I took it jokingly, but now when you are in the moment, chance favors the prepared mind, as Aristotle said. When you are in the moment and you actually need to be able to employ those strategies for how you manage stress, it becomes essential. Being able to develop those habits is really important in the journey before you bring it to medical school.

Kevin Pho: Chuka, in the article, both of you wrote about specific study tactics that medical students can implement. Talk more about that.

Chuka Onuh: As I was talking about study tactics, it is seasonal. That was one of the big things I learned. What may work in undergrad may not work in medical school. I will never forget my first anatomy exam in medical school. I was sitting here under my click-start exam on Canvas. For the first time in a long time, I was like: “Oh my gosh, I do not know everything on this exam.” What that told me was that medical school and medical education are going to teach you a ton. It is not going to expect you to know every single thing in granular detail. It is that process of learning, forgetting, and relearning.

In certain classes where it is going to require rote memorization, maybe using technologies like Anki to get that spaced repetition may be useful. However, if you move to something like physiology where you are more looking at organ systems, maybe that is going to require you to do the grunt work of sitting down and writing things out on a whiteboard and conversing with friends. I was talking to one of my friends who is also a medical student internationally in Germany. Literally tomorrow at 10:00 a.m., we are going to sit down and just talk about pharmacology. Sometimes that is what is needed. Then you move to board study, and now it is an integration of using third-party resources with going back and referencing notes. It is a very dynamic thing. Then you move to the clerkship phase. As I am talking to my peers who are on the clerkship phase now, it is about integrating that learning within the clinical practice but also using some of those third-party resources to prepare you for the Shelf exam, and then for Step 1, then for Step 2, and so on.

I think it is very much about being dynamic and being willing to let go of something in order to receive what is new in the moment. Like I said, I tell this to all the M1s: It is not about what you like, but what is needed in that moment. You have to be willing to say: “Hey, what is good for me may not be good for everybody else.” There can be this pressure to think: “Oh, this person is doing this. Should I be doing this, or am I not doing this the right way?” You have to run your own race. I will use a track analogy because my sister here is a state champion in track. Sometimes I would see her running the 400. If somebody goes off in the 400 and starts running somebody else’s race, they end up doing so poorly. The thing is about how you run your own race. How do you employ what is best for you and the strategies that are going to get you to be successful?

Kevin Pho: That is another thing that I have heard, that medical school is a whole different animal because in undergraduate, to get into medical school in the first place, you have to be among the best in undergraduate studies. But then sometimes medical school presents whole new challenges. Oge, you are in residency now, and of course, you are still learning probably in a different way than you did during medical school. So maybe expound on what Chuka said in terms of that evolution of learning throughout your four years in medical school and now in residency. How has the way that you have learned changed during that time?

Ogechukwu Onuh: Yes. I do have some specific examples, especially as a junior resident. The first part would be realizing the difference between learning and reviewing. Sometimes you do not know what people’s foundation was before. If you come in and think the way to study is to read the chapter, do the questions, show up to work, do this for your patients, rinse and repeat, and A plus B seemed to equal C, you then realize some people’s A’s and B’s were different to equal C. I may come in, and for example, in medical school you would read it and not go to lectures. They would say you do not need to go to lecture; you just watch it online. I would have told myself maybe I should go to lecture. I get in person and do that. Now as a resident, making sure it is adaptable is key.

I think residency is what they say sometimes in medical school: it is like a fire hydrant. I would say maybe residency is three fire hydrants in one. Also, now you are not just thinking about your process and how to get to point B, but you are now responsible for people. You have different rotations, different mentors, and different doctors that require different skill sets. Reiterating what Chuka said, definitely be dynamic but also realize that what we talked about previously with self-preservation allows you to serve patients that you are responsible for better. As for the learning, it is a lot more active learning. I realized when sometimes my foundation might require more reviewing. I think to have a better foundational knowledge of this, I can apply this versus now in a certain rotation or as a resident while having other commitments. I now need to make my learning more active. When I sometimes see a case, whereas in medical school maybe I would read the textbook, now I think: “Okay, I need to make sure this is a very efficient process that I fine-tuned through doing medical school, and now I can go back.” Tether a case, tether a patient encounter, and this is active learning. My learning needs to be a lot less passive and yield more active learning.

Kevin Pho: My next question has to do with support. In the article, you talked about some personal hardships where you leaned on each other. Obviously, both of you are in the medical field. But speaking more broadly, talk about the importance of a support network because the medical journey is a very difficult one, and if you compound that with personal hardships, it just makes it that much more difficult. Oge, why don’t you go first in terms of the importance and how do you find support if you do not have immediate family members also going through your path?

Ogechukwu Onuh: Absolutely. I would say the biggest support is realizing who is around you at the current time. I like to say that, especially to my brother, sometimes there is a difference between mentors and champions. I say champions are like when you see the star player in sports. He is doing great, and we love it; we are cheering for him. I would say that is a champion. Mentors are people who are there even when things are not going well or you are not necessarily the winning star player. Sometimes it can be finding those people wherever you are working.

I take support as making sure that I have learned to not be limited in where I find support. Limited means that it does not always need to be: “Oh, I am in this profession, so my mentors and my support come from this profession.” This once again ties back to what you do outside of work. Maybe your support comes from clubs, outside leagues, or people who can relate to you in a separate way from work. They do not see you as a singular identity but remind you that you are valued in aspects other than what you can produce for a patient. It is less transactional. Not to say that medicine is transactional, but when you only interface with one person in one setting continuously, it is a little bit harder to see that person outside of that context. Maybe you are having an off day. They do not have the context to say: “You know what, it is an off day. But she was really supportive here when we lost that game in soccer or when we were talking about daycares or movies.”

I have learned that support is making sure you are not limited. It does not need to be linear. It can actually be like a tree with branches. That is a lot more stable structure when things go differently. Residency is also a time where, unlike in medical school, as you get older it becomes less predictable. Families get older. Life happens. I would say two things: making sure you are not linear in where you get your support, and differentiating between mentors versus champions—people who are going to be there when they believe that they see your potential, even when you cannot see your potential at the time.

Kevin Pho: And Chuka, why don’t you give us your perspective on support on how important that is during medical school and where to find those sources of support?

Chuka Onuh: Just going off what Oge said, I think that support is something that you want to invest in. Again, it is about investing in it before it is needed. You never want to be in crisis then seeking help. You want to make sure you have a strong foundation. I think finding it outside of medicine is important. Be willing to make sure you invest in those relationships prior to what got you to medical school. One of my great mentors is a trauma surgeon out in Nashville. Every time I am back home in Nashville, I am always sitting down with him and grabbing coffee. It is so rich to be able to see someone who says: “Oh, I knew Chuka before he was even a pre-med student in undergrad. I knew him before he got to medical school.” So seeking mentors who have known you for a long time and seeking mentors in your peers is key.

I think about who is your tribe? That is why I ask people: “If you had a flat tire on your way, who are you calling in your medical school?” If listeners are like, “Oh, I do not know who those people are,” just go and sit. The way I made a lot of friends in medical school and found a lot of support is just sending cold emails saying: “Oh, we have an hour. Let’s go grab coffee on campus.” Get to know their stories and get to know their life. When somebody knows you and they are able to see you, then you feel like there is community. Also, find support in other things, whether it is your mental health or spiritual health. It is not a question of if there are going to be hard times, but when there are hard times. You want to make sure that when you are falling, you are able to reach out and grab onto things.

Also, I always say a “power move” when you think about mentors: I think the best mentors I have had are those mentors when I was a first-year medical student who were fourth-year medical students, especially after they submit ERAS. It is like when we talk to our elders. They are cashing out of the system. They are like: “I do not have anything to lose. I am just going to be completely real with you.” Those relationships have been able to give so many nuggets of knowledge that I did not even know I was going to need until I was like: “Oh my gosh, thank gosh I met with that M4 or that senior medical student when I was an M1.” They just dropped this nugget of knowledge on me that I am able to use now to navigate my course in this difficult time.

Kevin Pho: All right. We will end with each of you just sharing some take-home messages that you want to leave with the KevinMD audience. Oge, why don’t you go first?

Ogechukwu Onuh: Absolutely. I would say my first take-home message that always sits with me stems from a memory. I remember I was in anatomy lab as an MS1, and my classmate was a little older. Being in NYC, you got people who had different journeys of life. He said: “Just trust the process.” In my head, I was like: “Trust the process has never served me.” But seven years later, that moment comes to mind. You never know what moments stick with you. That is just life. It has a different tone now: Trust your process. Undergraduate, medical school, residency, and this field of work are unique in that you are actually more surrounded by people than you think, rather than going to your cubicle in your office then coming back. Sometimes you get to meet different people through different ways. So trust this process. It is always evolving. It is never a set process. Your process is adaptable.

The second thing is, kind of going with the mentors, but also realizing that you got a lot of advice and everyone means well because this advice comes from personal experiences. However, it is always okay to make this advice applicable to you as well. Do not necessarily do it algorithmically. Algorithmic medicine is very scary. You have gotten this far. Trust yourself. Trust your process to discern and take what you can and try different nuggets.

Lastly, as this journey process has happened, like we talked about self-preservation and holding onto those things that make it unique, it has been really cool to see what I have learned from being an MS1 to an MS2 to a resident. Careers can look very different but also be wildly successful in multiple ways. I used to think: “This is this, and this is what means a good career.” But I have seen so many people go and take their passions and create it. Residents made books. They write for TV shows. They are doing product management. They do consulting. These were identities they had before medical school. It is really cool to see them excel and have such a cool niche impact in that way. So I would say those are three things: self-preservation and keeping your hobbies; remembering that you have mentors; and trusting your process.

Kevin Pho: And Chuka, we will end with you. Your take-home messages.

Chuka Onuh: I think my main take-home message would be what I have been saying: In this game, your wins are everybody’s; your losses are your own. So how do you win on your own terms? Medicine is such a thing in that the system is going to take your success and say: “Oh, look at the great things we are cultivating.” But at the end of the day, I always think about when I walk across that graduation stage. How do I want to say I went through this process? What values do I want to make sure I kept and emboldened? What friends or communities do I want to make sure that I developed and engaged with? I think those are the main things.

Then when we think about this journey, it is not about the badges. I am looking at my medical student badge and thinking: “We take off this medical student badge, and you take off that white coat, or you take off that Patagonia. What is the one thing that is similar in all those instances? It is you.” You bring yourself to each of those moments. How can you make sure that you invest in yourself so that when you get to the end of the journey, you will say: “Oh, I did this thing on my own terms. I won on my own terms. I succeeded on my own terms.”

Ogechukwu Onuh: Chuka reminded me of something. Just to piggyback off that, when things are going well, everyone is celebrating. When things are not going well and when you are going through a process, it is important to also remember those who are there for you too. I think the biggest thing that I can also say for a takeaway is to show gratitude. A lot of mentors invest in you along your process, and we can be very linearly focused. It is a very grueling process to reach from one stage to the next. You are always thinking about the next stage and the next achievement you need. I have realized gratitude goes a long way. Remembering those people who are mentors, not necessarily just champions, and saying thank you to them once in a while is actually really important.

Kevin Pho: Wisdom from big sis. Thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

Chuka Onuh: Thanks for having us.

Ogechukwu Onuh: Thank you.