Ask questions that show they are now focusing on what needs to be known for patient"s sake rather than for exam. Feel financial strain of medical school because don"t feel they can continue to rely on families for financial support. Social relationships take on unique quality differentiation for those inside and outside of medical school. Enjoy elevated status among the outside but loneliness is common because many people on outside don"t" understand medical school and are generally unsympathetic to student"s complainants. Interact directly with patients in hospital setting new set of insecurities, don"t know enough to take on duties of a physician. Gap between real life and textbook feeling uncertain and inadequate (but patients usually accepting) Issues need to accept they will make mistakes, strike balance between clinical competence and unrealistic expectations of perfection, contagion (because expose to contagious disease), encounter with critically ill patients, deal with death.