I'll share my experience, having just graduated from the #2 ranked Med School in the UK, which included a year at Harvard. I'm 24 years old, I have a publication in Lancet, multiple other publications in top journals, multiple national prizes and I often feel like i'm on the border of mediocrity and failure. My secondary school (Age 11-18) was one of the most prestigious private schools in the country, it was the type of place that dates back to the 1500s - we had literal peacocks walking around the school grounds at their leisure. David Attenborough, various ambassadors, the Queen and other Royals were regular visitors and speakers. It was the kind of school like many of you have described, cut-throat and a world away from your typical state school. The first day back of Year 12 (Age 17), our form tutor asked every member of the class to announce their average GCSE percentage score for all 11 subjects. Not a single one of us had less than 96%, with at least half having 100%. That was the theme that continued throughout, whether you played music or sport at an international level, or won gold medals at Olympiad, that was just "your thing" of which everyone had at least one. Naturally the environment focused on breeding an unhealthy sense of arrogance and elitism into each of us. We all believed we were the best and deserved success compared to the 'ordinary plebs'. The only thing I regret from this time was that I got swept along into this mentality, because being in such a bubble environment it was hard not to. I strongly suspect if I had followed my peers to Oxbridge and studied something other than medicine, I might have continued in that vein for longer - as several prominent politicians (and alumni) that lead our country clearly have. When the time came to university applications, getting into a top medical school wasn't a challenge despite the competition that people from the state sector found insurmountable. Those kids were working part time jobs, looking after relatives and studying with whatever time they had left just to try and remain competitive. They never had a chance compared to us, who came from educated and wealthy nuclear families and hadn't a disadvantage in the world. University was the first time I was exposed to ordinary students from ordinary backgrounds. I very quickly abandoned false feelings of superiority when they became my friends, and when I was dealing with the sickest patients in society day-in and day-out. But the fear of 'mediocrity' was ingrained too deeply. This is where my experience will differ vastly from Blorcyn's - his is more typical of a northern non-London/Oxbridge medical school: There were two clear tiers in the cohort, those who wanted to just get through and become doctors, and those of us for whom anything less than a distinction was failure. Some wanted to dominate the competition and secure one of very few posts in neurosurgery, plastic surgery, cardiac surgery etc. (in January, I ranked #6 in the UK and did not secure one of 3 neurosurgical jobs). Some wanted to make a name for themselves immediately in academia, and start climbing the fast-track to professorship in various fields. Some had grand ambitions in related areas, medical law, biomedical engineering, pharmaceuticals, etc. 'Optional' Prize examinations had deadlines for application because of how many students would apply and every winner's name would be well known throughout the university. The political competition for Presidency of major societies like the Surgical Society or the Trauma Consortium was intense. I've talked about my year at Harvard before so I won't repeat it, save to say that the 100+ hours were not more than I was used to - only that they were mandated by the institution as opposed to "optional" (a misleading term, since everyone at home was doing them). It so happened my experience, and subsequent utter disgust and disdain for the American healthcare system killed the ambition to move to the USA permanently. Now having received my results and passed, i'm free until August 1st when my first job as a Doctor starts. This is supposed to be a time of complete peace, rest and relaxation - but the years of conditioning mean that I just can't. Since my exams finished on the 22nd of February, I've completed the process of setting up a registered charity, continued work on 3 separate research projects for publication, and started planning to take post-graduate speciality exams. When I was revising for finals, several times I saw a cool new game or TV show and I made a note of it saying "after exams i'll play/watch this". Now that time has come, and I just can't do it, within 20-30 minutes the deep ingrained feeling that i'm "wasting time" crops up and I have to do something 'productive'. It's made worse by the fact that in the past when I have let myself relax and only put in 60 hours a week rather than 80-100+, it's resulted in some form of failure every time. I only have 5 publications, peers have 10+. I've only won 4 national prizes, peers have more. At Harvard, I didn't achieve anything meaningful, peers there in the same length of time did things which impacted the world. I only ranked 6th in national selection and so didn't get the neurosurgery job at Cambridge. I am still too far from where I should be with my political ambitions. I'm lucky that despite all of this, and my continued failures and deviations into mediocrity, my family remain supportive and accepting. Above all else, I would attribute this as the biggest reason why my mental health has never deteriorated. I compare my experience to several individuals with very similar stories but parents who have not achieved as much as mine, and perhaps therefore have stricter expectations for the children whom they are living vicariously through; one committed suicide after failing a clinical exam in 4th year, and others suffer with anxiety/panic disorders/depression. We had these, both at my home university and at Harvard. They were a mandatory waste of time. The pressure on us to 'succeed' - whether put there by ourselves, or others, or both - is far greater than any counterbalancing desire to care about something pitiful like our mental health.