Be careful. You don't want to trip up and fail. You are right. Weeding out the weak is always a consideration. That is one reason they tell people not to work. Your best bet is to stay organized and approach every task as an individual effort. Do not get sick. Look for ways to trim your time spent in wasted activity. Go as early in the day as possible to get the info for clinical, so you don't have to stay up all night preparing. I don't think that getting loans is a good idea since you have a mortgage. Try to find a way to sneak schoolwork (think flashcards in your pocket) in at work. Take strategically planned vacations, leaves of absence, or "sick" days from work, but be careful. And learn the art of relaxation. Best wishes.