"There are no compromises." -Once a runner

Kudos to you for being able to handle Med School and your intensity of training. My college years were more slanted to the cross country and track teams than to the educational side. It was only in my 5th yr (after my eligibility was up) that I fully committed to the books. The Shoals has some great races. I ran Huff'n Puff in 2007, and am planning to run River Bottom Burnout to set AL state 1 mile record for 42yr old.

I would say missing the speed workout was a good idea. Your PR times hold on pretty good up to 5 miles, and after that they start seriously falling apart. Which means you are very far away from getting your VO2 Max speed worth. Which in turn would suggest that working on VO2 Max would direct you further out of balance in this area.

I think there are two areas that would give you the most improvement in the marathon:

a) Improving your health. The last 6 miles of a marathon are run with the liver. Different people are able to preserve their liver in different degrees under bad diet with collegiate levels of alcohol consumption. Some miraculously hold on for awhile, at least in their youth. However, it is best to assume that you are not the exception, that you are weak and that your liver is going to fall apart very quickly unless you nourish it with great care. I had just a little bit more base speed than you when I ran my first marathon at the age of 17 (4:26 1500 meters), my longest run had been a half marathon race, and I averaged about 35-40 miles a week prior to the marathon. In spite of the lack of preparation and crashing pretty bad at the end I still managed a 3:05. I believe one reason it was not 3:30 or slower was that I had never had alcohol in my life, which gave me a base level of health that could make up to a point for the lack of training.

b) Run base mileage, lots of it. At least in my case I have observed that my marathon times have pretty directly followed the consistent amount of miles I've been running. I've finished 43 marathons with the sustained mileage range varying from 40 a week to 120 a week prior to the race. The intensity did not seem to make a difference varying from pure base with occasional marathon pace or half-marathon pace tempos to 3 scheduled speed sessions a week, two of them being very tough VO2 Max. My times have been pretty much a direct function of sustained mileage as long as I did not exceed what my health permitted and got adequate nutrition and sleep to recover. Another interesting observation is that the more miles I would run, the less I had to pay for pacing mistakes in the race.

Thanks for the advice sasha. I know my times don't match up after 5 miles. I think it is a combination of my weight (165lb is too much for 5'7" runner) and the fact that the long distance times were all run last year since which I have gained a lot of fitness. I have been focusing on shorter distance this year. And that is also why I am going to make up that VO2max workout today. I am still getting ready for a mile race in two weeks. After that I will drop most of my quality and build my base up to 80mpw. The fact that my marathon time is so off the charts compared to the rest of my times is because of the two previously stated problems and the fact that I didn't take any nutrition during the race. This time around I am going to train with the nutrition I will use during the marathon.

a)My diet is very healthy except for the alcohol. I am cutting back on that as well.

b)I'll be doing 70-80mpw during my main marathon training phase. I don't think my body is ready for any more than that yet. It takes years for your body to become comfortable with high mileage. But I really respond well to doing workouts and recovery runs. So I will probably keep a VO2max workout, and work threshold and marathon paces into my long and medium long runs but keep the rest of my days very easy 8-10 miles.

What would you say your target event is overall? I agree it takes years to build up to high mileage. What marathon are you targeting in the fall? I can't even imagine racing a mile at this point--it's like a sprint for us old folk.

Well, I am not really sure what my target event is. I really like the mile. Compared to my other times, my mile time is much better. But compared to many people my age my speed isn't all that great. I would really like all of my running times to drop significantly from the mile to the marathon (no ultras for me until Im at least 30). And increasing aerobic fitness should do just that. I may be a bit slower during my marathon specific training, but until a bit older I should be able to then drop my mileage a bit, add more speed workouts and get it back.