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4.0 GPA, 36 MCAT, Summa cum laude, Mediocre Med Student

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I felt that way already at interviews, at some point I’d eventually think “Did they make a mistake when they invited me, these other people are crazy?”

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I once heard someone say that the first time they felt like an underachiever was once they started medical school, and in that moment I finally understood the feeling.

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Med students are on an even playing field when it comes to sleep deprivation and dependency on Starbucks, but it’s humbling to find out that your classmates have played on national sports teams, gone to trials for the Olympics, or got accepted to med school at age 19.

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The things that once made you feel special are now commonplace, as medical schools select the cream of the crop. Each one of my current classmates was the best in their school or first in their class, had several research projects going during every school year (and even over the summer), and probably volunteered overseas at least once or twice.

It dawned on me that I was average. Yes, the seven-letter word that…

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Medical School Prerequisites: Masochism?

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As a future physician it is your duty to have sound “scientific literacy”.   In in fell swoop I’ve answered the question stem to my blog entry, job well done me, time for a pint — oh wait, you were expecting an actual entry, back to work me.  Alright, so you’ve decided to take the physician plunge (make sure you learn the secret premed handshake) so let’s discuss those arduous prerequisites.  It’s a time honored tradition for premeds to bemoan the seemingly esoteric course work required just to get into [US] medical schools.  But, I believe most premeds miss the intent of the rigorous coarse work, falsely associating it with some type of twisted sadism created with the sole intent to crush your soul.  As a reminder, the typical premed course work consists of a year of:

  • Biology
  • General Chemistry
  • Organic Chemistry
  • Biochemistry *optional at most schools
  • Physics
  • English
  • Upper level math

Along your coursework you’ll probably eventually encounter this famous quotation incantation or another “Biology is just chemistry, chemistry is just physics, and physics is life”.  If that doesn’t encapsulate the importance of the medical school prerequisite consider that, as a physician, you will be expected to not only have an empirical understanding of medicine, you are also expected to be able to understand and even take educated guesses.   The prerequisites will serve as your foundation, when you become well versed in these courses making the leap into the MCAT will seem less intrepid.  In addition to science content topics, the MCAT will test scientific inquiry and reasoning skills:

  1. Knowledge of scientific concepts and principles
  2. Scientific reasoning and evidence-based problem solving
  3. Reasoning about the design and execution of research
  4. Data-based and statistical reasoning

(Hilborn & Friedlander, 2013)

Medicine is changing faster than ever, and it will likely continue to do so.  To stay in lock step with this evolution requires physicians to not merely be clinicians, and this requires premeds to obtain more than a sophomoric understanding of the core science breadth.

Besides, getting nerdy jokes like this is part of the experience.
Besides, getting nerdy jokes like this is part of the experience.

Don’t get me wrong, you can get pretty far on empirical data, typically it’s more important to know which medicine to use at a given instance than understanding which amino acid residue is phosphorylated.  However, at the same time, if you limit yourself to not understanding how things work you’ll be doomed to memorize everything because you won’t notice the patterns except from experience (not that there will always be one).  Personally, I feel doctors should understand the medicine and tools they are using: you should know how hydrogen atoms correlate to MRI scans while searching for tumors, understand how lens properties effect focal length and power of the eyes,  and why high doses of potassium can be fatal.   There’s a lot more to being a doctor than being a scientist, but if you don’t revel in the thought of science meshing with medicine than you have long torturous journey ahead of you.

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There’s a lot of ways for you to deliver positive outcomes to your fellow man, and a lot of them wouldn’t require these prerequisites, MCAT, nor over a decade of education and nearly a quarter million dollars in debt.  But, it takes a special type of sadomasochist to enjoy what it takes to serve people as their physician.  I don’t want to discourage anyone from medicine, but just remember if you’re going to be a patient advocate, a physician, you better be okay with having deep ‘scientific literacy’.  It’s just your responsibility.

twitter: https://twitter.com/doctorORbust For more research literature about the MCAT see:

 

Applying to Medical School: The Process

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TODAY'S GOAL: Get into medical school.
TODAY’S GOAL: Get into medical school.

SO, what is the admissions process?

You’ve probably scoured the internet trying to find the answer to just this question.  The good news is that there are not many steps, the bad news is that each step is challenge in itself.  In a nutshell all you need to do is take the premed prerequisites of the programs you want to enter, take the medical school admissions test ( referred to as the MCAT), and turn in a primary application through a system called the AMCAS and turn in secondary applications to individual schools.  And if all goes well you interview, and well get in.  Biggest advice I can give is get that application in early, that is the first week or two when the application window opens.  If you want a concrete and concise road map for applying to medical school I’d highly suggest picking up a book off of Amazon called The Medical School Admissions Guide by Suzanne M. Miller, MD, you can follow her on twitter @MDadmit.

Step 1: Finish or finish off most of the prerequisites for medical school.

This can be trickier than it may appear, because there is some variation in what each medical school you apply to requires as prerequisites.  Ideally, you want to apply broadly, so don’t get lulled into the trap of taking a narrow set of prerequisites just to fit your dream program.  Admittedly, no matter your stats applying to medical school is somewhat of a numbers game, so it’s important to apply broadly.  Moreover, the prerequisites aren’t simply hurdles meant to weed people out, instead they are meant to prepare you for the rigors of medical school; and ultimately these courses will serve as your science foundation as a physician later.  Interestingly, when medicine schools first hit the US the most important prerequisite was anatomy.  At some point they realized that memorizing gross anatomy didn’t necessarily have a positive correlation with training good physicians. So, over time the current stereotypical required course lists evolved into what we see now:

  • a year of General Chemistry (lab + lecture)
  • a year Organic Chemistry (lab+lecture)
  • a year of Physics (lab + lecture)
  • a year of Freshman English (this should include a critical thinking course)
  • a few upper level math courses (Calculus and/or Statistics)

However, as science and our understanding of what it takes to make a good physician evolves so does the need to add more courses to your breadth.  Don’t shy away from the “recommended” courses as they’ll give you a leg up during the admissions process (well, if you do well on them) and on the MCAT:

  • Biochemistry
  • Psychology
  • Genetics
  • Molecular Biology
  • Microbiology

Step 2: Take MCAT — hopefully only once.

The MCAT (Medical College Admissions Test) is often billed as the hardest entrance exam in the US.  As the MCAT itself also evolves its important to go straight to the source: https://www.aamc.org/students/applying/mcat/.  The MCAT has three sections, Physical Sciences, Verbal Reasoning, and Biological Sciences, each section is scaled so that each section has a value of 15.  The maximum score is 45 (3 sections, 15 points each), but typically the highest score achieved each year hovers around 42 — not a score to laugh at.  The average score among all test takers ends up being about 24 with a standard deviation of about 3 points, scoring at or over two standard deviations means you had a pretty good score i.e. the magic 30 or higher score we all lust over.  So, your goal is to get your 30 or higher on the real test, and to never take the test again unless you believe you can do significantly better than the first time (within a standard deviation or two).  After you take the real MCAT, it’ll take about a month to receive your score, so you must include this month in your time table of medical applications.  It may comfort you to know that the MCAT wasn’t designed to keep people out of medical school, it was implemented because the drop out rate in medical school was atrocious, so they’ve done more to mentally prepare people before taking the medical school plunge. Ideally, you should finished your prerequisites prior to taking the MCAT, though merely anecdotal I have known one person that did just fine on the exam without finishing all of the Organic Chemistry sequence — but, that person was an exception to the rule and Organic Chemistry is only glossed over on the MCAT compared to the rigorous year sequence.   Though, if you got destroyed in Organic Chemistry lectures you may differ in my opinion of how lightly Organic Chemistry is covered on the exam. To prepare for the MCAT you have several avenues:

  • take a preparation course
  • self study
  • take a preparation course then self study to fix you weak points

There are pros and cons to all of the options above.  The pro of taking a prep course is that you’ll have a guided and structured method to prepare for the MCAT.  Some prep programs also have the benefit of teaching test taking strategies, though it’d take a lot of practice to actually be able to depend on them come test day.  The con is the cost, and perhaps lack of flexibility to deviate from the schedule.  If you can afford to take a prep course I would suggest you do.  I self studied, so I can’t make any specific suggestions about which prep program is the best.  Typically people end up taking Kaplan, but this is probably because it’s a lot easier to stumble upon a Kaplan prep center than any other prep course in my opinion.  What ever you pick be ready to shell out several hundred to a few thousand dollars. Again,  having self studied for the MCAT and I did just fine, so it’s by no means impossible to pull it off by yourself.  The largest pro to self studying is costs (if you’re internet savvy you may find quite a bit for free).  Another pro is that, you get to learn at your own pace, but that could also be a double edged sword.  The cons are blatant, you’re on your own when it comes to everything from understanding to scheduling.  Be honest with yourself, if self discipline isn’t your thing then a prep course may be the way to go.   If you decide to self study, then you’ll have to find a self study prep package that works for you.  I used ExamKrackers study package plus their Audio Osmosis.  Later, after to get more exposure to material I added in a Princeton Review science workbook.  If you have the time and the money, I think the best route would be to take a prep course then take several months to self study, this worked exceptionally well for a friend. [I may add an additional entry on the MCAT should it come up]

The most important part of prepping for the MCAT is taking practice the official AAMC practice tests.  Until you have a few of those under your belt don’t even consider taking the real test, because nothing in your prep material is going to be as close to the MCAT as the MCAT.  Just go to the official AAMC they’ll have plenty of information about how to purchase access to legit MCAT tests, a little birdie told me that some of the old versions can also be found on bittorent.

Step 3: Fill out an AMCAS primary application and all it entails.

Ready for more acronyms?  Well, after you finish your MCAT you’ll likely become very ‘intimate’ with the AMCAS (American Medical College Admissions  System), affectionately uttered as one word by all those who toil under its rule.  The AMCAS is a general application that you feel out, called the primary application. And at the end your click some buttons to select schools and drop loads of cash (unless you qualify for Financial Assistance Program, I didn’t fyi).  The primary application will consist of:

  • the BEST Personal Statement (PS) you’ve ever written
  • course work plus grades (all college level work regardless of institution)
  • MCAT score
  • Letters of Recommendations (LORs)
  • Resume / Curriculum Vitae
  • Submitted Transcripts to verify your entries

It goes without saying that your PS and resume sections should be well written and concise.  Don’t feel pressured to push the character limit, don’t fall into the college trap of feeling compelled to reach a good ‘number’.  Instead, focus on being succinct, what can be said in ten words is always better than blathering about it for 100.  Also remember like most things: quality trumps quantity.  So, for your LORs it’s better to have 5 stellar LORs than 10 generics.  With that line of thought, don’t feel compelled to jam space filling entries into the resume section.  I will tell you that I went well under the character limit for the PS and didn’t use all of my resume entries because I didn’t feel it was necessary. Though, in the  end the primary application is mainly a test of how good you are at data entry.  It may take up to 6 weeks for the AMCAS to verify your course / grade entries you self entered.  Each time you enter a course you must also classify it, this is usually the trickiest part.  Though, I’ll save you the stress and tell you that you can easily find most of proper classifications if you follow the link and DL the pdf here. If you did everything write, and everything is received, AMCAS will ‘verify’ your application, as well as give you a two new GPAs one for the sciences / biology and another for everything else.  If you AMCAS finds issues with a lot of your entries they may return it to you for corrections.  After verification you’re ready for the next phase of applications, choosing schools to apply to.  If after verification you find issue with AMCAS evaluation of your transcripts and GPAs you have about 10 days to petition.  I petitioned successfully, this helped me raise my science GPA up, so it’s worth the effort if you think you have a case.

Step 4: Choose schools after being verified. *Though you should already know which schools you intend to apply to.

Getting verified is quite a relief, you earned a beer if you got this far.  After AMCAS recalculates your GPA don’t be surprised if it drops (though typically it’ll be nearly the same).  Now its time to pick schools, this can be hard to figure out.  In general I suggest purchasing the Medical School Admissions Registry (MSAR), look at each school, and make your own ranking depending on what’s important to you.  US News rankings are useless in my opinion, find a program that fits you as far as mission statement, stats, costs, location etc.  Also, the first school you apply to will cost about ~250 (I forget the exact amount) and each additionally school after that will cost about 35 dollars.  Make this cycle your last cycle and try to apply to as many schools as you can both afford and finish secondary applications to.  For most people 15 schools is a good number, 20 if you are nervous.  Anything after 20 is a waste of time because you probably can’t complete more than 20 secondaries without them starting to drop in quality.

Step 5: Fill Out Secondaries as they arrive.

Pretty much enough said.  Some schools will automatically generate a secondary for all applicants with a verified primary application, while others may screen applicants prior to asking them to fill out a secondary.  Sadly, a few schools even ask for you to pay for them to screen you application in the first place.  Secondaries range from school to school, so you will no longer be doing a general application, instead you’ll be inundated with various log-ins and passwords to use to enter your entries per school.  The content of the secondary varies greatly from writing many small entries, to writing very lengthy essays, all the way to just slipping a check in the mail.  Each secondary will run from 75 to 150 dollars — make sure to save that tooth fairy money.

Step 6: The waiting game: Interview Invites & Rejections

Schools will call or email you to invite you to interviews, or the worst case scenario to email you to let you know they are not interested in you.  If you did things right you’ll have a few interviews lined up, and you’re ready to think about “interview day”.  If you receive nothing, you probably already have a good idea of what may be the problem i.e. grades, MCAT, PS quality, experiences, so do what you need to do to address your shortcomings. After your interview there are three fates: accepted, wait list, and rejected.  The best news would be an acceptance, after a school makes an offer you pay a deposit to hold your seat.  You can accept as many offers as you’d like to, but you can only have on offer after May 15.  If you get wait listed, there may or may not be a priority wait list, also schools may or may not rank you by number.  If/when the matriculate dust settles they offer spots to fill up the remaining seats prior to school starting.  Being on the wait list is probably stressful, I was fortunate enough to not be left in limbo, and was accepted straight out to the program I wanted into.  I’ve heard of people being wait listed all the way until the day before the school year starts, so there’s hope for those who wait list even to the last second.  Now, you could also be rejected (received two myself), you’ll have to learn how to get over it, and move on.  Just remember all you need is one acceptance, and a rejection doesn’t necessarily mean you’re not fit to be a doctor instead they may just feel you don’t fit their program. Best of luck, for more info drop a comment or message me on twitter https://twitter.com/doctorORbust

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Medical School Interviews MMI

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What weight does getting an interview have?

Gaining a coveted invite to a medical school interview is nothing to scuff at, at least that’s what they’ll drill into you when you arrive at the school on interview day.  Overall, under 10% of those who apply (this will be a better ratio if you’re in-state, with a few exceptions) land interviews according to the MSAR (Medical School Admissions Requirements).  For example in 2012 Boston University received around 10,900 applications (840~ in-state and just over 10,000 from out-of-state), around 20% of those from in-state landed an interview while only 8.6% of out-of-state — ouch.  Now, here’s the good news, about 1 out of 5 students who interviewed there ended up matriculating.  I know what you’re thinking, that’s still pretty daunting.  However, keep in mind that schools send out more offers for admissions than the seats they have to give away, this should be kind of obvious if you consider that many people will get multiple acceptances.  So, a school might send out no more than double the offers than the seats offered, but when the dust settles the numbers of those who matriculate to those who are offered spots is different, so don’t let the numbers frighten you.   So if we assume that information we can extrapolate that if you interview your changes of getting in are actually about 1 out of 3, and that’s not half bad — especially if you have multiple interviews.

So, if you have an interview celebrate, you passed the weeding out phase of the application process.  If you are invited it’s because they already believe you can make it into medical school, and perhaps will even be a stellar medical scholar.  Here’s an analogy (stolen from a dean of admissions): if your AMCAS was your online dating profile, the interview is the first date.  During this first date, they are not just evaluating you but you should be also evaluating them, after all you’re in for a long committed relationship (and a likely a quarter million in debt).  Remember, they already liked you, that’s why you ended up their on interview day.  You just need to prove you’re the person they’ve been imagining or perhaps they’re ready to take you in but need to find out just a little more.

What are the formats of the interviews?

In general, there are four types of interviews you’ll encounter on the interview trail:

  1. Single interviewer (traditional)
  2. Panel interview (traditional)
  3. Multiple Mini Interview (MMI)
  4. Objective Structured Clinical Examination (OSCE, a medically oriented MMI)

Single and Panel interviews

The single and panel interview format will vary by program.  Some interviewers will have access to your entire AMCAS application, on the other extreme interviewers may only be allowed to see see your AMCAS essays and class listings without grades and MCAT scores or even letters of recommendation.  Whether it’s a single or panel interview it’s important that you pay attention to what information your interviewers are privy to, don’t just assume they believe you’re the golden child as they may know very little about your file by design.  Your interviewers may be PhD holding staff at the medical school, physicians, or even medical students.  In either event, it’s okay to be cordial and even funny, but keep in mind that it is a professional meeting so leave the self depreciating and late night comic club humor at home.  The interviews will typically last about 45 minutes, they may go longer if you and the interviewers hit it off (one of mine went over an hour, we didn’t notice the time).  Be ready to discuss just about everything from your childhood to your current family life (if you have started one, note that your parents aren’t your family, you are in THEIR family), to problems in school, to ethical questions and questions border-lining on politics.  One of the hardest questions I was asked was “How would you improve the healthcare system?”

I’m not going to write a treatise of all the questions, you’d need a book for that,  but in general they’re trying to figure out what exactly makes you tick, why they should take you not only as a student, but also as a colleague.  Here’s a plug for a good book that covers the questions you’ll typically hear in one form or another: Why Medicine?: And 500 Other Questions for the Medical School and Residency Interviews, by  Sujay Kansagra MD.

The biggest advice I can offer is read up on the school you’re interviewing, know about their philosophy and find 3-5 things you really like that’s unique to their program.  And be sure to practice your ‘elevator speech’, know what you wrote on your application to them, and stick to that.

What is MMI and OSCE MMI?

In an effort to screen out the robots applying to medical school many schools have adopted non traditional methods to evaluate you.  Both MMI and OSCE MMI toss you into a room with an actor for 5 to 10 minutes after you’ve read about 2 minutes to read a brief prompt prepping you for the situation you’re about to encounter.   Your interaction with the actor will be videotaped (very Big Brother like) and your tape will be used to evaluate you as an applicant.  The idea here is that it tests your real reactions to situations, as opposed to you running through the laundry list of answers you’ve prefabricated prior to the interview day.  Supposedly, this will measure your inter-personal skills and professionalism (as they’re is usually some type of ethical twist involved).

MMI and OSCE MMI differ in the scenarios you’ll encounter.  MMI is truly random, it might be a situation where a friend admits to cheating on the exam, or you ‘hit someone’s car’ resulting in the person going off on you.  I think schools that practice MMI pride themselves in how differently their MMI is, so with that in mind be ready for anything.  I didn’t interview at any schools that had pure random MMI, so my only advice is to pick the moral high road while acknowledging both sides of the argument.  On the other hand OSCE MMI, as you might of imagined, will always have a medical context behind it.  For example, you’ll pretend to be a doctor and they might give you a small paragraph about the mock patients chief complaint, and you merely need to go in and get a history on them.  But don’t be lulled into thinking that’s the end of the story, as there’s usually some type of ethical twist.  For example, during your examination on a patient who’s complaining about ankle pain you might surmise that actually they’re a possible drug addict looking for a fix.  At that point, it’s up to you to figure out how to take the ethical high road without being a robot — by the way, it’s probably never good to say “Sure, how much do you need?” in this scenario.   Just use common sense, don’t worry you don’t need to be a physician or even have much experience in the hospital to handle these, just treat it like it’s the real deal.

In a nutshell…

Interviews aren’t meant to break you, they are there to make you.  Always remember it’s a two way street, you’re both evaluating each other.  Make sure it’s the program for you, make sure it ‘fits’ you.  Do your homework on the school, their new programs, new research, philosophy etc.  Ask yourself, would I be happy there?  Bring questions to your interviewers, real questions no brown nosing.  For example, you want to know if they allow students extra time to prep for boards, what makes their clerkship better than others, or how will they make you a competitive when you’re applying for residency.  In otherwords, you need to stop trying to get in, believe you got in, and try to project to the future a medical professional.  Must of all, have fun.

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