P=MD

Greetings to all of those who may or may not still be with me. I have returned once again to discuss a topic very dear to my heart. This week marks the passing of my very first exam (anatomy) in medical school. I did well (as most did), but what really made the experience different from undergrad was the fact that my medical school does not grade or rank students beyond the simple Pass or Fail policy. It was a far less stressful process than when I was neurotically protecting my 4.0 GPA and my dreams of ranking first in undergrad. As people discussed the exam, realizing a mistake did not send people into a panic. It was just a matter of a shrug and a lesson learned. And yet, we all still learned the material despite the need to only get a 66. As I stated above, everyone did well and this exam was by no means a walk in the park. The drive to learn and do well is embedded into us, but the stress of failure is far less. I have to say that I am enormously pleased at having made the right decision of going to a medical school that has a pass/fail AND an unranked policy for the first two years (a ranked pass/fail class is not truly pass fail. There is still an incentive to out do everyone else and thus the temptation of competition and cut-throat behavior). As far as some people worrying that not having grades the first two years hurts their students, do you really think schools like Harvard, Yale, and other top 10 schools would be doing it if this was the case?

In other news, I had a very unique experience with an applicant today. She has yet to get an interview and so showed up for the tour of the school that is given to applicants. I can only assume that she hoped to impress the adcom by her dedication and initiative. I must confess that it crossed my mind to do the same thing when I was applying. However, now that I am on this side of the fence I can not stress enough that it only makes you look silly, not impressive. Besides, the admissions office (which granted her request to join the tour) is NOT the admissions committee proper, nor are they likely to pass on the information of such a "daring" stunt. My advice to applicants, don't try this. At the very least you are going to garner the ill will of the other applicants, who might be your classmates someday.

I got to touch a lung today

By request, I have returned to tell you all of the wondrous world of medical school. After a summer of teaching and ant research, I am now holed up at this learned center of medicine. Let me just say that it has been awesome from the start. Orientation was last week, so I have just about completed my first real week of medical school. So far, my biochemistry degree has allowed me to float through the courses, but (amazingly) we are already reaching the boundaries of my knowledge. That's right, in 12 hours of lecture I am well on my way to being in the same boat as everyone else. I will say this though; there is a lot of material, but it is relatively basic. So while it may true that we have covered a half of a semester's worth of nutritional biochemistry in a week, it was a very cursory look. No mechanism drawing, no math, and minimal emphasis on being able to do theoretical biosythesis. We are skimming at the speed of light essentially, which is not easy regardless of the depth. I will also say that the speed isn't quite what some people make it out to be. We are moving fast, but 12 hours of lecture is a month of class time in undergrad. So we are maybe moving twice as fast as undergrad in terms of content overview. At my school, we only have three classes. One is essentially a time commitment with little in terms of memorization or examination that is mostly concerned with basic clinical skills and humanistic discussions. The other is the one that I have been mentioning. And finally, we have anatomy.

Ah, anatomy. As my title indicates, I got to touch a lung today. Stuck my finger right through the rib cage and gave it a rub. Pretty trippy. I really have to say though, this person that donated his body for my education is probably the best friend that I will ever have. No, I'm not talking to the cadaver, but I am serious. How many of your friends would be willing to donate their body for you to mangle in the name of education? It is a truly amazing gift that this person has given me, and he will cotninue to live in all of my group for our entire careers as physicians. He is the our first patient, in a way.

As far as anatomy goes, it is a blast to dissect. Our fellow is a bit on the portly side, but the benefit of that is that its a lot harder to accidently cut through something important when its an inch deep in fat. The unbelievable details of the human body are daunting. Thousands of bones, muscles, nerves, organs, and blood vessels. And then, pieces upon pieces within all of those categories. They aren't kidding when they say that medical school is a white rapids river of knowledge. I'm still on the lazy river at the moment, but I hear the rumbling in the distance.

Thanks to all that have and continue to read my blog. If anyone has any specific questions or comments, that might spur me to post more often in the future. Don't be shy, I always respond in one way or another!

I am on youtube now.

In an effort to further spread my advice, I've decided to start posting summaries of the info here on youtube. You can find the first video here:

http://www.youtube.com/watch?v=eBeaqRfjNuw

Dream Come True

It happened today, I was accepted to my top choice medical school! I won't say where exactly, though those who know me personally will know and I ask that you don't post it here. It's on the east coast in a large city, which is where I wanted to live. Ironically, I wasn't even going to apply there, but I did so that I could get a letter from the president of my University (who used to be Provost there). Turns out that I fell in love with it during my visit, and I've been enamoured ever since! I've learned two things from this experience:

1) Waitlist is not a deathlist!

I really thought that I was done for when I got waitlisted at all of my top choices, but here I am now getting ready to attend my dream school! Even more so, I was accepted before the May 15th deadline, which is normally when waitlist shifts begin in earnest. It makes me wonder if sometimes medical schools first accept who they need, rather than who they necessarily want... Who knows?

2) It pays to be persistent.

I wrote several times to the Dean of admissions at this and my other top schools. I found out last week that I was going to receive my University's closest equivalent to a Valedictorian award, so I decided to give each school a call. After reaffirming my desire to attend this particular school, the dean offered me an acceptance then and there. They want students that want them, as many schools told me on interview day. If they can secure a student that was high quality (meaning they interviewed you) without the hassle of you possibly withdrawing later on its a win win situation. Do not hesitate to write a letter of intent to matriculate at a school that you have decided was your top choice. Be serious about this though, integrity is all that we have at this point. If you say to a school that you will attend regardless of all other offers, there is no going back if you're accepted. Your word is everything, and is far more important than any scholarship or other offer you might later get.

Question 15: What can I do to improve my chances during this cycle?

Two words: Apply smartly. This in itself can be broken down to two rules. 1) Apply early 2) Apply broadly.

Let's tackle the second first. There is no such thing as a sure thing. No matter how many interviews at better schools you were offered, no matter how high your stats are, there is never a sure thing until you have the letter in hand. I have seen plenty of people get shot in the foot by not applying broadly. Never apply to only Top 20 schools. So much more than grades and your resume factors in at that level. You might get interviews at a dozen and only get accepted at one (I did), if any. That tends to be the biggest mistake for applicants with high MCAT scores. Just because you are in the 97th percentile of the MCAT doesn't mean diddly, because quite honestly there are at least 1000 applicants with as high or higher of a score than you! The schools have plenty of heavy hitters to consider, and at that point it all comes down to what they are looking for. The interview tends to be the make or break moment, but don't think that big pile of materials that you sent has been forgotten. It is never an even playing field, from start to finish.

I would personally recommend applying to about 15 schools. Try to break down your list so that 30% are reaches, 30% are about average (as best as you can see) for your stats and resume, and 40% which you deem less competitive. Quite frankly, the MSAR and other resources fail to really show the competitiveness, so don't underestimate those schools. Many of them pick up nontraditional or special circumstance applicants that often have low GPAs or MCAT scores. The traditional applicant tends to need a little more oomph. I'd shoot to be at least a point or two above the median for schools that you consider average at (0.2 GPA more would be nice as well). Consider applying to a few DO and MD schools, to really get a good range of schools (especially in state ones). If for whatever reason you choose to only apply to MD or DO, make sure to apply to all of the ones that are in state for you. Not only do they tend to be cheaper, they also often prioritize in state students during the cycle.

Now lets talk about applying early.

This quite honestly is probably the single most effective way to improve your competitiveness once the cycle has began, unless you are retaking the MCAT after a dismal score. You want to be the first application that is looked at, when every interview and every seat in the upcoming class is available to be offered to you. The longer you wait, the further down you fall in the pile, the more jaded the committee becomes, and the less opportunities for interview and acceptances are there. Most schools are what is known as rolling admissions, in which the school will offer seats to applicants during the cycle, rather than waiting until the end of the cycle. Some schools opt to be nonrolling, giving all of their seats at once at the end of the cycle. Theoretically, this means that every interviewee has the same shot. I am skeptical of this, as the committee is still meeting to discuss your application, and would still rather be the first than last to interview.

Ideally, you would want all of your secondary applications done by early August at the latest, well before interview season begins. Most schools don't offer the secondaries until about July 15th, so there is some wiggle room for those who might submit their AMCAS in mid or late June. If at all possible, devote as much time to essay writing and revisions as you can once they start to arrive, and don't hesitate to reuse essays. There is a trade of between revisions and time delay, so don't overly knit pick (which is of course difficult for pre-meds). The primary application essay is the most important (see one of the earlier questions to learn more about it), of course, so expect to put the most time into it. Whatever you do, don't put them off! I know people with 3.8+/35+ stats that bought the bullet on both interviews and acceptances by waiting until November or December to submit the secondaries. Try to interview early as well, if you are given multiple dates. You never get a second chance to make a first impression, but its also nice to be the first to make one!

The two biggest problems for future physicians (part 2)

So last time I rambled about the overuse of our health care system, now lets talk about the single biggest preventable drain on our healthcare system; obesity. The baby boomer generation has no choice but to be a big cost to our healthcare system, as they are old and we have made it so they can get older (unless we decided to "prevent old age" in a number of gruesome and dystopian ways). Obesity, however, is prevalent in all generations and ages, and is only becoming more common. It is really a fascinating problem, from an evolutionary point of view. We have done something that no species has ever accomplished, we have reached a level of dominance where our fitness literally does not matter. For the first time ever, people that once had disease and disorders that essentially prevented them from ever reproduced are now doing so. Bad recessive alleles are no longer being repressed as much. In the same way, we have also reached such a level of dominance and prevalence of food here in the Western world that we have the ability to gorge ourselves to obesity. Despite all of the wonderful mechanisms that our bodies have evolved to counter all sorts of problems, a mechanism to prevent obesity was not something that ever arose.

Why? Simply because it wasn't necessary. Abundances of food have occurred before, but ultimately if an animal got fat (assuming predators and omnivores here), they couldn't catch the food anymore. They would then starve until a point to which they were fit enough to catch food or die. Our obesity does not prevent us from obtaining food, due to the nature of being able to exchange food for money. Thus obesity can be a life long condition, rather than a temporary one.

So how does this effect the medical community? Cost. Obesity is an expensive chronic condition that costs lots of money to fix or mitigate its side effects. Heart disease, especially, goes hand in hand with obesity. Everyone knows about the health problems and thus healthcare related to obesity, but hospitals and our community have another problem. Just like our bodies weren't built to respond to rampant obesity, so is the current medical structure of our society not prepared for obese healthcare. Hospitals were not BUILT to handle the super-morbidly obese patients that are now rolling in (no pun intended). I've seen an obese person on a extra large rolling bed get stuck in an elevator and go into cardiac arrest. He was literally too fat for the hospital, and the doctors trying to get a crash cart into the elevator were more than happy to comment on it. I watched a surgery on an obese man recently. It was an intestinal surgery and the longest part of it involved simply getting through the fat to the target. After the fat clearing, the surgeon turned to me and said "I just go paid 700 dollars for cutting fat." Mark my words, smart hospitals will be soon instituting a midlevel specialist who's sole job is to clear fat out of the way for surgeons. I'm sure that this is just one of the many things that will need to change in order to make hospitals economically and physically viable for our obese future, and there are many people hard at work at the problem. Do you think its a coincidence that newer hospitals have much wider hallways and bigger elevators? I wouldn't be surprised if fellowships in Obese Medicine start popping up sometime soon.

The four year pathway: Doomed?

So my recent string of waitlists has gotten me to think about something that had popped into my mind during medical school interview season. It seemed to me that the really top schools that I interviewed at were predominantly filled with older interviewers. I know that at a few interviews that I was the youngest person there, and I'm 22. I checked up on this, and it turns out that almost half of all students accepted to the Top 10 medical schools were non-traditional, meaning that they took some significant time off. Whether this includes people who took a year off, I'm not entirely sure, but either way this is a very significant number. It basically says that in order to be truly competitive at the very best schools you have to have MORE than an undergraduate experience. This makes a great deal of sense to me. As much as we pre-meds like to think that we are all the best, most unique candidate, I acknowledge that I simply can't compete with some of these applicants at this time. I've got the grades and the scores, and I've managed to smash more interesting EC's into my four years than I thought possible, but ultimately my two years of part time work in research is no match for someone with a two year full-time fellowship at the NIH, and my teaching and tutoring experiences simply don't match up with someone who did a stint with Teach for America. There just isn't enough time in four years to fit things of that magnitude, though some people may come close. 

So the question that I ask and have asked is if this is a trend? Will this slowly trickle down to all schools until basically every applicant applies after a year of post-graduate work. Not likely, in my opinion, but it is clear to me by looking up the data that the barriers to the very top schools are growing higher for those who wish to make it there in four years. Everyone will tell you that medical school admissions is growing in competition, and the very top is definitely keeping ahead of pace. So, should I have considered waiting and done Teach for America like I wanted? Maybe knowing what I do now I would have, because I honestly didn't even think that I would be competitive at this level until the interviews starting coming in. At this point though, I wouldn't give up what I have to try again. Who knows, maybe in the coming months it will turn out that I did manage to jump those towering walls.

And so the dust settles

Well decisions are out, and I'm a tad disappointed. Mostly waitlists and a few rejections mixed in from some of the Ivy's that I interviewed at. Nonetheless, I'm still pretty happy with how I did. I got rejected from the school that I dreamt of when I was younger, but honestly I almost didn't even apply because I had fallen out of love with it (In fact, I applied to it three months after everywhere else because I had a change of heart). The school I am currently matriculating in is highly ranked in both research and clinical, and has the special programs for Medical History that I am very interested in. While it doesn't have the glamour of, say, Yale, it has more respect from the medical community than any other single school that I have talked to physicians about. In fact, my father ( a physician) regards this school more than a lot of the dozen or so schools ranked above it. It's also the only school that none have ever had negative comments about either. It wasn't my top choice, but I did really find myself liking it. Honestly, if it had more "bang" in terms of name brand prestige I would probably list it as my top choice. That sounds a tad superficial, and I'm sure in a few years I'll look back and laugh at myself, but in my experience it seems like getting into Academic Medicine has a lot to do with the being from a highly ranked medical school. That being said, the $20,000 merit scholarship, with room for more, "eases my pain". I sent a letter off to my top choice, but I'm already preparing myself for matriculation. Great city, though not New York like I hoped. Great facilities, great medical history department, great honor to be going.

Well that's all for now. I'm in the process of preparing my undergraduate "graduate level" thesis for defense. I'll keep you all updated when I hear yay or name from my 5ish waitlists that I care about on May 16th. I've also standardized my labels for easier searching through relevant posts.

The final days are upon me!

In little more than two weeks, I will have gotten some form of response from essentially every school that I am waiting on. Many school choose to wait until March to announce acceptances (or the bulk of them), and starting tomorrow the letters will begin going out. I am waiting on quite a few schools, and my top choices as well. I've tried not to get too committed to a single school, because it isn't worth the emotional devastation if I don't get in. Despite this, I have my fingers crossed for a big, fat packet in my mail box!  At least I am fortunate enough to have an acceptance in hand. I really feel for those who are still waiting for one!

Oh, I added some new questions. They appear to have been written on February 14th, but I just published them. Don't forget to take a look!

A useful Table

http://www.aamc.org/data/facts/2008/mcatgpa-grid-3yrs-app-accpt.htm

Just so you know, some of those lower end acceptances were MD/BA students. Nonetheless, it is a quick and easy way to gauge the competitiveness of your stats. Don't take it too literally though, because it doesn't tell you the whole story. With good or bad EC's your competitiveness drastically changed. This also doesn't tell you WHERE those accepted students went.

Question 14: Advice on letters of Recommendation

As I mentioned last time, personal statements are an evaluation of your professional life among professors, physicians, and employers. They are designed to evaluate you on your performance and your personality in a generally professional setting. To this end, there are a few ways to optimize the quality of your letters.

1) The Basics

Overall, I would recommend at least 2 letters from Science Professors, 1 letter from a non-science professor, and two personal letters. By personal I mean from a research PI, a boss, a coordinator, a dean, etc. Not your best friend Timmy! Make sure that you have a doctor letter on hand as one of your personal letters. Other medical staff are great for other letters, but you should ALWAYS send a doctor's letter. You can have more than these five that I recommend, but the minimum requirement that has been highest (to my knowledge) was five letters minimum. Feel free to pick and choose, and to have additional letters for a given school if you know someone with strong ties there (you would send these types of letters directly to them, not with your primary application). If you are applying to a research intense school, a letter from your PI should always be among the letters that you choose to send.

2) Use a letter sending service!

This is sooo much more convenient than having each letter writer send out dozens of letters, or for you to do it for them. The biggest plus of this is that you can bypass some of the "maximum" letter limits, because you only have a single letter packet and schools will accept all of your letters because of this. Whether it makes a difference, I do not know. Regardless, its really convenient because you don't have to worry about things being lost in the mail, as they are sent to schools electronically. You also get confirmations that the service got them, and can select which schools receive them. Many pre-med advising offices do this as a service to their students, check! Otherwise Interfolio is a common one to use.

3) Fresher is better

The ultimate goal of these letters is to evaluate you as you are when you apply, not who you were in your freshman year. Sure, it might be tempting to collect letters from professors early in the game, but it would be much better if you maintained relationships with those professors until your junior year, or alternatively got letters from professors that you were active with in your junior year. This is a much better evaluation of who you are when you apply, and it gives them much more information about your college career to draw upon (discussed in number 5). I know that some of my best experiences came during my late sophomore and early senior year, things that defined me. Furthermore, some of my letter writers had been acquainted with me for years by the time that I asked for letters, and were much more likely to be qualified to evaluate me. Another boon is that, by your junior year, most of your classes will be pretty small. This makes it easier to build relationships with mentors.

4) Fame is nice, familiarity is better

Sure its tempting to get that Nobel laureate to write you a letter of recommendation, but it does you little good if all they write is "Student X went to my class, likes dogs, and asked good questions." This is something that I was told by adcom members that is so often the case. The point of the letters is to evaluate you, not to try and grab as many big names as you can. What good does getting a letter from a professor that knows adcom members if he or she has nothing to say about you, especially if they call him or her up to ask! That being said, one large name might be nice to have, especially if it is someone related to your major, department, or university. The ideal situation is that this person knows you well, and I'd recommend that the "famous guy" be a personal letter than one of your professor letters, just because these are often weighted more heavily (or so I have heard, remember to keep your salt shaker with you!). Bottom line, familiarity is going to get you a better letter. They will be able to talk about you in depth, and give an honest (and hopefully good) estimation of you. This is what you want!

5) Make a info packet for all of your writers!

Even if it's someone that has known you since a child, make sure to type up an extensive summary of who you are (with table of contents). Where you were born, what your parents do, siblings data, high school life and location, college life, jobs, awards, interests, grades, majors, minors, etc. Chances are, most of it won't be very useful to them, but there is always the chance that someone will be able to reference something that you did as part of their estimation, and it allows them to refresh themselves on the details of your life. Basically you want another AMCAS, except feel free to include interests and hobbies (such as traveling) that you didn't! This is why the table of contents is important, so that they don't have to wade through all of it looking for what they want.

6) You must pursue relationships

Want a good letter, you must take the initiative. Even if a professor likes you, chances are they aren't going to show up at your door to hang out. You must put in the time and effort to build connections with your letter writers, it isn't their job. Furthermore, never hesitate to ask someone that you feel might be helpful to be recommended by, for whatever reason. It won't hurt to ask! 

Question 13: Advice on Personal Statement?

The personal statement is enormously important (like everything else! :D). The personal statement is your first shot at being more than data. Everything else on your application is simply a description of what you have done, or a numerical evaluation of your academic performance. Your letters of recommendation are a representation of yourself in a professional setting, but your personal statement must include both your private and professional side. In addition, the personal statement is the one essay you are guaranteed that every school will see. Some medical schools do not have supplemental essays, so treat this always as your first and only shot to show them your stuff. Here are some tips:

1) Make it interesting

Adcoms read thousands of personal statements. Make yours a treat for the eyes.  You want to get your message across, but try and do it in a way that makes you seem interesting, as well as making the personal statement itself worth more than a casual glance. Chances are good that they speed read a good majority of personal statements, at least the first time through. There are plenty of ways to make it interesting. Talking about personal passions or meaningful experiences both tend to be good stuff. Don't feel that everything has to be directly related to a medical experience either. Say you have a passion for teaching and knowledge. If that is an important part of who you are and what is important to you, include it just like you would in your resume activities list (if you followed my advice!).

2)Don't Ramble

Length isn't everything. If you can get your message across just as well in a concise manner, do it. Using every last character allowed will ultimately have no effect. Furthermore, don't feel that you have to restrict yourself to a single topic. Going back to point 1, having multiple paragraphs discussing different aspects of yourself and your passions can be much more pleasurable to read than one, gigantic spiel about your great ant Ella. The more points you can make without seeming rushed the better. Look for filler information that isn't actually useful to the point you are trying to make. Does describing in depth the scene of the hospital the day you had a significant experience really increase the message when compared to simply writing "While volunteering in Trauma one day,"? Not likely! We will talk more about the benefit of having multiple topics to touch on later.

3) Getting it in early is good, make sure you have time for plenty of revisions.

Make no mistake, applying early is an enormous boon! However, your personal statement might be the most important essay in determining your interview potential. Make sure it is the best one you've ever written, and make sure that it is spotless. Grammatical errors are a huge negative to a lot of adcoms! Consider getting your personal statement proof read professionally, as well as taking it to as many proof readers as you can. When I wrote my PS, I wrote multiple paragraphs on things that I eventually didn't use. In fact, in some cases I condensed an entire paragraph into a single phrase by the end of my revisions. Write as much as you can and then piece the things that are best and flow well together. Have your advisers read it, your parents, your non-pre-med friends. Get as much commentary as you can, even if you choose to ignore it! Remember, this statement is about you. Just because you are given ideas from someone that you think have value doesn't mean that you should use them if they don't fit your message and who you are!

4) Your personal statement should fuse your application into something coherent.

In the end, your personal statement should make sense of all of the scores, classes, activities, and life experiences in the rest of your application. Show the adcom how the pieces come together, and how all of this combined makes you a great future doctor! This is the benefit of having multiple topics in your personal statement, rather than one long and grandiose one. You can relate the different parts of who you are together by discussing them and then synthesizing. Have a message, and make sure that each paragraph contributes to it. Tangents might sound interesting, but they are a waste of space if they don't add to the sum of your PS. Save them for interviews!

I won't publish my PS, but here is a general idea of how it flowed.

Introduction- childhood personality and how it lead to my desire to be a doctor.

Personal influence on my by someone I know that contributed to my desire to go into medicine.

What I learned from an experience in medicine, and how I have grown to prepare for it.

An event that strengthened my confidence in my ability to go into medicine.

Conclusions and summing it all up.

Question 12: Do you have any advice on taking the MCAT or studying for it?

Absolutely. The MCAT is a wonderful exam. No, I haven't gone crazy and I haven't been overdosing on caffeine (today at least). It really is, because its ultimately fair. Think about med school applications without the MCAT. I guarantee that anyone not in a top private school would be ultimately excluded. It would just be assumed that the guy with a 3.4 at a top school was smarter than the 3.9 at a public school, because the top school guy had the standardized test scores to get in there! It would make admissions so much more subjective than it is now, because there would be no firm reference on the level of academic ability of the applicants. The MCAT is not necessarily an IQ test, except for perhaps the Verbal reasoning, because it requires a certain level of outside knowledge. Regardless, your score tells much about the combination of your work ethic and natural reasoning abilities. We are not the same people we were in high school. Maybe the public school guy, like me, decided to go for fit or finances instead of prestige when he chose his school. Maybe he or she was an underachiever in high school. Maybe the private school girl was a top notch student in high school, but lost her drive or chose activities over grades. The MCAT puts everyone on an equal playing level. The material covered is not super advanced really, so where you learned it isn't going to affect you (Seriously, does anyone think that a brilliant Nobel prize winning Chemist knows more about the concepts of a general chemistry class? That knowledge is so basic that anyone with a PhD has plenty of knowledge. That professors realm of knowledge is so far above that of a general chem or organic chem class, that they probably have to review the material just as much as anyone, nor does their knowledge make it any easier to teach that class (in fact, perhaps it is harder because of that knowledge). Ultimately, your teacher's skill at teaching is what determines that, not their innovativeness in the field). The MCAT is a unbiased way of looking at a students academic prowess without consideration to their school, major, etc. Its why you can go to any school and, with the right gumption and talent, go to any medical school. It also gives medical schools perspective on your GPA by averaging the MCAT scores and GPAs of other pre-meds from that institution. For example, lets say a school had an average MCAT score of 33, and GPA of 3.6. If a student showed up with a 4.0 from that school, that's pretty impressive, given the already high quality of their students (based on their MCAT). Anyways, enough talk about the MCAT:

1) The MCAT is ultimately a self study exam.

Medical school is primarily self study, and so is the MCAT. No matter what any of the test prep folk might hint at, only you can get yourself a good MCAT score. Expect somewhere between 300-600 hours of studying before you're prepared. Naturally, if its been a while since you last performed a backside attack on a bromine functional group, your learning curve is going to be higher. The lectures offered by Kaplan and Princeton Review will not shoot your score up 10 points without some out of class review. It would take far more hours of lecture than even PR gives for that to be the case. However, I'm not saying the lectures are worthless. They are a great way to synthesize what you are self studying, keep you at a good pace and give you a schedule, and reinforce strategies and tips that can actually be pretty helpful . However, its the bazillion and a half questions, pages of notes, and practice exams that are ultimately what is worth the price. With a little extra time an effort, you could find a TA or a help center on campus (if you're still in school) to answer any content related questions you might have, but the lecture add on to the Kaplan and PR material provides you with a competent, MCAT oriented teacher that you can email questions to any time you need to. They are also familiar with their own material that is given, so they are better suited to answering questions.

2) 3-4 months of 20-40 hours a week is enough

If you feel like you need more time, go for it, but studying for more than a year is ludicrous. If it takes you that long to get through all the content and strategy, you're going have forgotten what you began a year a go. Doing it in as few months as possible is the best strategy for retention when you combine this with occasional reviews of the material.

3) An August test before your application cycle begins can be useful

This is useful for two reasons. First, it gives you a chance to retake the MCAT before the start of your application cycle if you don't get the score that you are looking for. This prevents you from being tempted to retake the MCAT when the application cycle has begun, and thus putting you behind the curve in beginning your applications, which will hurt you. It also gives you the advantage of a lower curve to compete with. This assumes that you are well prepared, but if you are the MCAT average is approximately 1 point lower in August, compared to May. This is probably because so many underprepared people take it in the Fall, but you can use this to your advantage if you've been studying since the previous summer. A lower curve means it is easier to reach the top scores (slightly). This, of course, requires that you have completed your pre-reqs in the first two years of your undergrad, or potentially during the summer. Do NOT try and take the MCAT without all required classes. Get the score you want the first time around. Medical schools note how many times you have taken it.

4)Take a noon MCAT, or prepare well for an 8AM one.

It is hard to be awake for the MCAT at 8AM, especially since you won't sleep well the night before on your own. I really regret taking my MCAT at 8AM, though I ended up doing well enough for my purposes. The problem was that I had not practiced taking 8AM MCATs, because I had taken most of my exams at night or at noon. Practice taking MCATs at the time you are scheduling for, be it noon or 8AM. I personally think that, even if you didn't sleep well, you will be more awake and alert at noon. It is true that so will everyone else that is taking the exam, but I'd rather trust myself at 100% against everyone else's 100%.

5) 35 is the magic number

Shoot for a 45T, period. Setting your goals lower only limits your success. Sure, you probably won't get a 45T, I didn't. However, I had a friend who wanted a 36. When he started to score 36s, he stopped studying as hard. He ended up not getting a 36, and I really think that it was because he didn't push himself towards perfection. If he had kept going until he was peaking at a higher grade, he might have made his goal or higher. As they say, shoot for the moon, if you miss at least you'll be among the stars.

That being said, 35 is the magic number. At this point you have reached the 95th percentile of scorers, and the differences between points starts to shrink to a single question or two. The difference between a 40 and a 45 is basically 5 wrong answers. This means that higher scores become less and less important at this point, because you could go up or down a few points by luck and chance. Medical schools recognize this. Even if a 43 sounds impressive on paper, its really not statistically much higher than 39 (99.9th percentile versus 99.8th basically). Once you reach a 35, you are about average or higher at almost every medical school, and you are reasonably competitive at even the top schools. I would not retake the MCAT once you reach this score or higher. You might feel that you can do better, and quite possibly you could. However, why risk it? I think I should have done better on the MCAT, and if that is true I will have another shot to prove that on the Step 1. Why risk it though? You're in the top percentiles, and its the rest of your application that will ultimately determine where (and if) you go to medical school.

In addition, a 33 MCAT score is considered competitive at most schools. You might not get into a top 10 school, but most students don't anyways. The only people who really care all of that are pre-meds anyways. A doctor is always a prestigious profession. Also, it should be noted that a high MCAT can help compensate for a low GPA. Don't expect to get into school with less than a 3.0 though, unless its been years since your undergrad.

6) Consider a chemical method of going to sleep.

Just like interviews, you will not sleep well on your own the night before. Especially if you are taking a noon exam, serious consider chemically putting yourself to sleep, either via a sleeping pill (small dosage, just enough to relax you) or even a couple drinks. Your mind will be racing, if you want to be asleep you'll have to force it to stop thinking. I'm serious, I laid in bed for 5 hours before I finally fell asleep. As I said, make sure its a light dosage so you don't wake up still feeling the effects (or with a hangover!).

Question 11: Is a knowledge of sports necessary to be a good doctor?

In light of the wonderful Superbowl game that was just played (but what was with all of the punching from James Harrison, way to go woman beater), this is quite a fitting question, especially since it touches on, my favorite topic, the Art of Medicine. It is my personal belief that one of the biggest reasons why medical schools have started insisting on well rounded and diverse students comes from the idea of people treating people rather than doctors treating patients. This is the benefit of being diverse personally and having a diverse group of medical students. You grow from each other's experiences and interests, making it far easier to relate to a diverse patient population. To this end, sports is a very big part of many patients lives. I personally am not a big fan of watching sports on TV, though watching it in person is fun. However, I think that having some basic knowledge of the sporting world can be useful. Most of what I know is picked up from headlines I read on internet news pages, but it tends to be enough to hold a conversation with the average fan. I also think that following local teams (if your city has them) is probably most important. Those are the fans that you are most likely to treat, and being able to relate with a patient on any level is a good thing. If that happens to be talking about theSteelers , then great. The bottom line is that having diverse interests and knowledge will help you make that doctor patient connection. It builds trust in your abilities as a physician and in the idea that you see your patient as more than just a case of the flu. It doesn't matter whether or not that its true, what matters is the growing conviction among the population that has come to see physicians as detached and lacking in compassion.

As I've mentioned in previous posts, sometimes a little personal interest and caring is the only cure that a patient nervous about a rash needs. Furthermore, in the case of a patient with a serious condition, they are much more likely to trust your advice (and FOLLOW it!) to the letter if you prove that you have a genuine interest in their well being. For those who have to fake that genuine interest, you'll be happy to know that it also lowers your chances of being sued. Patients don't sue doctors they see as friends or as people who truly tried their hardest to help them. Patients sue doctors that don't seem to care, and then ascribe the negative effects of their treatment to this (regardless of the truth). My father has never been sued in 30 years as an ER doc. He attributes it to the fact he's always cared about his patients and taken the time to talk about the game last night.

Do you have questions for me?

I am more than happy to answer any questions that I have yet to cover. I am always looking for good ones, so if you have one or more, feel free!

Question 10: What is some advice that you can give me about interviews?

1) Waiting time is exploration time.



I can not stress how important this can be. A lot of medical schools give you an hour or more where you have nothing to do but wait for your next appointment. Get out of the admissions office and explore! If you have 10-15 minutes before your appointment, that's one thing. However, sitting around comparing applications with a bunch of applicants is not going to help you get in or help you judge a school. True, a lot of medical students will pop in and out while you are hanging out in the office, but these are students who are going to tell you mainly the positive stuff about their school. Go find some disgruntled students! This is potentially the school you will have to study at for the next four or more years. You will have plenty of time to ask questions and talk to some students/applicants during the tour and meal periods. You will NOT have another opportunity to wander around and see things off the beaten path like research facilities and other things that you might be interested in. Further more, you might have the luck of learning something that could help you explain your interest in the school you are interviewing at , or something that you will be able to otherwise connect to your application. Learn as much about the school as you can, wander! Even better, you have the wonderful opportunity to possibly meet someone who could seriously help you get accepted. I once got stuck in an elevator for 10 minutes with on of the Associate Deans, and on another occasion I happened to stumble upon the Dean of Admissions, something that lead to an hour and a half friendly chat.



2) Staying an extra night has its advantages.



Interviews are all about showing the admissions committee that you are a good fit. Your stats and application gets you an interview, but your interview is, in general, essential for an acceptance. Staying an extra night, either before or after your interview, provides you with excellent opportunities. For one, you have another opportunity to wander around and meet people/learn things, as I mentioned above. For two, you have an enormous opportunity to socialize with students, especially if you happen to be spending Friday night there. While I suppose there is the very unlikely opportunity of meeting a student member of the admissions committee, the bigger benefit is you get to interact with students on a completely social level. This is a great insight into how students really feel and if you fit with their style. In addition, once I had a couple students actually plug for me with the admissions committee. I was extremely flattered, regardless of if it changed anyone's opinion of me.



3) Know something about your interviewer.



Generally, you are given the names of your interviewer at the start of the day, when you arrive. Naturally, you will attempt to be early anyways, so use that time to go find a computer. If you have an internet friendly phone, that'd work too. I have never had a problem using a medical school's library, simply explain that you are interviewing and it should be all right. So how does this advantage you? I'm not saying you should walk into your interview and say "I know where you went to school and where you live." A little too forward. Rather, you can use it to your advantage by steering your responses to reflect mutual interests and realms of knowledge. For example, say you are interested in public health and your interviewer is actively publishing on the topic. You would be able to have an in depth discussion on this topic. Also, it can be useful for when you are inevitably asked if you have any questions. If your interviewer is a cancer researcher and you have an interested in opportunities in the field, or just general questions about their research, feel free to bring it up. Highlighting mutual interests can never hurt you, but it certainly can help you. Adcoms are looking for students that fit with their philosophy, and your interviewer is a part of that philosophy. You want to be able to relate to your interviewer, because it will certainly make the interview less stressful if nothing else, even if the connection is that you were both from the same State and you contrast your State with where the medical school is. If you are asked how you know something, simply admit that you asked or looked something up on them. I've actually been complimented several times for taking the initiative of looking something up.



4) Dress conservatively, but don't hesitate to be fashionable or to stand out a little.


You definitely want to be professional at interviews, but don't hesitate to drop the white button downs for a shade of blue or the color that best suits you. I noticed at my first interview that I was the only one out of 20 students to wear something besides a white button down. I was consistently selected out of the group throughout by those leading conversations, demonstrations, etc. By my last interview, more than half of the interviewees were wearing something besides white. Coincidence?



5) Send thank you letters, assume they won't help you.


Don't fret about whether or not that a letter is going to help you or hurt you. Unless there is a specific request for letters, it will not affect your application negatively. They receive a bajillion of them, you will not seem pretentious or trying to brown nose. Most likely, by the time your have sent your letter and it is received, any notations on your application by your interviewer will have been submitted. There is a slight possibility of it helping you during later evaluations, I suppose, but don't count on it. Not sending them is not going to affect you for the same reasons. However, if you end up going to that school and you did not send a thank you letter, you might feel a bit guilty for not thanking them. After all, they were probably instrumental in getting you accepted. I know I do, and I fully intend to apologize if I went to one of the several schools I chose not to send thank you letters to, several of which I've been accepted to.


6) If given the option, schedule interviews as late as possible in the day.


For one, you will be more awake and alert than you would be for that 8:00 AM check in after tossing and turning all night. More importantly, you will have had hours to experience and learn about the school, quite possibly having done the tour and info sessions. This is an enormous advantage in tailoring your "Why this school" questions, which is sometimes a bit hard when you've only read about it.


7) Consider a chemical method of putting yourself to sleep the night before.


It can be really hard falling asleep for a variety of reasons. Jet lag, large time difference, staying with a noisy student, etc. All of this could seriously hurt you the next day. I know that at one particular interview, I was so exhausted that my picture they took is terrible (I had a lazy eye from being so tired), and I did very poorly at the interview. I also asked some pretty dumb questions, because I just couldn't sleep straight. Think about taking a light dosage of sleeping pills, or even a tad of ethanol (make sure you shower in the morning. A beer or two shouldn't leave an odor, but why risk it!).

8) Other little things

Smile, especially when meeting your interviewer
Don't try and smile the entire interview, it will look fake if it isn't natural
Learn to be humble and still get your message across
Thank them for any praise, be humble about it
I grew up on military bases, so I have always chosen to address my interviewers as Ma'am or Sir. Yes sir, etc. It seems like a lot of my interviewers were ex-military, as well.
Ask good questions. Even if they are standard, the best questions are the one's you didn't read on a list of "good questions." They come from yourself
Don't be afraid to pause before answering, especially if it is a new question.

It's an odd feeling

I had a uncomfortable experience recently, and its the first time that it has ever happened to me. I was dancing with a girl in one of my dance classes, and we were covering a style of dance that I had never done before. She was getting a little frustrated and clearly hoping for a new partner by the time we took a break, but we got to talking about medical school. She told me that she was a pre-med (year younger than me by the way), and was applying next year. I then told her that I had been accepted to medical school and how my interview process had been going. Her attitude towards me instantly shift 180 degrees. She was suddenly more friendly, enthusiastic, and forgiving of my mistakes. In fact, SHE started apologizing, even though it was clearly my lack of experience rather than hers. I was shocked, and I realize that this is probably only the first of many times in my life that my career in medicine is going to alter people's behavior and opinion of me. This kind of prestige is supposed to be a good thing, right? It's what a lot of people want when they apply for medical school.

It really bothered me.

"Commandments" of SDN

So SDN has the potential to be a great resource for pre-meds. Alas, the forums of the student doctor network are full of eccentricities and neuroticism. Here's a joking list of commandments for those who dare to venture into this abyss. 

1) Thou shall not troll

2) Thou shall not discuss MD vs DO

3) Thou shall not say MCATs

4) Thou shall not start the same stupid threads

4.5) Thou shall make liberal use of the search function

5) Thou shall not discuss under represented minorities

6) Thou shall wait till August to change thy title to medical student

7) Thou shall not post in class threads until thy art a member of said class

8) Thou shall consume great quantities of salt when partaking of SDN

9) He that speaketh of Prestige shall be stoned

10) Thou shall not seek to identify LizzyM

11) Thou shall not fret over one C+

12) He that speaketh of money or lifestyle shall be stoned

13) Thou shall limit thy post to 1500 characters.

14) Thou shall send thank you letters

14.5) Thou shall not send thank you letters

15) Thou shall limit thyself to one utterance of "We're going to be doctors"

16) Thou shall not ask if medical school is hard

My beef with DO students

I'd like to preface this with my intentions first, because discussing DOs is always a dangerous thing for someone on the MD track. I have complete respect for DO practitioners and their Art. I think no less of DOs, nor do I think they make worse doctors in any way. I have had the pleasure to interact with almost as many DO's as MDs, and they have performed just as well and I learned just as much. I can say this without bias, because it was not for a long time after my interactions with them that I even learned that they were DOs. My beef is with the younger generation of DO students (some of them, at least). The field of Osteopathic Medicine has fought long and hard for its right to be considered equal in the medical field. However, I have seen more and more behavior revolving around the idea that DOs are better than MDs, rather than both fields being equal in worth and quality. I hate hypocrisy, though I don't claim to be free from it. Three particular behaviors particularly irk me.

1) DO students and pre-DOs that claim that DOs are somehow better at treating patients as people, focusing on the patient rather than the disease, and are better at primary care because of it.

This is a bunch of subjective nonsense. There is no evidence to prove or even support this. Look at a veteran DO and a veteran MD and tell me if you notice any difference, besides personal choices of bedside manner. A good doctor of any degree does what works, and discards what doesn't. This is how one becomes a better doctor. There is no secret gift that DOs obtain at their school that can not be learned by MDs. Assuming some part of DO training does give them some sort of better grasp of medical art, an MD would see this, enquire about it, and begin to implement it. This is how medicine works, by continually learning and improving yourself. I personally don't think there IS some kind of training that makes newly minted DOs better at treating patients. What I think it is happening is that young DOs or DO students are eager and exceptionally friendly to patients (just as young MDs and MD students are). Patients are receptive to this eager use of the Art of medicine, and then say that this particular student is the best or most caring doctor they have had. They then assume this means that DOs are all better at patient relationships because of this. This isn't a fair assumption, as I said MD students and freshly minted doctors have an equal level of excitement that rubs off on patients. We are all young and eager to do what we have spent our whole lives preparing for. I have spoken to many veteran and retiring doctors, and what I always get out of it is this: "I was blessed to have a job that I could love for xx number of years, but I am tiring of it, and its time for me to quit." You will not be as fresh and excited your first day in the field when it is your last. I have watched my father since I was a child, and he has become more calloused by the long hard years of a dedicated practitioner. He still does his job with the same level of professionalism as he always had, but he doesn't leave a long shift the way he used to.

Anyways, the bottom line is this for me. If DO students can say that they are better at relating to patients than MD students, then I can say the reason is because they are closer to average intelligence (citing GPAs and MCAT scores), and thus find it easier to relate to patients because of it. Neither statement is fair or correct, so DO students please stop trying to insist you are better than MDs. We've accepted you as equals, why don't you do the same?

2) MD turncoats that become avenging angels of Osteopathy, and vice versa.

These people REALLY get my goat. It absolutely drives me nuts when someone wants nothing to do with DO schools, talks about nothing except MD schools, and then, when they don't get into allopathic schools, they are suddenly the champions of DOs. It tends to be these folks that commit 1) the most. I have no problem with you justifying that DO schools are just as good, because they are just as good at training doctors. However, when you start running around promoting the DO philosophy, saying how you couldn't think about doing anything but DO medicine, or even dare to try and talk down about MD students, you cross the line. I can accept that some students might fall in love with the DO philosophy after being exposed to it, but if you haven't even started school yet, or you are fresh into it, please don't come to me with that! You haven't even learned the extent of the DO philosophy, and you are going to go around trying to rub it into my face? Please!

The opposite goes as well. I know a bunch of students who were totally all about the DO gig, did nothing but talk and research DOs, etc. Then, they manage to get into an MD school, and all of the sudden its all about fit. It just so happens that they ALWAYS fit better at the MD school rather than the 8 DO schools they were accepted to. Always? Really? That's really interesting how you fit at the type of medicine that many pre-meds cling to as being superior. If you know you like osteopathy, go down that path. If you know you like allopathy, go down that path. If you are unsure, apply to both and keep an open mind. But don't you dare flip flop on me! This isn't a presidential debate people!

3) The American Osteopathy Association

These guys annoy me too. After all the battling and struggling to become equal, they have refused to reciprocate. The AMA gave their students the right to apply for Allopathic residencies, and even recently came out with a resolution prohibiting discrimination against DOs on the basis of their degree. And yet, MDs still can't apply for osteopathic residencies. This is absolutely unfair! You want equality? Its a two way street!

Kaplan should pay their MCAT teachers more

So I work for Kaplan as an MCAT teacher, and the other day something occurred to me. It was right after I declined another course to teach this semester, and a discussion with my boss on how he was struggling to find someone to teach it. I realized that MCAT teachers are getting a bit ripped off. I personally am ok with the money and don't really care, because I'm doing it for the teaching experience rather than because I want more money. However, there are 4 MCAT teachers and like 20 SAT teacher at my Kaplan site. We all get paid the same, despite the fact that MCAT teachers are more scarce (and we teach approximately the same number of students as the SAT folk, because our classes are much larger). It also takes a lot more work to teach a class room for pre-meds, though admittedly with a little prep and if you follow the material religiously you could probably fudge your knowledge. MCAT students pay more than twice that of most other test prep takers at Kaplan as well. And yet, Kaplan MCAT teachers don't get a cut of this. I'm surprised that this has never come up, because quite honestly each MCAT teacher is more valuable and difficult to come by than SAT teachers. We tend to have more education as well, since SAT teachers can start teaching at age 18, but few 18 year olds are prepared or capable of teaching the MCAT. Like I said, I don't care that much, but it does seem a little unfair.

Question 9: What are the pre-requisites for medical school

The pre-reqs for medical school vary from school to school. According to the Medical School Admissions Requirements (MSAR), the following numbers of school in the US, Canada, and Puerto Rico require the following courses:

Physics -120
Inorganic/General Chemistry- 119
Organic Chemistry- 121
English- 84
Biology- 85
Biology/Zoology-40
Calculus - 17
College Mathematics - 35
Behavioral Sciences - 9
Humanities - 14
Biochemistry- 13

out of 129 schools polled.

This however, does not give you the exact number of semesters required for each course. The most common recommended list is:

One year (2 semesters) of General/Inorganic Chemistry and labs
One year of General Physics and labs
One year of General Biology and labs
One year of Organic Chemistry and labs
None of these labs may be taken online, and all of these courses are needed to be optimally prepared for the MCAT.

In addition:

2 English courses, with writing portions
1 Calculus class and 1 statistics class.

I also recommend a semester of biochemistry and genetics. Neither of these courses are commonly required, but both of them are extremely useful as reviews for both the MCAT and medical school. I would also definitely suggest that you buy an MSAR the year that you apply and check the requirements for each school that you applied to. You do not have to have all of these requirements done before you apply, only by the first day of classes at medical school. I would strongly recommend that you not try to get around these requirements, and finish anything that you need in you Spring semester.

Here is a link that claims to have compiled all the math requirements for schools that have them:

http://www.brynmawr.edu/healthpro/documents/MedSchoolMath_Requirements_2009.pdf

Question 8: Should I take AP credit?

For those who are sure that they are going to pursue the pre-med track, I am a profound supporter of not accepting any AP credit. This is not to say that I don't think AP and Advanced classes in high school are valuable. Quite the contrary, I think that the classes themselves are enormously beneficial. The bottom line is, though, that a ton of AP credits will never make an adcom whistle and be impressed (my opinion). It might not directly hurt you on the admissions road, but it will not make you more competitive either. I understand the benefit of being able to jump into sophomore year classes, especially if you intend to double major, but here are my biggest reasons for not accepting AP credit.

1) You miss out on a GPA inflater.

This is my biggest plug for taking AP classes but not the credit. AP classes are very closely related to most of their namesakes in college. By taking AP Chemistry, you are setting yourself up to be very well prepared for General/Inorganic Chemistry your Freshman year. GPA is enormously important part of your application, and this is a great way to improve yours. This is especially true for your Science GPA, even if you are a science major. If you took AP Physics, Chem, and Bio, you have 6 science classes that are going to be a lot easier to get an A in. That's a huge boost to your GPA, and a great GPA buffer if you ever have troubles down the road with grades and get a couple C's. I personally would advocate dropping all AP credit that you get, but I definitely suggest that you at least drop the med school pre-requisites. Getting A's in every one of them (because you had already learned it in high school), will go a long way in showing that you are capable of tackling the basic sciences in medical school.

2) Some schools don't accept AP credit for pre-reqs, or only accept it conditionally

There are a number of schools that jut plain don't accept AP credit as legitimate fulfillment of the pre-reqs under any circumstances. Meaning, if you don't take the classes in college, you will not be allowed to matriculate at these schools, even if they accept you. I know a friend who had to withdraw his application from a couple schools because of this (he still was accepted elsewhere thankfully). I can't offer a full explanation as to why this is, but I assume it has something to do with them really want to check your basic science skills, especially for non-science majors. Most of the schools that don't accept AP credit are willing to strike a deal with you. Basically, you can still fulfill the pre-req requirements that you have AP credit for by taking a higher level science course in that area. So if you took AP credit for General Bio 1, you can take Cell Biology or Genetics (assuming it isn't a pre-req) to fill it. This is fine and dandy if you happen to be taking those classes anyways, but for non-science majors this is a pretty big burden. Even for science majors, it can be a hassle if you don't have any classes to fill, say, your Physics requirement. Why risk hurting your GPA on higher level classes that you don't want to take, or don't need to take? If you aren't interested in the class, forcing yourself to take it is dangerous to your GPA. Plus, you have to smash the classes into an already packed course load.

I would just like to note that I am only talking about pre-requisite courses here. AP philosophy isn't going to hurt you, as long as you get a Bachelor's degree.

3) Pre-requisite courses are a great preliminary review for the MCAT

The MCAT is more or less a review of the science pre-requisites, with some verbal thrown in. By not taking the pre-reqs in college, thats another year or more before you review some of that material (especially physics, it seems most people take it their sophomore year of college). Relearning the material one more time is just another layer of understanding that you tack on. It isn't enough MCAT prep in itself, granted, but every little bit is cumulative in your mind, and I personally felt that I was a lot more prepared going into the beginning of my MCAT studying than a lot of my AP heavy friends.

4) Graduating early isn't necessarily a good thing.

Granted, one semester early would be a nice extra long vacation, but I do not recommend graduating a year early, unless you are planning on waiting a year before medical school. Quite simply, graduating in three years means that, at the time of your application, you would have only had two years of college life to fill up your resume, rather than three (assuming you are applying at the end of your junior year like most students who aren't taking any time off). That's a lot of time lost to get involved in activities that look good on your resume, help direct your life interests, and potentially good make you a more well rounded or experience person. Admissions Committees are looking for maturity, so the younger you are the more you have to prove it to them (I know several 19 year old applicants with Top 10 level scores and grades, but have been waitlisted or rejected everywhere). They are also looking for people with life experiences, passions, goals, and a firm knowledge of why they want to go into medicine. I know that I, personally, had some of the most meaningful and important experiences of my undergraduate years in my junior year. I know that I would be an entirely different person without them, and quite likely I would not have been as competitive an applicant if I hadn't been able to draw from those experiences for my interviews or applications. For those of you who feel like they want to become a physician ASAP, so they can start practicing and making money, you aren't losing anything. Most physicians retire before they are absolutely incapable of practicing medicine, so unless you are planning to work until the day you die, its not like you can't make up that income by retiring at 66 instead of 65.

The two biggest problems for future physicians (part 1)

It's time that we took a trip back to the questions that I posed back in my first post: What makes/is good medicine and what makes/is a good doctor? Making good medicine and being good doctors in the future is going to, in my opinion, revolve around tackling two big problems here in the US.


1) Equal access to health care.


2) Obesity

As far as equal opportunity to obtain health care goes, I think that the underlying problem has to do with the consumerist nature of our country. There is a desire for "McMedicine", quick, cheap, and easy fixes. Unfortunately, the most quick fixes aren't cheap. Even the ones that are, when overused, have a rapidly mounting cost. This cost isn't just a monetary one, there is a detrimental effect on the health of the entire country by over use of quick and easy fixes. We are addicted to interventional medicine. Preventative medicine? Bed rest and chicken soup? No way! Who has time? I'll just pop some antibiotics (gee, hope I remember to take them all!) and be on my way. The simple truth is as long as we abuse the powers of intervention, we will never have guaranteed health care. Any system that is overused with be toppled by the pressure. Money is finite, therefore health care is finite. And yet, how can we stop people from overusing medical treatments.

At the same time, we are only setting ourselves up for bigger, badder bugs. Overuse and misuse of pharmaceuticals is directing evolution towards multi-drug resistant diseases. Evolution hasn't stopped just because we discovered its properties. It's amazing how much medicine has changed in the last 100 years. I don't mean just the equipment, science, and treatments. I'm talking about the whole concept of medicine, and who it should serve. 100 years ago, you could be imprisoned on an quarantine island in order to protect the public from whatever disease you had. Your rights were utterly revoked for the good of the population. That was good medicine back then, even though it might bother us now. A doctor's purpose was to rid humanity of disease, not a person. The medical community was at war with disease like TB, Typhoid, Dengue Fever, and many others. It was a battle that focused on the disease within people, not diseased people. If a few patients had to be trampled in the process, it was worth it for the greater good. When small pox was eradicated by global vaccination efforts, the fact that 1-2% of those vaccinated were going to die was worth defeating a disease that had a mortality rate ranging from 30%-90%. Now adays, we have people who refuse the vaccinations offered to their children, and are allowed to send those children to public schools. In many states, we can't even arrest an HIV patient who willingly infects people. I'm not saying that we need to go to the extremes that were once acceptable at the dawn of Modern Medicine, but I think we need to take some lessons from their book. Preventative medicine, especially vaccines, are what save lives. Sanitation and vaccines are what has resulted in the increase of our average life span, not normal interventional medicine. Certainly, surgeries and medications save individual patients here and there, but overall interventional medicine has been most effective in the relief of suffering, where as preventative medicine has resulted in the massive extension of human life. It is still a wonderful calling, but most doctors improve lives more than they save them. The exception are those involved in public health programs that emphasize prevention.

So I want more preventative medicine and less interventional medicine, what's my plan do you ask? Education. I personally believe that a physician's calling to educate spans both his students and his patients. We must integrate once again into the mainstream psyche that medicine heals and medicine hurts, and that prevention is the best way to healthy living. Washing hands does a lot more good, in the long run, than taking a pill. It's ok to be sick! Sickness, nine times out of ten, makes you stronger. It's good for you to have a fever and need to be in bed for a couple days, your body is flexing its lymph muscles!

At the same time, though, we can't blame patients for the health care crisis without taking some of the responsibility on as well. It is up to us as future physicians to resolve the one of the biggest medical issues of our time, how to reconcile the needs of the individual and the needs of the population. How much care is good medicine? Is it good medicine for the patient, or for the population. Is it possible to have good medicine for both at the same time. Is increasing the life span of HIV patients good for the population? Can we ethically not try and increase their life span as much as possible? Fun stuff, I just hope there is an answer. The rallying cry of today's medical world is "individualized care". The ultimate break from the population focus of the past century. The benefits to individuals stand to be immense. At the same time, though, we can't forget that our duty is to the community as well as our specific patients. There must be a compromise for optimal health.

Another thing that we as physicians must do, is never forget that we are treating people, that we must be very careful with concepts such as "acceptable losses". As more and more machines and tests are placed in between doctors and patients, one of the most important parts of medicine is at risk. There is healing in medical Art as well as Science, and when we stop interacting as people caring for people, we degrade our profession. I honestly believe that one of the main reasons that Complementary and Alternative Medicine has become so widespread in our culture, is because of the fact that it is a result of an imperfect system of medical treatment. As science has come to be held above all other things, many physicians seem to have lost the time necessary to treat using the Art of medicine. The success of many alternative practitioners is based on the fact that they CAN practice the art. They have the time that a busy physician with 40 patients to see in the next hour does not. They can listen to worries, have time to discuss them. The members of the CAM community can make friends with and present themselves as people to their patients at a level that most physicians are to busy to do.

Not all patients who come to a doctor are physically sick. We, as humans, have a tendency to fear the unknown. When a new dimple or pain appears on our body, we begin to fear that it is worse than it usually is. It gnaws at us, and we seek comfort in the vast knowledge of medical practitioners. The reason that we revere Hippocrates and his style of medicine, rather than his rivals', the Cnidians, is because the school of Cos was well aware of the need to be caring, friendly, and truly concerned with the patient. They could not cure much, but they were very good at predicting what was going to happen and identifying the disease. They cut through the unknown and brought knowledge, even if it was knowledge was death. Regardless of the outcome, they did their practice with caring and understanding. I have seen old ladies be brought in on ambulances because of a toothache. They would talk to the doctor for a few minutes and then leave happy with no medication. Sometimes, people just need a few minutes of a doctors time, a few minutes of someone who is concerned with their well being. Some people, having received knowledge of their illness, leave almost proud of their new found knowledge. If we are to fix medicine, we must understand this simple fact of human nature: Being sick scares us. Knowing why excites us.

I was shadowing my father a long time ago, and we visited a man complaining of knee pain without any visible cause of it. My father knelt down, felt the knee, and told the man that he was going to be fine and to ice it. He left happy. I asked my father if he really needed to feel the knee, and he said "No, but that was the cure." He then proceeded to give me some of the best advice I will probably ever get on the Art of medicine:

Always find an excuse to touch your patient.

I'll talk about the second biggest problem, obesity, on another occasion. Now go touch some patients!

One last semester

It's scary how fast these last three and a half years have gone by. I remember with terrifying clarity what it was like my freshman year. As eager as I am to enter the medical world, I shudder to think how fast it could go by.

I have to say that I am very satisfied with my academic career at my undergraduate university, and I am content to live it out with one slow semester. No more 22+ credit hours with 3 labs for me. Instead I've diverted my time towards working and a pending honors thesis, and will be dancing (literally) my way through this last semester. I don't think I will be working any less than I ever had, really. 40 hours of work a week and 12 credit hours, even when 9 of them are dance credits, is still pretty rough. I guess I've been blessed with the fact that I enjoy the busyness (this should be a word if it isn't) of it all. It was miserable at times, but it always felt good after pulling an all nighter to write a 20 page lab report. After working so hard for so many semesters, I really don't want to forget how, anyways. I think this is one of the biggest reasons that you need to love your major, and make sure you love medicine. Life is so much easier when you enjoy putting yourself through the grinder that is higher learning!

I'm so grateful to my undergraduate university for all of the opportunities I've had. Research, funding for projects, community service, heck I even got a letter from the President of my University. I hope that I can pay them back for it all. I intend to get the Dean of my Honors college, as well as my other letter writers, something nice to show how much I appreciate it. If I can offer two things of wisdom to you, oh ye undergraduates, it be these:

1) A large university does not preclude you from making good connections. There are a proportional number of slackers, and then some, in any large university when compared to a smaller one. Most of my office hour visitations were solo.

2) A letter from a familiar person is the way to go. And make sure that you give them big packets of information from you. Your whole life story. I was told by one of the members of the adcom (she had come to our school for a tour, and I was selected as one of the students to represent us) that a letter that shows that they know something about you is tops. She said that "We get so many letters from famous academics, who simply say this student came to class, got an A, and asked questions." I would recommend one or two big wigs in every packet, but makes sure that they read your information packet before you put them in the one you are going to send to schools! I got complimented multiple times about my letters, and I am so grateful to my writers for taking the time and interest in me to do me such a boon as they did.

Question 7: Advice on Activities?

Rather than suggest specific things that you could do to pad your resume, let me offer some overall tips:

1) The basics

To begin any pre-med resume, you have to have the things that most medical schools expect a pre-med to have done. They want to see that you have done community service, because this shows that you are interested in helping others and have compassion. They want to see that you have had leadership experience, because you will be in charge of a number of nursing, techs, etc, and good leadership is necessary when you are dealing with people's health or lives. They want to see that you have done clinical volunteering, so that you have seen doctors and patients interacting and are interested in helping people medically. They want to see that you have shadowed doctors (probably less important than the volunteering), so that you have a better grasp of what you are getting yourself into. I personally would recommend at least one year of clinical work or volunteering. It would be best if you started this year no later than your junior year, so that it doesn't ring of last minute resume buffing (salt shaker alert here, this is just the common consensus among pre-meds that I know). If you do your year of volunteering at the beginning of your Freshman year, I would recommend that you punctuate the remaining years with shadowing and short term medical stuff like a blood drive or two, so you don't have to explain why you suddenly stopped all medical related activities. The last "basic" is always useful, but only absolutely necessary when applying to heavy-weight research schools, and that is research. Off the top of my head I believe that 93% of acceptances at U of Michigan were given to students with research experience last year. Similar stats occur at other research schools. It doesn't have to be medically related research, so long as you were part of the creation of new knowledge. Publications are nice, so I would suggest getting started on this early in your undergrad years.

Remember, you can list activities that you began before college, so long as you continued them in college. Everything else must be after high school to be most effective. I cannot offer much advice to non-traditional applicants, but I would assume that the rules are a bit more relaxed for you, especially if you were, say, a Fullbright scholar ten years ago.

2) Have something that will make your readers say "Gee, I want to meet this applicant!"

There is no such thing as a guaranteed acceptance. I know people who were accepted at Top 10 schools, only to be rejected post-interview from their state school that they were highly competitive at in terms of academics. A 4.0 and a 45T alone isn't going to get you accepted everywhere, though I wouldn't go so far as to say as it wouldn't get you anywhere. For the rest of us mortals, though, extracurriculars are the best way to make ourselves stand out from the pack. As such, have an activity that is really unique, because these things can be quite strong selling points. For me, it was being involved in some post-post-post-post modern dance performances. You have plenty of time to pick up something that is off the beaten pre-med path, so have an interest that isn't what you would normally find in a room full of scientists. There's a reason that the top schools are always telling us how their students are marathon runners, Olympic competitors, composers, singers, and the like. For one, its just plain cool and impressive, and so those are the students they highlight. However, even the students who aren't quite as stand alone as that will often have things that are still pretty interesting to hear about. This desire for interesting applicants occurs at every medical school, and an interesting activity might land you an interview at your dream school. I'm not saying that you should fill your resume with nothing but outlandish activities, but one or two ice breakers will be very helpful.

2) Combine your interests and talents with your activities

This goes hand in hand with my first point, but it can really improve your extracurriculars when you combine your activities. Say you go volunteer at the VA or at a hospice, and on the side you take violin lessons. Why not go play your violin at the VA or hospice? If you want to help out a community service, why not run in a charity marathon if you happen to be a runner? Avid painter? Teach a painting class to inner city youth, or paint a mural for a community center. Be creative, it will mean a lot more to the people you help as well as the person reviewing your application.


3) Represent your message

If you want to go into academic medicine, research, public health, etc, make sure that you can justify it. If you tell your interviewer that you absolutely love teaching, but you haven't done anything teaching related (according to your resume), you risk making yourself look like you are trying to just be impressive. If you are interested in something and are going to state that it is part of your goals or beliefs, you should make sure that you are an active part of realizing them. If you are a staunch believer in helping the underprivileged, and intend to do so in your medical career, get out there and work at a soup kitchen or at a shelter. If you've never done anything to prove your interest in something, then how can the interviewer believe that you are telling the truth. This goes back to the whole point of having to justify that you are sure you want to do medicine by having medical experience.

4) Do things that are important to you, rather than simply trying to buff up your resume

You are trying to represent who you are, when you apply to medical school. A lot of medical admissions is just based on feel and fit. If you seem to connect well with the school and student philosophy, you are much more likely to get in. It is tempting to try and just pick out things that you feel will increase your competitiveness, but in the end you aren't doing yourself justice. I truly believe that my dancing was a bigger influence on my admissions cycle than most other things. I'm passionate about it, and it has let me do a lot more than simply clocking hours at community service event that I have no interest in. Speaking of community service, the majority of mine is education and inner city related, because I'm passionate about those things. Passion is your strongest ally on the application path. The admissions committee wants to see what you are really made of, what really makes you tick. You will do better at activities that you love doing, and you will be making yourself well rounded. As I've mentioned in a previous post, I personally feel that interviews are all about assessing your ability to utilize the art of medicine. Patients are people. As a doctor, the more well rounded you are, the better you will be able to interact and relate with your patients. This isn't about doctors treating patients, its about people treating people. A well rounded list of activities that are not entirely cookie cutter pre-med will do you more good personally and career wise than a bazillion hours of volunteering. Show your individuality and show your passion. If there isn't some kind of medically related experience that you can find that fits into your passions, you probably are in the wrong field.

5) Be a go getter!

Opportunities might knock, but it's best to pursue them! Good things don't come to those who wait, you must go to the good things. If there is something you want to do, find someone to help you do it, pursue it, modify it, or direct you in the right direction. Just because it hasn't been done before or doesn't exist doesn't mean you shouldn't do it. Med schools like innovation and people who are founders of things. Even if it's just a new program in a previous student organization. You must take the initiative, the dean of your college isn't going to show up at your door with your dream activity!