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!
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