What to look for in a medical curriculum

I exist again. As an update, I have now finished my clinical year and am in the process of studying for the USMLEs (the MCAT equivalent) and preparing to take a year off to continue my research in the specialty that I intend to apply into. I thought I would just take a quick break from my studies to give my thoughts on what is important in a medical school curriculum, looking back on it from this perspective.

1) Grades

Above all, know what you are getting into. Schools have a vast array of grading and ranking policies. Many schools have switched their pre-clinical years to a pass fail system, but a significant portion have retained an internal system of rankings (meaning they aren't really p/f it is just a farce). A select and growing group is unranked pass fail for the pre-clinicals. I personally am a fan of this, because of the fact that it takes the edge off of the learning experience. It gives you confidence to take advantage of the free time that you have rather than freaking out over random tables and appendices. The sad truth is pre-clinical grades don't mean much any more to residency programs. It is far more likely to hurt you than help you. If you do good, great how did this applicant do on their clincial courses and what were the USMLE scores? If you do bad, uh oh maybe this applicant isn't someone we want. Would being #1 in your pre-clinicals possibly be a distinguishing mark, absolutely. However, ONLY ONE PERSON WILL HAVE THAT DISTINCTION AND IT WON'T BE YOU.

Most programs continue to have clinical grades that have some form of ranking, or at the very least AOA (the phi beta kappa of medical school). Know what this entails. For some schools, it is just grades. Others look at grades, scores, research experience, etc, etc. Know what you are getting yourself into, even if it probably shouldn't be a determining factor.

2) When do you take USMLE Step 1

Step 1 is the most important exam of your medical school life. Know when you will take it, and just as importantly how long you get to study for it. Some schools get only a couple weeks off to study, whereas others get up to 10 weeks! That's a huge difference in stress level. A growing number of schools are starting to let students take the step 1 after their clinical training. I'm in favor of this approach. The clinical vignettes on the step 1 would definitely be easier with additional clinical knowledge, and stuff like genetic basis of diseases and pharmacology tend to come up a lot as well. You definitely forget a little more, but I think the net gain from more knowledge and more test taking experience (one major 3 hour exam per rotation) is worth while.

As an aside, don't listen to nonsense about teaching towards the step 1. Step 1 is an exam that, like the MCAT, requires copious review on your part. It is nice to know what resources are available to you (some schools host review classes, give you free books/question banks, etc).

3) Clinical Year Format

The clinical years are often ignored during the interview season, for the simple reason that they are further away and most of your interactions will be with first and second year students. Seek out people knowledgeable about the last two years,

Know exactly what the expectations are for you during clinical year. How many blocks during the third year are there and what rotations are mandatory vs electives (i.e. some schools do not require neurology, or surgical sub-specialties. It behooves you to get some electives in all specialties, so know if that is an option). Do you have any say in the order of your rotations? Are there breaks in between each block? How many vacation weeks? How long are each of the blocks (this is relevant for studying for the standardized exam at the end)? What is the general grading format (grades versus clinical evaluations. Which are more important. There is no right answer, but I prefer a combination of the two). How many fourth year electives do students get? How many students go abroad for electives? Do students get time to take the step 2 of the USMLE after clinical year, or do they have to make their own time.

You should also ask about how much time students get to interview. Two months is ideal.

4) Clinical Skills Prep

This is also very important. Know the institutionalized practices that help students improve as clinicians. Know how often students are educated on how to do interviews, physical exams, and presentations to attending physicians. Ideally, you want to have a solid understanding of each before starting the wards. You also want to know the general atmosphere of learning useful clinical skills. How often to students get to do blood draws, IVs, lumbar punctures, paracentesis, chest tubes, suturing, etc. Are there workshops given on these things? Are you taught how to do a rectal and genital exam prior to the clinical year? How much training are you given during the clinical year? For example, my school has one week rotations through the surgical subspecialties. As well as being an experience of itself, these rotations are expected to endow upon students certain skills. In anesthesia, we are allowed to intubate and place IVs, in urology we do genital exams and rectal exams, in optho we learn how to examine the eyes like a boss, etc. All of this stuff was taught to us prior to the clinical year, but getting it straight from the experts was far more useful.

As a warning, all students and schools will say that they get lots of hands on experience. This is why it is important to elicit the actual examples and programs.

5) Match list

This is not important. I only bring it up so that I can stress that it is not important. You can't read a match list, and I can barely read it (only in the specialty of my interest). So much has to do What is somewhat of interest, however, is the general geographic distribution of the class match. People often match close to the medical school for various reasons, which isn't really important to you. What is important, however, is students tend to benefit form programs that have had significant experience with a given medical school. If a schools match list doesn't have a single person sent to, say, Colorado, and Colorado is your dream residency location, then it may be worth taking note. You can still match in Colorado, but it may be a bit more of an uphill battle than if 32 kids in your class match there yearly. Likewise, one might think to do this within the specialty of your choice. I would discourage this only because specialty choice tends to fluctuate a lot from year to year (the year before me has 9 neurology applicants, the year before them had 1), where as locations tend to be pretty grounded.

I live

Hey readers,

For those who have asked, yes I do still read the site and I am still available to answer questions. I am in my clinical years now and I'm having a blast. This site was mostly meant as a repository for my views on a lot of important questions that get asked. If anyone has further questions I will be happy to write a response and post it here.

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