Wednesday, December 5, 2012

How to Get into Medical School: Part 1

So you’ve decided you want to be a doctor. If this is truly how you want to spend the rest of your life—or at the very least, a significant chunk of it—then I congratulate you. You’ve chosen a noble path, though there are no guarantees as to how things will ultimately turn out. If the origin of your motivation is uncertain, or there is something else you really feel like it would be cool to try out, then perhaps it would be wise to attempt the thing that interests you most first. Medicine will always be here to come back to.

For some, deciding on medical school is a decision that is reached one day—maybe it is a sudden enlightenment, like getting struck by lightning (but perhaps somewhat less painful….or not, I suppose). For others, including myself, reaching this decision is more of a journey. Perhaps a person is headed in one direction, but along the way is exposed to medicine somehow. They don’t think much of it at the time, but perhaps repeated exposures leave them with a nagging feeling that there is something fulfilling to be had here. After a period of honest exploration, our hypothetical individual realizes that medicine—and in particular, becoming a physician—is the best fit for them. Of course, it’s generally not as clear cut. Life is messy.

Regardless of how you got to this point, you’re here now. So what’s next? Following are some of my random thoughts on important aspects of the application process. Take them with a grain of salt. Or two.

On Deciding to go to Medical School

I touched on this briefly already, but let me just reemphasize an important point: Within the realm of medicine, there are many career paths, most of which do not involve spending at least twelve years or so of your life in school. If you absolutely “know” and can articulate good reasons for wanting to become a doctor, more power to you. If not, before you plunge into a point of no return, explore a little bit. Take some classes that are not necessarily medicine-related—maybe that astronomy class you always thought would be interesting, but you never had time for. You want to be a doctor, after all. Try to talk to people in other fields, or at the very least, do some research on the internet. Though you obviously need to understand the limitations of other people’s input—particularly random internet strangers—on your own life, there are many helpful websites for all kinds of different careers that can help you get an “inside look.”

If you have done all this and are set on medical school, then I would strongly recommend taking time to research exactly what you are getting into. Research the medical education process; read books about medical school, residency and beyond; understand what it costs you to become a doctor (and not just financially); understand how this process will affect you and those you love; digest exactly how much debt you will be going into and the realities of paying that off (don’t just think, “I’ll be a doctor; it’ll be fine"); explore the current healthcare system and try to get an idea of how things are changing and how that will affect you in the future. The world of medicine is changing, and if you are going into school with unrealistic expectations regarding your future, your work, your life, your finances—you will be disappointed. Think long and hard about this decision before you do something stupid.

Creating Your Application

The formation of your medical school application begins before you even realized you wanted to become a doctor. The shaping influences in your life—your experiences, your family, your friends, your enemies, your jobs, your education, etc.—all played a role in even giving you this desire in the first place. But now that you know, now that you have joined the neurotic ranks of premedical students worldwide, the formation of your application needs to stop being a passive process and become an active one. On that note, there are certain components (listed below in no particular order) that will be helpful to have in your application.

Volunteering/Clinical Experience

Most schools will look for some type of volunteering or community service activity in your      application. Theoretically, this shows a dedication to service and a willingness to make personal sacrifices. Practically, this turns into just another box to check for most premedical students. But it doesn’t have to be that way. Volunteering just once a week for a few hours at your local hospital, community aid program, shelter, etc., can be an invaluable way to learn about the practice of medicine, interact with people who might be diametric opposites of you, and broaden your worldview. This can be an awesome experience, and it doesn’t have to be medical in nature, either.

I personally volunteered at a hospital, first at the information desk and then in the emergency department. As a volunteer, you are at the bottom of the totem pole. But, you can also wander the hospital without too many questions being asked. The experience is what you make it. The extent of your patient interaction might be handing out warm blankets and food trays, but you can hand out warm blankets and food trays like a champ. In the process, you—unlike the rest of the busy hospital staff—might have the opportunity to connect with patients on a more personal level. You are the closest thing to someone like them in a busy emergency room—everyone else is wearing scrubs, trauma scissors, and generally running around like busy ants whose ant hill is on fire. So don’t just write off the opportunity—make something of it. You can also make connections with the staff, who might let you help them out with some “cool” things every once in a while if they see that you are actually making an effort. That said, don’t just make an effort to get noticed. Make an effort for the sake of making an effort, and see what happens.

Briefly, let me also note that you don’t need thousands of hours. I think I had 130 hours total, and that was enough. I ended up stopping when I had to move, and getting too busy later to get involved in my new hometown, but I had a blast, and some pretty cool experiences to boot.

For those who choose to volunteer in a non-medical capacity, first let me say this: that’s awesome, and it will set you apart a bit in the application process. Do something you enjoy; don’t just volunteer at a hospital so that you can say you could. That said, though, you will have to get some clinical experience. This can be in the form of shadowing (start with your family doctor, or cold call offices in the area to start if you need to. But get some, even if you do hospital volunteering. If you are volunteering at a hospital, ask the doctors there) or in some type of clinical job. Personally, I worked as an emergency room scribe for about two years. I had a blast, learned a ton, made good connections, and got some good letters of recommendation on top of all that. I also worked as a patient transporter (our official title was “patient escort,” but I tried to not publicize that…) at a large hospital for about a year, which provided me with a lot of patient interaction and the chance to see how the hospital works together as a dynamic unit. Other people work as EMTs, phlebotomists, laboratory technicians, ED technicians, etc. You don’t absolutely have to work in a clinical capacity—extensive shadowing can suffice. But if you are able to, I would definitely recommend it.

Research

Research is one of those things that isn’t necessarily required, but is nevertheless a worthwhile pursuit and very helpful to have. Honestly, some schools (Mayo, I’m looking at you…) won’t even really consider your application if you are researchless. Try to get involved with professors on your campus or local research groups in your area. If you can get some type of publication or presentation, that’s a plus. Whether you do clinical research or benchwork research, try to do something if you can.

I actually didn’t do research. When I had the opportunity to finally get involved, I was too busy with life, studying for the MCAT, school, work, planning a wedding, and on the verge of applying. If I hadn’t made it in this last cycle, I would be definitely getting involved now. It worked out fine for me, and I am very satisfied with how things turned out. But it would have been interesting to see, just for the sake of curiosity, how things would have turned out if I had had more research experience…

GPA

The bottom line here is simple: do well. You don’t need a 4.0, but you do need to demonstrate that you can handle the rigors of medical school. Most matriculating medical students have an average GPA of 3.5-3.7. Figure out study strategies that work for you (group study? solo study? notecards? rewriting notes? teaching your dog?) and do them. Your GPA is important, despite what some might try to tell you. This will distinguish your application, for better or for worse. You decide. As much as it is in your power, master the information presented to you—don’t cram—and show those classes who’s boss. Do particularly well in your core premedical prerequisites—biology, general chemistry, organic chemistry, physics, etc. Will a few Bs here and there destroy your application? No. Do people get in with abysmal GPAs? Yes. But you better have a darn good reason.

This is an important opportunity to show medical schools how well you can perform. Don’t waste it. 

MCAT

Remember how your GPA was an important opportunity to distinguish your application and show how good of a student you are? Well, this is the other opportunity. GPAs may be variable from institution to institution, but the MCAT is a standardized indicator of how well you will perform in medical school, and you will be judged by it.

The first thing you have to decide is when you will take it. I, and many people, elected to take mine in the spring of my junior year. This allowed me a little bit of time for a retake (albeit in exchange for a slightly later application) and allowed me to start medical school right away after undergrad. Some people take it later, perhaps later in their junior year or even in their senior year, so that they can have more time to study or take a “gap year” to do research, travel, work, play video games, etc. Whenever you take it, try to have your premedical prerequisites out of the way. Also, keep in mind that schools get picky about old MCAT scores—as a general rule, you want to apply within three years of taking the test.

Once you’ve decided when you will take it, you have to decide how you will study. If I had to guess, I would say that most people probably study on their own. There is a lot of information out there and a lot of resources you can purchase. This method allows for flexibility and works well if you are self-motivated and able to plan out a schedule and stick to it. One self-study method I have heard good things about is this plan devised by a fellow with the alias of SN2ed, posted on Student Doctor Network (a helpful site for tons of information from other—occasionally overly-neurotic—premeds).

Another option is to use a preparatory course. There are many out there—Kaplan, The Princeton Review, etc—and you can even just buy the materials and not use the course, if you want. I personally chose to use a prep course. I did this because, in the season of life when I took the MCAT, I was already busy with school, work, and getting married, and honestly just wanted someone to hand me the material I needed so that I could get straight to studying. I used a prep course called Altius, and thoroughly recommend it—with the caveat that your experience may be very different than mine. This course provided me with classroom session, a tutor, materials, practice AMCAS tests, and an entire academic year of preparation for this monster of a test. I ended up doing pretty well, and have no regrets.

Whichever option you choose, rock it like a champ. 

A Brief Note…

Allow me to pause here and note that your clinical experience/volunteer experience, GPA, and MCAT, and research experience form the cornerstones of your application. If you can excel in all areas, that’s awesome. If one area is lacking—for me, that was research—then you should try to compensate for that in the other areas.

That brings us to the end of Part 1. Next up, I’ll focus on creating your AMCAS application, gathering letters of recommendation, writing your personal statement, submitting secondaries, interviewing, traveling, and—hopefully—getting accepted.