Jessica Freedman, MD

By Jessica Freedman, MD
President of MedEdits

Your son or daughter wants to get into medical school. Of course, you want to help, but how? Many parents, including those who are physicians themselves, are overwhelmed by the medical school application process. They want to guide their young adult children but also want to allow their “kids” to work independently and don’t want to do too much hand holding.

So, what do you, as parents, need to know about the medical school admissions process to help your premedical student to succeed? This article reviews some basic material to help parents and their children make wise choices that will help them to gain acceptance to medical school.

Know the facts, but try not to add more pressure to the cooker

It is important for parents to know what is required of their children to gain admission to medical school. This means knowing the premedical prerequisites and the activities in which students should be involved. But it also means understanding how to help without adding more stress.

Achieving this balance often depends on the relationship between parent and child. It is essential, however, that parents understand that their children are young adults who will someday soon be required to make independent (and very important) decisions. Since a career in medicine requires maturity and independent thought and decision making, parents should encourage these qualities while remaining involved in their children’s lives.

Consider carefully what college to attend

Many premedical parents ask me where their child should attend college. The most common question is: “Should my child attend a prestigious college where ‘As’ are more difficult to earn or go to a college or university that is considered less prestigious but where high grades may be easier to earn?” The answer to this question is not easy.

What is most important with regard to medical school admissions is academics. A high GPA (3.9) and a strong MCAT score (above 30 with a good distribution) are the most important factors for an application to be considered for review by an admissions committee. I have seen people who went to outstanding colleges but earned 3.3s or so who had difficulty gaining admission to medical school. Thus, students with similar MCAT scores but with higher GPAs from less prestigious undergraduate colleges may receive more interviews (and thus more acceptances) than the student who went to a top ranked college but had a lower GPA.

Help your child choose best major and courses for them

The emphasis in medical school admissions now is diversity. So, beyond the basic premedical prerequisites, students should major in what interests them most. Majoring in something other than biology or chemistry would be looked upon favorably by admissions committee members. It is always wise, however, to take upper level science classes regardless of the student’s major to demonstrate academic excellence in the sciences. I also suggest that all premedical students take biochemistry and, if possible, statistics; Medical schools like to see these courses on transcripts.

Think about the activities in which your premedical student should participate

Just as with their courses, students should become involved in activities that motivate and interest them. While everyone knows that medical schools “like to see” research, community service, and teaching, first and foremost, all applicants must have clinical and shadowing experiences. Also important is that students do not become involved in extracurricular activities at the expense of their academic success and that they do not accumulate a list of activities just for the sake of doing so. In-depth involvement is preferred over a long list of superficial activities and will likely lead to stronger letters of reference.

Put together a good “team” to help your son/daughter gain admission to medical school

This team should consist of professors, mentors, extracurricular leaders and premedical advisors. Remember that you cannot be everything to your child and that having other people to provide support and guidance throughout this process is helpful. I find that many “kids” like to have other objective authority figures to help advise them.

Think seriously about some time away from formal academics

Many applicants now take a year away from formal academics before going to medical school and apply during the spring of the senior year rather than the spring of junior year.  Some parents are uncomfortable with this idea, but it can be difficult for students to get “all of their ducks in a row” in time to submit a successful application at the end of their junior year of college. Applying in the senior year also allows applicants to have an extra year of grades on their transcript, which can be important for many applicants whose grade point average (GPA) tends to trend upward from the freshman to senior year. I find that some applicants who are not successful the first time they apply often fail because they and their parents did not understand how much work and organization is required for a successful medical school application.

Understand that the medical school application process is long!

As parents, it is important to understand that the process of applying to medical school requires a tremendous amount of endurance and perseverance. Many parents of my clients who are physicians lament: “It wasn’t this complicated when I applied!” Indeed, as medical school admissions have become more competitive, the process has become more laborious and expensive.

The application season officially begins when the student starts thinking about composing and submitting his or her primary application in June. But, students must also take all required courses and the MCAT and request letters of reference and transcripts in addition to composing an excellent application. Then, after the primary application is submitted, students must fill out secondary application essays for many schools and go on interviews. Some applicants may not know what school they will attend until they “get off a waitlist” in August. Thus, the application season may last for more than a full year.

Medical school applicants tend to be a highly motivated group who hold themselves to high standards. Sometimes, in an effort to make sure their kids stay on track, parents ask questions constantly, do GPA calculations, plan curriculums and seek out summer activities that will bolster their child’s application. There is a fine line between helping and hovering, and I find that this added pressure can sometimes backfire.  The premedical race requires agility and careful judgment, and parents play an important role in helping premedical students to reach the finish line.

Jessica Freedman, MD, a former medical admissions officer, is president of MedEdits (www.MedEdits.com), a medical school, residency and fellowship admissions consulting firm. She is also the author of the MedEdits blog, a useful resource for applicants: (www.MedEdits.blogspot.com).

Dr. Conrad Fischer

Despite the growing number of scientific advances over recent years, the ability of doctors to cure or deal with diseases that were fatal not ten years ago, and heightened recognition by patients for those in the medical profession, a study conducted by Dr. Conrad Fischer suggested that many in the medical field were highly dissatisfied with their careers. Armed with these alarming results, Dr. Fischer set out to let everyone know that now is an exciting era in medical history and, quite possibly, the best time to be in medicine. The result is his book, Routine Miracles.

Dr. Conrad Fischer, author of Routine Miracles, is an infectious diseases specialist and a prolific teacher of medicine; he has published twelve books for the medical community. He is also an influential medical advocate. He was instrumental in the construction and passage of legislation that led to the near eradication of pediatric AIDS in the United States. He was formerly the Associate Chief of Medicine for Educational and Academic Activities at SUNY Downstate School of Medicine. He has been Chairman of Medicine for Kaplan Medical since 1999, and has held Residency Program Director positions at both Maimonides Medical Center and Flushing Hospital in New York City. He lives in New York City with his two boys.

Dr. Fischer recently sat down to talk to the Student Doctor Network about his research.

Please explain a little about your research for Routine Miracles and what surprised you the most?

There is an enormous disconnect between patients who feel the “miraculous” nature of what they receive in terms of treatments and a near-numb “routineness” of flat emotionality from doctors.  I can’t help but feel the root of the problem stems from our own medical school faculty and senior physicians poisoning the minds of medical students.  In our own research data it shows that 80% of medical students feel that medicine was better 25 years ago and that the public does not trust them. They identify senior physicians and faculty as the source of this impression. So, our best role models for a life of practicing medicine, and pursuing a life of investigation turn out to be the most damaging influence of all.

Why is this the best time to be practicing medicine and why is it the worst time?

Treatment is the best it has ever been by far.  We now have brain operated artificial limbs, hearing restoration, cancer cures, corneal transplants in four minutes, and cures that seemed like science fiction a few years ago.  It is hard to write good science fiction because the facts catch up so fast. Paradoxically, a recent study showed that more than 90% of primary care doctors are dissatisfied.  There is an unprecedented level of demoralization at a time when we can heal people in so many amazing new ways.  The worst news is that our freshest and newest members, students, interns and residents firmly believe medicine was better before and we are devolving as a profession.  They are not motivated to follow a life of investigation that will give us the next generation of scientific and medical breakthroughs.

You work with students every week. How are they different from you and your colleagues 20 years ago?

Students and especially residents are less cynical, less sarcastic and more professional than they were 20 years ago.  This is because of the mandatory decrease in resident work hours. You couldn’t possibly expect the same energy and compassion when you were up for 36 hours straight.  Now residents rest a little and you are kinder, warmer, and not burnt out and cynical.  Most MDs do not see this.  They look down on new students telling them it was better before.

Students on the other hand seem more concerned with personal economic issues.  They think the sky is falling in medicine, so they should find a nice high paying subspecialty to hide in.  There is virtually NO drive to consider careers of investigation that might lead to new cures.  So, you have nicer and kinder people taking care of patients, but who rarely question how they might find a cure.  In 20 years I predict the rate of medical advancement will be dramatically diminished.

In your opinion what three things need to happen quickly to help fix our healthcare system?

1. Universal coverage
2. Doubling of the research budget at National Institutes of Health
3. Decrease or supplement the cost of Medical education so that students choose a future that is not based on income potential or concerns about paying off student loans.

Why are you such a fervent advocate of universal health insurance coverage for all U.S. citizens?  How do you respond to arguments against—and fears surrounding—implementing a system of socialized medicine?

First off, universal coverage is just the right thing to do. I think the concern about financing is ludicrous. We did not worry about financing when the military budget went from 350 billion to 750 billion, which is considerably in excess of the amount needed for healthcare reform.

“Socialized medicine” is a scary word to frighten ignorant people. We have Medicare as a government run system as the largest insurer in the country. We have the veteran’s hospitals as the largest system in the country and it all works well.

Doctors are scared for their paychecks. Other people are, frankly, just unconcerned with people who will be sick if they think they have to pay for it.

If we are to live in a Great Civilization, we MUST take care of all our citizens, Period.

Routine Miracles

As you stress in Routine Miracles, young doctors are frequently weighed down by hundreds of thousands of dollars in student loan debt.  What would you change about how we finance medical school education?

I would subsidize the medical schools to lower tuition and I would add trading a year of tuition for every year you spend in a lab during research. We do it for the military, why not for research?

It only costs about $2.4 billion a year for EVERY student in the country.  That is about what we paid for ‘cash for clunkers’ car program.

What is your relationship with insurance companies like?

This is the only thing that 95% of MDs and students agree on – it is HORRIBLE!  If I had to deal with insurance companies full time, I would drop out of medicine.  I also find it unconscionable that while facilities are closing because of budget gaps, the CEO of Aetna insurance is getting a 32 million dollar salary.

What do you hope people will take away from reading Routine Miracles?

Unless we take better care of the emotional well being of our best and brightest students and trainees, in terms of seeing the grandeur of finding new cures and treatment, the amazing advancement in medicine will screech to a near stop.   There is action to take here. It is about fixing the disconnect between breakthroughs and the complete lack of excitement and engagement of the “Best and Brightest” new doctors.  Routine Miracles is about how, in an age of extraordinary advances, we need to get our students into the lab and in a life of investigation and discovery.  If we don’t do this now, the future will be a lot less bright.

by Paul Goleb

You have all certainly heard the expression “good things come to those who wait.”  Since our first days of pre-school, the virtue of patience has been constantly reinforced as a valuable trait.  For years we have stood in lines and waited for our turns.

In the fast paced life of a physician, in which potential decisions must sometimes be made in a matter of seconds, patience is sometimes an undervalued trait. In the realm of medicine, “waiting” almost seems to be a dirty word for both patients and physicians alike.

Nowhere is this more evident than in the life of a medical school applicant, a life in which waiting for days, weeks, and even months at a time is commonplace.  If you have ever applied to medical school, I am confident that you have spent more than your fair share of time waiting.

As pre-med students, we are notorious for our constant worrying and over-analysis of the most minute details and the long gaps in correspondence with medical schools do little to ease these anxieties. Months between application submissions, interview invitations, and potential acceptances often seem like cruel punishments to over-anxious pre-meds like ourselves who interpret no news as bad news.

I, like many other medical school applicants this year, was placed on a wait-list over the course of this past admissions cycle. I, like almost every other applicant placed onto a waitlist reacted to the news with a sense of disappointment, disenchantment, and (at best) a slight sense of hope. I, unlike many others was eventually admitted to the medical school of my dreams in a matter of days following my placement on a waitlist (twice to be exact).

Ironically enough, the only day out of the past eight months in which I did not fervently check my e-mail or anxiously pace to my mailbox since the submission of my primary application was the day I was accepted to medical school. The one day that I stopped trying to find what I was looking for, what I was looking for somehow found me.

The morning before I was accepted off a waitlist, I found myself coming to the realization that I would have to re-start the arduous work associated with the application cycle: re-taking the MCAT and re-submitting my primary application only days after I had graduated from college. The prospect of studying, writing, applying, and traveling for interviews again had been wearing on me over the course of the past several months.

As I usually do, I went to my neighborhood park to play a game of pick-up basketball to clear my head. About twenty minutes later, to my surprise, I saw my mom frantically walk by the court in a pace that suggested she had very good or very bad news (or had to find a bathroom ASAP). My surprise grew when my mom ran onto the court, stopping a game of basketball in its tracks to give me a hug and tell me I had just been accepted to medical school. I stopped, the game stopped, my mom grabbed me and tried her best to hug me (or squeeze the life out of me) and slowly, I realized what I had waited for since this past August had finally arrived, in May, multiple weeks after I had graduated college with no sure-fire post-graduate plans and plenty of anxiety.

The remainder of the day became a blur of congratulatory phone calls, text messages, and visits from neighbors. This euphoria created such a sense of stunned disbelief that I almost forgot to return my paperwork indicating I would actually accept my admission into the class of 2013 (a minor detail). Waking up with plans to begin studying for the MCAT again and eventually going to bed a soon-to-be medical school student made for quite the exciting day. I was honestly astounded by the good news I had almost given up hoping for.

It took nine months to the day for the secondary application I submitted in August to lead to an acceptance in May. The application, interview, and waitlist process certainly made the year seem like an eternity. Also, I like to think I took the longest possible path to my eventual acceptance. My application was put on hold after my initial secondary application submission, I received a post interview hold, and to top that off, I was placed on a waiting list following this marathon year of waiting and hoping.

It is tough to say if I honestly did believe I would get off my waitlist. Based off of anecdotal evidence from peers, friends, and professors, I thought my chances to get accepted off of a waitlist were one in a million (at best). Waitlist statistics are typically not released by medical schools, which are the sole institutions that know exactly how many students (if any) were admitted via waitlist. I have been told that not even AMCAS, the veritable treasure trove of pre-med statistics and semi-pertinent percentages possesses this information.

The entire situation repeated itself two weeks later in a much less dramatic fashion when I eventually received the same good news at the second school where I was wait-listed. I could not believe my good fortune. While I do not know the exact probability of these two independent events occurring, it seems to be a very rare occurrence. The utter surprise I felt in getting accepted off of my initial waitlist became a sense of sheer disbelief when the process repeated itself.

By no means do I intend for this article to sound like a personal pat on the back, congratulating myself on my two, equally miraculous waitlist acceptances. I believe readers can search various SDN acceptance threads for that type of writing.  I find myself writing this for a much different purpose. In writing this, I hope to give a sense of hope to those currently on waitlists or those who may soon find themselves on a waitlist at some point in the application cycle. Additionally, August is an interesting point for applicants in the medical school process. Past year’s applicants who have been wait-listed find themselves still hoping (with good reason) for a last minute acceptance into a medical school class beginning this year while a number of current year applicants are just beginning what could potentially be a very long application cycle. It is a busy, stressful time for applicants both former and current.

Reflecting on the process, our teachers and parents may have been right about this whole waiting thing, as much as it hurts me to admit. I consider myself a habitually impatient and multitasking person, but patience is the key to surviving the medical school application process. In my experience, I have found it is true what they say; good things come to those who wait, or in my case, to those who are wait-listed.

By Jessica Freedman, MD
President of MedEdits: Medical Admissions

Because the competition for admission to medical schools in the United States is extremely strong, many applicants consider attending medical school in the Caribbean. In fact, a great many bright and talented applicants are now opting to obtain their medical education in the Caribbean.

How can you decide what is the best choice for you? What must you consider in evaluating these schools? And will you be able to obtain a residency in the United States after you graduate? To help you decide if attending a Caribbean medical school is a good choice, this article provides a framework for evaluating these schools and the success of their graduates.

A Little Background

In the last four decades, the Caribbean has seen a steady increase in the number of medical schools on the islands as well as the size of their student bodies.  In the late 1970’s three Caribbean medical schools were established: American University of the Caribbean, originally located on the Island of Montserrat, Ross University on the Commonwealth of Dominica, and St. George’s University in Grenada.   Since their inception, these schools have educated many US citizens seeking a medical education outside the US,  and now about 60 medical schools in the Caribbean are listed in the Foundation for Advancement of International Medical Education and Research (FAIMERs) International Medical Education Directory (IMED).

The physicians who graduate from Caribbean medical schools play an increasingly important role in the US health care system by supplying residency programs with qualified applicants and helping to meet a well documented physician shortage, particularly in primary care medicine.  While accreditation, didactic studies (first and second years of medical school), and clinical rotations (third and fourth years of medical school) differ among institutions, requirements for graduate certification in the United States, as outlined by the Philadelphia based Educational Committee on Foreign Medical Graduates, are the same for all students graduating from all international schools, including the Caribbean.

Caribbean Medical School Accreditation

An article by van Zanten et al published in the June 2009 edition of Academic Medicine reviews some of the processes by which Caribbean medical schools undergo external quality assurance.  Accreditation for Caribbean medical schools is on several levels, including local Ministry of Health accreditation by some  individual Caribbean country’s government, regional accreditation by organizations such as The Caribbean Accreditation Authority for Education in Medicine and Other Health Professions (CAAM-HP). The World Health Organization (WHO) does not accredit medical schools but maintains a list of schools that are recognized by local governments. In the United States,  The National Committee on Foreign Medical Education and Accreditation of the US Department of Education (NCFMEA) of the United States Department of Education determines whether the process conducted by an accrediting organization is comparable to the Liaison Committee on Medical Education (LCME) process of accreditation. This is a voluntary process so not all schools undergo this evaluation. If a school’s accreditation is deemed comparable to the LCME process, then that country can apply for US federal loans for those students. Currently, only 3 schools in the Caribbean are eligible for these loans.

California, Florida, New Jersey, and New York require individual school review and approval for Caribbean students to do rotations in that state.   In California, not only must the individual school be approved for clinical clerkships but the student’s clerkship and course work must be approved by the state medical board to obtain residency and subsequent physician licensure.  Any deficiencies in clinical training, as determined by the state, may need to be remediated to practice in California.  Many other states defer to California’s approval for the purpose of licensure because most do not have their own approval process. Also of note, New York has the largest number of international medical graduates in residency training and about one third of residency programs in the US are located in the state of New York.

It is important to know which organizations have accredited any school you consider attending.  Knowing if the state in which you intend to practice recognizes your school is also important.  Caribbean medical schools proudly display these accreditations on their websites so if an accreditation is missing, be wary.

Quality of Medical Education in the Caribbean

Another recent study by van Zanten and Boulet published in Academic Medicine examines the quality of medical education in the Caribbean. The report finds tremendous variability in both the quality of undergraduate medical education and in students’ performance. The only way to evaluate the education Caribbean medical students received was to examine students’ scores on the United States Licensing Exam (USMLE) Step 1, which is taken after the second year of medical school. Investigators calculated the average USMLE Step 1 first time pass rate for each country in the Caribbean. In evaluating this data they also took into account that some islands have more than one medical school.  The countries with the highest percentage of students passing the (USMLE) Step 1 on the first attempt were Grenada (84.4 %) and Dominica (69.7%). Countries with the lowest pass rates were Saint Lucia (19.4%) and Antigua/Barbuda (22.9%).

Preclinical Years

Students typically spend the first four to five semesters of medical school in the Caribbean completing basic science courses before taking USMLE Step I.  Basic science curriculums in the Caribbean are similar to US curriculums.  Some schools offer a fifth semester, either in the Caribbean or in the US, to help students prepare for the USMLE Step 1 and transition to their clinical semesters.

Living in the Caribbean can present many challenges for those who have never lived outside the United States. For many students, it will be their first time away from the United States for a prolonged period of time. Many of the luxuries found in large US cities, such as restaurants, movie theaters, shopping malls, and commercial gyms, are not available on the islands, and friends, family, and religious support groups are thousands of miles away. On the plus side, many students form strong relationships with classmates and also enjoy learning about the history and culture of the local West Indian population. Former students also have fond memories of celebrating yearly holidays such as Carnival, the colorful, festive, and historical event celebrated annually throughout the Caribbean.

After successfully passing the USMLE Step 1, students proceed to their clinical rotations, which usually are outside of the Caribbean.  When evaluating schools, it is important to ask what percentage of students who initially enroll in each class actually take and pass the USMLE Step 1 and successfully proceed to clinical rotations.

Clinical Years

Core clinical rotations and third and fourth year curriculum in Caribbean schools resemble those of US medical schools. Caribbean schools that offer clinical training in the US have strict guidelines about the location and quality of students’ clinical training.  All core rotations and subinternships must be completed in hospitals with which the Caribbean medical school has an active, written affiliation agreement and which have appropriate clinical faculty members. Rotations must be approved by the Accreditation Council for Graduate Medical Education  (ACGME). In addition, it is preferable that hospitals have approved residency training programs (or their British equivalents) in the specialties through which students rotate.  Students also take both parts of USMLE Step 2 (clinical knowledge and clinical skills) after the third year.

Hospitals in which electives are taken should also have approved postgraduate programs in those specialties.  For example, it is best to do an anesthesia elective at a hospital that has an anesthesiology residency. Regardless of school affiliation, however, individual hospitals still reserve the right to screen individual students for elective clerkship acceptance. Some individual hospitals and departments do not accept international rotating students, which can limit the away electives in which students can participate. From a competitive perspective, it is always preferable to participate in clinical rotations located in hospitals that not only have ACGME accredited residency programs but are academic teaching hospitals rather than community hospitals.

If I Go To a Caribbean Medical School, Can I Get a Residency?

Graduates of Caribbean medical schools have tremendous success in obtaining residency positions, even in competitive specialties. It helps to attend a well-established Caribbean school, perform well on the USMLE Steps 1 and 2, and obtain strong letters of recommendations. (See my previous articles: Getting Into Residency Part 1 and Part 2 for more information.) Before applying for the residency match and early in medical school, students should strategically plan their clinical clerkships in the US, ideally arranging rotations in the settings where they prefer to match.  In recent years, Caribbean students with strong academic and clinical performances have been able to obtain competitive residency positions at an increasing rate.  However, the largest number of students pursue less competitive specialties, such as internal medicine or family practice.  Some students are also able to ”prematch” into residency positions outside of the National Resident Matching Program (NRMP).

When evaluating the success of a Caribbean medical school’s graduates, it is important to find out specifically where and in what specialties students match. Also determine what percentage of fourth year students match into categorical programs. This information may not be easy to obtain. While schools typically publish their match results, it is unclear if these lists are truly comprehensive.

After residency, Caribbean medical students, along with their domestic colleagues, will obtain board certification and must meet specific requirements for state licensure. The quality of one’s residency training usually carries more weight than the medical school attended, so obtaining the best possible residency and even fellowship can help Caribbean students overcome some of the bias foreign students face when competing for competitive attending positions.

Educational Commission for Foreign Medical Graduate (ECFMG) Certification and Graduate Medical Education Programs

To be eligible for ACGME accredited residency programs in the United States, and for licensure in many states, students who graduate from a Caribbean medical school must obtain an ECFMG certificate. Eligibility for this certificate includes graduating from a medical school listed in FAIMERs online International Medical Education Directory (IMED) and passing the USMLE Steps 1 and 2 (both clinical knowledge and clinical skills).  For more details, see the ECFMG website at www.ecfmg.org.

Questions to Ask

School History

• When was the school established?
• What percentage of students are US citizens?
• By whom is the school run and what are the credentials of the academic faculty?
• Has the school had any recent changes in leadership? Are any leadership changes expected?

Caribbean Medical School Accreditation

• By whom is the school accredited and is the school accredited by the states of California, Florida, New Jersey, and New York?  Is the school listed in FAIMER’s IMED?

Admissions, Medical Education and Curriculum

• The quality of your medical education begins with the advice you receive prior to attending a Caribbean medical school. Is your premed advisor well versed in the pros and cons of attending medical school in the Caribbean?
• If interviews are required, by whom are they conducted – alumni, administrative staff, faculty and/or current students?
• What are the mean overall and BCPM (biology, chemistry, physics and math) GPAs and MCATS of accepted students? Are MCATs required to submit an application?
• Does the school have more than one matriculating class annually and are admissions rolling? Unlike most US schools, Caribbean medical schools typically have two to three first year classes that begin at different times during the academic year.
• What is the average size of each entering class? Does the size vary depending on the start date?
• How many students enroll in each first year class? What percentage of students who enter as first year students start third year rotations as scheduled?  What percentage of first year students match into categorical residencies in the United States during their fourth year? What percentage of first year students graduate? (Understand that graduating does not necessarily mean matching, so both of these questions must be answered.)

Financial Concerns and Living Conditions

• Do most students fund their education using outside loans or scholarships? Are these loans backed by the US government or are they private loans? Does the school offer financial guidance to help students choose the best loans and make responsible financial decisions?
• Where do students live and what are the housing conditions? Does the school provide housing?

Clinical Studies

• Where do students do their clinical training? Can students choose where they do core rotations? Are the rotations ACGME accredited? Do students work alongside US medical students?
• Are students allowed to do elective rotations? How many? Can students do away electives at nonaffiliated hospitals? Does the administration or faculty help students obtain away electives?

Residency Match and Professional Guidance

• Does the school provide guidance to help with the match process? Do students have an assigned advisor to help them?
• Where and in what specialties did students in the most recent graduating classes match for residency, and what percentage of fourth year students matched into categorical residencies?
• What percentage of students do not match annually? What percentage of students must enter the “scramble”? For students who enter the scramble, does the school provide assistance to find an unfilled residency spot?

Alumni and Student Support

• Where do alumni practice geographically, in what specialty and in what type of practice (community or academic)?
• Will the school provide contact information for alumni and current students with whom to speak?

Medical School in the Caribbean

Going to medical school in the Caribbean can be a good option as long as you do your research and make an educated choice. The medical education you will receive in the Caribbean varies tremendously, and the success you will have after graduation depends on many factors. Attending a top Caribbean medical school is a great option for some students but, just as for US medical students, once in school you must “do the right thing” to secure an excellent residency, (See my article Getting Into Residency Part 1 and Part 2.) I have had several Caribbean medical student clients earn residencies in competitive specialties, including anesthesia, emergency medicine, and internal medicine so, yes, it can be done!

Jessica Freedman, MD, a former medical admissions officer, is president of MedEdits (www.MedEdits.com), a medical school, residency and fellowship admissions consulting firm. She is also the author of the MedEdits blog, a useful resource for applicants: (www.MedEdits.blogspot.com).

The author would like to thank Marta van Zanten for clarifying parts of this article.

References

1) van Zanten M, Boulet J R. Medical education in the Caribbean: variability in medical school programs and performance of students. Academic Medicine. 2008;83: s33-s36.

2) van Zanen M, Parkins LM, Karle H, et al.  Accreditation of undergraduate medical education in the Caribbean: report on the Caribbean accreditation authority for education in medicine and other health professions. Academic Medicine. 2009;84: 771-775.

By Laura Turner
SDN Staff Writer

The Student Doctor Network, in coordination with the Student Osteopathic Medical Association (SOMA), is pleased to announce the winner of the first annual SDN Scholarship in Community and Preventive Medicine. The inaugural winner is Tamar Nazerian, a first year medical student at Western University College of Osteopathic Medicine.

Scholarship Winner Tamar Nazerian

The scholarship was launched earlier this year to provide support for students that plan to enter the field of community and preventive medicine.

Lee Burnett, physician and co-founder of SDN explains, “As a nonprofit charitable organization we have a responsibility to the greater community.  Our goal with the scholarship is to provide support to a student that also feels that sense of community responsibility. Tamar Nazerian has worked extensively in the area of preventative care. It is wonderful that she is the first recipient of this scholarship.”

Prior to matriculating at Western University, Ms. Nazerian served as the Project Coordinator for the University of Southern California/Childrens Hospital Los Angeles University Center for Excellence in Developmental Disabilities, working on two federally grant supported projects. The first was called Project Access for Pediatric Epilepsy, which used telemedicine to bridge the communication gap between pediatric primary care physicians and pediatric subspecialists in rural areas. The second project focused on providing children with special health care needs who are transitioning into adulthood with information to enable them to find appropriate medical care. She also worked at the UCLA Lili Claire Family Resource Center as a Program Coordinator.

Ms. Nazerian completed a Masters in Public Health at the University of Southern California, with a focus on Child and Family Health. She received her Bachelors of Science in Physiological Science from the University of California, Los Angeles, with a Public Affairs minor with a Social Welfare emphasis.

“I am thrilled and humbled to be the first recipient of this scholarship,” Tamar Nazerian said. “As I wrote in my application essay, I have found that the strategies that are most effective at improving the overall health of a community are not those that rely on individual behaviors or access, but instead focus on improving society’s collective health and wellness. My goal is to serve as a Pediatrician and focus on early intervention to improve the health and well being of children and society as a whole.”

A complete text of Tamar Nazerian’s application essay is available here.

“We look forward continuing to support students that are focused on community and preventive medicine with this and other scholarships in the future,” said Lee Burnett.  The annual SDN Preventive Medicine Scholarship was offered as two awards, one for SOMA and the other for the AMA-MSS.  SOMA chose to start the scholarship with the 2009 academic year.  In 2010, annual scholarships are planned for additional healthcare professions.

Ahh, simple childhood games. Music playing. Walking around a circle of chairs. I’m eyeing the one closest to me.

*the music stops*
I scramble for a chair.

“I’m sorry, Joe. You can’t sit in a red chair. Those are for people with Outies. Your belly button is an Innie. You need to find a blue chair.”
“But the kindergarteners took most of the blue chairs for their game…”
“I’m sorry. Just see if you can find a left over one.”
I cry.

While this never actually happened, it is a recurring nightmare I have (and may explain my deep seated phobia of blue chairs). This game represents how health professional school admissions, particularly medical school admissions, work.

For medical schools, there are a good number of chairs that are spoken for before you’ve even submitted your AMCAS. How many depends on the types of alternate acceptance programs the school offers, but these programs contribute to the ultimate class size and subsequently are fewer seats available during the AMCAS application cycle.

As an informed applicant, what you can do is realize that you’re only going to be competing for the blue chair.

What alternate acceptance pathways are there?

BS or BA/MD Programs
These programs offer medical school acceptance to exceptional students either directly out of high school or early in their undergraduate careers. After completing their undergraduate and program requirements in anywhere from two to four years, students in these programs join the entering medical school class at the institution affiliated with the program.

Early Acceptance Programs
Similar to the above, some schools will offer early acceptances to students at linked universities or within their home state. This generally occurs sometime following the junior year. These students also matriculate with the entering class.

Special Masters Programs
Many medical schools offer Special Masters Programs. These programs allow students to take classes with M1 students in order to show they can excel at medical school coursework. While the degree of linkage between SMPs and Medical Schools varies from program to program (few, if any, offer a direct acceptance), many will at least interview every SMP student and SMP students will traditionally be accepted to their home institution with a higher rate than the general applicant pool. SMP students do apply through AMCAS, but they are deceptively competitive for the school in question.

Where else do the spots go?

Deferrals
Every year, there are students that are unable to matriculate the year they’ve applied. These students defer and subsequently join the next year’s class. This is a small number of students and this happens each year, so it may be negligible, but these students are already holding acceptances in the application year that the entering class is applying so they may be considered as drawing away from the total number of available seats.

The Innie/Outie Factor
State residency is a large issue at state funded schools. Unless the school is private and state residency is not a factor, there will be separate pools for in state and out of state students. This is a division of seats you’ll need to consider.

A Note on Gender
A false impression exists that schools hold a specific number of seats for males and a specific number of seats for females. While researching this article I was informed by an admissions committee member that the approximate 50/50 ratio of male to female students is not a function of intentional admissions selection, but rather a function of the proportion of male to female applicants.

Applying the Math

Those were some nice observations, but what does it all mean?

Let’s take a hypothetical state medical school trying to fill a class size of 200:

• This school had 5 deferrals from the previous year.
• It accepts 20 students per year from an Early Acceptance program from its Undergrad.
• It accepts 20 out of 30 students per year from its SMP program.
• The In State Acceptance Rate is 70%
• No BS/MD program.

Now let’s pretend you’re an In State applicant applying to the above school. How many seats are you actually applying for?

200 seats
x.7 In State student acceptance rate
140 Seats for In State Students

That doesn’t seem too bad, but wait, the linkage programs and SMP programs are predominantly for in-state students. Deferrals are able to attain IS residency in some states.

140 Seats
-5 Deferrals
-20 Early Acceptances
-20 SMP Acceptances
95

While there is a 70% acceptance rate for in state students, the applicant is only applying for 47.5% of the seats in the class. Out of State applicants are essentially unaffected by these programs.

Below is a table of the make up of that class mentioned above:

Where can I find this information?
One source would be the school’s website. You can search for info regarding any alternate admissions programs or Special Masters Programs. Additionally, the AAMC publishes the Medical School Admission Requirements (MSAR) annually. This gives the best breakdown of admissions stats and class profiles. Check both of these and combine the results to give you the best understanding of what programs are operating and their scope.

What can I do about it?
When looking at a medical school, or any health professional school, it helps to know your odds. A lot of money can be wasted for spots that were filled years ago. A little research can help. Know how many spots a school has open for you. This will tell you if that long-shot application is worth the money.

By Jessica Freedman, MD

AMCAS 2010 opens in early May and the next wave of applicants is preparing to submit applications, so it seems apropos to summarize some key observations I have made while privately advising medical school applicants. Here is my list of some essentials for medical school applicants to improve their chances of acceptance.

1. Submit an early application
   Everything you read tells you that the #1 rule of medical school admissions is to apply early. But, I find that many applicants still ignore this advice. You should not only submit your application as early as possible but also make sure that your transcripts and letters of reference are sent in promptly.
2. Take your MCAT exam early
   Again, the key word here is “early.” Your application will not be reviewed until your pending MCAT scores are in so, if you have worked hard to submit your AMCAS application in June, don’t negate this effort by taking an August MCAT.
   
3. Don’t apply once for “a practice run”
   Yes, people do this. I suggest applying only when you are truly ready. While the stigma of being a reapplicant is declining, being a third-time applicant does trigger a negative bias, so it is best to try and make your application as perfect as possible the first time around. Take an honest inventory of your stats, experiences and accomplishments and decide if you are ready to apply or if you must do something to enhance your candidacy.
   
4. Apply broadly
   It may be your dream to attend a top 10 medical school, but be realistic. Too often, applicants apply to only a few schools initially and limit their chances. It is important to apply to a broad range of schools both in terms of geography and ranking. Around this time of year, I receive calls from applicants who say “Well, I didn’t get in last year but I applied only to five schools because I wanted to stay in California.” If you really want to increase your chances of being accepted, do not limit yourself.
   
5. Think about your story
   I encourage applicants to think about their unique story and path to medical school. What motivates you? What are the overarching themes in your background and experiences? Why do you want to be a physician? Really thinking about who you are, how you got there and what you hope to do in the future will set the stage for your entire application process. Think about this throughout your education. And, remember, nothing is set in stone. As you develop new interests, expertise and hobbies, your story will evolve and change. Just make sure that your story doesn’t have any major unaccounted gaps in time because admissions committee members often regard these gaps as “red flags.”
   
   
6. Make your application entries descriptive
   While some applicants write a bulleted and brief description for each AMCAS entry, my advice is always to give as much information as possible in your written activities descriptions. You have a 1325 character limit per entry so, unless you have nothing to say about your experiences (which would be a red flag in my book), use this space to your advantage. The person who wants to read less can opt to skim your entries but the person who wants more information won’t take the time to pick up the phone and inquire about your experiences. These descriptions present an opportunity to write about your insights, experiences, accomplishments and observations.
   
7. Do not regurgitate your application entries in your personal statement
   It is important to say something new, different and fresh in your personal statement that does not repeat your application entries. Interestingly, I find that many applicants shy away from the very topics and aspects of their backgrounds that make them unique. Applicants also lament that they don’t really have a story or anything special about them. Boloney. Every applicant has a compelling story, but sometimes you need an outsider to bring it into focus. Often applicants are self conscious about the very experiences that will make them more compassionate providers (and more attractive applicants), such as being an immigrant, growing up with few opportunities or having their own encounters with illness. Applicants often say, “I don’t want anyone to feel sorry for me and I don’t want to tell a sob story.” As long as you present your story in a matter- of- fact way and write about the positive direction of your path, you won’t be perceived as a whiner. It is often the most challenging times in our lives that are the most catalytic, and any experienced medical educator understands this.
   
8. Fill out your secondary essays in timely fashion
   Here is that theme again. Early, early, early.   For schools that have secondaries, your application won’t be screened until the secondaries are in.
   
   
9. Practice Interviewing
   Many applicants think interviewing is easy and, for some, it is, but everyone needs practice. Even if you are a great public speaker, sitting down and talking about yourself one on one with a person in a position of authority does not usually come naturally. Also remember that you can guide your interview and highlight what you think is most important about you. Most medical school interviews are fairly low stress and conversational, so enter your interview knowing which experiences and thoughts you want to discuss and emphasize. When I do mock interviews with clients, I am often surprised at how many people, including those with a long list of impressive achievements, are not able to present their stories cohesively and comprehensively.
   
   
10. Make every interview count
    Every interview is an opportunity for an acceptance. Be sure to smile, be positive and be personable on your interview day. Regardless of “scoring systems” or “rankings,” there is a huge subjective component when evaluating an interviewee. This “halo effect” works both ways; if someone perceives you positively, this will likely carry over to everything about you and your candidacy, whereas if someone perceives you negatively, the opposite is true. I have several clients who received only one interview invitation which resulted in an acceptance. So, approach every interview, literally, as if it is the only one.
    
    
11. Get good advice
    This isn’t as easy as it sounds. Seek out individuals who are knowledgeable about medical school admissions and provide sound guidance. When I used to evaluate applicants as an admissions officer, it was often obvious when an applicant received bad guidance because they did not have the best mix of experiences, had poorly written documents or weak interview skills.
    
    
12. Stay objective and be honest with yourself about your chances
    If it is late in the season and you have not received any interviews or only have wait list offers, consider what went wrong and correct your mistakes. If you plan on reapplying, you must, once again, do so early. If you reapply in August after you realize you won’t get off a wait list, you may again be unsuccessful. Inevitably it is the waitlisted applicant who reapplies in June who gets off a waitlist in August just before classes start.

Learn from my collective experience working with medical school applicants and try to make the most of your candidacy. What I have learned from my clients, most of all, is that the new generation of physicians is a motivated, well-intentioned and inspiring group with a positive outlook.  Apply well because our patients need you. Good luck!

Jessica Freedman, MD, a former medical admissions officer, is president of MedEdits (www.MedEdits.com), a medical school, residency and fellowship admissions consulting firm. She is also the author of the MedEdits blog, a useful resource for applicants: (www.MedEdits.blogspot.com).

In 1987, NOVA’s cameras began rolling to chronicle the lives of seven medical students embarking on their years-long journey to become doctors. From their first days at Harvard Medical School to the present day, none of them could have predicted what it would take, personally and professionally, to become a member of the medical community.

The final installment of NOVA’s Doctors’ Diaries is a two-part special premiering Tuesday, April 7 and 14 at 8pm ET/PT on PBS (check local listings).  The longest-running U.S. documentary of its kind, Doctors’ Diaries begins by reuniting the physicians on the steps of Harvard Medical School 17 years after graduation.

The seven physicians profiled in NOVA's "Doctors' Diaries" (photo credit: NOVA - Betsey Cullen)

Footage from the previous four installments in the series offers a rare and candid look at the rewards and personal sacrifices each has made over the last two decades – from the stress of medical school exams, to the first cut into a cadaver, through first wedding ceremonies (and sometimes second or third), internship, residency, and life as a certified M.D.

The seven physicians featured in Doctors’ Diaries have taken divergent paths:

• Tom Tarter, Bloomington, IN – The Bronx-born, long-haired, tattooed ER doctor has constantly grappled with how he is perceived as a physician. After his contract was terminated at the local hospital he became an itinerant M.D., forcing him to look for work in distant locations. Once a bouncer, an Olympic-hopeful weight lifter, and a mechanic, Tom is now on his fourth marriage and struggles to make ends meet.
• Jane Liebschutz, Boston, MA – Currently an internist specializing in underserved populations, domestic violence, and addictions. NOVA was there for the gut-wrenching moment when Jane experiences a patient dying in the operating room for the first time.
• Jay Bonnar, Belmont, MA – This private practice psychiatrist is also involved in outpatient group therapy and teaches at the hospital.
• Elliott Bennett-Guerrero, Durham, NC – A successful anesthesiologist who picked his specialty partly based on the less demanding hours-this now affords him more time to be at home with his second wife and two young sons and pursue his new passion: golf.
• Luanda Grazette, Thousand Oaks, CA – Originally trained as a clinical cardiologist, Luanda now works for a pharmaceutical company to develop drugs that will help heart patients.
• David Friedman, Baltimore, MD – As an ophthalmologist and professor at Johns Hopkins University, David aims to one day establish a hospital to provide eye care to the millions of people worldwide who currently have no way to improve their poor vision.
• Cheryl Dorsey, New York, NY – Although she eventually completed her pediatrics training, she never practiced. Cheryl put her residency on hold to found a program that provides free curbside health services for minority communities; today she is the president of the same nonprofit that funded her Family Van mobile clinic.

Producer and director Michael Barnes recently spoke with The Student Doctor Network about Doctors’ Diaries.

Michael Barnes (photo credit: Jim Murphy)

How have you seen the profession of physician change over the course of the series?

Managed care was well entrenched in 1987 when we started filming at Harvard. A couple of the doctors we followed are the sons of physicians. They describe that it was their fathers who saw the biggest changes in the profession. Under Ronald Reagan’s presidency, Congress encouraged the transition of the insurance industry from a not-for-profit ethos into a for-profit approach as enabled by Health Maintenance Organization Act of 1973. Without exception all seven doctors in the series believe the for-profit approach is flawed and that the healthcare system is broken. But this is the model under which they became doctors. Perhaps the biggest change for them is yet to come if the healthcare system can be reformed.

What do you think you would find if you started this series over in 2009 with a new set of first-year medical students?  Do you think the experiences would be similar?

Over the past two decades most medical schools have improved the curricula for the first two years of training (as Harvard did back in 1987 with the New Pathway). I understand 3rd and 4th year students at Harvard now do their rotations at one hospital rather than switching every month. Since we filmed, legislation has resulted in Interns working less hours with fewer nights on call. Despite these changes I am certain the medical school experience would be almost identical to those we recorded in Doctors’ Diaries. There are no short cuts to the process of becoming a fully initiated member of the medical tribe.

Over half the doctors that were featured in the program were married and divorced during the 21-year span of the program.  Do you feel that medical students, residents and physicians are more likely to have negative incidents in their personal lives due to the stresses of their profession?

In the UK, and I suspect in the United States too, physicians do have a higher risk of divorce (as well as drug abuse and suicide) than other professions. Based on our seven physicians it seems that the most difficult time to sustain intimate personal relations is during medical school and residency. Relationships that began later seem to be faring better, perhaps because a reasonable work life balance has been achieved. A couple of the doctors described how their tendency to treat their spouses “like interns” led to conflict.

One of the students (Cheryl Dorsey) is not currently a practicing physician.  Was her journey the most unexpected, or did another student surprise you more with his or her choices?

Luanda’s choice to stop seeing patients and work fulltime in research at Amgen was a surprise. But I am sure her love for patient care will pull her back in to clinical practice at some point soon. Although she kept to herself any misgivings about going to medical school I did sense that Cheryl was ambivalent. Although Cheryl took a circuitous route to get there it is wonderful to see how completely fulfilled she is in her job leading the Echoing Green foundation (that provides seed money for social entrepreneurs).

At the time that the original series was produced, 1987, the whole “reality TV” concept did not exist.  Today, documentary and “reality” television is common.  Do you think that the numerous medical reality shows give a realistic or unrealistic vision of the life of physicians, based on your experience with Doctors Diaries?

I don’t watch a lot of reality TV about doctors. But shows that trade on reality should respect it. Doctors’ Diaries will influence how these seven doctors are perceived and judged by viewers. Even though we shot around 500 hours over two decades for the NOVA series making a film that is completely true to their lives is impossible. Real life is a muddle and as storytellers we must impose structure by deciding which scenes to keep in and which to leave out. As we edit ever more finely it comes down to choices about individual words and frames. The NOVA series only documents a tiny fragment of their lives. But our guiding principle is always to portray the spirit of their careers. In striving to achieve authenticity I have found a good test is to imagine the doctor watching the scene in question in the same room as myself. If that would be an embarrassing experience I have probably made a bad decision. At a recent preview screening which a couple of the doctors attended Jay remarked, “I recognized myself”. I hope the others can say the same.

The Student Doctor Network targets pre-health professional and health professional students.  What key message or messages should they take away from this series?

As Luanda once said becoming a doctor is only for people who cannot imagine doing anything else. Tom agreed and said that if you have any doubts about giving up a decade of your life there are several careers such physician’s assistant and CRNA, which do not require quite so many years of training.

For more information on Doctors’ Diaries, please see the NOVA website at http://www.pbs.org/wgbh/nova/doctors/.

The discussion here will focus on the MCAT scores, timing, strategies and other issues.  Discussion about the content of the MCAT and details about the exam itself will be held to a minimum and would extend this already lengthy post too much.

The GPA

Obviously, the higher your GPA, the better. Generally, anything above a 3.5 GPA is considered very good and very competitive. Jumping from a 3.0 to a 3.5 GPA will make a huge difference in someone’s application, whereas jumping from a 3.5 to a 4.0 GPA will not be quite as dramatic (although it is obviously an advantage to have a 4.0 versus a 3.5 GPA).

The GPA really reflects how seriously an applicant has taken his or her undergraduate studies. A high GPA is a reflection of strong study habits and work ethics. Medical schools look at an applicant’s GPA for that reason – to evaluate if the applicant is likely to work hard in medical school. A high GPA has been found to be a very good predictor of success and the likelihood that someone will NOT drop out of medical school.

It is also worth pointing out that a high GPA can compensate somewhat for a lower MCAT score. The GPA usually does carry a lot of weight in the admission decision. If both MCAT and GPA are lower, admission to medical school becomes much harder. However, having said that, there is more to the overall application than the MCAT and GPA alone. An otherwise stellar application can also overcome a lower GPA and MCAT score – to a point.

The 3.0 GPA is a cutoff for most medical schools. However, some applicants are accepted every year that have a lower GPA, so this value is by no means absolute. Again, it all depends on the strength of the overall application…and the MCAT score.

For example, for the 2005 school year, 155 applicants were accepted to allopathic medical schools (out of 17,978 total accepted that year) with a GPA that was lower than a 2.75. (Undergraduate Grade Point Average, Medical School Admission Requirements, 2007-2008, page 29) So, it is possible to gain admission with a low GPA, but you can see from these numbers that this is very rare. Also, these individuals most likely had stellar applications otherwise.

For most of the allopathic (MD) medical schools, an average GPA of 3.0 is the minimum they will consider for extending interview invitations, regardless of what the rest of your application looks like, but there are a few exceptions.

The MCAT

The MCAT (or Medical College Admission Test) is one of the most dreaded parts of medical school preparation and is required by all U.S. medical schools, including all allopathic (MD) and osteopathic (DO) schools. Note that most Caribbean and international medical schools do not require the MCAT.

As of 2007, the test is administered in a computerized format throughout most of the year. Before 2007, it was only given twice a year as a paper test-once in April and once in August.

If possible, you should try to take the MCAT early so you receive your scores back by the time you submit your medical school application (AMCAS for allopathic schools and AACOMAS for DO schools). Before 2007, it took sixty days to grade the MCAT and release your scores, so taking the April MCAT around April 15 gave you the best possible timing for submitting your applications early (around June 15).

The earliest date applications can be submitted is June 1, but you needed to wait for your MCAT scores to submit your application. So, in reality, your earliest day for submitting your application before 2007 was around June 15. With the 2007 changes, scores are now returned within thirty days (and supposedly the eventual goal is a fourteen-day turnaround at some point). To submit your applications on the earliest day possible, you should therefore plan to submit your applications June 1 and take the MCAT no later than thirty days before this date (May 1). Submitting your applications early gives you a huge advantage in the admissions game.

The MCAT score

Each of the three multiple-choice sections (biological sciences, physical sciences, verbal reasoning) is worth 15 points for a total of 45 points, but it is nearly impossible to achieve a perfect score. The average MCAT score each year is somewhere around a 24 (eighty in each section).

A good score that is competitive at most MD schools is around 30 and a stellar score is somewhere above a 34 to 36, which is competitive at the top medical schools in the country. A score of 36 or better would put you in the top 2 percent of the country. The writing sample is scored with a letter system from J (lowest) to T (highest), but is much less important than the number score. You never hear anyone mention the letter score. All you ever hear people talk about is the number, although some people insist that the letter score is also considered in the admissions process somehow.

To give you an extreme example that the MCAT is not the only measurement that is important, 60 applicants were admitted to allopathic medical schools in 2005 who had an MCAT score that was less than 17 (Performance on the MCAT, Medical School Admission Requirements, 2007-2008, page 27). Keep in mind that there are a few allopathic medical schools in Puerto Rico, for example, that have very low MCAT averages (20.1, 21.3, and 23). These schools could be responsible for many of these numbers. Again, this sort of low score is a rare exception. Essentially, an MCAT score below 25 will make it almost impossible for you to gain admission to allopathic (MD) medical schools. You will still be competitive for osteopathic (DO) medical schools, podiatry schools, and Caribbean medical schools.

For most of the allopathic (MD) medical schools, an MCAT score of 21 is the minimum they will consider for extending interview invitations, regardless of what the rest of your application looks like. For some of the more prestigious medical schools in the country, the minimum MCAT score is around 30 to 32, below which you will not make it past any screening for interviews, regardless of how strong the rest of your application is.

The more applications a medical school receives every year, the more the school tends to eliminate applicants by MCAT scores and GPA alone when screening applicants. It is the easiest and most cost-effective way to limit the search for competitive applicants – and especially the more popular and prestigious medical schools use these criteria more heavily.

Medical schools like to use the MCAT as a way of screening and comparing applicants since it is the most objective measurement. Your GPA varies with the difficulty of the courses you take and the type of college or university you attend for undergrad. The MCAT provides one way to compare everyone at the same level.

The MCAT score is a reflection of your ability to reason, think, and interpret charts and data. It has less to do with your work ethic or your ability to memorize, which are two factors reflected more by your GPA.

MCAT Preparation

The MCAT test is intended to test material presented in general biology, general chemistry, organic chemistry, and general physics. For review, it is important to stress the most important concepts and information in each of these areas. Generally, it is better to know the basic concepts very well than to know a lot of information superficially. Having said that, most of the questions on the MCAT are very difficult, and often it feels like they are testing concepts you have never heard of. Some additional course work can be helpful, but is not required. Although it is not necessary to memorize every formula in physics, chemistry, and the other courses covered, you should know the bread-and-butter formulas of each subject, particularly in physics. Don’t focus on all the derivative formulas. Memorize the main ones – you will need them.

They may ask a question like “If I throw a ball out of a window 25 m above the ground, at an initial velocity of 15 m/s, how long will it take until it hits the ground? How far does it travel vertically until it hits the ground?” So, you will need to know your formulas to figure out these questions. However, most questions are not this straight forward.

You will need to decide what type of person you are and what you will need for preparation. Some students swear by commercially available review courses such as offered by Kaplan, Princeton Review, Columbia Review, Cambridge, and Lippincott Williams and Wilkins. They are rather expensive, with a price tag up to $1,500, but many physicians and other successful applicants strongly suggest you take a review course.

Review courses often provide a classroom type setting with lecture format to review pertinent topics in all the MCAT prerequisites. You still have to study the extensive review material that comes with the course as you would in any class.  Other programs just provide the materials and the plan without classroom lectures. In either case, they provide the structure and the plan to get you through all the pertinent material in an orderly fashion.

You still have to put effort into the prep course like any other class you have taken before. Just attending the prep course may not help you out much, although they do cover a lot of test-taking strategies, which are helpful for test taking in general and not dependant on how much material you learned. Also note that these courses work only for review. If you have not had physics or organic chemistry before, you cannot learn the material in the prep course. These are review courses.

They also offer practice tests throughout the course and provide hints and tricks, do all kinds of analysis of what was on previous tests, and help you with time management techniques and other topics. This type of review may be very well worth it if you are the type of person who is a procrastinator or needs a structured program that is already set up and scheduled.

For those who are able and willing to work through self-study, there are many good review books and book series from the same MCAT review companies.  The Student Doctor Network has also published its own MCAT review book. The books contain the same basic material used in the courses, but you are on your own. So, you have to set aside a certain number of hours per week for a few months to review and work through the materials on your own. Expect to prepare for three to four months before the test.

I would highly recommend purchasing the Web practice MCATs online. They are the real deal, made available by the AAMC (Association of American Medical Colleges), the makers of the MCAT and not some version made up by Kaplan, Princeton Review, or other test-prep companies. These practice tests are well worth the money and you can take them under real testing conditions. Set aside a few Saturdays at your library in a quiet corner, or at home – undisturbed. You can grade yourself at the end to see how you did. One of the practice tests is available free of charge. You can purchase additional practice tests online (http://www.aamc.org/students/mcat/practicetests.htm ) for $35 each.

The MCAT is really a thinking test. You will need to know the sciences to do well, but many of the questions do not directly test knowledge. They may ask you to interpret some data or extract some answers from a passage. It has been said that you cannot really cram for the MCAT.

Average GPA and MCAT scores

Note that the two following tables give average GPA and MCAT scores for both allopathic (MD) and osteopathic (DO) school matriculants for a few years.

Data for allopathic (MD) schools

Mean Medical College Admission Test (MCAT) Scores and Grade Point Averages of U.S. Medical School Applicants and Matriculants, AAMC Data Book, 2006, page 38

Data for osteopathic (DO) schools

Grade Point Averages and Mean Medical College Admission Test (MCAT) Scores for Entering Students, Osteopathic Medical College Information Book, 2007 Entering Class, page 80

Note that it is easier to get into osteopathic (DO) schools than allopathic schools (MD) by roughly 5 points on the MCAT and something like 0.15 points on the GPA.

Regarding GPA calculation, MD schools count every course grade earned even if you have retaken a course. If you earned a “C” in organic chemistry the first time, retook the course and earned an “A” later, they will count both grades for calculating your GPA. DO schools only count the retake grade (”A” in this example) and not the lower grade you earned the first time.

The average MCAT score for MD schools is around 30 and GPA is around 3.6. For DO schools, the average MCAT score is around 25 and GPA around 3.4. Especially if your MCAT score and GPA are below these values, your extracurricular activities weigh heavier in the admissions decision and can make the difference between getting an interview and no interview.

Caribbean medical schools typically do not have any MCAT requirements with few exceptions. If they do, they will accept lower GPA and MCAT scores than MD and DO medical schools.

Retaking the MCAT

If you score low on the MCAT, it may be a good idea to retake it. However, you absolutely have to show improvement. I know some students who increased their scores a good three to five points and it made all the difference. If you score the same or lower than your original MCAT score, retaking the MCAT only hurts you because you have just demonstrated that you really cannot do well, even if you have another chance.

Often, it is advisable to take a prep course, if you haven’t already done so, to prepare for retaking the MCAT, especially if you didn’t take the exam seriously enough the first time. You have to be willing to put a lot of hard work into preparation before retaking the exam again; just retaking it will buy you nothing.

Sometimes, if the MCAT score is not very high but still acceptable, it might be better to work on extracurricular activities to increase the overall strength of the application to compensate. However, a lower MCAT can limit some of your medical school choices. Certain medical schools may not consider you at all. Generally, osteopathic (DO) and Caribbean medical schools have lower MCAT requirements than allopathic (MD) schools. There is also quite a bit of variation between various MD schools.

The decision to retake the MCAT may depend on your goals overall and not necessarily on the score you received the first time. Also, keep in mind that it is very hard to increase your MCAT score, especially if you were prepared for the test the first time and there is not much else you can do to prepare. Increasing a score from a 24 to a 28 is probably much easier than raising a score from a 30 to a 34.

Important Note: A premedical advisor should be consulted to help you decide whether you should retake the MCAT and what strategies are appropriate for you to maximize the effectiveness of additional preparation. Only an experienced premed advisor who knows you personally and knows something about the MCAT can tailor advice to fit your specific circumstances. This is a big and important decision.

You may retake the MCAT up to three times, which can be all in the same year if you wish. However, retaking the MCAT for the fourth time, and every time thereafter, you have to jump through some hoops to be able to take the MCAT again. The AAMC requires a letter proving that you are really applying to medical school and not just taking the MCAT for other reasons (maybe you are teaching MCAT prep courses on the side and you can teach it better by taking the MCAT yourself every year).

By Sameer Apte
SDN Senior Moderator (MCAT Forum)

Modern medical education is a surprisingly young field. If you were to travel back only 90 years and enroll in medical school, you would find yourself in the midst of the greatest paradigm shift in the history of American medical education.

At the time, medical training curriculums were non-standardized, schools were largely profit driven, physicians were required only to have a diploma to practice, and the selection criteria for medical students were either sparse or non-existent (1-3).

At the request of the newly formed Council on Medical Education (CME), Abraham Flexner, a noted educator and scientist, visited every medical school in North America and wrote a scathing review of their educational practices (2). The “Flexner Report”, as Flexner’s review is commonly called, was the first step in the standardization of medical education.

Flexner’s findings, backed by the CME’s influence, not only prompted a re-evaluation of how medicine was taught, but also who it was taught to. Physicians-in-training were often not required to have a high school or university education, and entrance tests were proprietary and variable in rigor (1-3). As a result, attrition rates for medical school freshmen ranged from 5% to an astounding 50% in the 1920s (3). Furthermore, the quality, or lack thereof, of those that did graduate was harshly regarded by Flexner himself (2).

In 1928, in an effort to ensure the readiness of matriculating medical students, F.A. Moss created the “Moss Test”, the first standardized Medical Colleges Admissions Test (MCAT) (3, 4). Through a series of true/false and multiple choice questions across six to eight subtests, an applicant’s memorization ability, scientific vocabulary, reading comprehension and logical reasoning were evaluated (4, 5). In conjunction with the admissions reforms suggested by the Flexner Report, the implementation of the MCAT slashed medical school attrition rates to 7% in 1946 (3, 6).

Since Abraham Flexner’s time, the MCAT – administered by the Association of American Medical Colleges (AAMC) (7) – has undergone a number of major restructurings, each one aimed at adapting the test to better suit the medical landscape of the era (3, 8).

The second iteration of the MCAT came in 1946 and featured the section “Understanding Modern Society” (later renamed “General Information”) (8, 9). The inclusion of this sub-test reflected the emerging idea that physicians should be well versed in areas “over and above those which may be related to medical school grades (3)”. Medical school admissions committees, however, reportedly placed the greatest importance on the scientific sections of the MCAT, and did not give the general information sub-test much credence (3, 10).

In the 1970s, the AAMC put forth substantial effort to enhance the ability of the MCAT to assess personal qualities. “Compassion, coping ability, decision-making ability, inter-professional relations, realistic self-appraisal, sensitivity in interpersonal relations, and staying power-physical and motivational” were characteristics deemed important for practicing physicians (3). The project, however, was abandoned; in the MCAT of 1977 to 1991, the general information section was eliminated, and the remaining sub-tests covered only scientific knowledge, reading comprehension, and quantitative skills (11).

Today’s MCAT features three separate multiple-choice sections covering physical sciences, verbal reasoning, and biological sciences, as well as a long answer writing sample section. Results from each section of the MCAT are statistically analyzed and a grade distribution is generated that closely approximates a bell curve.

The multiple choice sections are scored on a scale of 1-15, while the writing sample is scored on a scale of J-T. Because the MCAT aims to accurately assess a very wide range of applicants, the AAMC goes to great lengths to reduce the effects of cultural and social bias, as well differences in testing conditions. Thus, the performance of examinees on the MCAT can be reliably compared (12).

For 18 years, the current structure of the MCAT has been the mainstay of standardized testing in medical school admissions; however, as the face of medical education continues to adjust its mission and objectives, the AAMC will continue to review and revise the exam (13). For instance, concordant with the recent integration of modern technology and medical practice, the MCAT has moved from a paper-and-pencil format to a computer-based format (14).

More recently, in October of 2008, a committee to comprehensively review and re-design the MCAT for the fifth time was commissioned by the AAMC (15). The Committee, called “MCAT review 5″ (MR5), consists of current physicians, medical school administrators, faculty members, and medical students. Because the MR5 committee is still in the evaluation process for the current MCAT, it is not known how the test will change, only that the changes will be drastic16. If MR5 meets its projected time-line, MCAT examinees in 2013 will most likely be faced with a standardized exam that bears little resemblance to the MCAT of today.

It is in the criticisms of Abraham Flexner and the creation of the Moss Test that the origins of the MCAT can be found. Since that time (only 90 years ago), the MCAT has kept pace with the remarkable evolution of medicine by constantly changing its own nature. With the advent of the MR5 committee, the time has come, once again, for the MCAT to don a new face. Although it may soon be unrecognizable to those of us who took it today, the MCAT will always be a part of the medical school admissions process, in whatever form it may present itself.

***Be on the lookout for an upcoming article revealing what might be in store for the future MCAT. MR5 committee members, MCAT administrators, and other medical education experts will give the Student Doctor Network information and insight.

Citations:
1.    Beck, A.H., STUDENTJAMA. The Flexner report and the standardization of American medical education. Jama, 2004. 291(17): p. 2139-40.
2.    Flexner, A., Medical Education in the United States and Canada (Bulletin Number Four). 3rd ed, ed. T.C. Foundation. 1910, New York: W.B. Updike & The Merrymount Press. 1-363.
3.    McGaghie, W.C., Assessing readiness for medical education: evolution of the medical college admission test. Jama, 2002. 288(9): p. 1085-90.
4.    Moss, F.A., Scholastic Aptitude Tests for Medical Students. J Am Assoc of Medical Coll, 1930. 5(2): p. 90-110.
5.    Moss, F.A., Report of the Committee on Aptitude Tests for Medical Schools. J Am Assoc of Medical Coll, 1941. 16(4): p. 234-243.
6.    Mullin, F.J., Selection of Medical Students. J Am Assoc of Medical Coll, 1948. 23(3): p. 163-170.
7.    AAMC. Official Medical College Admissions Test Website.  2009  [cited 2009 March 4th, 2009]; Available from: www.aamc.org/mcat.
8.    Erdmann, J.B., Separating Wheat from Chaff: revision of the MCAT. Acad Med, 1972. 47(9): p. 747-749.
9.    Young, R.H. and G.A. Pierson, The Professional Aptitute Test, 1947 A Preliminary Evaluation. J Am Assoc of Medical Coll, 1947. 23(3): p. 176-179.
10.    Glaser, R.J., Appraising Intellectual Characteristics. J Med Educ, 1957. 32(10): p. 31-45.
11.    McGuire, F.L., The New MCAT and Medical Student Performance. Acad Med, 1980. 55(5): p. 405-408.
12.    AAMC. MCAT Essentials.  2009  [cited 2009 March 4th, 2009]; Available from: http://www.aamc.org/students/mcat/mcatessentials.pdf.
13.    Mitchell, K., R. Haynes, and J. Koenig, Assessing the Validity of the Updated Medical College Admissions Test. Acad Med, 1994. 69: p. 393-401.
14.    AAMC. Medical College Admission Test will Convert to Computer-Based Format.  2005  [cited 2009 March 4th, 2009]; Available from: http://www.aamc.org/newsroom/pressrel/2005/050718.htm.
15.    AAMC. Medical College Admission Test to Undergo Review.  2008  [cited 2009 March 4th, 2009]; Available from: http://www.aamc.org/newsroom/pressrel/2008/081016.htm.
16.    AAMC. AAMC Launches Review of MCAT Exam 2009  [cited 2009 March 4th, 2009]; Available from: http://www.aamc.org/newsroom/reporter/feb09/mcat.htm.