You are accepted to both MD and PCLT programs if you are accepted into PCLT. Once you are in PCLT you have the option to decide whether you want to stay in it or pursue the normal MD track. I believe you have to decide this by the end of the first year. PCLT admission = standard MD admission on a special optional track (PCLT). Source: Duke was my undergrad, I know people in the program who I'm close with, and I'm applying to the program. But if there are any current PCLT students who could confirm this that would probably be best. And you are considered for PCLT at the same time you are considered for MD so you aren't at a disadvantage for normal MD admission if you aren't selected for PCLT!