Reflections on the Medical Admissions Process

 
Each year on the SDN forums as the summer rolls around, there is always a flurry of threads asking for advice on the various aspects of the application cycle. For the first-time applicant the application process is at once exciting and nerve-wracking, caused by uncertainty in what to expect and the inherently unguided nature of the process combined with the much-anticipated arrival of this moment.
The application to medical school is perhaps the first time that applicants are given a more or less blank slate on which to express themselves and told to go at it with very few guidelines. I will leave it to the reader to peruse SDN, particularly the forums, and find information on the particulars and mechanics of the application process (check out the 2011-2012 Applicant Sticky for links to relevant threads, some of which are included below). Instead, I want to offer here a few tidbits of general advice to applicants that are embarking on this year’s application cycle.
Last year I had the great fortune to interview at a wide gamut of institutions – from state schools to the world’s most reputable institutions – and I did a lot of reflecting on my experiences as a medical school applicant both while the process was in full swing and after I made my final decision. My goal is to provide insight into the process to quell some of the fears that arise from uncertainty about what to expect and offer some pointers that, I hope, will help you throughout the upcoming year.

Before You Submit Your Application

Reread, reread, and reread your AMCAS application some more

Make sure all of the information is entered correctly and check for spelling and grammar mistakes multiple times. I developed the habit of reading my entire application at the end of every day I worked on it; I read my application in its entirety more than ten times before I submitted it. In addition to minimizing writing mistakes, this will also make you very familiar with what you wrote in your application, which will be important for interviews.  Ideally, you should also have someone who knows you well, and someone who does not, review your application.
Relevant threads:

Completing the AMCAS application is a thought-intensive process
I’m skeptical of anyone that is able to complete the application in a day or two. Every question is an opportunity to reveal more about yourself, and considering that the AMCAS application and any secondary applications will be all that the admissions committee bases interview decisions on, both (but especially the primary) should be treated extremely seriously. Don’t write your personal statement or complete the activities and experiences sections haphazardly – make sure you take advantage of the opportunities to share your personal motivations and interests and why medicine is the field for you.

Don’t rush any part of the application

Contrary to most SDN advice, you don’t need to submit the application within the first few days of June in order to be “on time.” While the time required for applications to be verified does get much longer quickly, you won’t be receiving any secondaries until mid-to-late July unless AMCAS and schools change how they do things significantly. Don’t compromise the integrity of your application for the sake of submitting on the first day possible. Taking a few days to intensively review your application and make necessary changes will yield many more benefits than submitting the application on the first day possible without reviewing and editing.

Make sure to fully explain activities and experiences on the application

Unless it’s patently obvious what was involved in a particular activity (shadowing experiences probably don’t need to be elaborated, for example), the admissions committee members reading your application may or may not know what you did or what was involved even though it might be obvious to you. Remember that the people reading your application have no idea who you are; you have to make sure you review your application with that mindset. The only things they’re going to know about you are what you disclose in your application. Everything from your personal statement to your activity descriptions should speak to your character and your motivation to become a physician. This is, in my opinion, the most important purpose of the AMCAS application and is a goal you should strive for when answering each question or completing each section.
Relevant thread: Tips on entering your work and activities

Be deliberate about the applications you submit

Every year I hear stories about an applicant being forced to matriculate at a school he/she really doesn’t want to because he/she wasn’t accepted to any other institutions. Why even apply to that school to begin with? Worse, many applicants are left without an acceptance because they didn’t create a realistic list of schools based on the quality of their application.
An applicant’s final list of schools should not be a random selection of institutions. Instead, the final list should be carefully chosen to reflect the overall strength of the applicant’s application and his/her personal preferences. An applicant with a 3.3 GPA and 30 MCAT, for example, likely shouldn’t be applying only to the Harvard/Yale/Hopkins tier of schools. On the other hand, an applicant with a 4.0 GPA and 39+ MCAT should feel comfortable going with a few reach schools unless he/she absolutely wouldn’t want to attend them.  I’d recommend that you set up a three-tier classification scheme: schools which you have a good chance of getting into (“safeties”), schools where you have a shot (“competitive”), and “reach” schools where an acceptance is possible but unlikely.
Use the AAMC’s Medical School Admissions Requirements (MSAR) to compose your list. This is the selection process I used and I was left with a list of schools at which I was fairly competitive (as evidenced by being invited to interview at 13 of the 16 schools at which I fully completed applications).

  1. Flag all schools in the MSAR at which your numbers are competitive. I would define “competitive” as being within two standard deviations of the mean or above using the GPA/MCAT ranges provided for each school. This, of course, is assuming that the rest of your application has no glaring weaknesses.
  2. If you feel comfortable doing so, flag a few reach schools. I would define “reach” schools as either schools that are notoriously competitive, which includes most of the top 20 schools in popular rankings schemes, or schools at which your numbers are well below the mean.
  3. Eliminate any schools that aren’t out-of-state friendly if you’re classified as an out-of-state applicant for that school.
  4. Eliminate any schools in locations that you absolutely wouldn’t want to be.
  5. If you need to cut your list down further, do research on the schools using their websites. I would recommend looking at information on dual-degree programs (if that is a route you might be interested in pursuing), the curriculum, the grading system, and any unique programs/opportunities they might have for their students.

While the final number of schools an applicant chooses to apply to should be based on a variety of factors, including the overall strength of their application, I would aim to apply to no more than twenty schools if possible. Even with that many schools the application process begins to become prohibitively expensive and time-consuming.
Relevant forum: What are my chances?

Get ready for a long year with lots and lots of waiting

I submitted my application on June 2nd, 2010 and didn’t finalize my school decision until April 18th, 2011. I started working on my application in May, so it took almost a complete year from when I started the cycle to when it was finally done. There is no other way to describe this process other than to say that it can be miserable. That said, it can also be an exciting and fun time of your life. When else will you be able to travel the country and meet some of the best students, clinicians, and scientists in the world? Though I know that it’s much more easily said than done, try and be patient and enjoy the experience. To use a cliché, “stop and smell the roses.”

Be humble

The most important piece of advice I can give is to be humble.  Don’t go into this process with any expectations. Again, there are a myriad of people who come to the SDN forums and are angry because they didn’t get into their first choice school and they don’t know why, they didn’t get into any school and they don’t know why, they didn’t get a scholarship and they don’t know why, and so on.
One glance at the number of applicants, number of interviews granted, and ultimate number of acceptances awarded should provide a reality check. Most schools accept less than 10% of their applicants each year; the most competitive institutions have acceptance rates less than 5%. Even the interviewing numbers are daunting: most schools only interview about 20% of their applicants and then only accept 10-50% of that group!
The unfortunate truth is that you aren’t guaranteed a medical school acceptance, even for those applicants that have particularly strong applications. Overall, about half of all applicants are accepted somewhere, but if you go into this process expecting to get into a top institution with a full tuition scholarship, you’re more than likely going to be in for a rude awakening and will be very disappointed. This process will humble you like no other. Once you get that initial acceptance, anything else is just icing to make the cake sweeter. Midway through the process your ego will be beat up, you will feel unaccomplished and subpar, and you will feel unworthy of getting into medical school. I think this is a feeling most people have, so don’t worry if you feel that way. It’s better to feel like that than like you’re unstoppable and will get into every school you apply to. The latter will certainly leave you disappointed; the former will leave you excited and grateful for what you accomplish.

Completing Secondary Applications

Secondary applications that contain essays must be treated seriously

I’ve met many applicants that discount the importance of secondaries, and while that might be fine at some schools that simply require a rehash of your AMCAS information, be particularly careful about applications that ask some form of the question, “why us?” This question is extremely important, and a well-crafted answer might very well be the difference between getting and not getting an interview. It’s fine to reuse essays in applications, but make sure the essay you’re reusing directly answers the question being asked. Don’t try and shortcut the essay by using an answer that tangentially addresses the question. I was never able to recycle essays without any sort of editing, and if nothing else different length requirements will cause you to cut parts of your essays.
Once secondaries start arriving, you can find the secondary prompts for many schools on the forums, which will enable you to prepare to complete your secondaries.  These threads are not yet available for 2011-2012.

Be prompt but don’t rush

Be prompt with your secondaries, but as was said with the AMCAS application, quality should not be sacrificed for a quick turnaround.  As an example, it took me a month to turn in my Pritzker secondary – significantly longer than what I took for any other school and breaking the “two-week” rule – and I was still accepted and will ultimately be attending school in Chicago. While some schools might gauge interest by how quickly you return the secondary, a poorly completed but quickly returned secondary will get the applicant nowhere. Secondaries that simply require a payment or confirmation of demographic information, however, should be completed immediately if possible.

Be particularly kind to the admissions staff when calling about the status of your application

In fact, as a courtesy I wouldn’t even call about the status of your application before being invited to interview. If every applicant to a school called the office and spent 30 seconds asking what the status of his/her application was, the office would literally spend full days in the aggregate responding to those inane calls. Call if you have something legitimate to ask about, but calling and asking about your application in an attempt to express interest is just silly. Also keep in mind that admissions offices are sorely understaffed for the amount of work they do. If they don’t get back to you right away or are terse with you on the phone, be gracious and thankful and try not to be bothered by it. If you dealt with thousands of neurotic pre-meds year after year, I’m sure you would be a bit frayed, too.

Attending Interviews

First, CELEBRATE!

I remember getting my first interview invite, and though it was to a school that ended up being my last choice, I was still extremely excited. Your first interview invite serves as validation that your work has paid off and that your application was successfully completed and well done.

Book Your Interview

After you’re done celebrating, make sure you book your interview date (if the school allows you to choose dates) as soon as possible, especially at rolling schools. Those dates will fill up quickly early on in the cycle. If you’re still in school, you’re going to have to miss class. Class, in my opinion, isn’t an excuse for choosing a later interview date over an earlier one, especially if the difference in interview dates is several weeks. As long as you’re accepted by the end of the cycle and don’t fail any courses, you’re going to be the only person that cares about your senior grades. This is obviously professor-dependent, but I found that all of my professors were more than willing to reschedule exams, assignments, etc. for my interviews. As long as you keep the lines of communication open you shouldn’t have any problems.
I highly recommend taking advantage of student hosting programs if they’re available at the institutions you’re interviewing at. Staying with students significantly reduces the cost of attending an interview and gives you the opportunity to talk with a student about the institution, which will give you plenty of ammunition for questions and a unique “in the field” view of the school. If a school doesn’t provide you with any information about a hosting program in the interview invitation or on its admissions website, send the admissions office an e-mail asking for information on student hosts. For whatever reason, some schools don’t provide information about student hosts unless asked. Don’t expect your host to show you around the school or the surrounding area; like you, they are students and are likely very busy.
Relevant thread: Etiquette when staying with student hosts

Get Prepped

Check out the SDN Interview Feedback database for the institution, particularly paying attention to questions that previous students were asked and what the interview day is like.
Men, make sure you have a decent suit. Buy one if you need to – it’s worth the investment to have a quality suit that fits well. Take the time to get measured and make sure you get a suit that you feel comfortable in. While a suit alone won’t get you accepted or rejected, you absolutely must look professional. Your personal appearance comprises a significant portion of what an interviewer will think about you when he/she first sees you.
Relevant thread: Men’s Interview Clothing #2
Women, the key word for you is “professional.” Before I started attending interviews I thought this would go without saying, but try and keep the cleavage and extremely short skirts at home. You would be surprised at what some people consider to be “professional.” I’d also recommend bringing a pair of flats for the walking tours; most schools are fine with you leaving the professional façade for the sake of comfort, but if you’re concerned about whether or not this would be acceptable I would call or e-mail the admissions office prior to your interview.
Relevant thread: Women’s Interview Clothing #2

Re-read your application the night before

One thing that I didn’t do but wish that I did was reread my application, especially secondaries, the night before each interview. Your overall application – of which your interview is a part – should tell a story, and rereading what you wrote in your applications can help keep that story cohesive. In a majority of my interviews, I – rather than the interviewer – directed the conversation, so you are usually able to tell your “story” throughout the interview. Answer all questions directly and honestly, but highlight your strong points while minimizing or not mentioning your weak points (unless, of course, you’re directly asked about them). If an interviewer doesn’t ask about something and you don’t mention something, no one will know unless you have otherwise listed it on your application. Offering up negative or dubious aspects about yourself is an definite no-no. Keep things positive and try to keep the interview under your control without being too assertive.

Be positive and excited

Be positive and excited about an institution you are truly interested in attending.  Be engaging in your interview and make it clear that you’re happy and want to be there. Making an effort to express this disposition will make you memorable and can make the interviewer more positive and excited to talk to you. Remember, interviews are exchanges: the demeanor you portray will be returned to you by the interviewer.
Relevant thread: Pre-Allo FAQ Series: Interview Survival

Your interviewer is out of your control

You can’t predict what kind of interviewer you’re going to get. If you get a combative, weird, quiet, etc. interviewer, you can’t do anything but try and adapt and make the experience as positive as possible. Stay calm, answer their questions, and be upbeat.

Don’t memorize your answers

While you should be prepared for the most common questions (why this school, why do you want to be a physician, etc.), I wouldn’t rehearse an exact wording of your answers under any circumstances. You’ll risk coming across as stiff, boring, and uncomfortable if you simply recite a memorized answer. Try and remember key ideas but improvise how you’re exactly going to express them – if you’re a decent speaker, your response will sound fresh and unrehearsed.  A great way to do this is by participating in mock interviews.

The end of cycle interview

What does it mean to have an end of cycle interview?  At some institutions, nothing, as they hold slots to accomodate end-of-cycle interviewees.  However, at schools that offer rolling admissions, the later your interview, the fewer the number of available slots.
When I was interviewing, my experience was that an end of the cycle interview didn’t bode well for my chances at that school.  Think about it: if your file was complete in August but you don’t interview until January or February, what does that say? I wouldn’t say that you’re interviewing for the waitlist per se, but if the school really wanted you, you would get that interview invitation quicker than four to six months after you apply.  I’m not sure what else that can possibly say but “we’re interested in you, but not that interested.”

Have questions ready

Make sure you have a question or two ready to ask your interviewer when you get to the “so, do you have any questions for me?” phase of the interview. I used the exact same two or three questions with every interviewer, so if you struggle to come up with specific questions for each school, simply reuse general questions. I’d recommend taking a look at the school’s website the night before your interview to try and come up with some topics for questions. If the tour and/or meet-and-greet is before the interview, pay attention and try and get some questions from those parts of the day. This approach will make you seem very interested and knowledgeable about the school, which can be a big plus.

Be flexible and be yourself

My best piece of advice for interviews is to be flexible and yourself.  Unfortunately there’s not an easy way to change who you are, which will more than anything dictate how you do in interviews. If you’re quiet, nervous, and not personable, you’ll more than likely portray that to some degree, though some people can mask their personalities better than others. That’s who you are, and there’s not much you can do about it. Be as excited as you can about the school, vary your intonation when talking, be enthusiastic (but not overly so) when you speak, and be genuine. You need to be able to handle anything and everything smoothly and turn your interviews into positive experiences no matter what you’re presented with. This isn’t something that can be taught, really – at least not immediately. It’s more reflective of how you interact with people in social situations. Understand that if you’re entirely honest about your interests, motivations, and career goals, you’re most likely not going to get accepted to a few schools. Each school has a particular goal when building a class and it’s highly improbable that you will fit the criteria of every school you apply to. Try not to be disheartened by a few rejections.

Accepted, Waitlisted, or Rejected

If you’re accepted – CONGRATULATIONS! You’re going to be a physician!
If you’re waitlisted, stay in the game – you were granted an interview for a reason and you weren’t rejected outright for a reason. The school is genuinely interested in you, but they can’t accept everyone. If this is a school you really want to go to, send updates, tell the admissions staff/dean that you want to go there, and hope for the best. I have very minimal experience with being on a waitlist because I chose not to play the waitlist game, but I have been following the school-specific threads on the SDN forums I was waitlisted at to see what people are doing once waitlisted and how things are going.
At the Ivies, it seems that sending the admissions office multiple letters of intent and updates is the best way to go. I don’t understand how people can send in 3-4 update letters with meaningful updates over the course of a cycle, but they do, and it seems that those are the people who get in. If you’re waitlisted at one of these schools, get your pen and paper (or computer) ready and start drafting those letters. It’s a game, and if you want to win you have to play it. Other schools don’t subscribe to this philosophy and would prefer not to receive updates or letters of intent. If you’re unsure whether or not the office will accept additions to your file, simply call and ask.
If you’re accepted/waitlisted, make sure you know what financial aid forms are required for your file to be complete and get them in on time. If you’re accepted earlier in the cycle (any time before January), you probably won’t be able to do much other than get all of your information together and come up with a system to keep track of what you have and haven’t turned in. Make sure you know exactly what you need to turn in and when. I missed out on financial aid deadlines at a couple of schools I was interested in because I was careless; had those been my only acceptances, I would’ve been in a very bad situation. While most schools will usually send out an e-mail reminding you to complete the financial aid process, they likely won’t hound you to make sure you turn everything in. That’s your responsibility.
If you know you’re not going to attend a school, do both the admissions staff and other applicants a favor and withdraw as soon as possible. This is a courtesy more than anything else.
If you’re rejected, don’t take it personally. As I said, there are simply too many qualified applicants to admit to any one class. I used to think that sort of phrasing in rejection letters was disingenuous, but when you look at how many people are applying for admission to a class, it’s certainly possible. How many people with 4.0/40+ numbers and outstanding extracurriculars apply to Harvard, Yale, Penn, or Hopkins each year? That cohort alone is probably enough to fill their classes. At every school the situation is similar: unless you’re applying with an extremely extraordinary application, you’re not going to get into every school you apply to because there are simply too many people that would be excellent additions to a class to admit each year. Keep your chin up and move on to the next school.

Making the Decision

If you’re fortunate enough to hold multiple acceptances, you’re going to ultimately have a decision to make. Unfortunately I can’t tell you what factors are most important in choosing a school; that’s going to be an extremely individualized set of criteria, and what’s most important is going to vary from one person to the next. My general piece of advice is to go to Second Look weekends/revisits at every school that you’re seriously considering. You’ll have plenty of opportunities to meet potential future classmates, talk with current students about questions/concerns you may have about your education, and get another fresh look at the institution. The final decision will probably be, more than anything, a gut feeling. Every program will have its strengths and weaknesses, and it’s up to you to determine whether you can live with those things or not.
If you’re considering a school that is well known to provide scholarship money and/or merit-based financial aid but you’re concerned about costs, I would strongly recommend letting the admissions office know and asking to speak with either the admissions dean or the director of financial aid. Schools generally want to hold on to their accepted students, and you would be surprised at what they’re willing to do to try and convince you to come to their institution. Don’t expect anything, but asking for an increase in scholarship/financial aid awards isn’t inappropriate as long as it’s done tactfully and humbly.
These are some of the questions that I asked (both to students and myself) when ultimately trying to choose a school. As you attend interviews and start to realize what exactly you want in a medical school you’ll come up with your own questions.

  • How much is it going to cost?
  • During the first two years, do the classes generally foster a collaborative atmosphere?
  • Is the grading true pass/fail or a traditional letter system?
  • How many exams are taken during each course? How many courses do students take at a time?
  • What kinds of research opportunities are available to medical students? Is it possible to take a year off for research?
  • What is the role of the medical student on the team during the clinical years?
  • Did I like the current students, faculty, and administrators that I met? Could I see myself as a member of this institution?
  • Do I like the city/community/area the institution is in?

Again, you will need to define the factors that are most important to you and base your decision on your own preferences. Once you’re accepted, schools will usually bend backwards to get you information or get you in touch with students to address any of your questions or concerns. Take advantage of this resource: in almost every case, students are the best people to get information from since they experience the school from the same perspective you will and can speak to the educational as it currently is, not as it was in the past or how the administration would like it to be.
While there are certainly a lot of factors outside of the applicant’s control throughout the application process, make no mistake: the ultimate results are not “random” or a “crapshoot” as seems to be popularly said. You can put yourself in the best position possible by completing a quality primary application, thoughtfully answering any questions on secondary applications and returning them promptly, and making an enthusiastic, confident, and memorable impression on your interviewers.
If you’re able to do those things – and do them well – your chances at success will be much greater and you will more than likely achieve your goals. The upcoming year will be stressful and induce some serious anxiety, but, at the end of it all, hopefully it will also be filled with unique memories and looked back upon as a time of possibility and excitement.
Best of luck, 2012 applicants!

17 thoughts on “Reflections on the Medical Admissions Process

  • Very well written. I have kept it bookmarked for the next 3 years prior to my application cycle.

  • It’s myriad not “a myriad”

  • Simon, come on. Really?

  • “Myriad” can be used as a noun or an adjective. Either way, that’s your comment for this well-written post? Go away. 🙂

  • “Flag all schools in the MSAR at which your numbers are competitive. I would define “competitive” as being within two standard deviations of the mean or above using the GPA/MCAT ranges provided for each school.”
    Competitive is “within two standard deviations of the mean”? You must be mistaken. A more sensible definition of “competitive” would be for your GPA or MCAT to match the mean GPA or MCAT for a particular school.
    If your GPA or MCAT are at least one standard deviation above the GPA/MCAT means for a particular school I would say that you are an extremely competitive applicant for that school.

  • Actually, although this line of discussion is really splitting hairs, I agree with Cole’s guideline that ‘competitive is “within two standard deviations of the mean.” Being slightly above or below the mean puts you right in the range of the average pool of accepted applicants. I do think, however, that with many schools, the applicant pool gets more competitive every cycle, and thus the ‘mean’ MCAT or GPA goes up just a little each year. Just my two cents.

  • Actually two standard deviations within the mean describes 95.6% of scores. This is hardly “competitive”. This group is basically the entire applicant pool save for the top 1.7%, and the bottom 1.7%. If you are 2 standard deviations below the mean, you are in the bottom 2% of scores, and you will not get an interview from any school.
    One standard deviation above the mean places one in the top 15.9% of scores. This probably correlates to an MCAT in the mid to upper 30s.

  • Actually an MCAT score in the mid to upper 30s is in the 95+ percentile range. If I recall the graph correctly, scoring a 38 puts you somewhere in the top 2% of all test takers for that year. I can see why 2 standard deviations above the mean would seem reasonable, at least MCAT score wise.

  • haha good job cole. my sis just pointed this article out to me

  • Extremely informative. I applied this past cycle, and I can vouch for everything written here. He did his research on this, as he even included information on the girls bringing flats for the campus tours. I will be sending this article to my friends who are applying for the upcoming year.

  • Humility is absolutely, without question, the most important trait you can have.

  • For those applying for 2012–Pay attention! This is an amazing article and will help you immensely if you actually follow everything in it!

  • What advice is typically given to an applicant who does not want to apply to his or her state school?

  • If you don’t want to apply… Don’t Apply…??
    No rule says that you have to apply to your state school. It might be an unintelligent decision, assuming you’re not wanting to apply because the program may not be up to your perceived standards. A state school is (typically) a great possibility for acceptance, but who really cares if you don’t want to apply to your state school.
    Excellent article. Very well written and you can tell the author embodies all the traits he mentions are important in the entire application process. Very informative.

  • SIC ‘EM BEARS!!!

  • What a great help Alex! Thank you so very much! As a graduating, Pre-Med, Non-Trad entering the application process in the Spring, this was of great benefit! To all the nay-sayers picking at fine details… use your time more productively.

  • Thanks! I’m getting ready for an interview (yay!) and needed to know how to feel about it all. 🙂

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