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Good question. There are two things we can implement now that should be relatively easy. Then two things that seem a little difficult.
First, the easy ones...
1. Every medical school should randomly call the contacts of students that it's planning to interview, even if there are absolutely no red flags on the application. This should scare applicants into not embellishing their hours. Unfortunately, embellishing hours is a big grey area, whereas something might be considered honest to one person, but would be considered lying to another.
2. ADCOMs should not be scared to ask why a pre-med decided to do certain activities. If a pre-med is going to devote so much time and forgo any sort of monetary compensation, then it should be fair game to ask pre-meds why they got involved with a certain activity. I don't know why "ZERO to Mother Teresa" applicants don't raise any red flags? 😵 This should cut down on the number of activities people do, unless they are great bullsh*tters of course.
Now the harder ones...
3. AMCAS should create a standardized grading sheet to be used to evaluate pre-meds at their volunteer activities. Currently there is absolutely no oversight (unless an ADCOM personally knows a volunteer coordinator), so an ADCOM can only gauge an applicant based on what they tell them. Therefore, two applicants with an equal amount of hours might be judged the same, even though one may have been an honorary part of the hospital team, while another would sign in and ditch. If pre-meds were graded, then you would see people stop half-assing what they do, people will stop embellishing hours, and people will stop ditching volunteering. It might be a pain for volunteer coordinators, but it should work out for them. After all, I'm sure that young pre-meds can do far more labor than the elderly. The only difference is that the elderly genuinely want to be there, while the pre-meds don't. The pre-meds' poor attitude is what kills their productivity. Now, if pre-meds were actually held accountable, then hospitals can save money by hiring less techs, secretaries, and other paid positions. Currently, pre-meds have horrible reputations, and I don't think hospitals are willing to replace paid labor with people who are extremely flaky and don't care about what they are doing.
4. AMCAS should extend activities through high school. For a while, you'll see who only started doing these activities right when they became pre-med. If you extend the timeline to high school, people will need to know long ahead of time that they want to pursue medical school. ADCOMs can see who was perhaps actually altruistic. This is flawed though, since the system will reach equilibrium, and high schoolers who are thinking about medicine will know to start early. But I can't imagine putting on such a facade for so many years! Though high-achievers won't mind because even if you drop pre-med, those activities will still look mighty nice on other graduate school applications, or for future employers.
Number 4 further widens the discrepancy between high economic tier applicants and lower ones. Many of the ECs done by high schoolers are either put together by their parents, heavily encouraged by parents, made possible by parents (think as basic as a ride to the volunteer place), and generally only available to students who have the free time t work without pay. There is no way a high schooler can be held responsible, in a positive or a negative way, for what they did or did not do in high school. Also, no job application or grad school cares about high school activities..