Diminishing returns on shadowing hours?

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LnSin

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I had a unique opportunity to shadow several physicians in two countries that aren't the US (note, I also have US shadowing hours) full time for two summers--so I'm sitting at around 850 hours total. It was one of the greatest experiences of my life.

At what point are these hours meaningless? Most people I know have like 70 hours, and that's considered "good enough," is there any value in listing that I have 850 hours? Will it "help" my ~150 (closer to 200 when I apply) clinical volunteering hours?

I ask because when people achieve something like 1000 hours of volunteering, that's a huge highlight of their application and a great talking point--can the same thing be said for shadowing hours?
 
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While shadowing is important, and having roughly 50+ hours of it is becoming the "gold standard" for applications (my number might be a little off, I admit), I don't think there is much to be earned from having 800+ hours. Shadowing is great to learn what the lifestyle and general working environment for physicians is like, but it is a rather passive process where you don't contribute much to the experience yourself. Also the fact that your shadowing was with non-US physicians diminishes its impact a bit, as those experiences really don't prepare you for what life as an American physician would be like.

I mean, definitely still put it on your application, but don't think that it will be a magic bullet that will ensure you get II's. (Also, 200 hours for clinical volunteering is pretty good, that's about where I was when I applied this current cycle).
 
Non-US shadowing does not achieve the goals for which shadowing is recommended.
40-50 hours in a US physician's office is fine. Primary care is especially useful.

So I should only list my US shadowing hours? Do my international experiences not help in a conversation about the global practice of healthcare?
 
I think having international healthcare experience would be helpful for a comparative and global outlook on medicine. But shadowing is passive. A clinical research job abroad that lets you do research, gather clinical experience, and shadow physicians would be more meaningful.
 
So I should only list my US shadowing hours? Do my international experiences not help in a conversation about the global practice of healthcare?
You may certainly include it in your activities but it does not serve as the type of shadowing we are looking for, the type that lets us know that you have an idea of what a doctor's day is like in the US.
 
You may certainly include it in your activities but it does not serve as the type of shadowing we are looking for, the type that lets us know that you have an idea of what a doctor's day is like in the US.

Thanks prof! So just to be absolutely clear, my 50 hours in the US are "good," and the other 800 may help, so it wouldn't hurt to put it in the app and use it as a talking point if it comes up?


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Thanks prof! So just to be absolutely clear, my 50 hours in the US are "good," and the other 800 may help, so it wouldn't hurt to put it in the app and use it as a talking point if it comes up?


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It's fine as long as you didn't participate in any of the areas of concern in the link I posted.
 
It's fine as long as you didn't participate in any of the areas of concern in the link I posted.

Nope! It was strictly observation (England was very stern about it too!)


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Shadowing is a passive endeavor done for yourself
This is a unique observation that I haven't heard of before, thanks! I think it will make for a good discussion.

I disagree with your premise--to say that shadowing is indulgent is akin to stating that listening to a professor lecture is selfish in the same way, or watching educational videos on edX is self-serving. Shadowing is a pursuit of knowledge--at least, for me, it was--and that should not be admonished by something like the sin of indulgence. To argue that the pursuit of knowledge is selfish debases why--in my opinion--the AAMC values shadowing: I need to understand how medicine is practiced, and if it takes me 800 hours to make sure that I may be a good fit for this field, then so be it. I would rather spend 800 hours shadowing to realize that medicine is not for me, than to spend 50 hours, go into the profession unaware of its intricacies only to quit, and waste others' time and effort (and money!). Shadowing is not selfish in the long-term--and I don't think any activity in the pursuit of education is self-serving in that regard.

Spending 850 hours in an international pursuit that is passive and indulgent must be weighed against the ratio of volunteering, community service, etc,
I think it is intellectually dishonest to compare these two fundamentally different activities, especially when you take a ratio like you are suggesting. The implication that I am hearing (and please correct me, I do not want to paint broad strokes) is that you value volunteering more than shadowing, because one "serves others," while the other does not, however I do not think that these two should be compared relative to each other. My shadowing does not detract from my volunteering, and my volunteering does not detract from my shadowing (I don't think you would make the argument that, if I had more research than volunteering, I value academics over service). These two activities should be weighed on an absolute scale independent from each other: how much volunteering was enough for me to understand the role of service in the field of healthcare, and to understand the meaning of service to others?

I would hope that a program of this length is more organized and interactive
It wasn't a program, I contacted these doctors of my own volition (mostly), and arranged a plan for both summers to observe the incredible variety there is in global medicine. And for what its worth, I am not certified to do anything more than watch, especially internationally. One doctor did teach me how to do sutures (funnily enough, I actually learned laparoscopic first, and then on a banana in the "normal way"!) but this was the exception--I learned with my eyes, I'm not certified to be "hands on" patients, I think that would be highly negligent. What kinds of activities do you consider non-passive, with regard to shadowing?

Isn't passive observation how we learn? Lecture classes and such? Should this be admonished?
 
So how are your other ECs?

Volunteering = 400 (200+200) clinical+non clinical
Research = 1200

Those are the big ones, do you want me to list my other 'minor' ones? I don't want to derail, is all.
 

AdComs on SDN have repeatedly stated that shadowing is inherently a passive activity that one should not over-indulge in, and that volunteering and more active forms of clinical experience are much more preferred and have a larger impact on admissions decisions than shadowing hours. Your comparison between shadowing and lecture-based learning falls fairly flat, as most people will state that active learning practice after lecture is where you actually learn and synthesize the material. Also, as before, volunteering is definitely more valued than shadowing, hands down, and time is a finite thing and time spent doing one does indeed detract from time available to do the other.

I'm glad that you were able to have the opportunity to shadow foreign physicians, but I don't think it is going to sway your application chances as much as your demonstrated interest in clinical and non-clinical volunteering and your experience in research.
 
. Service to others is basis of motivation and commitment to medicine that most adcoms look for. The premed perception that significant hours in research and shadowing are the most important experiential items to admission committees miss the actuality of the data.
I absolutely agree, and I haven't said anything to the contrary! This is no perception that I have made, nor have stated. My inquiry is to your implied statement that an excess of shadowing hours appears as "indulgent." I haven't found a response to the following: what makes my shadowing hours detract from my already established volunteering? Namely, if I only had 50 hours of shadowing, would my stats then fall into the ideal ratio?

appropriate ratio

which brings me to my next point: in my time lurking SDN, I have never heard of such a required ratio of hours to have. I know that one must have "enough" hours of shadowing, volunteering, and research, but I have not heard of any AdCom so far (nor in any AAMC materials that I see linked) that suggest there is a specific target ratio of hours to aim for. Thanks for bringing this to my attention, and I will attempt to rectify this. However, a precursory google search reveals a thread from 2008 where a non Ad Com member states that a 20:1 ratio of volunteering to shadowing is "good." I can't find any other metrics to aim for...
 
So a ratio of 1200 hours of research, over 900 total hours of shadowing, 200 hours of clinical volunteering and 200 of non-clinical community service, is the direct opposite of what I consider an appropriate ratio for a highly motivated and committed candidate.

But do hours really matter? I thought meaningful experiences and longevity of experiences matter far more? If that's the case, is there an appropriate ratio?
 
But do hours really matter? I thought meaningful experiences and longevity of experiences matter far more? If that's the case, is there an appropriate ratio?

I think for most people, hours signifies longevity. If you are cramming in 300 hours in 6 months, the might look a little fishy.
 
I think for most people, hours signifies longevity. If you are cramming in 300 hours in 6 months, the might look a little fishy.

yeah but i don't care about 300 hours (and i don't know why adcoms would care about hours either). i'd see that 6 months of experience are probably not sufficient for a meaningful experience.
 
yeah but i don't care about 300 hours (and i don't know why adcoms would care about hours either). i'd see that 6 months of experience are probably not sufficient for a meaningful experience.

Because AFAIK, you list it by hours on AMCAS. So they talk about it in those terms because consistency is helpful.
 
Because AFAIK, you list it by hours on AMCAS. So they talk about it in those terms because consistency is helpful.

start and end dates are listed too. as well as experience descriptions. even when there's an hours entry, i don't know why adcoms would care when start/end dates + experience descriptions + maybe some strong letters from supervisors tell a clearer story.
 
start and end dates are listed too. as well as experience descriptions. even when there's an hours entry, i don't know why adcoms would care when start/end dates + experience descriptions + maybe some strong letters from supervisors tell a clearer story.

I agree with you. Just brainstorming.
 
But what evidence do the hours show? What does it say when an applicant has a huge amount of shadowing in comparison to a much smaller amount of total service, both clinical and non-clinical? And what does it say when most of that is outside the US on a summer break? What does it further say when the applicant has a huge amount of research time, especially wet bench? What is their motivation and commitment to medicine which is the service of others? What would a summer of say, building house, or working in another community endeavor? Are they more focusing on learning medicine and being a doctor before they show they understand the commitment it needs? Are they motivated because they want to wear a white coat or because they understand what it means to be in another's shoes, or helping those who may need it?

Tell me what this all says about a person? that's what hours and the balance of everything in an application must address in order to get invited to an interview and ultimately get into medical school

But longevity addresses and answers all those questions. Hours can be padded, exaggerated and lied. It's harder to fake start and end dates that can be more readily verified, and longevity of experiences better illustrate commitment to activities than hours.

Someone with 2 years of experience with 500 hours would likely have more meaningful things to talk about than someone with 6 months with 500 hours.
 
But longevity addresses and answers all those questions. Hours can be padded, exaggerated and lied. It's harder to fake a start and end dates that can be more readily verified, and longevity of experiences better illustrate commitment to activities than hours.

Someone with 2 years of experience with 500 hours would likely have more meaningful things to talk about than someone with 6 months with 500 hours.

I think the point is that they are looking at the hours in conjunction with the time frame. The comparison of hours between different activities is more about what that says about you than longevity.
 
I think the point is that they are looking at the hours in conjunction with the time frame. The comparison of hours between different activities is more about what that says about you than longevity.

But hours aren't a valid metric for measuring commitment to activities. It's the experiences themselves and how applicants can present them in essays and interviews.
 
the conclusion that Community service/volunteering should be highest, shadowing less, and research last

Again this is where I'm having trouble following you: the AAMC rates these metrics individually--I don't see your evidence for the logic that having an excess number of hours in one metric is a detriment. You cannot seriously tell me that an individual who has spent 4 years in a research lab working on an independent project in cancer signalling pathways (an interest, god forbid) would be looked down upon if he didn't also volunteer for 4 years. My volunteering (clinical and non clinical) is spread over 2 years.

You are making it seem like it's not possible to get the most out of a volunteering experience if it's not at the "top of the list." I can have research interests and still show compassion and dedication to the field of medicine.
 
But hours aren't a valid metric for measuring commitment to activities. It's the experiences themselves and how applicants can present them in essays and interviews.

😕
Adcoms definitely look for sustained commitment to service. By definition, that means you will be doing it for a period of time. Hours + time frame is how you measure that. Someone who has 100 hours over a year vs someone who has 300 hours over a year, etc. The experience the person gets out of it is a separate, though equally important (and maybe even more so).

If someone has 1000 hours of research and 200 hours of non-clinical volunteering, that's definitely and imbalance and says something about their priorities.
 
Again this is where I'm having trouble following you: the AAMC rates these metrics individually--I don't see your evidence for the logic that having an excess number of hours in one metric is a detriment. You cannot seriously tell me that an individual who has spent 4 years in a research lab working on an independent project in cancer signalling pathways (an interest, god forbid) would be looked down upon if he didn't also volunteer for 4 years. My volunteering (clinical and non clinical) is spread over 2 years.

You are making it seem like it's not possible to get the most out of a volunteering experience if it's not at the "top of the list." I can have research interests and still show compassion and dedication to the field of medicine.

As someone who recently went through the application cycle with a really high ratio of research hours reported compared to service hours, gonnif definitely has a point about what an "appropriate" balance of time commitment should be. My excessive time devoted to bench-top research definitely hung over my application throughout the cycle and particularly at interviews, it seemed to be the only thing that interviewers would talk about, to the point of never writing anything down about my commitment to service (whether it was clinical or non-clinical) in their evaluation sheets. A large ratio of research to service or other extracurriculars will make AdComs repeatedly ask themselves "Why isn't this person going for a PhD then? If they love research so much, why are they trying to get into an MD program?" You will easily get pigeon-holed into a role that may or may not truly represent yourself as an applicant.

I'm sorry if you don't think it's fair, but AdComs will *absolutely* look at the relative time that you put into different activities and make assumptions about what your true motivations are, and what it says about your personality. If you don't show that you are well-rounded, and are instead skewed to one aspect or another, AdComs will look upon you negatively (the sole exception being if you skewed yourself towards volunteer service, which is a positive). That is indeed how it works. In addition, foreign shadowing leaves a bad taste in many people's mouth as "medical tourism" and does not fulfill the idea behind why the AAMC promotes shadowing for applicants.
 
😕
Adcoms definitely look for sustained commitment to service. By definition, that means you will be doing it for a period of time. Hours + time frame is how you measure that. Someone who has 100 hours over a year vs someone who has 300 hours over a year, etc. The experience the person gets out of it is a separate, though equally important (and maybe even more so).

If someone has 1000 hours of research and 200 hours of non-clinical volunteering, that's definitely and imbalance and says something about their priorities.

Like I said, hours are often exaggerated and are only a limited perspective on commitment to service. It's the longevity of experience that matters far more. Someone who spent 2 years doing an EC with 200 hours likely has more meaningful experience than someone who spent 6 months and 200 hours.

Hours are a very poor metric for assessing commitment to service, and SDN places an undue emphasis on it for some reason. Hours can be overstated, faked, lied etc. It's harder to fake start and end dates, and to fake passion on ECs in essays and interviews.

Moreover, someone with 1000 hours research::200 hours volunteering does not have an imbalance in priorities simply because it inherently takes longer to do research and get meaningful results than to volunteer.

The AAMC survey that is cited here is also misleading because every medical school has its own priorities. Top schools usually care about strong academics, strong research and strong leadership potential, and aren't too concerned about clinical/nonclinical experiences as long as they are met sufficiently (at least a year). Service-focused schools care more about commitment to service (in terms of years and how meaningful experiences are), so clinical and nonclinical volunteering are critical. The AAMC survey serves as a general reference and should not be used as an absolute truth that applies for every school.
 
As someone who recently went through the application cycle with a really high ratio of research hours reported compared to service hours, gonnif definitely has a point about what an "appropriate" balance of time commitment should be. My excessive time devoted to bench-top research definitely hung over my application throughout the cycle and particularly at interviews, it seemed to be the only thing that interviewers would talk about, to the point of never writing anything down about my commitment to service (whether it was clinical or non-clinical) in their evaluation sheets. A large ratio of research to service or other extracurriculars will make AdComs repeatedly ask themselves "Why isn't this person going for a PhD then? If they love research so much, why are they trying to get into an MD program?" You will easily get pigeon-holed into a role that may or may not truly represent yourself as an applicant.

I'm sorry if you don't think it's fair, but AdComs will *absolutely* look at the relative time that you put into different activities and make assumptions about what your true motivations are, and what it says about your personality. If you don't show that you are well-rounded, and are instead skewed to one aspect or another, AdComs will look upon you negatively (the sole exception being if you skewed yourself towards volunteer service, which is a positive). That is indeed how it works. In addition, foreign shadowing leaves a bad taste in many people's mouth as "medical tourism" and does not fulfill the idea behind why the AAMC promotes shadowing for applicants.

Adcoms comparing relative applicant priorities in research to service is fine and makes sense. But it makes no sense to do so by calculating ratio of hours of research to hours of service and using that to determine priority. It is a very flawed metric that has too many confounding variables, and it's subject to exaggeration because hours are self-reported.

I can have a more meaningful experience volunteering at a hospice than doing research even when I spent 200 hours in past one year volunteering and 2000 hours in past 3 years doing research.
 
I can have a more meaningful experience volunteering at hospice than doing research even when I spent 200 hours in past one year volunteering and 2000 hours in past 3 years doing research.

I think you phrased exactly what I want to say--kind of. I get different experiences from volunteering and doing research/shadowing, and these metrics are not equivalent (1 hour of research is not the same of 1 hour spent at my ED, or 1 hour hosting a dialogue about race).
 
Like I said, hours are often exaggerated and are only a limited perspective on commitment to service. It's the longevity of experience that matters far more. Someone who spent 2 years doing an EC with 200 hours likely has more meaningful experience than someone who spent 6 months and 200 hours.

Someone who spends 2 years doing something and only has 100 hours vs someone who spends 2 years doing something and has 300-400 are not equal. It might be a small distinction, but the second person definitely put in more time.

And your second point is not only something I didn't disagree with, but the exact point I made a few posts ago.

Me said:
If you are cramming in 300 hours in 6 months, the might look a little fishy.

Hours are a very poor metric for assessing commitment to service, and SDN places an undue emphasis on it for some reason. Hours can be overstated, faked, lied etc. It's harder to fake start and end dates, and to fake passion on ECs in essays and interviews.

So you're saying that adcoms should just assume everyone is lying about their hours?

Moreover, someone with 1000 hours research::200 hours volunteering does not have an imbalance in priorities simply because it inherently takes longer to do research and get meaningful results than to volunteer.

Sure it does. If you've spent that much time doing research and that little amount of time volunteering, your priority is obviously in research. Being an undergrad doing research does not require thousands of hours. You are not making the next big breakthrough or working on a PhD.

The AAMC survey that is cited here is also misleading because every medical school has its own priorities. Top schools usually care about strong academics, strong research and strong leadership potential, and aren't too concerned about clinical/nonclinical experiences as long as they are met sufficiently (at least a year). Service-focused schools care more about commitment to service (in terms of years and how meaningful experiences are), so clinical and nonclinical volunteering are critical. The AAMC survey serves as a general reference and should not be used as an absolute truth that applies for every school.

I think you are more likely to get into the vast majority of med schools with a lot of volunteer hours and a small amount of research vice a lot of research and a small amount of volunteering. But I could be wrong. It just seems like almost every med school cares about service to others but only the top research schools really care about research beyond having minimal exposure to it (if at all).
 
It is a very flawed metric that has too many confounding variables, and it's subject to exaggeration because hours are self-reported.

I'm not saying it's a perfect system without its flaws, but I am positing that it is the way things work, whether we think it makes sense or not. Time spent on activities (regardless of their relationship to research, service, or shadowing) will be used to judge an applicants priorities. If you sit at a bench-top for 1000 hours as an undergraduate, those are 1000 hours that you could not spend doing another activity. Research, even at some of the largest schools in the country, does seem to be a low priority, especially with the idea that *some* research involvement is necessary for favorable outcomes but not excessive involvement. I agree with Matthew as below:

Someone who spends 2 years doing something and only has 100 hours vs someone who spends 2 years doing something and has 300-400 are not equal. It might be a small distinction, but the second person definitely put in more time. [...]

Sure it does. If you've spent that much time doing research and that little amount of time volunteering, your priority is obviously in research. Being an undergrad doing research does not require thousands of hours. You are not making the next big breakthrough or working on a PhD.

I think you are more likely to get into the vast majority of med schools with a lot of volunteer hours and a small amount of research vice a lot of research and a small amount of volunteering. But I could be wrong. It just seems like almost every med school cares about service to others but only the top research schools really care about research beyond having minimal exposure to it (if at all).
 
Someone who spends 2 years doing something and only has 100 hours vs someone who spends 2 years doing something and has 300-400 are not equal. It might be a small distinction, but the second person definitely put in more time.

And your second point is not only something I didn't disagree with, but the exact point I made a few posts ago.





So you're saying that adcoms should just assume everyone is lying about their hours?



Sure it does. If you've spent that much time doing research and that little amount of time volunteering, your priority is obviously in research. Being an undergrad doing research does not require thousands of hours. You are not making the next big breakthrough or working on a PhD.



I think you are more likely to get into the vast majority of med schools with a lot of volunteer hours and a small amount of research vice a lot of research and a small amount of volunteering. But I could be wrong. It just seems like almost every med school cares about service to others but only the top research schools really care about research beyond having minimal exposure to it (if at all).

While I dont disagree that volunteering is in general more valuable to most medical schools than research, I dont think adcoms care about hours as much as they do about commitment and what you got out of it (read: what you can write on your app about it and how you come off in the interview). It has repeatedly been mentioned on this forum by some senior folks that "How many hours?" is precisely the wrong question. That being said, short commitments with absurd hours are going to raise eyebrows (unless its a service activity associated with a scholarship; some of these require like 300 hours in a single summer for example) and long commitments with very low hours are also going to make people question how involved you really were.

The takeaway is that you dont need a bajillion hours in 100 activities to do well in the process. I know plenty of people who did one volunteer activity every week for several years in college and that was literally the only volunteer activity they put on their app (typically clinical) and they were accepted to medical school.

Obviously I'm biased because I love research but putting in hundreds to a thousand hours into basic science research is about what it takes to get anywhere meaningful (read: potential to publish a first author paper on a project you were on start to finish) . You aren't going to win the Nobel as an undergrad but research is enriching and fun (if you are into it) and, personally, I do not feel there are any diminishing returns from sticking with a demanding project for a long period of time. There are (admittedly very few) undergrads who *do* make very significant contributions to their fields; i.e. publish in Nature, PNAS, etc., present at national conferences...

My point is that if you are getting a lot out of an activity, then there wont be any diminishing returns to doing more. With shadowing there are always diminishing returns because after you've observed what the physicians day is like in a couple of different settings, you get the idea and will know whether you are willing to keep going or not.
 
Someone who spends 2 years doing something and only has 100 hours vs someone who spends 2 years doing something and has 300-400 are not equal. It might be a small distinction, but the second person definitely put in more time.

There is a distinction but that can be easily countered by simply adding more hours and adcoms will believe that. Basically the 2 yr/100 hours can simply report it as 2 yr/300 hours that seems just right, and adcoms have little to no reason to verify it. Why would they? In contrast, it's harder to fake longevity and start/end dates.

So you're saying that adcoms should just assume everyone is lying about their hours?

Adcoms should simply be aware that hours can be misrepresented and falsified. Start and end dates can't be readily exaggerated.

Sure it does. If you've spent that much time doing research and that little amount of time volunteering, your priority is obviously in research. Being an undergrad doing research does not require thousands of hours. You are not making the next big breakthrough or working on a PhD.

Lab protocols can take hours to run the experiment successfully, and messing up may require restarting the experiments all over. Programming experiments can be lengthy and having several bugs in the code may require hours of troubleshooting to simplify and get it working. There's a reason why research doesn't follow business hours. Volunteering can be done conveniently few times a week.

I can have 300 hours of volunteering experience over 2 years and find it very meaningful. But I can also have 1000+ hours of research over 3 years in basic science that I hate but listed it since my PI likes me and I still learned some new things even when I decide research is not for me.

I think you are more likely to get into the vast majority of med schools with a lot of volunteer hours and a small amount of research vice a lot of research and a small amount of volunteering. But I could be wrong. It just seems like almost every med school cares about service to others but only the top research schools really care about research beyond having minimal exposure to it (if at all).

That's only true as a general trend, but general trends don't apply to specific, individual school decisions. This is where school missions and the ambiguous, subjective notion of fit become important.

I'm not saying it's a perfect system without its flaws, but I am positing that it is the way things work, whether we think it makes sense or not. Time spent on activities (regardless of their relationship to research, service, or shadowing) will be used to judge an applicants priorities. If you sit at a bench-top for 1000 hours as an undergraduate, those are 1000 hours that you could not spend doing another activity. Research, even at some of the largest schools in the country, does seem to be a low priority, especially with the idea that *some* research involvement is necessary for favorable outcomes but not excessive involvement. I agree with Matthew as below:

Research is focused on productivity and meaningful experiences (how applicants can discuss their work in a meaningful way). So hours are totally useless for research experiences and I don't even know why someone brought it up earlier for weighing experiences comparatively. And research doesn't follow business hour schedule because things can go wrong in the workflow and it takes time to troubleshoot + get things done properly.

There are better ways of comparing meaningful experiences, and using hours is by far the worst metric that is subject to confounding and misleading factors (on top of being self-reported and thus subject to exaggeration and falsification). Instead, using start/end dates for longevity, experience descriptions in AMCAS, secondaries and interviews, and often strong letters from supervisors/coordinators present a much more complete and compelling narrative on the applicant.
 
We are on the same page here; I was presenting my questions as the kind of things an adcom thinks about when building a picture of a candidate.

Oh. I guess my main argument in the discussion has to do with emphasis on hours. I personally dislike using hours as metric for commitment to ECs and prefer using longevity via start/end dates.

I wish AMCAS removes Hours Entered feature in their application system. But alas, they have no reason to do so.
 
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