Duke ($$$) vs Case/CCLCM ($=0)

[veltron]

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I hope I don't upset anyone with this thread. I am genuinely hung up on where to go. I know... "first world problems" and all, but I'd love to hear some viewpoints. My internal debate within my mind can only get me so far---outside perspective would be nice.

So I've been very fortunate this cycle and have got into both schools. The Cleveland Clinic/Case Western program gives its students a full-tuition scholarship. My parents make about $160,000/yr and said they would cover my living expenses, but no tuition. Not sure what kind of aid I'd get at Duke, but let's pretend zero (So, basically I'd end up with $200k debt at Duke vs no debt at Case., worst possible scenario) The problem is I really like Duke, especially because I want to go into academic medicine. Another complication is CCLCM is a 5-yr program, so I'd be making money one year earlier at Duke.

Duke - pros

• I love the 1-yr pre-clinical, frees up third year to do research
• Epic match list with most people ending up going to the northeastern powerhouse institutions
• One of the highest residency director ratings (4.5/5.0), ranked #8 in USNWR
• The name itself might help with competitive residencies and later in my career when I go into academic medicine.
• The students seem amazing
• I like the lack of cold and snow in Durham; also like the cheap cost of living and open spaces.
• I am attracted to the prestige of the school; have to be honest.
• Students seem very happy

Duke - cons

• $200,000 debt, more after interest.
• Puts pressure on me to enter a high-pay specialty to pay my debt.

Cleveland Clinic - pros

• Strong match list
• No debt
• Case Western is a good school
• No grades in clinical years (though it puts more pressure on doing well on STEP I)
• No pressure to go into high-pay specialty

Cleveland Clinic - cons

• I really dislike PBL, and Case has 0 lectures, all PBL, students teaching students, with some seminars where faculty will teach you
• Students seemed stressed out
• Cleveland seems terrible, but I don't mind location too much.
• You could argue the mandatory 5th year means 1 less year not earning doctor money.

In the end I guess it comes down to whether I should buckle down and go to a school that I really do not prefer, because even a much preferable school is not worth ~$250,000. Or whether, on a doctor's salary, the debt is not that bad and I should just go where I am happy. It's also a question of whether Duke would give me the edge I want for academic med., or if Duke and Case can really both do the trick. Thanks guys.

 

[nemo123]

I don't know if you can confidently say that Duke will give you an edge academic medicine wise. CCLCM was created precisely for those aspiring to go into academic medicine, which is the reason why they have a 1 year research requirement.

Do both schools have second look on different sets of dates? You should try to attend those to see how you like each school after spending more time there and see the camaraderie between your future classmates.

 

[troioi91]

.

 

[veltron]

Do both schools have second look on different sets of dates? You should try to attend those to see how you like each school after spending more time there and see the camaraderie between your future classmates.

Attending for both, but I wonder whether it matters. I guess best scenario is I love the experience at CCLCM Second Look. Right now the dichotomy is as troioi91 describes:

So far, it seems like you're weighing your favorite pick (program, location, curriculum, everything it seems) v. being unhappy for 5 years but without significant debt.

That's what it feels like right now. I guess the worst part (i.e., PBL) would only be 2 years of discomfort, since clinical rounds and research are MS3-5

Definitely want to add I am blessed to be in this position though. Don't want to seem like I am complaining I am in some terrible position.

 

[troioi91]

Another perspective with time units, independent of pros/cons:

Mathematically, if you will be *on average* earning ~$220k+interest-ish during that extra year of earning power (since you have to stay a fifth year at Casr), it'll be a wash to go to Duke -- independently of which one you like more. If you think you'll be earning $125k-ish, you might think,"Is this worth 1 EXTRA year of my average salary to pay for Duke tuition?" (4y + 2y paying back) v. CCLCM (5y + 0y paying back).

If you're on the fence about the above question (about financials through a time perspective), where do you think YOU'LL be happier and, thus, more successful? People usually compare medical school programs, but sometimes forget that there is more career-building to do after med school and it's important to keep pushing on as a med student. Does social support play a role for you? What do you like to do in your free time and would you be able to do it at either place?

 

[rainbowbrite76]

My opinion may seem biased because I am currently on the cclcm waitlist, but I'm on the "hold" list and not the "high hold" so I have taken it as a rejection anyway - take from this what you will.

1. You are clearly favoring Duke.
2. Medical school is hard enough so why add more stress/mental anguish by going somewhere you will be unhappy?
3. You made the point of how the 5th year means you will "lose" 1 year of income. Regardless of what specialty you choose you will "lose" one year of resident pay or about 50K. Factor in the 50K difference when analyzing the final debt you expect to incur.
4. This mental ping pong is useless since you are missing one key piece of information- the financial aid award for Duke. Medical school debt can be soul crushing so your concerns are valid, however wait and see how much you may get.
5. I'm repeating myself here. GO WHERE YOU WILL BE HAPPY! Without getting into specifics, I can tell you that you can't put a price on your happiness.

Both schools offer great things, but it sounds like you already made your choice. Go to second look with an open mind. If you think you can be happy at cclcm then go there. If you leave with the same concerns, then Duke it is. Best of luck!

 

[EnjoyingTheJourney123]

From what you have listed in your pros/cons list, it really sounds like Duke is your pick without considering finances (seems pretty obvious). Your list of pros show that you obviously have a preference for Duke. I think you make a really good point that in the extra year you would spend at CCLCM, you would be missing out on 1 year of doctor money. I think this is a very unique situation and is different than just one school being cheaper than the other (in this case, free). However, with the money you would make in your extra year of "doctor money", I think this marginalizes this difference and doesn't play as big as a role. You could even end up making more money (depending on the specialty you enter) going with the Duke route over the extra year at the CCLCM route.

Overall, to me it sounds like you would be much happier at Duke and it sounds like the curriculum is more of what you are looking for. If you absolutely don't like PBL, then CCLCM probably isn't the place for you. I mean from your con list, it sounds like you are unsure about the curriculum (PBL), the student atmosphere (stressed out), and location (Cleveland = terrible/don't mind it). I would say these things are pretty important, at least to me, when considering a medical school and it sounds like CCLCM would not be ideal. It sounds like you love the curriculum, students, and location at Duke. Also, you mention the prestige and residency director rating at Duke and I would agree this makes it very attractive.

I would look at it like this, if you go to CCLCM and you are unhappy, you will always be wondering what it could have been like at your preferred medical school (Duke). If you go to Duke, the worst thing that will happen is that you have to pay off a year's salary (that you would have missed out on at CCLCM in the first place) after a 4 happy years spent at your first choice in medical institution.

The reason I am favoring Duke is based on the tone/attitude I got from your pros and cons list. However, this is just my opinion and the decision obviously comes down to what you value/weigh over the other.

 

[nerdlete40]

Hey veltron. Not sure if I'll be contributing anything new here, but it sounds like Duke is where your heart is. It would be one thing if the Cons you cite for CCLCM were fairly minor, but it seems to me that these Cons would be core aspects of your experience as a student there. PBL, for example, is a big part of what CCLCM is all about and if you don't like it, that could definitely result in added stress/unhappiness that could otherwise be avoided. It also seems like you aren't a fan of Cleveland, whereas you do like Durham. Keep in mind - 5 years is not an insignificant amount of time to live somewhere you actively dislike. As far as the students being stressed, this can be tough to judge objectively on interview day but I would encourage you not to underestimate the power of your gut reaction. Hope this helps! Good luck with your decision.

 

[snowflakes]

I think you would match fine from both because the 1 year research at both school combined with a good STEP1 score is what makes their graduates competitive. Duke overall may be more prestigious than Case, but don't forget, statistics like rank and residency PD score don't separate CCLCM from Case. CCLCM is a great program, and normally with a program of that caliber, I'd say take it over paying full tuition at Duke. However, CCLCM also has a very unique setup, and I think you really have to make sure you would be happy in that setting. The tiny class size and all PBL are integral parts of the curriculum at CCLCM. If you really can't see yourself happy with those elements of CCLCM, I would pick Duke.

 

[seeinghowitgoes]

So usually a big proponent of taking the lowest cost option, and I love what CCLCM seems to have to offer, but I'd honestly say Duke in this case...

Most of your cons for CCLCM do seem minor/subjective and I would encourage second look if only to confirm your fears. Regarding location, I think Cleveland would surprise you (winters are bad, no getting around that, but as somebody who has knoweldge of the city I think "terrible" is probably a bit too harsh). Happy to go into why but but long story short it's got culture by way of the Cleveland Orchestra, Cleveland museum of art, playhouse square, etc, multiple areas with nightlife both downtown and a short cab ride away, super low cost of living, etc.

Regarding students being stressed out, I have probably a dozen friends at the program (CCLCM and Case more generally), and most seem less stressed than any other students I know (including those getting ready to start step 1 prep). My anecdotal evidence of course also doesn't meet a non-biased, rigorous threshold, but my point would be to check out the dynamic at second look because interview day may just not have painted the true picture (though I get you have limited interaction time with schools so can't blame you for forming the opinion).

Match list, step one, academic medicine seem about equal - Duke may be more prestigious than Case, but probably not all that much more than the Clinic if at all. Plus it's all about thresholds, and both schools are above the threshold that matters in the professional realm.

HOWEVER, even with all that being said, the point that jumps out is you hate PBL. That is literally CCLCM's foundation. If you're gonna hate it, I'm sure it'll show and could make for less than optimal group dynamics in what is a small school driven by small groups.

CCLCM stresses wanting students that fit their unique system - one of the few schools that I remember actively saying "don't come here if you don't like our setup; we're different in a lot of ways and respect that it won't be for everybody."

You seem to know that system isn't for you, which is totally understandable. I think because it is so fundamental to the school, and because it may impact not only you but the group dynamic that you'll be forced to continuously drive, I think you're in the rare situation where you can forgo the money and feel you made a totally informed, reasonable, and rational choice.

Just my 2 cents - good luck!

 

[Papa Doc]

Don't have much to say because both appear to be amazing choices. Just remember that while money will always seem like an issue in the present, your career earnings will immensely outweigh the money spent on medical school and so I would be careful to let that influence your decision and make you go to a school you don't really want.

 

[masaraksh]

Don't have much to say because both appear to be amazing choices. Just remember that while money will always seem like an issue in the present, your career earnings will immensely outweigh the money spent on medical school and so I would be careful to let that influence your decision and make you go to a school you don't really want.

Very true. People who get accepted to CCLCM/Duke are easily going to be able to pay back med school loans even if they had to borrow full CoA to attend.

 

[CCLCMer]

So usually a big proponent of taking the lowest cost option, and I love what CCLCM seems to have to offer, but I'd honestly say Duke in this case...

the point that jumps out is you hate PBL. That is literally CCLCM's foundation. If you're gonna hate it, I'm sure it'll show and could make for less than optimal group dynamics in what is a small school driven by small groups.

CCLCM stresses wanting students that fit their unique system - one of the few schools that I remember actively saying "don't come here if you don't like our setup; we're different in a lot of ways and respect that it won't be for everybody."

You seem to know that system isn't for you, which is totally understandable. I think because it is so fundamental to the school, and because it may impact not only you but the group dynamic that you'll be forced to continuously drive, I think you're in the rare situation where you can forgo the money and feel you made a totally informed, reasonable, and rational choice.

Agree with all of this completely.

veltron, in most cases, I'd say you'd be a fool to even consider giving up a full scholarship at one med school to go somewhere else and pay full price. But because of the way group learning is built into the curriculum at CCLCM, you not buying into the system would hurt your own education as well as the education of your entire class. You clearly recognize that CCLCM is not a good fit for you, and so I agree with the person I quoted that you should respect that gut feeling and go elsewhere, even if it means having to take out loans.

 

[deleted271537]

Echoing what most others have said, don't count out Duke solely because of the money. That being said, it is extremely difficult to turn down a full ride. I know plenty of people who said that they thought they wouldn't like PBL and then ended up liking it, and vice versa. In terms of reputation and which school will serve you better for your long term goals, I think both will serve you well. I guess what it really comes down to is whether or not you think PBL will hurt your education. If not, I would follow the money. Otherwise, go to Duke and don't look back!

 

[veltron]

Original poster, here.

Wow, I am blown away by how thoughtful, helpful, and kind-spirited these replies have been. Thank you so much, guys. It sounds like it comes down to whether I like PBL and my gut feeling, and that is something I will really focus on when I attend second look for both schools this April.

Also, I just discovered Duke has very generous need-based aid, even for people with families like mine, who earn in the mid 100k's per year. Not to jinx myself, but, based on applicants with similar financial profiles, I might end up only taking on $90k in debt at Duke---much less than the $200k I anticipated.

I hope people reading this thread don't walk away thinking CCLCM is a terrible program. I think it is amazing and on-par with the top schools in America. But every applicant will have unique, idiosyncratic preferences. Also, I apologize if I hurt anyone's feelings by saying Cleveland "seems terrible." I have a predilection for hyperbole.

 

[baltimoreman]

Original poster, here.

Wow, I am blown away by how thoughtful, helpful, and kind-spirited these replies have been. Thank you so much, guys. It sounds like it comes down to whether I like PBL and my gut feeling, and that is something I will really focus on when I attend second look for both schools this April.

Also, I just discovered Duke has very generous need-based aid, even for people with families like mine, who earn in the mid 100k's per year. Not to jinx myself, but, based on applicants with similar financial profiles, I might end up only taking on $90k in debt at Duke---much less than the $200k I anticipated.

I hope people reading this thread don't walk away thinking CCLCM is a terrible program. I think it is amazing and on-par with the top schools in America. But every applicant will have unique, idiosyncratic preferences. Also, I apologize if I hurt anyone's feelings by saying Cleveland "seems terrible." I have a predilection for hyperbole.

Disclaimer: I am on hold at CCLCM.

Keep in mind that you will likely not graduate from CCLCM with zero debt. The scholarship covers tuition and not living expenses. They said at my interview that their average indebtedness is around $60k.

 

[Amba]

Disclaimer: I am on hold at CCLCM.

Keep in mind that you will likely not graduate from CCLCM with zero debt. The scholarship covers tuition and not living expenses. They said at my interview that their average indebtedness is around $60k.

I think it's closer to $40K iirc, but your point remains.

 

[byaaaaaaah23]

You absolutely shouldn't go to CCLCM if you hate PBL. You'd be so unhappy the whole time because that's pretty much what CCLCM is.

 

[mhoon1803]

Hey veltron, I'm a fellow applicant also trying to decide between CCLCM/Duke. My advice is if you don't like PBL, Duke will be a better fit. I just got an email from Duke(R. Wallace) saying that they haven't sent out merit scholarships. I'm guessing they may wait after 4/15 when AMCAS releases info on med school acceptances for accepted students (purely speculative). So, keep your fingers crossed!

Btw, I went to Duke for undergrad so if you have any questions about living in Durham, feel free to ask.

 

[ClevelandClinic]

Also multiple that debt by at least 2x, because by the time you end up paying off that debt the interest that is build up on that sucker is ridiculous

And also for future applicants or current candidates:
There is misconception on SDN that there are no lectures at CCLCM and that it is purely PBL-based which is far from the truth. PBL is a major component of CCLCM but there are lectures (there are more lecture sessions than PBL sessions, there are only three 2 hour-PBL sessions per week). CCLCM does in fact have lectures but they call them "seminars" because theyre suppose to be interactive, not you being "lectured" at although many times that is what ends up happening which is perfectly fine.

Also let me add this about PBL because I also had initial worries. Is PBL an inherently inefficient way of learning? Yes extremely, but so are majority of the didactics especially when faculty cover obscure things or research that is far beyond the scope of what you should actually be taught. This happens at every medical school, and it's compounded at Duke where you only have 1 year to learn 2 years worth of stuff (I can't even imagine that even 2 years isn't enough, seriously you'll realize the insane amount of knowledge we have to retain in a very short period of time as medical student). Look up threads on Duke with students saying that they had to do a lot of their learning on their own (you will realize that at every medical school you will need to learn material on your own, at least at CCLCM you have the flexibility to learn on your own without having to worry about the extra BS that is associated with lectures such as assignments, weekly quizzes and exams). Plus, PBL is only for the first 2 years, and forcing you to learn concepts and then teach others does in fact make you learn and retain some of that knowledge. CCLCM also provides you the flexibility to do research for all 5 years, classes end at noon (free time in the evenings to do research, take Master's classes), no classes Thursdays, free Master's within the 5 years, etc.

I'm so grateful for being at CCLCM with no grades, no exams even during clinical rotations especially when you see other medical students who have to go into clinic the same hours as you but have to worry about getting honors AND studying for the Shelf exams (Shelf exams are optional for us but most take them anyways and only we see our scores). During the first 2 years, I was able to focus on Step 1 and do research which will actually benefit me, not spending hours and hours trying to learn obscure things that will only appear on a weekly quiz or exam. This is how education should be: recognizing my own weaknesses to work on rather than trying to get an A or worry about getting honors (which is very subjective) while having the flexibility to pursue and further my career interests. I love it!

 

[MedWonk]

My initial inclination was full tuition all the way, but if the major component of that school's curriculum will make you hate your experience there, then I would go to Duke. You'll perform better where you're happy. After all, the whole point is to become the best physician you can be in whatever specialty you choose. Might as well choose the school where you think you'll get the most out of your education.

 

[veltron]

CCLCM does in fact have lectures but they call them "seminars"

Also let me add this about PBL because I also had initial worries. Is PBL an inherently inefficient way of learning? Yes extremely, but so are majority of the didactics especially when faculty cover obscure things or research that is far beyond the scope of what you should actually be taught. This happens at every medical school, and it's compounded at Duke where you only have 1 year to learn 2 years worth of stuff (I can't even imagine that even 2 years isn't enough, seriously you'll realize the insane amount of knowledge we have to retain in a very short period of time as medical student).

I'm so grateful for being at CCLCM with no grades, no exams even during clinical rotations especially when you see other medical students who have to go into clinic the same hours as you but have to worry about getting honors AND studying for the Shelf exams (Shelf exams are optional for us but most take them anyways and only we see our scores). During the first 2 years, I was able to focus on Step 1 and do research which will actually benefit me, not spending hours and hours trying to learn obscure things that will only appear on a weekly quiz or exam. This is how education should be: recognizing my own weaknesses to work on rather than trying to get an A or worry about getting honors (which is very subjective) while having the flexibility to pursue and further my career interests. I love it!

OP here. These are all very persuasive points! While I was firmly in the Duke camp, it seems it's a toss-up again. Sounds like CCLCM is about as non-stressful as it gets... Especially for the clinical years. And I might end up with better clinical skills.

 

[CrunchyTeddy]

First of all, congratulations on your acceptances! Speaking with current students at Second Look will be extremely telling. I'm in a similar situation myself, and like you, I have my doubts about PBL. It seems like this is a common worry among many prospective students. If you don't mind me asking… How is the curriculum structured at Duke, and how much small-group learning do they use? I think it'd be helpful to have a comparison of the two.

I know I'm echoing the points of many other SDNers here, but wait for your financial aid package from Duke! If it's really only $90k, then this debate will probably be resolved =)

 

[DermViser]

Don't have much to say because both appear to be amazing choices. Just remember that while money will always seem like an issue in the present, your career earnings will immensely outweigh the money spent on medical school and so I would be careful to let that influence your decision and make you go to a school you don't really want.

That highly depends on the specialty you match into. CCLM is an excellent choice and much better financially along with a year of research.