Exciting changes to the curriculum at the Medical College of Wisconsin. [Show Summary]
Dr. Jane Machi, Assistant Dean, Admissions and Recruitment at the Medical College of Wisconsin, explores the MCW Fusion Curriculum – and completing med school in three years.Interview with Dr. Jane Machi, Associate Dean for Admissions at the Medical College of Wisconsin. [Show Notes]
Welcome to the 511th episode of Admissions Straight Talk. Thanks for joining me today. Are you ready to apply to your dream medical schools? Are you competitive at your target programs? Accepted’s Med School Admissions Quiz can give you a quick reality check. Just go to Accepted.com/medquiz. Complete the quiz and you’ll not only get an assessment of your chances, but tips on how to improve your chances of acceptance. And it’s all free. Again, use a calculator at Accepted.com/medquiz to obtain your free assessment and those tips that I just mentioned.Our guest today is Dr. Jane Machi, Associate Dean of Admissions and Recruitment at the Medical College of Wisconsin. Dr. Machi earned her MD at the Medical College of Wisconsin and is a proud alum, as you’ll hear shortly. In her clinical practice she specializes in pediatric emergency medicine, in addition to serving at MCW as an associate professor and associate dean of admissions.
Dr. Machi, welcome to Admissions Straight Talk. [1:43]
Thank you.Can you give an overview of MCW’s MD program focusing on its more distinctive elements? [1:53]
Sure. The Medical College of Wisconsin has a campus in Milwaukee, and we have two regional campuses, one in Central Wisconsin in a city called Wausau, and then we have a campus in Green Bay. We’re a private institution. Our Milwaukee campus has 50% of our students from Wisconsin and 50% are out of state. And then our regional campuses are really geared towards replenishing the physician shortage that everyone is facing. We’re not unique in that regard, and the regional campuses were opened with the hopes that the students that we train there when they complete the residencies will return to Wisconsin.Predominantly, those campuses are geared towards Wisconsin residents, so close to 80% on each campus come from Wisconsin. I think one of the most unique things about our curriculum in particular, which our students rave about all the time, is our scholarly pathways. On the Milwaukee campus, they have opportunities to dive deep into a topic that they’re really passionate about. Some examples are we have an urban and community health pathway. We have a global health pathway. We have a patient safety and quality improvement pathway. We have research pathways. The students can choose.
They go through a series of orientations to each of the pathways, and they choose and they do a scholarly project typically in their first two years. And then on the regional campuses, they also participate in a scholarly pathway, but there is one, and that is the physician in the community pathway. I should say that our Milwaukee campus is a four-year campus, so our students spend four years with us. The regional campuses are three-year campuses, so you get out of medical school one year earlier. The target specialties for those campuses are really primary care and psychiatry oriented, and those are the types of students that we try and recruit.
We know very well that students may change their mind once they get into medical school. They may find another field that they’re more intrigued by and want to spend more time in. There is an option for them to do a fourth year if it’s necessary, depending on the specialty that they’ve chosen. That’s a little bit about MCW.
Does the curriculum differ other than length at the three different locations? It sounds like Milwaukee has more breadth of offerings and the two regional ones are, as you say, focused on primary care, which I assume are family medicine, internal medicine, pediatrics. [4:24]
And pediatrics.So not OBGYN? [4:43]
No.Although we do have students from our regional campuses who do choose to go into OBGYN and many of them have done it in three years. Many of the specialties that you might think take four years to get into, we have had students match into residencies after the third year. A fourth year is not always necessary for all of our students. But some that require that additional year, like emergency medicine, there are special rotations that they have to do that they just can’t accomplish in three years. The curriculums are comparable. The regional campuses, it’s very accelerated, so there are no summer vacations.
On the Milwaukee campus, there are breaks and the regional campuses don’t have those breaks. That’s how we are able to get them to complete all their requirements in the three years. There are not as many electives; there’s no more time for electives. That’s really the big difference. We’re going to get to the curriculum in a minute, but the initial first two years, they’re done together with our Milwaukee students. The regional campuses participate in the same courses. They’re just doing it in their geographic areas.
They have their own Sim labs, their own anatomy labs, their own resources on each of the campuses, and they do their rotations in their regional geographic regions. The Green Bay students will stay in that area, and the Central Wisconsin students actually will spend time in hospitals that are in all different rural areas in that central part of the state.
Is there a focus on rural medicine in your region? [6:30]
There is by virtue of their locations. A predominant shortage of our physicians in Wisconsin are those that practice in rural areas. One of our focuses is that we would like our students to be interested in rural medicine and want to return to a rural community to practice to fulfill those needs in our underserved rural areas.What is the Discovery Curriculum that I was reading about in preparing for our call? Both the three- and the four-year options? The first two years are the same, right? What are the first two years? [7:03]
No. I will say that the Discovery Curriculum will be replaced by the MCW Fusion Curriculum starting July of 2023. We’re about to start a different curriculum.We’re really excited about it. It’s been a lot of hard work. There are many, many people that have been involved in developing this curriculum. Rather than having year one, year two, year three, year four, it’s actually a three-phased curriculum, which I think many medical schools have gone to, where you spend… It’s no longer two years of traditionally what we think of basic science. That’s been decreased in its amount of time. On the Milwaukee campus, they’ll spend 18 months doing their early clinical exposures. There are doctoring threads, learning communities. The scholarly pathways will not go away.
That’s the one thing from the Discovery Curriculum that is coming intact to the MCW Fusion Curriculum. The regional campuses will do it in a shorter amount of time because they don’t have summer vacation. They will get it all done in a briefer time. Phase two is basically what we traditionally think of as the core clerkships, and that’ll be 12 months. And rather than spending block times in specific rotations, they’ll be divided into areas like inpatient medicine, outpatient medicine, and then the surgical specialties, and they’ll spend a year doing those. And then the third phase is really sort of the self-discovery phase where students can really individualize their education.
If you want to be a surgeon, you can do a lot of different surgical things and rotations, electives, and focus that fourth year or that phase three… See, I’m in the fourth year. Phase three.
I have a whole new language to learn. In phase three, it’s really individualized and we’re really wanting to prepare our students to become really good residents, have them be prepared to start their intern year when they graduate.
That was a wonderful introduction. Let’s turn to the application. What is the secondary like? Does MCW screen before sending out secondary? I guess that should be the first question. Do you screen before sending out secondaries? [9:43]
The only real screening that we do is basically for basic eligibility criteria. Making sure that their undergraduate credits are coming from either a regionally accredited US or Canadian medical school. That’s the biggest screening that we do. And then if you meet the eligibility criteria, you’re sent a secondary application and given that opportunity to fill it out.What do you hope to glean from the secondary that you don’t get from the primary? [10:22]
I think one of the big things that I think the secondary allows us to learn about the applicant is how they see themselves at MCW. Did they do their homework? Did they look on the web? Are there certain things within our curriculum that they’re incredibly interested in? How do they see MCW preparing them for the future? Everybody tries to hesitate to use the word fit, so I’m going to say align. Do they align with MCW’s missions? Can they see themselves being a student at our school? That goes for all of our campuses.It seems like one of your big missions is supplying physicians specifically in Wisconsin. Are ties to the state really important for applicants to MCW? [11:06]
Only on the regional campuses is that a specific thing that our goal is to have predominantly Wisconsin residents on those campuses. Like I mentioned before, the Milwaukee campus is 50% Wisconsin. That is where we cap it. Ties to Wisconsin aren’t necessarily something that we look at and identify and pluck them out of the pool other than, like I said, the regional campuses.But it is about alignment, if you will, with mission, I guess, your strength and your approach to medical education. Is that correct? [11:49]
Yeah, yeah. It gives us an opportunity to get to know them a little bit better. I know applicants spend… There’s a lot of essay questions that they have to fill out on every secondary that they’re invited to fill out and given that opportunity. But I think it allows us to see, do we see them as a student in our school? Is Milwaukee the right place for them? Is Green Bay the right place for them? Is Wausau the right place for them?Do you ever recommend to a student, “I think you’d belong better at that campus than the campus you applied to,” or not so much? [12:29]
No, we don’t do that. When the students apply, they rank which campus is their number one, number two, number three, whatever. We have three campuses, so they get up to three choices. We select students based on their choice. If they’re a Milwaukee number one, they’re looked at for the Milwaukee campus. If they are a regional campus number one, they’re looked at first for the regional campuses. Not everybody gets to interview.Occasionally, we have students who rank a regional campus number two, and that may be where they are invited. Sometimes I think that we see that they are really in good alignment for what those campuses offer, and so we give them an invitation to interview on our regional campuses.
What is the role of the Casper in your evaluation process? [13:26]
We use Casper as one data point amongst all of the many. It’s not something that we use to screen in, screen out. It is looked at as a non-cognitive variable amongst many other variables in our screening process, in our interview process, and then in that final decision. Sometimes things come out in the interview and the admissions committee will have a discussion about, well, their Casper score was whatever it is. That seems to be more who they really are. Sometimes it may influence a decision, but we don’t use it to…You don’t use it for screening? [14:12]
No, no, we don’t.You don’t screen for interviews based on the Casper? [14:17]
Not solely based on a Casper score. No. Not solely based on that. If they have a really low Casperscore, the admissions committee will… They screen every application of everybody that we invite to interview. They will see all of the scores and it’s a piece of data that they use. Does the writing match? If they have a really low Casper score, does it come through in some of their explanations of how certain experiences influence them? I’ve seen it in applications where it does align with how they write and how they think and how they’re portraying themselves. Many times it doesn’t. We don’t use it in any algorithmic, mathematical, magical equation.You don’t use it in a vacuum either, it doesn’t sound like. [15:15]
No, no. Like I said, it is just one piece of information amongst all that other information.That seems to be growing.You have the primary, the secondary, the Casper, even before you get to the interview. What is a common mistake, and I’m not talking about typos now, that applicants make in approaching the primary and/or secondary application? [15:30]
I think my pet peeve when I read applications, and I’ve been doing this for many, many years, one of the things that I notice is they will just list their shadowing hours. I did 65 hours of shadowing, and they don’t talk about it. We’re not a school that counts hours to give credit for a certain experience. To me, and it is one piece of advice I give to anybody that approaches me and wants to talk about how to apply to medical school, is to talk about what those experiences meant to you.How did it shape you in some way? Are you going to use what you observed in your practice? What did you learn from the physicians? Those sorts of things. I’m always disappointed when I see many, many hours spent and no explanation. I don’t know how to interpret that. That to me is I think one of the biggest mistakes that I see.
I think that’s very valuable feedback. [16:48]
Typos are always a big thing. I know you didn’t want to talk about typos, but that is a high stakes application. If you can’t take the time to make sure there are zero typos, one starts to wonder about, is it your attention to detail? Did you really care about it? How bad do you really want this? Especially if there’s many. You can forgive one or two, but I’ve seen applications that have had several on both the primary and the secondary. You start to wonder about the person.I should probably not make it “except for typos,” but I think everybody, all medical school applicants know they shouldn’t have typos in their application, whether they succeed or don’t succeed. They may not realize the part about listing hours like a badge of pride… I still appreciate the point about it. They may not realize though that listing hours like a badge of pride is not really what you want. You want to see some insight into that experience, what did you get out of it. [17:27]
I think the hours are important. It does tell us how much of themselves they invested and what they’re choosing to do. The admissions committee is quite savvy. They know who’s box checking. I think the number of hours is that cue. If you don’t write anything about the experience other than what it was about, I think it indicates perhaps, were they just trying to beef up their application in some way, whatever the experience is? Any of the experiences, they should be reflecting and thinking, what competency is this achieving for me? What have I gained? What am I getting out of it? Applicants should focus on things that they’re passionate about. We’re hoping they’re passionate about medicine.What makes for a great interview? [19:02]
I think what makes for a great interview is someone who’s actually authentic and true to themselves. I think the overly rehearsed, sometimes almost canned answers are a turnoff. I mean, you need to be prepared and you need to think about the questions. There’s certainly many places where students can get access to all kinds of questions that potentially they may be asked, but we’re looking for honesty, sincerity, and a good person. We have students do some of our interviews.One of the things we ask them to consider is, would you want them to be a student in school with you? Do you want them to be your colleague? Being yourself is really important, but also preparing and knowing where you’re interviewing.
What is the interview day like? Is it in person at this point, or is it virtual like you and I are talking now? [19:57]
We’re currently doing our interviews virtually on all of our campuses. We haven’t made any final decisions as to how we’re going to do this next academic year. We’re having discussions about what’s best. There’s pros and cons to both sides. Our regional campuses, they’re in smaller cities. If you’ve never been to Green Bay or Wausau, how do you know? Should you get to see this school that you’re going to attend? Milwaukee is the same way. If you’ve never been to the Midwest or to Milwaukee, getting to see the school, the campus, meeting people, there are a lot of benefits to having it in person, but we also see the other side.It’s a high cost. We’re having on the Milwaukee campus applicants coming from all over the United States, Canada, and other countries. That’s a huge cost to the applicants. Our interviewers, it’s convenient for them to be virtual as well. They’re not having to travel between clinics and trying to get to the interview on time. It’s a lot easier for them to just log in from their office wherever they are, in whatever hospital. It does make it easy on both sides, but we haven’t made any final decisions about what we’re going to do next cycle.
Just very recently, for the first time since COVID, I talked to a med school admissions director who said that they are going in person. [21:28]
Yeah, I think it depends. If you’re an in-state university and you are only recruiting from your state, the travel time isn’t that far. But for a school like ours where we have applicants coming, like I said, from all over, it’s harder and it’s costly.MSAR says that the Medical College of Wisconsin received around 11,000 applications, I guess last cycle or the cycle before. [22:03]
That’s the COVID cycle. We were in that dumpster fire altogether, where we’re like, “Where are these people coming from?” Yeah, we all lived in that.How do you cut down from 11,000 to around 800? That’s less than 10%, and then to a class of 265 students. I assume half of that are Milwaukee and the other half are the other two campuses, right? [22:24]
Yeah. On the Milwaukee campus, we have 220 students, because MSAR doesn’t… We can’t separate our campuses, so it’s one number. The 265 is our three campuses together. Milwaukee is 220 and we interview 650, 700. Most everybody applies to the Milwaukee campus regardless. And then on the regional campuses, certainly the numbers are smaller, the class sizes are much smaller. Central Wisconsin is about 20 and Green Bay is about 25. That’s another factor that applicants should consider is, do they see themselves thriving and flourishing in a smaller setting, in that smaller group?The committee is one of the hardest committees at work at the Medical College of Wisconsin. They spend an inordinate number of hours screening. Like I said, everybody that gets an invite has been screened from page one to page whatever and given either yes, bring them in for an interview, no, not at this time. We have to magically come to 50 on the Milwaukee campus. It has to be magic. There is this mathematical magic that happens somehow. And then the same for the regional campuses, really selecting and looking really hard at our pool of Wisconsin residents.
Lots of meetings. Lots of screening. We probably interview about 100 or so for each of the regional campuses to get to those class sizes, depending on the campus. Somewhere 90 to 100 for each of those. That’s where I think you get to the 800 interviews because they added all up.
Going back to the different curricula at the different campuses, is the three-year option not available in Milwaukee? [24:38]
No, it’s not available.It’s only available at the… [24:49]
At the regional campuses.What makes an applicant jump off the page for you in a positive way? [25:04]
I think one of the things, at least for me, is I peruse just through the experiences is some of the breadth and the depth. What have they done? If I’m reading their personal statement, do I get the sense that they’re truly passionate about medicine, not just helping people, but about medicine in specific? Can they communicate that? Looking at their road traveled, all of the other attributes that they bring to the table, those are the sorts of things that I tend to pay attention to. How have they prepared themselves? Is this really the career for them and have they really thought it through?I think that’s one of the common things at the end of the day when the committee is saying yay or nay is a lot of it is understanding of medicine and do they really know what they’re getting into and do they understand and have they exposed themselves. I think that’s becoming more and more important as healthcare is changing. Do they understand interprofessional teams and how to work with all of the different arms, the nurses, the care partners, the pharmacists, the dieticians, the families for that matter? Can they see themselves being a part of that?
Because we’re not solo in a vacuum. If that’s what they think, then maybe becoming a physician isn’t for them because it is a collaborative affair for sure.
One of the questions I get constantly from applicants is, should I send an update letter? Should I send a letter of intent? And that sometimes varies from different schools at different points in the application process. What is your view? What is the process at the Medical College of Wisconsin? [26:58]
The Medical College of Wisconsin accepts updates at any time. The applicant is welcome to go into our information portal and upload their information at any time. We’re not quite there yet because we’re still interviewing. But when we start to look at our wait list and we start to make decisions, because we don’t rank our wait list, as we build a diverse and all those sorts of things class and have a well-rounded group of students, sometimes those updates help us understand what have they been doing since they interviewed?That application, the primary, one gets filled out so early that some things may have changed entirely. They may have said, “Yep, I’m going to be a CNA, and then that job didn’t pan out, but I ended up being an EMT,” or whatever their choice is. Sometimes those things change and letting us know, or they want to let us know why the Medical College of Wisconsin is in their top tier of schools to attend. I think it’s important. We allow them to upload at any time.
When do you stop sending out invitations? [28:24]
When all the interview days are full, and sometimes that’s the week before the last interview day. We continually invite people. As the interview cycle goes on, applicants are starting to get… If they’ve interviewed in more than one school or they got into their dream school, they may decline our interview, even though they had scheduled one. That opens up a slot for somebody else. We just continue to run through until we get to the very last interview day. This year we’re interviewing through mid-March. On the Milwaukee campus, we have five interview days left, I believe. The regional campuses still each have a handful as well. So the Thanksgiving thing, I don’t know about that.It’s open until the interview day is full and remains full. If someone drops out the week before, we’re going to try and find somebody to put in that slot. We certainly want to fill each interview day. We don’t want to leave slots empty for sure. I don’t know about that.
How do you view prerequisites taken at community college or two year colleges? [30:09]
I think we view them like any other prerequisite. Most applicants who attend a community college will eventually transfer to a four-year university. It’s not so much the performance in the community college years, it’s that transition to a four-year university. We have many, many students who have attended community college. Sometimes that’s the way they get started in college because financially it makes the most sense for a lot of our applicants, unless it’s a technical college, something like that, that really isn’t focused, but getting prerequisites at the community college…How do you view shadowing and virtual shadowing? Do you think it’s important that applicants shadow? And then what about virtual shadowing? [31:03]
I think it’s important to learn from as many different physicians as you can and not be so narrow that you’re just with one specialty, because there are so many. As physicians, we all practice in a different way. I’m a pediatric emergency medicine physician, so I see kids and their families in the highest stressful environment, whereas another specialty may not be like that to that degree and to get that understanding that we’re not all the same. Where do you see yourself fitting in? What intrigues you and what interests you? I think we’ve managed the virtual shadowing, particularly since the advent of the pandemic.We’re still seeing those effects on our applications and probably will for the next year or so. As hospitals have opened up and clinics have opened up, more and more of our applicants now are having the opportunities to do in-person shadowing. But we understand. Again, it’s about what did you learn and how did it impact you, no matter what the opportunity was. How is it shaping you as a future professional in medicine? I think it took us a little bit to adjust to what it all meant. We didn’t really understand. The committee didn’t understand.
We have a very fantastic recruiter who spent time orienting the faculty to all these different web shadowing types of platforms and what each offers and what did they actually get out of it, that sort of thing. We could understand a little bit more when we saw a certain shadowing website what they actually were getting out of it. I think we’ve adjusted pretty well.
But I’m going to guess that if in-person shadowing is an option, you would prefer it to virtual? [31:03]
I would, and I would think an applicant would prefer it as well to be up close and personal and be able to ask questions and actually see the patient in live time. It’s nice that things have opened up. It’s given that opportunity once again for students to come and see what it’s like and what our jobs are like. You get to see all of the other people that we work with, the team, not just hearing how we work through a case problem, although that’s important, but you get to see the interactions and really understand what the day is like. Because I think that’s what shadowing is for, is to get a taste of what the specialty is, but learning from the physician what their day is like and why did they pick it.I think sometimes in those virtual shadowing, sometimes there’s not always those opportunities because they’re attended by so many to actually get specific questions answered. I think relationships get built. I’ve become a mentor to students who were pursuing medicine just by virtue of them emailing me and saying, “Can I shadow you?” And then we just developed a relationship. I think there are those opportunities to gain insight from someone and develop a mentoring relationship, which is really important.
Listener question. Now, you are a physician obviously. If you are a med student today planning to apply in 2023, this upcoming cycle or the cycle following it, what is the one thing you would be doing to prepare yourself for medical school? [34:40]
I think I’m going to sound like a broken record. I really think that it’s important to get exposed to as much of healthcare as you can. I think that’s really important. Take care of patients. See if that’s something you can do. I think those clinical experiences, whether it’s being a medical assistant, CNA, an EMT, where you’re actually having to show compassion and empathy for someone in their most vulnerable states, can you see yourself doing that and communicating with people in that regard? I think it can be very soul telling that if you can’t find that within yourself, then maybe medicine isn’t the right career for you, that you should think about something else.I would say gain as much exposure as you can and as your schedule allows. Leadership is incredibly important. I certainly was not a leader. When I was an undergraduate, I didn’t do those things. But I think as physicians, we’re leaders of a team. Having those qualities and being able to lead a group, a club, or something at your college or your university is I think really important. Those are my two things, I think. There’s probably a lot more that I would say to do. I think most of all is doing something you’re really passionate about. Again, not the box checking and doing things that you think the medical school is looking for, because that’s not going to better you as a person.
Really be passionate about the choices you’re making. It says a lot. When you write about it, it’s going to shine through, as opposed to, “I just did this because they wanted me to. I didn’t get anything out of it, or it’s not something I see myself doing long-term.” It’ll come through in the communication.
I remember one of my first clients, my first med school clients, he got in and he called me afterwards and he said, “We wrote in one essay about my butterfly collecting. That was the one thing that every school that I interviewed at asked me about.” [36:54]
Yeah, and that’s important too, as burnout is such a hot topic, well-being. In the MCW Fusion Curriculum, there’s a huge focus on well-being and career development. Med school is very stressful. How do you maintain your self-health and take care of yourself? It’s really important. To have those habits or those hobbies, it’s really important because it’s what brings you joy, and it’ll come through. I often will say, what do you do outside of science and medicine?Because sometimes people just really haven’t done much else because they’ve been so focused on those sorts of things. But how are you going to handle the stresses if you don’t have an outlet in some way, shape or form, whatever it is?
What would you have liked me to ask you? [38:05]
What would I have liked you to ask me? I think most everything you asked, but I think from myself and personally, because I am an alum of the Medical College of Wisconsin, I’m very proud to be an alum of the Medical College of Wisconsin, I think one of the biggest things that I have seen over the years and since I was a medical student is really, and this is going to sort of sound cliche, but I really mean it, it’s collaborative. It’s friendly. The faculty really care about our students and wanting them to be successful. We’re in their corners. We want to build relationships with them.I gained so many mentors when I was in medical school just by the relationships I formed when I was on my clerkships or doing other rotations. It is really that environment that really attracted me. I was an older student, and so my outlook on life was maybe a little bit different than somebody who was fresh out of college. I wanted to be in a place where I felt like I was going to fit in and not be isolated. I wanted to be accepted. The medical college was a great place, and I’m just proud to be an alum. I could gush, but I’ll stop about that.
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