If you were to improve the process of MD/PhD application and admission practices, what would you recommend?

[Fencer]

I am holding a session on this particular question (If you were to improve the process of MD/PhD application and admission practices, what would you recommend?) at our national meeting of MD/PhD programs. I would like to hear suggestions, particularly from applicants who participated in the 2019 MD/PhD cycle. If you prefer, please PM me. Your suggestions might truly impact future MD/PhD application cycles.

Fencer

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[navy kenzo]

More transparency and accountability from programs. Schools should be clear with when they've filled their interview spots, when they expect decisions to be rendered and communicated, etc. As an applicant a lot of my frustrations came from sitting in limbo . Some examples of this:

- I was rejected without an interview from Northwestern, UIC, and UCSD in March/April. Obviously, by December I figured I wasn't getting an interview but how hard is it to send a 3-4 sentence email to applicants at this point telling them they aren't being interviewed? What's even more frustrating is how several of my friends applying were rejected from some of these programs in December, which left me very confused.
- For some programs, I only figured out that I wasn't accepted after talking to other applicants and learning that they had received already been accepted. It took another 2-3 weeks for the school to email me about it.
- For a non-rolling school, I was accepted several days after one of my friends who had interviewed a few months after me. So for a few days I assumed I was rejected and was very disappointed only to be completely surprised a few days later.

These are just a few examples, but these things really makes applicants feel like we're worthless to programs after spending hours writing applications and secondaries and spending >$100 to apply. If applicants have deadlines for submitting applications, responding to interview offers, and accepting/declining acceptances, MD/PhD programs should be expected to respond to applicants in a timely and clearly-communicated manner as well. This behavior is extremely off-putting and borderline unprofessional. For MD programs, I get it, there's tens of thousands of applicants to deal with, but for MD/PhD where the pool of applicants is a fraction of the size and the physician-scientist community itself is already small, I think we deserve a bit more respect.

 

[Lucca]

More transparency and accountability from programs. Schools should be clear with when they've filled their interview spots, when they expect decisions to be rendered and communicated, etc. As an applicant a lot of my frustrations came from sitting in limbo . Some examples of this:

- I was rejected without an interview from Northwestern, UIC, and UCSD in March/April. Obviously, by December I figured I wasn't getting an interview but how hard is it to send a 3-4 sentence email to applicants at this point telling them they aren't being interviewed? What's even more frustrating is how several of my friends applying were rejected from some of these programs in December, which left me very confused.
- For some programs, I only figured out that I wasn't accepted after talking to other applicants and learning that they had received already been accepted. It took another 2-3 weeks for the school to email me about it.
- For a non-rolling school, I was accepted several days after one of my friends who had interviewed a few months after me. So for a few days I assumed I was rejected and was very disappointed only to be completely surprised a few days later.

These are just a few examples, but these things really makes applicants feel like we're worthless to programs after spending hours writing applications and secondaries and spending >$100 to apply. If applicants have deadlines for submitting applications, responding to interview offers, and accepting/declining acceptances, MD/PhD programs should be expected to respond to applicants in a timely and clearly-communicated manner as well. This behavior is extremely off-putting and borderline unprofessional. For MD programs, I get it, there's tens of thousands of applicants to deal with, but for MD/PhD where the pool of applicants is a fraction of the size and the physician-scientist community itself is already small, I think we deserve a bit more respect.

I agree with this. I would also add that it’s entirely possible for MD admissions to be improved this way as well. I think Michigan is an admissions office to look to in this (and many other) regards. Want to know what’s going on in the cycle at their school? Check the twitter. Oh 10 IIs went out today? Maybe next week. Boom. Done. Even a very modest and I suspect rather easy change such as this, if implemented at every school, would improve the application process significantly.

On a related note, having a better and transparently defined timeline would help as well. Having IIs or acceptance calls go out only one day a week is a boon to applicants, frankly, by freeing them from the anxiety of being chained to their notifications 24/7. Imagine if every school decided to make decisions only a single day of the week, whether it be IIs or acceptances, at least until April before major WL movement when quick decisions may need to be made. I don’t think that’s an unreasonable request and I do think it would help applicants and lessen the burden on admissions offices to answer endless phone calls and emails asking about the status of applications.

 

[Lucca]

On an unrelated note, I will once again put in my vote for the pipe dream of:

1. Hard cap on number of applications per applicant
2. No secondary fees and one single flat fee for application, not per school.

 

[Seihai]

On an unrelated note, I will once again put in my vote for the pipe dream of:

1. Hard cap on number of applications per applicant
2. No secondary fees and one single flat fee for application, not per school.

What's the justification for #1? It doesn't seem quite fair to applicants that are applying broadly to top-tier programs for various reasons. Admittedly, I am biased because most of the MSTPs/MD-PhD programs with good programs in my research area seem to be T20s, and I've tried to diversify my list as much as possible, but I could only pare it down to 30 schools without seemingly compromising my chances at being able to do research in the field I want.

I can't comment much on the cycle though as I am only currently applying, rather than having been an applicant that has gone through a full cycle.

 

[Lucca]

What's the justification for #1? It doesn't seem quite fair to applicants that are applying broadly to top-tier programs for various reasons. Admittedly, I am biased because most of the MSTPs/MD-PhD programs with good programs in my research area seem to be T20s, and I've tried to diversify my list as much as possible, but I could only pare it down to 30 schools without seemingly compromising my chances at being able to do research in the field I want.

I can't comment much on the cycle though as I am only currently applying, rather than having been an applicant that has gone through a full cycle.

In short, it is the only change which makes #2 at all tenable while minimizing, as you point out, the negative effects it may have on applicants. It will probably never happen tho so I wouldn’t worry about it.

 

[Neuronix]

Review and screen the primaries of applicants before inviting the secondary application.

This would save applicants who never had a chance cost and effort on a secondary. However, it would impact the medical school's revenue from taking the secondary fees from everyone who applies.

 

[Seihai]

Review and screen the primaries of applicants before inviting the secondary application.

This would save applicants who never had a chance cost and effort on a secondary. However, it would impact the medical school's revenue from taking the secondary fees from everyone who applies.

I was about to post this. Far too many people are sent secondaries that flat out never had a chance at a school, for reasons unknown to me. It would better address the points @Lucca made in my opinion.

I think it could be argued that this could result in a net positive for the school - having to review fewer secondary applications could result in savings in manpower and time.

Obviously, this assumes that there aren't schools out there that intentionally send secondaries to people and THEN screen them out automatically (or prescreen but send secondaries regardless, just never reviewing the response). I don't have kind words for those schools, but I'd like to see them defend their position.

 

[kepler16b]

The goes for MD as well, but secondary applications also should be through AMCAS instead of each school having their own proprietary system.

 

[Seihai]

The goes for MD as well, but secondary applications also should be through AMCAS instead of each school having their own proprietary system.

I think the system that allows you to log in directly through AMCAS to submit the application is the best compromise. Some schools that use LiaisonCAS already do this (JHU, USC, UMich).

It'd be nice if you could also combine certain very common secondary prompts (like the diversity essay) and standardize them a bit better, but I think that's asking for way too much.

 

[Fencer]

This year, the number of schools using LiasonCAS (WebAdMIT) is increasing as the old "free" solution, AP Tools is being retired by AAMC. The software is relatively expensive for a stand-alone MD/PhD program (i.e.: MD school uses a different admissions software than the MD/PhD program). The annual license, at the lowest level (<1000 applicants, every MD/PhD program) is $8,500 or $30-50 per applicant. Some schools use the secondary fees to pay for this service. Keep in mind that majority of the MD/PhD program budget is for student positions (stipend, tuition and fees).... a ~ $0.5-0.8 Million dollars scholarship over 8 years.

 

[Seihai]

This year, the number of schools using LiasonCAS (WebAdMIT) is increasing as the old "free" solution, AP Tools is being retired by AAMC. The software is relatively expensive for a stand-alone MD/PhD program (i.e.: MD school uses a different admissions software than the MD/PhD program). The annual license, at the lowest level (<1000 applicants, every MD/PhD program) is $8,500 or $30-50 per applicant. Some schools use the secondary fees to pay for this service. Keep in mind that majority of the MD/PhD program budget is for student positions (stipend, tuition and fees).... a ~ $0.5-0.8 Million dollars scholarship over 8 years.

My understanding is that LiaisonCAS is a third-party solution - is there a reason AP Tools is being retired by AAMC? If I had a choice, I'd push them to try to update it or revamp it and bring it back simply to reduce those secondary fees, since that is an incredible limiting factor in people applying to schools.

This is also a bit selfish on my part, but I would honestly look for all MD-PhD programs to at least use the same application portal where I could simply access all of my available secondaries at once. It's a bit stressful to dig through all of my emails to make sure I have kept track of all of my secondary invites.

 

[JoaoMoutinho]

I would like to add that I found myself wishing that there was something like an MSAR specific to MD/PhD admissions. Especially when I applied to public schools, I felt it was hard to judge if a school would be a good fit numbers-wise or not because I didn't have a way of knowing if their MD/PhD stats would line up with in-state applicants, out of state, or neither. Using the AAMC facts tables definitely helped to know if I could be competitive at all, and a handful of schools do list stats for applicants interviewed/accepted etc on their websites (or at least the minimum requirements for the program, which didn't always align with MSAR). Maybe I was the only one, but it was difficult for me to identify where I realistically had chances, especially as a low GPA/ high MCAT applicant.

I ended up doing a fair amount of guessing and made my school list based on a broad "mid-tier" estimate combined with research interests and a light sprinkling of schools that I knew for sure would be a reach or where I had regional ties. Things obviously worked out in the end (I had mostly interviews at "safety schools", plus my state school and one super reach school), but I still feel that it would be extremely helpful for schools to let you know what type of applicants usually end up interviewing there and actually going there. If you had asked me where I thought I would interview when I submitted my application, the only school I would have gotten right would have been my state school, where I was working at the time and knew the program leadership. There is a lot more to admissions than GPA and MCAT, and there is inevitably a lot of unpredictability to the process, but if I had to apply again I would definitely want to have a better/more efficient way to gauge whether I would be competitive at a given school or not.

3 possible solutions I can think of:

1) schools simply list that information on their websites
2) MSAR adds an MD/PhD tab with information
3) AAMC makes another fact table that shows median + SD for GPA + MCAT for MD/PhD programs


Other than that, I think people have already addressed most of my major concerns here. I can't imagine that it's easy for adcoms to have to sift through hundreds of applications from qualified applicants and to have to find ways to stratify them. Even just from what I've seen here and conversations I've had with the faculty at the school where I matriculated, I think it has to be really tough to juggle the whole application cycle and deal with hordes of stressed pre-meds in addition to the rest of your usual responsibilities that don't magically disappear during the admissions cycle. Thanks to everyone who takes the time to help out with admissions advice here or in other places– I never would have gotten an acceptance anywhere without a lot of help along the way. Hopefully I can find a way to pay it forward down the road.

I will throw a shout out to one school that interviewed me in October, told me I would find out at the end of January, and then didn't actually tell me anything until I followed up for a second or third time in late March!

 

[Lucca]

I would like to add that I found myself wishing that there was something like an MSAR specific to MD/PhD admissions. Especially when I applied to public schools, I felt it was hard to judge if a school would be a good fit numbers-wise or not because I didn't have a way of knowing if their MD/PhD stats would line up with in-state applicants, out of state, or neither. Using the AAMC facts tables definitely helped to know if I could be competitive at all, and a handful of schools do list stats for applicants interviewed/accepted etc on their websites (or at least the minimum requirements for the program, which didn't always align with MSAR). Maybe I was the only one, but it was difficult for me to identify where I realistically had chances, especially as a low GPA/ high MCAT applicant.

I ended up doing a fair amount of guessing and made my school list based on a broad "mid-tier" estimate combined with research interests and a light sprinkling of schools that I knew for sure would be a reach or where I had regional ties. Things obviously worked out in the end (I had mostly interviews at "safety schools", plus my state school and one super reach school), but I still feel that it would be extremely helpful for schools to let you know what type of applicants usually end up interviewing there and actually going there. If you had asked me where I thought I would interview when I submitted my application, the only school I would have gotten right would have been my state school, where I was working at the time and knew the program leadership. There is a lot more to admissions than GPA and MCAT, and there is inevitably a lot of unpredictability to the process, but if I had to apply again I would definitely want to have a better/more efficient way to gauge whether I would be competitive at a given school or not.

3 possible solutions I can think of:

1) schools simply list that information on their websites
2) MSAR adds an MD/PhD tab with information
3) AAMC makes another fact table that shows median + SD for GPA + MCAT for MD/PhD programs


Other than that, I think people have already addressed most of my major concerns here. I can't imagine that it's easy for adcoms to have to sift through hundreds of applications from qualified applicants and to have to find ways to stratify them. Even just from what I've seen here and conversations I've had with the faculty at the school where I matriculated, I think it has to be really tough to juggle the whole application cycle and deal with hordes of stressed pre-meds in addition to the rest of your usual responsibilities that don't magically disappear during the admissions cycle. Thanks to everyone who takes the time to help out with admissions advice here or in other places– I never would have gotten an acceptance anywhere without a lot of help along the way. Hopefully I can find a way to pay it forward down the road.

I will throw a shout out to one school that interviewed me in October, told me I would find out at the end of January, and then didn't actually tell me anything until I followed up for a second or third time in late March!

Your #3 suggestion already exists unless I’m misinterpreting

https://www.aamc.org/download/321548/data/factstableb10.pdf

It’s where we get the data for the sticky on this board

 

[Fencer]

Facts table B-10 is for the entire national class. An improvement that I believe was implied, would be to list per school MCAT, cGPA and Sc GPA for their MD/PhD program matriculants.

 

[JoaoMoutinho]

@Lucca @Fencer nailed what I meant. I had said that the national table you linked was useful in determining whether I would be competitive for MD/PhD programs at all, but I sometimes found it difficult to determine whether my stats would be competitive at a given school or not. This was especially true at public schools where there is often a big difference between in-state and out of state applicant stats, and residency isn't a factor for MD/PhD admissions. Sorry I hadn't made that clear the first time.

 

[Lucca]

@Lucca @Fencer nailed what I meant. I had said that the national table you linked was useful in determining whether I would be competitive for MD/PhD programs at all, but I sometimes found it difficult to determine whether my stats would be competitive at a given school or not. This was especially true at public schools where there is often a big difference between in-state and out of state applicant stats, and residency isn't a factor for MD/PhD admissions. Sorry I hadn't made that clear the first time.

Ah yes only some programs do this and they may only give the average without an IQR or a range. It would be nice for programs to publish this on their sites.

 

[EvoMed]

Ah yes only some programs do this and they may only give the average without an IQR or a range. It would be nice for programs to publish this on their sites.

I actually don't think it's self-evident that publishing this information would be a good thing. I think its important for programs to be forthright about cutoffs, and they should take responsibility to make sure that they aren't accepting secondary payments from students that they will screen without even evaluating. However, beyond that, I don't know that releasing data would be productive towards the ultimate goals and interests of the students or of the programs programs.

 

[Lucca]

I actually don't think it's self-evident that publishing this information would be a good thing. I think its important for programs to be forthright about cutoffs, and they should take responsibility to make sure that they aren't accepting secondary payments from students that they will screen without even evaluating. However, beyond that, I don't know that releasing data would be productive towards the ultimate goals and interests of the students or of the programs programs.

Why do you say that? It can provide applicants an idea of where their stats are baseline competitive. Are you suggesting it may discourage otherwise very competitive applicants from applying because they are intimidated by the published stats?

 

[EvoMed]

Why do you say that? It can provide applicants an idea of where their stats are baseline competitive. Are you suggesting it may discourage otherwise very competitive applicants from applying because they are intimidated by the published stats?

Yes exactly. I also think it could discourage programs from accepting those same types of students, as publishing metrics could lean to relying on them to outcompete each other.

 

[JoaoMoutinho]

Yes exactly. I also think it could discourage programs from accepting those same types of students, as publishing metrics could lean to relying on them to outcompete each other.

Are you aware of any evidence suggesting that MSAR has had this effect on MD-only admissions?

 

[kepler16b]

Agree somewhat with EvoMed here. By allowing the MD/PhD numbers to be swallowed up by the med school averages, MD/PhD directors don't need to prioritize stats to inflate the prestige of their program. If they published numbers, they might be inclined to chase high stats.

 

[Fencer]

Agree somewhat with EvoMed here. By allowing the MD/PhD numbers to be swallowed up by the med school averages, MD/PhD directors don't need to prioritize stats to inflate the prestige of their program. If they published numbers, they might be inclined to chase high stats.

... and then become part of the public information dataset for comparison between/against programs when study section members are critiquing the MSTP grant submissions.

PDs fought hard to remove MCAT/GRE from the NIH tables to truly allow for better diversity. Unfortunately, the proposed MSAR MD/PhD section strategy with ranges might back-fire on us.

 

[Seihai]

... and then become part of the public information dataset for comparison between/against programs when study section members are critiquing the MSTP grant submissions.

PDs fought hard to remove MCAT/GRE from the NIH tables to truly allow for better diversity. Unfortunately, the proposed MSAR MD/PhD section strategy with ranges might back-fire on us.

I can see this becoming a problem for the admissions committees. However, from the perspective of diversity, I feel that a significant limiting factor is that many underrepresented students with lower stats simply never even try to apply to the likes of Harvard or Stanford because they don't know what the stats ranges are.

Cornell does regularly post their ranges along with their averages (Admissions FAQs | Tri-Institutional MD-PhD Program). I note that Cornell has a notedly diverse population of MD-PhD students even though they publish these stats (moreso than many other higher-ranked MSTP programs). I suspect this is because they don't actually post the 10th, 25th, 50th, 75th, and 90th percentiles thereof (rather the 0th and 100th percentiles).

Perhaps a compromise might be simple to mention the range of possible scores (lowest and highest) to encourage students from underrepresented groups that bring diversity to apply even with lower stats (as they can see the lowest score accepted) while also giving an element of realism for the ranges to consider when applying.

Supposedly, at the APSA Diverse Double Docs summit, they recommended doing this to increase diversity:

This suggestion admittedly comes from a perspective of naivety as I have no experience with MSTP grants and am only an applicant this cycle, rather than someone who has actually gone through an entire cycle.

 

[mdphd_applicant]

My single proposal would be to have a single portal for everything and have the essays standardized. I understand the "why X" essays, but like the diversity essays get old and so do the research ones. They filter out students not based on fit but based on time and money, which ironically reduces the diversity of the class.

The entire process is set up as being super super expensive and also very logistically difficult. I would not be able to get through this process w/o being quite well off myself and having mentors/physicians/parents to lean on.

I wish schools could agitate for a longer primary application that I only have to fill out once. And let it be. No secondaries is my ideal.

 

[EvoMed]

As I spend the weekend on secondaries (wishing I was hacking away at lab work): Pre secondary screening!!! If you're going to screen me, screen me early!! I'm cautiously optimistic about my overall chances this application cycle, but I do expect that some schools will screen me out. I suspect that such schools had sufficient information before sending me the secondary. Secondaries are very time consuming, and it's a shame that I'm going to spend a good deal of time on short essays that may never get read (Not to mention the financial cost).

 

[Fencer]

At our session at our national conference, several directors admitted not even knowing how much was their secondary. There was discussion on shortening the secondaries. In fact, a point of discussion was the "Twitter secondary" - 100-150 characters or so. The main outcome of the session was to raise awareness of the application process, and that we must increase our communication with applicants about the process. I did proposed a cap on secondary cost.

 

[Seihai]

At our session at our national conference, several directors admitted not even knowing how much was their secondary. There was discussion on shortening the secondaries. In fact, a point of discussion was the "Twitter secondary" - 100-150 characters or so. The main outcome of the session was to raise awareness of the application process, and that we must increase our communication with applicants about the process. I did proposed a cap on secondary cost.

>proposed a cap on secondary cost

Thank you. The cost of secondaries has disproportionately affected lower-income applicants who don't qualify for FAP, locking out so many qualified applicants. The fact that the students are (predominantly) fully-funded programs (in terms of tuition, though obviously overhead on the administrative side isn't necessarily covered) makes it feel almost strange to pay >$100 in secondary fees.


>several directors admitted not even knowing how much was their secondary

This is interesting to me - who exactly was in charge of developing and writing the secondary questions if the program directors didn't have feedback/information into that? I had always thought that it was the admissions committee + director for that year that chose what questions to ask on their secondary.


>increase our communication with applicants about the process

I think this would be a great thing - something like what UMich does regarding when interviews are sent out and sending interviews out on a single day might be too extreme of a step, but it could be a model for the kind of communications that applicants might appreciate about the process.

Do you know what the next steps are, if you're allowed to talk about them?

 

[Maebea]

The structure and operation of MD-PhD programs are by no means standard across medical schools. Some have administrations that are robust and well funded, while others get by on a shoestring budget. Secondary applications are typically controlled by the MD admissions dean. At our school the admissions dean decides on the format of the secondary. We are able to insert a few MD-PhD items, but the additional essays and information requests that take up so much of an applicant's time are beyond the control of the MD-PhD program. Likewise, the application fee and whether there is a prescreen before one gets a secondary application is controlled by the admissions office. None of the money from the application fee comes to the MD-PhD program; in fact, we have to pay a fee to use the MD admissions system.

We do endeavor to be transparent in the admissions process. We tell applicants how we make admissions decisions, when they can expect to hear from us, what percentage of interviewees are accepted, etc. We do not delay interview or rejection notifications, but let applicants know as soon as we have made a decision, even if it is the same day they submitted their application. This works for our program, but may not work for every program. I am pretty sure every program does the best it can, within the limits of its resources and institutional culture.