Inside the head of an adcom member....

Discussion in 'Pre-Medical - MD' started by MD2b06, Sep 1, 2002.

  1. MD2b06

    MD2b06 Senior Member
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    This is a lil something my cousin who's applying this year sent me. Quite an interesting read... Thought those of you that are going through the process this year would find it useful. I know I always wondered how adcoms looked at apps when I was a pre-med. This guy, while not very PC, tells it like it is...


    Advice to Undergraduates Planning to Apply to Medical School

    Al Davies, M.D.


    I am writing to you with the assumption that you are in college or thinking about going to college. My goal is to assist you so that a very few years down the line your application for residency or fellowship will come across my desk, implying that you will have been successful getting into medical school. If you think in this long term view you will be more successful, but even if you are not you will have a larger understanding of why you were not.


    So, let?s just take a moment to ask you what you think I want to see years from now when you are applying for a position as a physician in a large clinic or medical school faculty? What do you think would make you stand out? What qualities and experiences would I want to see? What do you think I would want to avoid, and what would be severe enough to have me discard your application out of hand?


    I take applications very seriously. I have seen all kinds - applications for college, medical school, residency, fellowship, faculty positions, hospital privileges, private practice positions, pharmaceutical industry positions, and high tech companies. There are themes that run across these applications, themes you should know about. Themes you should try to meet, and themes you should try to avoid.


    Note, that I am not asking what qualities do you think a doctor should have. Why would I not ask that? Well, because applications are a very poor way of finding that out. That is why there is so much personal evaluation of people as they go through education and training, so that the application is only one small part of a much bigger evaluation process. Interviews are important in the early years, but later observation by your mentors becomes the biggest factor. Let me give you an example. When I am evaluating an application for a residency in Internal Medicine there is no factor more important than what a Professor of Internal Medicine said about you as a medical student. Now, take that back down to the level you are currently suffering to overcome - college. We need to know that you have the capacity to learn massive amounts of data, so what your mentors say about your cognitive skills is vital. Who are your mentors? They are your college instructors (in the form of grades and recommendations), and the MCAT folks.


    So, I have you beginning to think a bit about how you want to end up, and perhaps you are beginning to see that what you do now will be on that silly little application I see five or ten years down the line. How, what and where you do it is the key.

    Point # 1. Think about what you should look like on paper 10 years from now, then make yourself reflect that goal.

    You will need to show me that you can memorize. In the first year of medical school you will be expected to learn more facts that the average college graduate has learned in the entire preceding life. Your acquisition of new terms will bring in a vocabulary larger than the one you already have, even if you already speak several languages. In that year you will not eat, or sleep without a pressing urge to keep up with the new knowledge flooding your brain. I got so much in the habit of using every available moment to learn that I studied even in the bathroom. Now, many years later I have an incredible urge to pick up a text before I go into the bathroom because I am conditioned to use every spare moment.


    The time - honored method of testing your capacity to learn masses of facts is to look at your organic chemistry scores. You need to understand the subject, but beyond that question, it is the first and sometimes only specific course you will have taken before applying to medical school which really presses you to learn en masse.


    In a more general sense, committee members look at how well you took on a difficult college and successfully completed it on time. If you took seven years to get through Podunk Community College, and you obviously struggled, and you have no reasonable explanation for taking so long other than that you learn slowly, plan on getting a cold shoulder on Decision Day, the day the committee decides your fate.


    So, why is it so necessary to learn so much so fast? You probably heard your friends tell you it is just a hazing, a trivial rite of passage you wouldn?t really have to do if medical school faculties weren?t so filled with Neanderthals. That is ignorant bunk. Medical school faculties are filled with honed professional teaching machines who won?t waste time or money on your silly self unless you grow up. You really, really do need to be able to learn massive amounts of information. The reason you have to is that the amount of information a doctor must carry in order to be effective and responsible is incredibly massive. Yes, there are reference texts for all sorts of things, but remember that as a doctor you must be able to remember the important stuff off the top of your head. If you have forgotten something, and you forgot you forgot it, you are in real trouble when Mrs. Jones is crashing in respiratory failure in the middle of the night and you are the only doctor who can help her. Bodies are complex, and until they stop being that, doctors will have to learn massive, massive amounts of stuff.


    And, by the way, the first year of medical school is the easiest. Just wait. The first year is a vacation compared to your internship. But, I get ahead of myself.


    Part of this is not just a question of cognitive capacity in this area where doctors really do have to be unusually talented. Part of it is that you have to be able to show by persistent action that you are motivated to do it. How many business people change their jobs after a few years? How often do soldiers get reassigned to new tasks? How many people do what they do for the rest of their lives without a major career change. The statistics show that as many as 60% of Americans will have a major career change within the first decade after do achieving career status. For doctors it is thought to be under 3%.


    Doctors have to be dedicated. They have to stick to it. Sticking to it means you have to like it. You have to like learning. You have to like being pushed, being under pressure. If you don?t find, do yourself and your imaginary patients a very big favor, and do something else. And do me the favor of not feeling guilty when I see your application, detect your lack of pluck and dedication, and I throw your application in the pile labeled "No," which is short for "No Way On an Earth Inhabited by Oxygen - Breathing Mammals." I don?t want you killing people because you got tired, or decided on your own that it wasn?t really important to know that stuff.


    I know lots of nurses, pharmaceutical reps, biomedical engineers, and so forth who aced an exam, but didn?t? t like having to do it semester after semester. These are fine professions, and many people choose them out of preference, but it is a hard cold fact that many people in paramedical jobs are there because they enjoy parts of medicine yet don?t want to put in the effort to be a doctor. That is perfectly OK, and you should not feel at all ill - at - ease if you feel that way. If you do, be kind to yourself and the admissions committees, and move on to other things.

    Point # 2. This is the Big Leagues. Don?t mess with it if you ain?t willing to sweat it out.

    Lest you think I am being arrogant about the superior intellect of doctors, I would point out that I don?t think doctors are doctors because they are the smartest people on earth. It is true that the dumbest doctor has to be smarter than the average bear, but I am less addressing some generic idea of smartness than I am pointing out the reality that there are personality features, specific intellectual requirements, and a whale of a lot of motivation which are mandatory. We, the members of the committees, didn?t make it that way. That is the way it is, and we are trying to find the right people to meet the task.


    Somewhere along the line someone will ask you why you want to be a doctor. As an undergraduate you are free to cough up some platitude. That you recognize that the reason must be primarily selfless is good. Have you ever wondered what kinds of answers medical students give to that question if asked in a residency interview, or what a resident says during a fellowship interview? Well, the truth is that we rarely ask that kind of soppy question, fortunately for both you and us. By the time you are a doc your level of work and dedication is a non -verbal testament to what you are about. You will have become an embodiment of your dedication and motivation. Your daily routine will be to make significant impact on the lives of people. Little girls , their fathers, and their grandmothers. You will make a difference. You simply can?t not. So, when someone asks why you want to be a doc, first ask yourself whether the person asking is a physician (as opposed to a Ph.D. advisor for pre - med students). Compare,"I want to help people" with "I am intrigued by digestive, lung, and cardiac function, and want to apply that intellectual drive to improve the health of the good working people of Southern Nevada." Guess which will get that peanut? Don?t try to out - idealize an idealist.
     
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  3. MD2b06

    MD2b06 Senior Member
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    Where you do this training is important, but perhaps not as important as the differences in costs between schools. Expensive private schools are very, very nice, and if you can afford an expensive private medical school also, that is also very nice. However, if funds are more limited, I would put the money in the medical school rather than the university level. As a bright high school student you probably had or have visions of prestige in going to a "name" school. That is true - in the eyes of your high school friends and Aunt Alice. However, the hard cold facts are that there are many universities where being the best student you can be will prepare you as well as the private schools will, especially if you are behind the pack at the expensive school.


    Now, if you are reading this while in college, don?t suddenly think of changing colleges. There are two reasons. The first is that if you want to do so you missed the point. The point was that applying yourself well right where you are will do you the best service. The second is that as a committee member I watch like a hawk for any evidence that you have personality problems, emotional illness, adjustment issues, lassitude, or other features not conducive to being a great doctor. So, having a transcript showing you were moving around is a red flag that you will have to explain. Saying you did it because you thought it would look better on your application simply shows naivet?, or worse, dishonesty.


    Having said that, there are exceptions. Sometimes you get into a spot which is best fixed by moving. If you are in a small college and your girlfriend dumps you, you would be expected to have the maturity to deal with it, and stick it out. However, if your husband has to move 1000 miles because his new post - graduation job requires it, then you may have a valid reason to move.


    Another exception is the Podunk Rule. Again, this is not a matter of arrogance. It is a fact of life that a competitive swimmer swims better against a real opponent than against a toddler. If you find yourself in Podunk Community College and you realize you have much stronger aspirations than your peers and teachers, and you note that no one else in you college is even thinking of applying to medical school, then we would consider it a sign of real wisdom and motivation to move to a college more suited to produce a medical school applicant. That doesn?t not just apply to Podunk Community College. One applicant I knew did undergraduate work in a school well known for art and dance, and it was not until she changed to a university with a real science and math department that she blossomed. She is now a fine doctor who knows more about medicine than her fine arts peers, and more about fine arts than her physician peers. She?s happy.

    Point # 3. Get into a serious (but not necessarily expensive) school, but make the most of where you are. Doing well at a state university is far, far better than being marginal in an exclusive school.

    So what do you do if your resume ends up having a few glitches here and there? Well, the best thing is to not have glitches, but if you do, show an effort to set things straight. If you did poorly in a class, retake it and ace it, then explain what was the reason you did poorly in the first place. If your reason was that you were drunk that year, don?t expect empathy. You won?t get it. Drunk is not funny, nor is it what committees are looking for, because it is not what society in general or patients in specific tolerate. If you have been drunk, high, or have emotional problems first get them responsibly managed by professionals. You have no business worrying about medical school if you ar emorethe patient than the doctor. Your health is more important than getting into medical school, and if you surmount that challenge you may make a fine doctor. But you clearly won?t if you don?t.


    However, committees know that college years are stressful and that you are not simply a student learning, you are a human going through a transition between adolescence and adulthood, that romantic, economic, family, war, and other distractions may get in the way. Just explain honestly what happened.

    Point # 4. Deal with your imperfections honestly and in a forthright manner. Have a good (and true) explanation. I am far more likely to overlook a sophomoric mistake honestly admitted than a lie or self - deception about something.

    When you are approaching application time, get a number of applications to look at. Seek brochures, talk to doctors you know, and spend some time investigating. Just like my advice about college, medical school does not have to cost a million dollars. I do think it is worth trying to get in at the competitive places, but only if you can actually envision yourself going there. Don?t waste time, money, and worry if in your heart you would hate going there. By analogy, imagine yourself in boot camp in the Army. They come along and ask who is interested in going after a Green Beret. It would be suicidal and very, very poor judgment to do it solely for the machismo. Those guys and gals eat raw bugs for sport. If you hate raw bugs, don?t be a Green Beret. Simple rule. Now, back to medical schools. Some medical schools are tougher than trying to be a Green Beret when you don?t want to put that level of effort into it. There is no shame in not applying to such places, but there is shame in dogging it if you get it.


    Seek a medical school which reflects your nature. A smaller secondary school in a less urban setting if that suits you, or a war - zone atmosphere of an inner - city school if you are a warrior. Investigate them on your own terms. Why do you think there is no big catalog somewhere (including this document) which tells you what school is perfect for you? The reason is that what fits well for you is not reflected so much in the objective facts as it is in the sense and nature of the place. Visit. Talk to alumni. Call the school and find out who went there who lives near you (they keep track of alumni for the purposes of extorting money from them and for just this purpose - to advise applicants, so they know who lives near you, I assure you). Then call up that person and ask to speak for a few minutes. Don?t take one person?s word for it. Ask several. Then when you are at your interview with the medical school, tell them you investigated them. They will love the show of motivation and insight.


    And yes, interviews at the medical school are essential. At least have a formal interview with an alumnus. Interviews both tell them you are seriously interested and given them a chance to see what you are like. If they have questions about your record or likelihood of successfully completing medical school, this is their chance to ask and your chance to make up points. Don?t go into terrible debt to interview. Most of the time advance preparation and planning make these interviews plausible and productive. Again, they are looking for someone who can figure out that planning 3 weeks in advance can save $800. You are asking them to let you be a doctor where you will daily have to creatively find those kind of money - saving decisions for the rest of your life.

    Point # 6. If you don?t put more effort into finding good matches in medical school than you put into a good term paper, you deserve that rejection notice you will be holding.

    Don?t get into things inconsistent with or incompatible with being a doctor. Don?t be a felon, druggie, ne?er do well, lazy person, or dolt.


    As to which medical school, notice I have said very little. Get the point. Find a place you can get in, and fit in. The University of Southern Illinois is said to be very oriented to Family Practice. The University of Southern California is said to be very oriented to other things. It is far too early for you to decide what will be your specialty, but choose on the basis of the academic environment you find most appealing. If you are a gunner (a person who loves taking and acing tests), an academic in utero, interested in hard core bench research, or are bound to a future in nationally prominent politics of medicine, then go to an expensive private school or a well known major university connected to an inner - city hospital, which has a freshman class in the 100 range. If you are a little more laid back, most medical schools would be fine. If you are not so hot on gunning and are more interested in a gentler pace, try a medical school which is less than a decade old and has a freshman class in the 50-75 range.


    One major advantage of the more competitive schools is that they attract fine people who become a big portion of your learning experience. I did my residency and fellowship at Duke, where faculty are phenomenal, but I learned a huge portion of what I learned from the other residents and fellows. If you want to improve your academic level as well as your academic prospects, study with the big guys.

    Still, there are many fine programs out there which provide superb learning experiences. In fact none in the US are not capable of turning out great doctors. The best students in 50 -70 of the medical schools in this country are actually quite similar in knowledge and capacity.
     
  4. MD2b06

    MD2b06 Senior Member
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    In summary, I don?t have any good way of telling you what exact steps will guarantee your acceptance. Get a clue, Sherlock! The test is that you realize it is a test! Get into the best college in which you will succeed, and ace the place. Do well on MCAT or any equivalent exam. Plan ahead. Investigate. Converse. Strategize. But keep balance and don?t go overboard. If you can?t tell the difference between working hard enough and going overboard you need a little direct help. Talk to someone. Email me. Improve on your mistakes, admit them, and explain them without being defensive. Practice your answers to the expected questions before your go to the interview, not on the way home afterward. Be smart.


    Good luck, and I hope to see your application in a few years.

    What if I don?t make it?

    It ain?t the end of the world. Ever have a friend who lost a romantic interest, and they thought it was the end of civilization, yet you knew they would bounce back? It is a lot like that here - if you don?t make it you need to pick up your life and make something constructive of it all. And unless there is actually some major weakness to be professionally managed, you can and should, and probably will.


    After all is said and done, remember that every year there are more clearly qualified people applying to medical school than there are positions to fill. You may not get in simply because there is not enough room. You may not get in even if you are great. A bunch of my buddies were rejected, and I still think of them as more worthy than was I.


    Retry twice. If not successful, they are telling you that the reason is not lack of space in the school, but lack of visible evidence that you would succeed if admitted. Don?t let family or friends pressure you. Be an adult, and set your own course. Realistically, move on. And find an avenue which appeals to you and uses your talents. Most people in that situation end up being very glad with the way things work out. I know that may not feel good now, but don?t bloody your nose too many times. Getting in is the easy part. If that didn?t work so well it will go straight downhill from there. Accept the reality even if true that you have been woefully misjudged, and move on.
     
  5. cabruen

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    Very interesting. Thanks MD2b06.
     
  6. lady bug

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    Very interesting read. It motivates me! thanks for posting. :)
     
  7. Spiderman [RNA Ladder 2003]

    Spiderman [RNA Ladder 2003] Platinum Member
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    where is this Al Davies from?
     
  8. monster2

    monster2 Senior Member
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    I admire this Al Davies guy and his no-nonsense attitude. While he seems to have the ideal candidate mapped out, he's forgetting a few things. Here is the truth about this game we call "medical school admissions." The first thing you have to understand is that med school (just like your current university and
    almost everything else in this world) is a business. In a nut shell, you send in an application, they send you a secondary, you send the secondary back with $50, and
    they either eat up your money and reject you or invite you to an interview. Either way your $50 is gone. Now if you are a decent applicant, you'll get anywhere from
    1 to as many as 10 secondaries (assuming you apply to 10 schools). Now with $50 PER secondary you can see that med schools rake in the dough from all those
    hopefuls who send back those secondaries. So you realize that first and foremost med schools want your money. As far as "well-roundedness" goes, that is all a
    bunch of b.s. The very first thing the admissions comittee looks at are your CORE science prereqs (gen. chem, physics, ochem, bio) and your MCAT. If those are
    not up to par then they toss your application and don't even waste a secondary on you. Of course there are those med schools (i.e. Tulane) who send a secondary to
    everyone who applies. This way they're assured of getting that $50 from the majority of the people who send back their secondaries thinking they have a chance
    when in reality they've been hussled for $50 (and med schools talk about "integrity", integrity my ass). I know this sounds easier than it is done, but a 3.7+ science
    GPA, 30+ MCAT, and an undetectable acting job at the interview will get you into a med school, but maybe not your preferred choice of school. But let's face it
    and M.D. is an M.D. There are doctors who graduate from top places like Harvard and JHU who opt to do academic medicine and rake in no more than $120K a
    year, while there are doctors who graduate from schools like Southern Illinois and pull in over $500K a year. It's all about what you do after you get that M.D. that
    counts...you can either waste your time doing research in a lab or you can set up shop in Beverley Hills and bring in the big bucks. And why is "well roundedness" a
    bunch of b.s.? Simple, because every year med schools graduate a large majority of self-centered, arrogant docs who are in this business for themselves. They "say"
    they want compassionate docs, but for the most part doctors are less than so. So you see, a high GPA, a high MCAT, and a good con job at the interview WILL
    get you into a med school...the rest is b.s.
     
  9. loomis

    loomis Lifetime Student
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    very fascinating. thanks for the post, MD2B06
     
  10. tatabox80

    tatabox80 Super-Duper Member
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    Are you on an adcom? If not, you should really be on one because you DEFINATELY seem to know it all when it comes to medical school admissions and how to be a GREAT doctor! All of your posts reflect this :rolleyes: :rolleyes: :rolleyes:
     
  11. Ligament

    Ligament Interventional Pain Management
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    Dr. Davies sounds like such an ass from this article. Take it with a grain of salt.

    regards.
     
  12. MD2b06

    MD2b06 Senior Member
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    No idea where this guy is from. He did mention doing his residency training at Duke though. Anyway, I just want to assure everyone that not all adcom members think like this. It really varies from person to person. Some are no-nonsense types and are not very forgiving of applicants shortcomings, and others like to look at the whole person. Some of the stuff he says is a bit over the top, but for the most part, I think he paints a brutally honest and realistic picture of how applicants are viewed.
     
  13. tBw

    tBw totally deluded
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    Okay, as people seem so interested in what is going on in the mind of an adcom member I have used my quantum cerebral scanner to record a few thoughts...so here it is:

    "Hmmm, I should ask a question, hmm, what shall I ask...haven't had time to read this file yet, lets go with a safe question...

    Why do you want to be a doctor?

    (ignoring answer scans application file...) whats this, a C in Organic chemistry. Excellent! I can ask them about that later...oh ****...they stopped talking...better ask another question....

    And why this medical school?

    I don't like their tie, all those patterns, very distracting...ummm...what are they saying?

    I see you got a C in organic chemistry, is there anything you would like to add about your academic performance?

    Stares out window....I wonder what Carol will cook for dinner tonight....I really wish I could get back and look at those latest assays...ooops, they stopped talking again...ummmm....

    What do you think of the current state of health care?

    I wonder if I was this naive 20 years ago...

    Well, unless you have any questions, thank you for coming, and we'll let you know...


    Yes! Back to my assays....
     
  14. premedicine.com

    premedicine.com Junior Member

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    The third..what are adcoms thinking was Hillarious!


    LOL
     
  15. PrincessCKNY

    PrincessCKNY Crown Royal Member
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    I decided to bump this up for all the newbies who seem to be in limbo about which undergrad institution to go to. This is a good read and definitely puts things into perspective.
     
  16. dumbest premed

    dumbest premed Membership Revoked
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    What this dude is saying is 85% bulls**t. I can name at least 10 stoners right off the tip of my tongue with marginal GPA's and MCATs who got into med school this application cycle out of my "Podunk State School."

    It's not as hard as this guy is making it. Monster2 and the boy wonder painted a much more accurate picture of it. The adcoms aren't that thorough as you think. From my observations over this application cycle, during which at least 15-20 people I know fairly well got accepted, this process is mostly luck once you make the numerical cutoff.

    There are at least 5 people I know who made a total joke out of the process...who just applied "to apply beacause they had the numbers" and couldn't give a rat's ass about medicine. Believe it or not...they got in. As it even says on my school's premed advising website, if you have a 3.5+ GPA and 30+ MCAT you have virtually a 100% chance of getting accepted...that is if you can put on a good act during the interview.

    The adcoms aren't looking for perfection, as this guy is putting it. They just want to fill up their classes with halfway decent people and collect the tuition.
     

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