Linda Abraham: You’ve done a lot of research on what are the predictors of success in medical school. I know you approach that in a very analytical PhD research-driven way. What are the predictors? What has your research shown? [17:04]
Dr. Tan: I’m still working on it. It’s a work in progress and we’re still trying to pull it apart and think more carefully about it. The thing that I have found is that, honestly, this is something that if you read more into the published literature, it seems somewhat obvious, although students don’t think it’s obvious. I think when you look at the data, you will see that the metrics, the GPA and the MCAT score, and all of those pieces that give medical schools a certain sense of comfort that they’re not dooming you to failure when they accept you to medical school, is an important part of the review that medical schools are doing. That’s not in dispute. It’s important.
But, I think also that students overemphasize that component in schools in this country and universities in this country, because we also emphasize classes and academic excellence, I don’t necessarily think that we dissuade students from that perspective as much as perhaps we should.
But, there is a huge other component to the application that is important. Those are the things that you learn from being a citizen of the world. You learn from being in a professional setting. You learn from having disagreements and interactions with other people, from having personal failures, and from just knowing yourself and understanding your path in the world and what that looks like for you. I think that students really don’t spend enough time thinking about that component and I think that has a lot to do with students not being successful in the application process.
One example would be if you talk to students about how they select the medical schools that they’re applying to, they seem very confused by that question. And generally what they will tell you is some version of, “Well, I’m applying to good schools,” or, “I looked at the U.S. News Reports list and I picked these schools.” There is no component of it that has anything to do with their fit with the particular schools. The school, in contrast to that, that is all they think about. They are thinking about the fit of the student with the school. For example, what I tell my students in terms of an analogy so that hopefully that makes more sense is that if you’re going on a date…
Linda Abraham: I was just thinking that’s where you were going.
Dr. Tan: Yeah, if you’re going on a date with someone and the date doesn’t work out, you don’t end the date thinking, “I am a horrible person. I am undate-able. I should just give up on dating because it’s over. My life is over. I might as well just go live in a box.” Generally speaking, people don’t make that assumption. If they go on a date and it doesn’t work out, they think, “Oh gosh, I didn’t have a lot in common with that person. They liked this. I liked that. I didn’t realize that they were… I need to be more specific about how I select people or where I go to find people” or whatever your criteria is. The fact that I don’t mesh with somebody who enjoys a lot of sports doesn’t make me a horrible person. It just makes me someone who shouldn’t date someone who’s very into sports. I think that students don’t think of admissions that way. They take every rejection very seriously, but then they also don’t do that characteristic selection where medical schools are definitely thinking about, “Is this person the kind of person that we want to be a physician? Are they interested in medicine because it is a service profession? Do they understand the field and know what they’re getting into?” Generally speaking, that’s the generalized, “Are you a good date, period?” But, much more of the selection criteria, particularly during the interview process, but in the secondaries as well, and certainly to some degree in the primary application, is about all of the nuanced difference between this school and that school.
One thing that I’ve found very interesting about sitting in on medical school admissions meetings is that there isn’t a lot of conversation about, “This kid is going to be a great physician someday, but not at our medical school.” It’s not an issue of dispute that they are a good candidate for medicine. The dispute is, is this place the best place for them, which I found very eye opening, that a lot of it is much more about, “Yes, but at this institution or other places?”
One way that we’ve really been able to help students be more successful in the application process is just to force more conversation or encourage more conversation about the specificity of fit, really understanding what they want in a medical school, what medical schools want in a student and really getting to know themselves to a level where they can really have those deeper conversations about that. I think that that makes a significant difference.
The other thing that I think makes a significant difference is that there are some things that are just tried and true good advice, like, applying early and having letters of recommendation from people who actually know you, that you will hear from any advisor that are obvious good suggestions that, frankly, I don’t need data to support. But, I have. I’ve talked to deans of medical schools about this, as well, and it really is a lot of specificity. So, in terms of the data, that level of, “Yes this, but not that,” is hard if it’s really based on individuality, and so I think to myself, that the challenge of medical school admissions is trying to fit those nuanced pieces together.
Linda Abraham: We also emphasize, in advising out clients, the importance, if it was specific medical schools, especially in terms of the secondaries and the interview component of medical school applications. Some of the qualities that you were talking about sound like self-awareness, maturity, and resilience. [23:22]
Dr. Tan: Absolutely, no question. I can’t tell you what’s important to you. You have to tell me, and if you don’t know, then you have to figure it out, absolutely.
One of the things that I really appreciate with working with this particular population versus younger populations – I taught high school years ago – and one thing I’m really grateful to not have to do anymore is that I can really hold my students accountable for being adults, and being mature, and really doing that level of self-exploration.
I also think it’s really important for being happy professionally, that you need to know what you need to be happy and successful. You need to define success, not look it up in a dictionary. I think that’s really important, because otherwise, how will you know when you get there?
Linda Abraham: Yeah, you’ve got to know where you’re going. How do the Johns Hopkins postbac programs either nurture or foster those qualities in the programs that you run? [24:29]
Dr. Tan: One thing is that we have a year-long advising course that our students participate in. We have a curriculum for it. We have a number of assignments, and it’s a very comfortable format for people who are eager to be in an academic environment, and we lay out all of our objectives and all of our goals for students, so that they understand where we’re going and what we’re trying to accomplish, and I think that helps students build a sense of trust that we’re going to be able to help them achieve their goals if they just stick with us. I think that’s important, because I think that we all have a tremendous ability to grow as people, and do that level of self-exploration and self-knowledge, and all of that, but I think we have a lot of fear about doing it, or uncertainty, and certainly I have had students say, “Yeah, but, how is this going to help me get into medical school?”
We try to build an infrastructure that helps students understand that we are heading towards the goals that they want, and that they need to stick with us, and we will get them there. Through the process of starting with very easily accessible questions, we just talk about things like, talk about somebody who was impactful in your life. Talk about a situation that you were really happy, a favorite book, a superpower you wish you had. We, from a back door almost, start accessing a student perspective, and we basically act as – what’s a good word? – an interpreter of a student’s internal dialog. A lot of times, students are very good at telling me who they are, but they’re not good at listening to themselves telling them who they are.
Linda Abraham: They may also be not very good at controlling what they tell themselves about who they are.
Dr. Tan: Yeah, and I think that if we ask them, like if I ask a student, “Who are you?” I’m, frankly, probably not going to get a very good answer. I’m going to get some manufactured, “This is what I tell people.” Particularly for the career changers, who have a personal identity that in many ways is wrapped up in another field. That can be an exceedingly hard direction for them, because they aren’t quite at a point where they see themselves as future physicians. They want to be physicians, but they aren’t like, “I’ve tried to be a physician my whole life.” They’re not quite there yet. You have to ask them what seem like silly questions, just to head them down that road and get them thinking about what’s important to them, and what would they like to accomplish, and where do they see themselves down the road, without actually asking them, “Where do you see yourself in 20 years?” which is an incredibly scary question, even for me. To ask a student that question and expect an authentic, real answer, I think is asking too much.
Linda Abraham: What do you see as the big advantage to students who invest in a formal postbac program, like the ones that you are the director of, as opposed to doing informal postbac programs, taking classes? [27:37]
Dr. Tan: If you’re talking about informal postbac programs just as students who are taking classes, I think honestly the academic component of what’s expected for a postbac student is, it’s pretty easy to figure out. You can look at the prereq list from medical schools, you can piece that together. You can, if your academic grades are not where they should be, maybe you’re just retaking classes that you didn’t do well in, or whatever. It’s pretty straightforward, and I don’t think most of the time that is the piece that’s difficult for students.
I think the most frustrating, confusing part of the process is everything else. Even very practical things, like what should be included in a personal statement. How do I think about a list of target medical schools to apply to? I need to talk to somebody about my MCAD score. What do I do now? I’m struggling with the CARs section. What do I do now? What’s the difference between using Dr. Smith versus Dr. Peterson for a letter? Should I do this? Should I do that? What’s included in a secondary? Can you look at my experiences? How do I handle the most meaningful prompts? Those things are the parts that hang students up and force them into a position where they’re trying to make the best decision they can, but, they simply don’t have enough information.
I think the benefit of a postbac program is that, as I said earlier, often though not universally, postbac programs are going to have access to hands-on academic advising. That’s certainly not true of all postbac programs, but it tends to be a larger component of postbac programs.
Really, what you’re getting out of those programs is, yes, absolutely, the ability to take classes, and then somebody to talk to about your classes, sure. It’s also everything else. Which experiences should I pursue? Should I do research, or should I not do research? Do I need to do community health? Having somebody to ask those questions, and being able to trust the information you’re getting, I think, is totally invaluable.
Linda Abraham: Big difference.
Dr. Tan: Yeah, it absolutely does. Definitely, that’s an advantage to postbac programs. I do know, in talking to just general students, not necessarily just mine, but at conferences and things, that sometimes students do have access to their undergraduate pre-professional advising office after they graduate as an alum. Not true at every university, but some students do. If you have access to that through an undergraduate office, and you feel like you’re getting adequate support, yes, you can absolutely do it through just taking classes somewhere, because you are getting that information some other place. Doing it through a postbac program wouldn’t be necessary, but there are lots of students that either feel like either they don’t get access to the pre-prof office for some amount of time after they leave, or maybe yes, they do theoretically, but them and hundreds upon hundreds of other students. Or, they in some way feel like it’s inadequate if they’re at a university where their advisors are generalists, or it’s a small institution where it’s not somebody…
I, for example, do nothing but advise students who are premed. That is my sole job. It’s really hard to stay on top of advising if you’re doing all of the prehealth fields plus law, plus people wanting to do PhD, plus people who want to teach, plus people who want to do everything under the sun, much less across multiple fields and not just in the sciences. If people have those kind of advisors, they might feel like they really need somebody who is dedicated to this and knows what they’re doing.
The other advantage is that, certainly our programs, but there are others that do this, do offer a committee letter, which really simplifies the letter submission process for applying to medical schools in a lot of ways.
Linda Abraham: Most postbac programs, especially the academic enhancers, but I think it’s going to apply to the career changers also, they take the postbac one-year program, they complete it, then they apply, and then they have a year before they actually start medical school. That’s typically called the glide year. What do you recommend they do during the glide year? [31:51]
Dr. Tan: One thing that we recommend from the very beginning with students is, so often students are focused on their goal being getting into medical school. Which is not entirely accurate. It is a goal, a short-term goal, but it is not the goal.
Linda Abraham: It’s a means to an end.
Dr. Tan: Yes, exactly. The goal is really something else external to medical school. It’s helping people. It’s starting a nonprofit. It’s pushing back the frontiers of science on some disease or critical state. Increasing access to a particular population or in a geographic area, or whatever it is. I think that, if you keep that goal in mind, and you recognize that we are the product of our experiences, and our experiences, and the order in which we have our experiences shape the way that we think about the world, then, you would recognize that you have a limited amount of time. My students do, anyway, before they go to medical school.
Then, after you attend medical school, there is a waterfall exodus from medical school, where you’re expected to do residencies, and fellowships, and whatever else you’re doing. Then, you’re a practicing physician, or you’re at a hospital, or a clinic, or whatever, and then all of the sudden, it’s kind of a weird time to do other things.
We tell students to think about any experience that they want to have before all of that stuff that they want to have, a field they want to understand, an experience they want to have, something they want to try out, anything like that, that would be frankly weird if you did it in medical school or beyond, your gap year is an excellent time to try that out.
For example, students who want to understand research better, because they’re not sure if they want to go whole hog into research in medical school, or as a physician, or not. It’s a good time to do research, certainly, and I have a lot of students that do that. Hopkins is a hub for people interested in research, and so we get a lot of that. We also have people who are interested in trying to understand how insurance plays a role in how patients access medical care. Maybe then, they would be involved in an insurance company, or an outreach group, or part of the hospital that deals with all the insurance bits and pieces. Once they’re a practicing physician, frankly, they need to practice medicine. That’s a weird time to say, “Wait, I’m going to go take a break and work at an insurance company. It’s invaluable in terms of going into medical school and thinking about, “What does this mean for me?”
We also have students who want to do international stuff, and they want to get a handle on the global landscape of healthcare.
All of those things are totally feasible. We have students who are working on language skills, working as translators in clinics, because they want to be bilingual, or more bilingual, or more effective in their language skills in medical school, because they want to go to medical school that has hospitals, or clinics, or populations that would be well-served by those skills. Really, any of that is fine. We do it in a very individualistic way.
You can absolutely use your glide year to fill in gaps if you feel like, “I’m a little light on community service,” or research, or clinical care, or, “I would really like to see what it means to do hospice care. I really want to understand end-of-life care,” or, “I’ve never really been in a surgical setting, so I’m going to do OB-GYN work, and see how that goes.”
All of that is totally fine, but usually we have students who have a wish list. They really have always wanted to blank, and they’re gap year is a good time to try that stuff out, before you frankly run out of time.
I’m sure you and I both have a list of things that we’re waiting, because now we’re at a point in our lives where it’s not a good time to say, “I’m going to go take a year and do this thing I always wanted to do.”
Linda Abraham: There’s also some things that I wanted to do, and I probably never will do, because I didn’t do them when I’m younger. That also happens.
Dr. Tan: I encourage my students not to do that. Many, many of my family members have done Peace Corps. I always wanted to do it, but it just never seemed like the right time, and now I have kids, so now I have to wait until the kids are out of the house. I can’t, now is not a good time. I can’t say, “Hold on to that for a minute.”
I have a student right now who’s considering doing Peace Corps. That would be two years. I have students who want to do Teach For America. They’re really interested in that. That’s a longer commitment. I have students who really want to focus in research. They maybe spend two years doing that. It’s more about getting to your destination and being grateful for the path there; it’s not about how quickly can I get to medical school.
Linda Abraham: Here, you talked a little bit about how you wanted to be, or considered at least, joining the Peace Corps at one point, but I have a different question for you. How did you, a PhD in molecular biology and biophysics, get so interested in premed postbaccalaureate education? [37:30]
Dr. Tan: My PhD is actually in the biology department. I was in the biophysics department, and I was doing molecular biology work. That’s why it’s written that way on the website. More directly, what I was really interested in is education and puzzles. Those are really my two great loves.
Linda Abraham: Thousand-piece? 5,000?
Dr. Tan: Yes. Even as a kid, actually, I was pre-vet until I started doing research as an undergrad, and I just loved the puzzle and the curiosity of research I just was fascinated by the concept that the textbooks that I had in class were full of the blood, sweat, and tears of hundreds, thousands of people, every day, who were working on problems that we literally did not know the answer to. I was just fascinated by that. That combined with the fact that, with the PhD, you get to teach in a university setting. I absolutely fell in love with that, and I thought for sure that I would do that.
I was a little burned out as an undergrad, and so I took a break for a while and taught before I came back to school for my PhD. I absolutely loved my time at Hopkins as a graduate student, no question. It was absolutely formative.
I also learned pretty quickly that I didn’t want to be in a lab. I saw my esteemed faculty as spending a lot of time doing grant writing. That’s what you do before you get a Nobel prize. Once you get a Nobel prize, it’s way easier to secure money for your lab, but the tenure track path is really scary, and it requires an immense amount of commitment to being in a laboratory setting from dusk till dawn and beyond.
I looked around me, and I saw other people, like my husband, who are absolutely passionate about the research that they do and being in the lab. My husband would be in the lab constantly if we allowed it. I didn’t love it that much, and I figured that the luxury of having a degree that had lots of options was to figure out what I could be passionate about, and it wasn’t pipetting all day and all night. I was looking at other things that I really liked, and I started thinking about teaching, and I love the mentorship part of teaching, but I don’t love grading students. I don’t love assessing students and saying, “You are good, and you are bad, A, you know, C.” I don’t love that part. I also love writing. I spend a lot of time writing. I also love innovation, and finding new ways of doing things, and thinking outside the box, and just the fun of creativity.
I honestly just happened upon postbac. It was not an intentional choice, as wonderful things often aren’t. I loved it, because it was a mix of working with an older population that I could really engage in deep conversation and really push them to think deeply about their world, and what they wanted. There’s the educational component. I still would talk science with my students. I teach chemistry boot camp to my career changers. I talk research with a lot of my students. I’m still one foot in the sciences. But also, I can spend a lot of time having, frankly, more important conversations about, “What do you want out of your life?”
I’m really grateful that I ended up here. I spend a lot more time helping students think about their world, and I think that’s, honestly for me, better than talking about biophysics, and membrane protein association, which is what my thesis was on.
Linda Abraham: I don’t know anything about membrane whatever it is that you just said. My science background is very limited, and I’m probably exaggerating when I say that. I certainly know the satisfaction or working one-on-one with young adults and helping them achieve their dreams, figure out what their dreams are sometimes. That is something that’s very satisfying about my work, which is of course related to what you were doing. I can hear that really well.
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