No Clinical Experience: Doom?

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I have no clinical experience, but really high GPA, publications, hopefully MCAT in mid 30's and great rec letters from MD's with name recognition. Is it even worth applying this cycle in this situation? I hope to get into MD/PhD program, but I will be satisfied getting into any school. I will try to get some volunteering done before I submit secondaries, but I am dangling with the idea of getting some clinical experience and applying next year. Is it worth it rolling the dice this year with what I have?

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I once made a thread asking if I should shadow and they told me with no clinical experience my chances are not good.
 
You should still apply. MD/PhD programs tend to overlook lack of clinical experience at the cost of excessive research and numbers. You just have to make sure that your MCAT *IS* in the mid 30s or above. Now why you didn't go shadow someone is beyond me, but that's more of your loss than a hit to your application. It's pretty fun.

BTW, MD/PhD program deadlines are sooner than regular MD. So you should get your stuff in like now.
 
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My question would be why you think medicine is for you if you've never had clinical experience. This would also be the question posed by interviewers.
 
Clinical experience is a must I'd say. Perhaps there's the off chance that an MD/PhD program would give you a shot.

In reality though, the question posed above is extremely important. How could you know that you are ready to commit the next 8 years of your life to a profession if you've never been exposed to what that profession can be like?

Directly from Case Western's Website:

Case Western U said:
I do not have any clinical volunteer experience; Will this weaken my application?


Yes, most medical schools want to see that you have spent a significant amount of time around sick people. This indicates two things; you know what it’s like to be around sick people and you have a strong desire to help others. A 4.0 GPA student with a 40 MCAT who has not volunteered at a hospital or spent any time in clinical setting, will greatly weaken, if not destroy their application.
http://www.cwru.edu/provost/ugstudies/prehealthfaq.html#FAQ14
 
If you have other experience dealing with people (not even in a clinical setting), you could run with that. Or maybe try to pick up a volunteer position that gives you at least some clinical exposure before your interviews.
Yes, clinical exposure is important, but I know several people who got in w/o it (and not into MD/PhD program).
 
It's great that you'll have strong LORs from notable MDs, but how did they get to know you? Was it through research, or did you actually shadow them? If you did indeed shadow them, that's at least a little bit of clinical experience. I think you should still apply and I hope you find some success despite the clinical aspect of your app.
 
MD/PhD programs tend to overlook lack of clinical experience at the cost of excessive research and numbers.
True to a point. They'll overlook having less clinical experience, but having none is still going to raise red flags. It's do-able, but your options will be more limited than they need be.
My question would be why you think medicine is for you if you've never had clinical experience. This would also be the question posed by interviewers.
Absolutely. If you have zero interest in the clinical side of medicine, I think most interviewers would recommend a PhD.
 
As most people here have said, applying is going to be a much rockier process without at least some clinical experience. It sounds like you're pretty much ready to apply with the rest of your application, so if I were you I would start the clinical volunteering NOW. That way, at least you have something to say on the topic when interviews come along. If you have the time, it may also help you to volunteer in two very different environments (e.g ER and Methodone clinic, private practice and surgery ward, etc).
 
If you have zero interest in the clinical side of medicine, I think most interviewers would recommend a PhD.

Agreed. As far as the interviewers are concerned, you haven't shown passion for both MD and PhD...just PhD. Those programs are insanely hard to get into and the vast majority of premeds have clinical exp. So up against those other applicants, they will take people with both clinical and research experience rather than just one. A famous MD saying you'd be a good doctor isn't going to sway most adcoms when you have no experience yourself.... If you can wait another year and get that experience, you're a shoe-in (assuming you also do get a mid 30's MCAT).
 
I have no clinical experience, but really high GPA, publications, hopefully MCAT in mid 30's and great rec letters from MD's with name recognition. Is it even worth applying this cycle in this situation? I hope to get into MD/PhD program, but I will be satisfied getting into any school. I will try to get some volunteering done before I submit secondaries, but I am dangling with the idea of getting some clinical experience and applying next year. Is it worth it rolling the dice this year with what I have?

I was in a very similar situation as you two years ago (high stats with little/no clinical expereince); I ended up applying and didn't get much love. Consequently, I sucked it up and got some clinical experience during the spring before the next application cycle. The difference was astounding. This cycle I applied to 10 schools, interviewed at 5, and got accepted at 3 (and 1 WL)...didn't change a damn thing other than the clinical expereince. My advice, if you haven't submitted your AMCAS, is to set something up ASAP with a doc. Once you have something lined up (in other words, when you'll know the duration of the task and job duties), put it down on your AMCAS and send ASAP (but obviously follow through with it). It's still relatively early in the 2009 cycle; get your clinical expereince and knock this bitch out of the ballpark.
 
I am only 21, so I am not that old. Plus, I am graduating this fall, so I will have half a year to do as much volunteering as possible before next summer. One year will not really hurt me much in the big picture, but I am thinking I can start volunteering at the hospital where I go to school before the interview . I hope my stats and what I have will get me that. If I don't get in anywhere this cycle, it's not that big of a deal for me.

Another point, I looked at Northwestern and UChicago hospitals and they require 100 hour commitment and I only have a month and a half till school starts (not in the same city). Are there any other options that are more short term?
 
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I was in a very similar situation as you two years ago (high stats with little/no clinical expereince); I ended up applying and didn't get much love. Consequently, I sucked it up and got some clinical experience during the spring before the next application cycle. The difference was astounding. This cycle I applied to 10 schools, interviewed at 5, and got accepted at 3...didn't change a damn thing other than the clinical expereince. My advice, if you haven't submitted your AMCAS, is to set something up ASAP with a doc. Once you have something lined up (in other words, when you'll know the duration of the task and job duties), put it down on your AMCAS and send ASAP (but obviously follow through with it). It's still relatively early in the 2009 cycle; get your clinical expereince and knock this bitch out of the ballpark.

Great story!

I applied last cycle with minimal experience and as a non-traditional. I've since been volunteering at a cancer program and been a caregiver for my mother post-stroke (probably the most intensive clinical experience I've ever had it's like shadowing and patient care 20 hours a week!!!) I have a feeling that'll get me beyond last cycles 2 interviews 2 wait lists...

Anyway. it can't hurt to get crackin on the volunteer/shadowing, etc. The MD letters might mitigate your lack of clinical experience though.
 
Alternatively, you can send your AMCAS now, and then write all the schools an update letter when you get your clinical experience set up. I think most schools accept update letters (although you can usually go to the FAQ sections of their application site to find this out).

That way you won't risk being late with the AMCAS and secondaries, etc, but will still be able to notify schools of your clinical experience, and maybe even re-express your specific interest in their school if you're feeling ambitious.

I didn't do this mind you, so it's just speculation, heh. Although, I have heard many good things coming from update/letter of interest letters, so it might be worth a shot?

Also, I do know a handful of students like you were accepted straight out MD with no clinical experience on their AMCAS (although they did have volunteering and other community-type EC's), so it's not IMPOSSIBLE, just harder.
Good luck :)
 
I think it's really up to you how much time and effort you want to throw into something that might not turn out for you in the end. Last year I applied with 3.75/37 and no clinical experience. Ended up with four interviews, zero acceptances. One of my interviewers refused to take me seriously at all. It really is painful to be a high achiever and see yourself SLOWLY getting snubbed by everyone. If you do go through with it, apply VERY broadly. I didn't, and it cost me.
 
I would say if you have a great MCAT (high 30s to low 40s) you'll get in somewhere if you start shadowing or volunteering now. If you're hoping for a top 20 school, then I'd wait a year and get more clinical experience because they get more applicants with great numbers, LORs, and pubs than they can accept.
 
I think it's really up to you how much time and effort you want to throw into something that might not turn out for you in the end. Last year I applied with 3.75/37 and no clinical experience. Ended up with four interviews, zero acceptances. One of my interviewers refused to take me seriously at all. It really is painful to be a high achiever and see yourself SLOWLY getting snubbed by everyone. If you do go through with it, apply VERY broadly. I didn't, and it cost me.

Agreed...pull the trigger when you know it will count.
 
You will be alright with a little clinical experience, but none is troublesome. I have to admit, I did hardly any and still did just fine, but I think it would have definitely helped me. I agree with Textuality, send them an update letter ASAP when you get your clinical experience set up. Good luck.
 
you can talk about your clinical experience when filling out the secondaries
 
Okay I met with a couple of MD's who were on admission committees and are good friends of mine. They told me that my recommendation letters and the fact that my mother is an MD/PhD are a good substitute for lack of clinical experience. Also my immigration experience and extended tutoring and teaching background can really help me if I frame them around patient communication in my personal statement. Overall, they told me adcoms realize that most clinical experience at this level involves at most drawing blood from a patient and at the least just following a doctor. Neither of them saw shadowing as an activity worth spending your time on. After knowing me for two years, neither one of them had any doubts about my passion in medicine and they were sure that admission committees would share the same opinion if I properly present myself in my PS and the interview. This was drastically different from what I heard on SDN and I would just like to share this with the rest who are hesitant to apply without clinical experience.
 
Okay I met with a couple of MD's who were on admission committees and are good friends of mine. They told me that my recommendation letters and the fact that my mother is an MD/PhD are a good substitute for lack of clinical experience. Also my immigration experience and extended tutoring and teaching background can really help me if I frame them around patient communication in my personal statement. Overall, they told me adcoms realize that most clinical experience at this level involves at most drawing blood from a patient and at the least just following a doctor. Neither of them saw shadowing as an activity worth spending your time on. After knowing me for two years, neither one of them had any doubts about my passion in medicine and they were sure that admission committees would share the same opinion if I properly present myself in my PS and the interview. This was drastically different from what I heard on SDN and I would just like to share this with the rest who are hesitant to apply without clinical experience.

cant speak to md/phd, but i only started clinical experience as i was submitting my amcas and only shadowed starting in March. I have about average accepted stats for mid-tier schools and have 0 acceptances from 5 interviews. (i did also apply late.) 2 interviewers asked me point blank if i had done any shadowing and all of them asked me how i came to know i was interested in medicine. so my experience has been about the same as dedikated2liftin and timberwolf.
 
Okay I met with a couple of MD's who were on admission committees and are good friends of mine. They told me that my recommendation letters and the fact that my mother is an MD/PhD are a good substitute for lack of clinical experience. Also my immigration experience and extended tutoring and teaching background can really help me if I frame them around patient communication in my personal statement. Overall, they told me adcoms realize that most clinical experience at this level involves at most drawing blood from a patient and at the least just following a doctor. Neither of them saw shadowing as an activity worth spending your time on. After knowing me for two years, neither one of them had any doubts about my passion in medicine and they were sure that admission committees would share the same opinion if I properly present myself in my PS and the interview. This was drastically different from what I heard on SDN and I would just like to share this with the rest who are hesitant to apply without clinical experience.

See, when people leave out important information, it changes everything completely. I am guessing that you'll followed your mother around at least ONCE to see what she does. And you're probably aware of all the downsides as well. Though I would still at least get clinical experience elsewhere, you aren't in the sinking ship we once thought you to be. :p
 
Why should this be an issue? It's so easy and quick to get clinical experience that you'd have to be lazy not to have any. Pick up the phone, volunteer for four hours/week for a while at a hospital, and you're done.
 
Why should this be an issue? It's so easy and quick to get clinical experience that you'd have to be lazy not to have any. Pick up the phone, volunteer for four hours/week for a while at a hospital, and you're done.

I'm not sure folding linens does the trick. I think you need to see care being given. That being said, it probably is not that hard parlaying volunteering in a hospital to being able to follow some doctors around. I found coming to an emergency room with no direction painful and didnt realize how important seeing doctors work was to doing well in the application process. In retrospect I should have been more proactive and taken the initiative to ask some nurses how I could help and then eventually asked for the opportunity to do some shadowing.

Case Western's website, that someone else posted above, looks like it does a nice job of making it clear that shadowing is a requirement. I think other schools really could do a lot better job communicating this. Burried in 12 pages of requirements to prospective students n Maryland's website are three vague sentences:

"There are no prescriptive activities that will guarantee acceptance to medical school. Each applicant is encouraged to pursue activities that will demonstrate their special talents and which will support their motivation for a career in medicine. Exposure to clinical medicine, and knowledge of the advantages and disadvantages of medicine as a career, are expected."

I guess my personality is averse to taking the initiative, and asking others to make an effort, to do something only for the sake of helping me get into medical school. But its certainly worth doing to not go through an application cycle without any acceptances, a hard lesson I've now learned ...
 
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Why should this be an issue? It's so easy and quick to get clinical experience that you'd have to be lazy not to have any. Pick up the phone, volunteer for four hours/week for a while at a hospital, and you're done.

Easy yes, quick no. Real clinical experience takes YEARS to get. Going to the local ER for 3 months and then calling it quits is not enough exp for most schools. I had over two years of clinical exp and some institutions told me that it played a factor in my ultimate rejection. Actually it was the only reason that I was given for being rejected from my state school.

The lesson I learned from my application experience is to get as much clinical exp as possible...and then get some more...THEN, take that number and multiply it by 1.5 and then list it as your total clinical experience on your AMCAS.

You can never have enough clinical experience.
 
What kind did you have? If you have some shadowing and some with patient contact, I don't see why that wouldn't be enough?
 
I think that a lack of clinical can make or break your application only if you are lacking something else. I honestly cannot see someone with a high gpa/mcat, great LORs, great PS, and an adequate interview getting rejected for not having clinical. As has been mentioned previously, most schools are aware that clinical volunteering is usually meaningless for most applicants. Very few of us get the opportunity to experience meaningful clinical volunteering. I would not expect to get into top schools without at least some clinical experience, but I think there is a good chance for those applying without it at middle tier schools.
 
I think that a lack of clinical can make or break your application only if you are lacking something else. I honestly cannot see someone with a high gpa/mcat, great LORs, great PS, and an adequate interview getting rejected for not having clinical. As has been mentioned previously, most schools are aware that clinical volunteering is usually meaningless for most applicants. Very few of us get the opportunity to experience meaningful clinical volunteering. I would not expect to get into top schools without at least some clinical experience, but I think there is a good chance for those applying without it at middle tier schools.

Everything I've learned, except for my experience with my instate school, would lead me to agree with you. I had above average MCAT and GPA with good letters and interviews. I know this b/c they told me over the phone. Out of 550 applicants I didn't even make the top 300. The ONLY explanation they gave me for the rejection was because "compared to other applicants your clinical experience was lacking". The only other negative aspect of my app was that the interviewers couldn't determine my motivation for medicine although they still gave me positive recommendations.

I also called another school where I was rejected (UChicago) and they told me that my clinical experience was lacking.

The clinical experience I applied with was 12 months in ER, 3 months in Onco, 15 months volunteering in a medical dental clinic (with half of that being in direct contact with patients), and additional OR and physician shadowing. I THOUGHT I was golden.
 
Everything I've learned, except for my experience with my instate school, would lead me to agree with you. I had above average MCAT and GPA with good letters and interviews. I know this b/c they told me over the phone. Out of 550 applicants I didn't even make the top 300. The ONLY explanation they gave me for the rejection was because "compared to other applicants your clinical experience was lacking". The only other negative aspect of my app was that the interviewers couldn't determine my motivation for medicine although they still gave me positive recommendations.

I also called another school where I was rejected (UChicago) and they told me that my clinical experience was lacking.

The clinical experience I applied with was 12 months in ER, 3 months in Onco, 15 months volunteering in a medical dental clinic (with half of that being in direct contact with patients), and additional OR and physician shadowing. I THOUGHT I was golden.

That makes zero sense. How can you be lacking clinical if you have over 2 years total of clinical experience. If you look at many people's applications, they have less than 2 years total (or less than 300 hours total) and have no problems.
 
The clinical experience I applied with was 12 months in ER, 3 months in Onco, 15 months volunteering in a medical dental clinic (with half of that being in direct contact with patients), and additional OR and physician shadowing. I THOUGHT I was golden.

Stop lying. Clinical experience should be the least of your problems if above is true.
 
Okay I met with a couple of MD's who were on admission committees and are good friends of mine. They told me that my recommendation letters and the fact that my mother is an MD/PhD are a good substitute for lack of clinical experience. Also my immigration experience and extended tutoring and teaching background can really help me if I frame them around patient communication in my personal statement. Overall, they told me adcoms realize that most clinical experience at this level involves at most drawing blood from a patient and at the least just following a doctor. Neither of them saw shadowing as an activity worth spending your time on. After knowing me for two years, neither one of them had any doubts about my passion in medicine and they were sure that admission committees would share the same opinion if I properly present myself in my PS and the interview. This was drastically different from what I heard on SDN and I would just like to share this with the rest who are hesitant to apply without clinical experience.

I think your safest bet is to just go ahead and do some sort of clinical activity. It won't hurt you at all and has the potential for others to see, concretely, your motivation for entering medicine.
 
Stop lying. Clinical experience should be the least of your problems if above is true.

No need to jump to conclusions. I'm just telling you what they told me. Personally I don't believe it was the reason I was rejected. I do believe it played a role in my UChicago rejection just because its a very competitive school.

In reality, I believe I was rejected due to the fact that I was a first-time white, male, upper-middle class applicant who presented a good but not great application. My in-state school has a rich history of rejecting first time applicants who are competitive while giving acceptances to less qualified second-timers. I think the story about my clinical experience was just their way of avoiding having to tell me about their addmissions' politics.

I did recieve acceptances and interviews from other schools so my "lack" of clinical exp is pretty questionable. Whatever the case may be, I was told by more than one university that I could have used more clinical experience...so take it for what its worth.
 
That makes zero sense. How can you be lacking clinical if you have over 2 years total of clinical experience. If you look at many people's applications, they have less than 2 years total (or less than 300 hours total) and have no problems.

Hence my current frustration and utter DISDAIN for my in-state school.
 
I think your safest bet is to just go ahead and do some sort of clinical activity. It won't hurt you at all and has the potential for others to see, concretely, your motivation for entering medicine.


Yeah I might as well volunteer once the school year starts and in case I am asked in the interview, I will have something to say.

And it seems lack of clinical experience is a PC response to a rejection. That's one of the few things that never cannot be effectively quantified.
 
Easy yes, quick no. Real clinical experience takes YEARS to get. Going to the local ER for 3 months and then calling it quits is not enough exp for most schools. I had over two years of clinical exp and some institutions told me that it played a factor in my ultimate rejection. Actually it was the only reason that I was given for being rejected from my state school.

The lesson I learned from my application experience is to get as much clinical exp as possible...and then get some more...THEN, take that number and multiply it by 1.5 and then list it as your total clinical experience on your AMCAS.

You can never have enough clinical experience.

ha ha, true, what a waste though.
 
there are plenty of people who get accepted without any clinical experience at all, but all of them have observed what a doctor does in some way.
 
there are plenty of people who get accepted without any clinical experience at all, but all of them have observed what a doctor does in some way.

i think we are lacking a common definition of clinical experience.
 
i think we are lacking a common definition of clinical experience.

LizzyM's definition of "Clinical Experience" is any activity where you are close enough to smell patients. I think that in reality, if your experience fufills one of the following two criteria, it's a clinical experience:

1) Real-world (in the field) experience that gives you an idea of what a doctor does day in and day out:
Shadowing, Observerships etc.

2) Real-world hand-on experience interacting with patients:
Volunteering in a hospital, being a care worker, etc.
 
How important is shadowing specifically? I've been volunteering at a hospital emergency department for almost two years, but I don't have any shadowing experience.
 
LizzyM's definition of "Clinical Experience" is any activity where you are close enough to smell patients. I think that in reality, if your experience fufills one of the following two criteria, it's a clinical experience:

1) Real-world (in the field) experience that gives you an idea of what a doctor does day in and day out:
Shadowing, Observerships etc.

2) Real-world hand-on experience interacting with patients:
Volunteering in a hospital, being a care worker, etc.

I had 2) but not 1). If med schools distinguish between these two types of expereinces, a better definition should probably be in order ...
 
How important is shadowing specifically? I've been volunteering at a hospital emergency department for almost two years, but I don't have any shadowing experience.
Your clinical experience, similar to what Vihsadas says, should accomplish two things:

1. Give you a good understanding of what a doctor does for a living AND
2. Give you the opportunity to work closely with patients

That's it. But you should ideally have both.

Shadowing is great for #1, but often does nothing for #2. If you're just a fly on the wall, it doesn't really do the whole enchilada. You'll need to do something else as well.

Volunteering in a clinical setting (most commonly in the ER, from apps I've seen) is great for #1. But often in these situations, when you have any involvement in actual care, you are working with nurses, not the Emergency Physician. Not great for #1.

So make sure your experience or experiences nail both. Sometimes you can find a great gig that does both well. The most common I've seen this at is folks who volunteer at free medical clinics. The opporunities are out there. And there's nothing wrong with stringing together multiple volunteering gigs. Your app looks stronger because of it.
 
Your clinical experience, similar to what Vihsadas says, should accomplish two things:

1. Give you a good understanding of what a doctor does for a living AND
2. Give you the opportunity to work closely with patients

That's it. But you should ideally have both.

Shadowing is great for #1, but often does nothing for #2. If you're just a fly on the wall, it doesn't really do the whole enchilada. You'll need to do something else as well.

Volunteering in a clinical setting (most commonly in the ER, from apps I've seen) is great for #1. But often in these situations, when you have any involvement in actual care, you are working with nurses, not the Emergency Physician. Not great for #1.

So make sure your experience or experiences nail both. Sometimes you can find a great gig that does both well. The most common I've seen this at is folks who volunteer at free medical clinics. The opporunities are out there. And there's nothing wrong with stringing together multiple volunteering gigs. Your app looks stronger because of it.

The free medical clinic is a GREAT experience. You get to do a lot more at these establishments than in a hospital setting. This is where I got all my hands-on exp. as well as the majority of my shadowing. Its also the only clinical experience topic that came up in ANY of my interviews (All of my interviewers asked specifically about my free medical clinic experiences).

Shadowing helps but I would say that if you had to rank shadowing vs hands-on patient contact, the later would DEFINITELY be more attractive from an application stand point. Both are valueable.
 
You may pass the secondaries, but you'll flunk the interviews.

MD/PhD, they'll ask, why not just PhD?
 
During our Admission Committee discussions we stress the importance of shadowing experience. How does one ever know that medicine or surgery is for them without exposure to the day-to-day life of a physician or surgeon? It is important to see patients with a physician but not to expect to do much physicianship. You should pay attention to cases as I like to ask applicants to tell me about a patient that they saw while shadowing.
The question that comes up in our "faceless adcom" discussions frequently is how much shadowing is enough. My answer is that if either parent is not a physician it is important to gather two or three shadow experiences. These experiences should allow you to answer the question "do I really want to do this kind of work" not "do I have it in me to get through medical school and training" or "is this good enough for the faceless adcoms."
 
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During our Admission Committee discussions we stress the importance of shadowing experience. How does one ever know that medicine or surgery is for them without exposure to the day-to-day life of a physician or surgeon? It is important to see patients with a physician but not to expect to do much physicianship. You should pay attention to cases as I like to ask applicants to tell me about a patient that they saw while shadowing.
The question that comes up in our "faceless adcom" discussions frequently is how much shadowing is enough. My answer is that if either parent is not a physician it is important to gather two or three shadow experiences. These experiences should allow you to answer the question "do I really want to do this kind of work" not "do I have it in me to get through medical school and training" or "is this good enough for the faceless adcoms."

Another adcom on SDN, great, thanks for the input, very helpful!

If an applicant having shadowed allows you to have a conversation with them, or read an essay of theirs, that helps you determine their motivation for medicine, then I would understand that reasoning.

But as a means for applicants deciding for themselves if they are interested in medicine, I always point out, how many premeds drop the process after shadowing? I dont know any. I know tons who have after genchem, or orgo. Premeds I know just do not decide medicine is for them based on their clinical experience or shadowing - they base that decision on something else. They may say they do in an application, but thats another matter...
 
During our Admission Committee discussions we stress the importance of shadowing experience. How does one ever know that medicine or surgery is for them without exposure to the day-to-day life of a physician or surgeon? It is important to see patients with a physician but not to expect to do much physicianship. You should pay attention to cases as I like to ask applicants to tell me about a patient that they saw while shadowing.
The question that comes up in our "faceless adcom" discussions frequently is how much shadowing is enough. My answer is that if either parent is not a physician it is important to gather two or three shadow experiences. These experiences should allow you to answer the question "do I really want to do this kind of work" not "do I have it in me to get through medical school and training" or "is this good enough for the faceless adcoms."

What if we already know what a physician does from other things like being treated by physicians ourselves, observing surgeries on ourselves (even pre-meds get sick) and others, frequent visits to the doctor to care for a family member, etc? Because I feel I know what physicians do on a daily basis without having to shadow, I've seen a lot of gruesome things in the ER room, so instead my volunteer work focuses mainly on patient interaction. What can I do on my application that expresses I know what being a physician is like, without having to shadow? (which I do want to do, but it'll be too late as I will have my app in before that)
 
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