Hello fellow SDNers. I wanted to spark a discussion regarding an issue that I've been thinking extensively about since the beginning of last summer and that is the goals, nature of, and success of the current medical school admissions process. I ran several of these ideas and suggestions past the Dean for Medical Education at the school I'm currently doing research at and was surprised to receive positive feedback and genuine interest in some of these points. Was curious to hear what people (especially current and former applicants) thought.
It appears to me and many of my pre-med friends and acquaintances that the current system of med school admissions feels extremely contrived, with artificial hoops set-up for no discernible purpose than to please some bigwigs or administrators sitting on admissions committees. Schools are often extremely vague about what they're looking for. It seems that much of the process is "fake" and rewards mindless box-checking/conforming to certain requirements than really preparing oneself for a career in medicine. If we're really honest with ourselves, we would admit that this process has at least somewhat affected how we structure or schedules/ECs/summers and the thought of medical school is always looming in the back of our minds as we go through undergrad.
Applications for residency/post-graduate training differ significantly from those for medical school. As is well known, residency directors look at 1. USMLE Step I score (in order to have a standard for comparing all applicants) 2. Clerkship grades (are you a strong clinician? can you work with other residents/attendings?) 3. Letters of recommendation from physicians (very field dependent but writers are often from the specialty you're applying to) 4. Research (are you committed to academics/advancing the field? More so at top programs). They care very little about anything else. Some cool ECs and volunteering may be good talking points but they never make or break an application. People want to know a) Are you smart? b) Can you be a good physician with whom we can work with for the next 3-7 years? The whole process seems much more intuitive, almost like applying for any normal job.
Now, what if we can extend some of these principles in order to make medical school admissions look more like residency applications? I've heard of some people advocating for a match system in order to minimize waitlisting, which is an interesting but slightly different discussion. First, we must establish "the point" of the whole system. How can we find people who will make excellent physicians and advance the field we're so passionately about? I think the crucial questions that we must ask are 1) Are you a smart individual? Will you be able to successfully graduate from medical school and become licensed? 2) Are you interested in medicine?What makes you passionate about the field? 3) Are you somebody with whom people can work?
In order to better answer these questions, I'd like to propose the following modifications:
1. MCAT + GPA: These should be very heavily favored a la Step I.
2. Eliminate ridiculous cut-offs that some committees have in terms of box checking. A personal anecdote: My SO who is on the committee of a top 5 med school at my undergrad told me that a 3.9+ from Princeton with good research, no red flags, worked through college to support themselves, and who spent 2 years in Colombia streamlining healthcare delivery systems got dinged because of insufficient shadowing. "How do we know he's really interested in medicine, they asked." These kinds of attitudes from members who aren't even physicians (see point 4) are ridiculous and archaic. There should be no cutoffs for clinical experience/shadowing, volunteering, or other requirements. The resume padding that occurs among pre-meds is wildly rampant (I myself am guilty of this) and really isn't productive for anybody or makes a good use of students' time. I've seen posts on SDN that boast getting 100000 hours of hospital volunteering just to one-up somebody else.
3. Make requirements for letters of recommendation more flexible. In a college environment, interacting with professors (particularly science professors) is fairly difficult without some major outside involvement like performing research with your science professor or having him/her as an adviser for your student organization. When applying this cycle, I felt that the people who really knew best were NOT my science professors who lectured from power-point slides but were physicians who I shadowed, my PIs, and EC/student org advisers. Personally, I think this point needs to be discussed/addressed. I chose to present an abstract (on a topic I was not remotely interested in) with one of my science profs in order to better get to know them for a rec letter. This "playing the game" shouldn't be necessary.
4. Make admissions committees MD only (except for screeners). I personally believe that you should not be permitted to assess students' suitability to pursue a degree which you yourself do not possess. Some of the administrators/PhDs on these committees have no idea what real medicine is like (I'm not claiming I do either) and have no idea how out of touch this process is with the reality of pre-medical preparation. Some of them genuinely believe that people who spend a couple hours a week tutoring or going on 2 week trips to Guatemala (never to be seen again) are somehow more compassionate than those who don't.
5. Repeal MMI interviewing in favor of traditional interviews. The whole notion that setting up a bunch of contrived scenarios is somehow better than speaking with and getting to know an actual person is ridiculous. REAL patient interactions occur in the traditional fashion. Residency interviews occur in the same 1 v 1 way. You need to learn how to present your thoughts/ideas/story in a cogent manner to any person who is sitting in front of you. That is real life and nobody will be asking you what you would do if you crashed into a BMW in the parking lot. The most natural solution to this in my view would be to have residency application style "speed-dating" interviews with multiple people.
6. Convert affirmative action utilizing race into an affirmative action system that takes into account socioeconomic status. The latter method would incorporate indigent individuals of ALL races. At several of my interviews/second looks, the vast majority of URM students were super rich and attended private schools. There is absolutely no way that they were more disadvantaged than an Asian or Caucasian growing up in coal country or more likely to serve URM groups in the future. They all admitted to wanting to pursue derm/plastics and open up private practices. Obviously, this is highly controversial and anecdotal but an affirmative action system utilizing socioeconomic status intuitively seems more fair and may better differentiate those who are more likely to practice in underserved areas. Asking individuals who checked the URM box additional questions regarding their ties to certain groups during interviews can also help address this.
Full disclosure: I was very fortunate to be successful this past cycle. This does not, however, mean that I support all of the aspects of medical school admissions or believe that there should not be serious changes to the system. I'd love to hear what other people think.
