(Adapted from a presentation by Sylvia Robertson, Asst. Dean for Administration and Finance, Pritzker School of Medicine, Univ. of Chicago, at the Medical School Admission Seminar, November 1, 2003)

What do medical students wish they had known when they applied?

Partly, that admission to medical school is not all about the numbers (grades and MCAT scores). Medical schools do not want to accept students who will be a failure in medical school because they have not taken a rigorous science curriculum and are not capable of success in medical school. The numbers and grades can suggest whether the applicant has an adequate background and ability, but they are not the only important factors in choosing among applicants.

Applicants with a GPA of over 3.7 and MCAT scores of 11's are routinely rejected by medical schools--Why?

The schools are looking for more than numbers--in addition, they are looking for signs of inner strength and many other qualities. A physician should be a person who places a high value on humanism, self control, altruism, knowledge, skill, and duty, and who is willing to dedicate his/her life to service to others. The concept of duty includes taking responsibility for your own actions, being service oriented, and feeling an obligation to other people and a responsibility to society. Knowledge of science and medicine and personal ability contribute to skillfulness. Knowledge of cultural issues, acceptance of diversity in patients and colleagues, and ability to communication effectively with people whose backgrounds are not similar to one's own are valuable attributes for a physician. A well-rounded liberal education in a person who is emotionally, physically, and mentally healthy is likely to support these skills.

Questions applicants should ask themselves include:
 

• Are you willing to make sacrifices for another person? If not, why not? If so, when? For whom?
• Do people trust you? Why? Should they trust you with their lives? Who do you trust and why?
• Are you comfortable with your usual role on a team? Is it leader, follower, facilitator, information source?
• How do you respond to failure and loss? Have you helped other people through failure or loss?
• Can you accept that you can't learn and control everything?

The Arnold P. Gold Foundation (a public foundation dedicated to humanism in medicine) held a national symposium in 1998 co-hosted with the University of Chicago to discuss the barriers to sustaining humanism in medical education imposed by the medical school admissions process. As part of this symposium, the participants proposed attributes desirable in physicians. Medical school applicants should demonstrate these nine attributes in both their applications and in their interviews.

1. Integrity:
   • Do you take responsibility for your own actions?
   • Do you exhibit a concern for truth, right, fairness, opposition to injustice? Examples?
   • How do you handle mistakes?
   • Do you have the confidence of others?
   • What are your core values and beliefs?
   • How do you reach a right decision in an ethical situation?
2. Respect for others:
   • How have you demonstrated your esteem for others?
   • How have you celebrated cultural differences?
   • Are you culturally competent?
   • Have you pushed your comfort zone by interacting with others from different backgrounds from your own?
   • Who do you describe as a "difficult" person or patient? (Your answer should not show disrespect or a lack of understanding of the difficulty of being a sick person.)
   • Avoid stereotypes, generalizations; avoid describing groups of people as "those" people.
3. Empathy:
   • How well do you understand the needs and feelings of others?
   • Do you exhibit kindness, compassion and respect for others, on a daily basis?
   • Have you experienced diverse types of failure and loss? How have you dealt with failure and loss? Has it given you any insight into how others feel?
   • How have you dealt with someone who has different beliefs from yours?
   • Who has served as an empathetic resource for you? Describe the interaction and situation.
   • How will you meet the emotional and interpersonal demands of medical school?
4. Common sense:
   • Do you reject simple solutions in favor of more complex ones? (Could you reject a treatment plan that is unrealistic in terms of the patient's lifestyle?)
   • Do you have unrealistic expectations of yourself and others?
   • Do you choose practical solutions that make sense rather than valuing superficial appearances? (Could you choose to wear boots to an interview on a rainy, muddy day?)
   • Do you have much common sense? Or not? Examples?
   • Do you value common sense?
   • How do you go about solving problems?
   • How do you set priorities? How do you choose the right thing to do first in a crisis?
5. Maturity:
   • Are you demonstrating a lack of maturity by applying to medical school before you are ready and before you have taken sufficient coursework to be well prepared?
   • Does your personal statement show a lack of responsibility for your actions, by laying the blame for deficiencies on others?
   • Have you made a sustained committment to your extracurricular activities?
   • Do your high school experiences make up a more important part of your life and your personal statement than your more recent experiences?
   • How open are you to criticism? Can you learn from it? Does it make you defensive?
   • Are you in control of your moods and your anger?
   • Have you learned to focus your efforts and achieve your goals even if there are personal distractions complicating your life?
6. Motivation:
   • Examine it!
   • Are you clear about your ability to sustain a committment to medicine? Can you put it into words, with examples from your experience?
   • Do you have a real passion for lifelong learning, especially about science?
   • Are you truly dedicated to service to others, no matter how hard or costly?
   • Are you dedicated to excellence in your profession?
   • Is there any other career path that appeals to you, even as a back-up plan?
   • Do you have a family? How are they involved in your decision? Will you have their emotional support?
   • Are you relying on motivation based on a decision made as a child? Have you reexamined such a decision as an adult?
7. Inner strength:
   • Can you deal with happy, healthy patients? What about depressed, overstressed patients?
   • What about patients who are noncompliant--can't or won't do what you tell them to do?
   • What about terminally ill patients? What about an athlete who faces the loss of a leg?
   • How could you help a person who is out of control, exhibiting self-destructive behavior find a way to face their problems and deal with them effectively?
   • Do you know how to find the appropriate resources to help your patients?
   • How do you respond to challenges--to your knowledge, to your authority, to your self-esteem?
   • Do you require perfection of yourself and others? How do you react to a lack of perfection in yourself and others?
   • Are you calm under presssure? Or not? How do react in a crisis situation, and how do you react after one is over?
   • Do you withdraw into yourself or turn to others in a crisis? Who do you turn to, if you do? Why?
8. Personal effectiveness:
   • How do you relate to others?
   • Do you have a sense of humor? Do others appreciate it?
   • Do you inspire confidence and trust in others?
   • Can you function as an effective leader?
   • What is your motivation for leadership? To obtain power? To achieve goals? To reach a concensus?
   • Do others find you a comfort in group settings? Are you supportive, reassuring? Do you smile?
9. Dedication to service:
   • The demands, tasks, and rewards of being a physician require a committment to service.
   • Have you made such a committment to service others? How? Why?
   • What activities demonstrate that you can be a servant to others?
   • How do you see the impact of your committment on others?

(Adapted from a presentation by Erin Graham, Director of Admissions, SIU School of Medicine, at the Medical School Admission Seminar, November 1, 2003)

Are you a non-traditional applicant? Are you a non-science major, or older than most applicants? Or both?

If so, you may have concerns that are different from other applicants.

MYTH: You are too old to go to medical school.

REALITY: The age at which you enter medical school is a personal choice, and depends on how you deal with the problems of time, sacrifice and cost that medical school involves. SIU School of Medicine graduated a woman over 50 last year.

There is no need to hurry to finish the courses necessary to prepare you for medical school. It is a sign of maturity to plan a curriculum that will make you a competitive applicant, no matter how old you are. Taking the minimum number of science courses to meet the requirements is not enough. A non-traditional student, even more than a traditional one, has to be better than the competition in terms of their credentials. You need upper level biology courses (such as microbiology, cell biology, biochemistry, advanced physiology) not only to be successful in medical school, but to be a competitive applicant, no matter what your major is.

You need to think realistically about the demands of medicine and medical school. Considerations:

• What do you know about medicine as a way of life? (see the section called Beyond the Numbers.) Have you shadowed a physician? Can you get a job in a clinical setting? Will you be able to give up your present job in order to get one in a clinical setting?
• Have you considered the cost of medical school? The average debt of students graduating from SIU School of Medicine, a state school, is $90,000 (including undergraduate and medical school expenses).
• Medical school requires time. Not just in the years of education and residency, but time away from your family and friends.
• How will you deal with the stress of medical school--on you, on your family? Anxiety, stress, fatigue are part of the life of a medical school student. Will you have the emotional support of your family?

How can a non-traditional applicant compete with a traditional applicant?
A non-traditional applicant may have a variety of experiences that the traditional applicant does not. Your life experience is valuable. The experience of having and keeping a full-time job is important. Having supported yourself and perhaps a family is a responsibility that many younger students may not have had to accept. If you have had a different major or a different career from most students, you will have a different perspective on patients and on the practice of medicine that you can communicate to other students. Usually, non-traditional applicants are among the most dedicated medical students, because they have made more sacrifices to get to the point of applying to medical school.

Non-traditional applicants are often hard for admissions committees to evaluate. If the applicant had good grades, but took the coursework a long time ago, it may help to take higher level courses before applying. Most admissions committees look at the most recent coursework, usually science courses. If the applicant had poor grades when he/she was in college before, then he/she needs to prove that he/she can do better now. If the student is truly more capable and more focused now than they were before, he/she will be able to earn high grades (only A's and B's) in the current upper level science coursework. It will be necessary to explain the previous year(s) of poor grades and to show that he/she is not the same person now as before. A non-traditional applicant may have to do twice as much work as a traditional applicant to prove that they are a competitive applicant.

When you are applying, provide evidence of your determination to be a competitive applicant, of your maturity, and of useful experience that has contributed to your committment to medicine. Your depth of coursework and knowledge in science should be comparable to that of a new graduate. Your grades in upper level courses are the most important. You certainly need to take the minimum required courses, but you also need to go beyond that to be a competitive applicant.

Various other considerations:

• The MCAT scores are even more important for non-traditional applicants than for traditional ones. Strive for 9's and 10's (range 0-15). There is no substitute for good scores, except better ones.
• Time utilization: How do you fill your day outside of class? Are you working? Taking night courses? Other activities? Family? Kids?
• On AMCAS application, list everything you did post-high school, even if your undergraduate years were a long time ago. Include college extracurricular activities, even if they weren't medically oriented. They will look at old course loads (15/semester), and new grades (should be A's and B's). Non-science coursework is important too. Your ability to manage a full course load plus your other activities is evidence of your study habits and other skills.
• Who you are, what is important to you, your character--these are evident from what you've done with your time.
• Letters of recommendation/evaluation: If you have no pre-medical advisor, it is ok to have letters sent directly to the schools that you receive secondary/supplementary applications from. Usually you should be prepared to supply 3 academic letters (preferably science instructors) and 1 letter from a non-academic source, such as a physician or employer. These should be recent letters, from instructors in recent coursework.
• Be knowledgeable about the field of medicine. You should have investigated the current events in medicine, current ethical issues, advances in diagnosis and treatment, etc., before you consider yourself ready for an interview.
• Slow down! Don't let age pressure you into a hurried preparation. Do the work that's necessary to make yourself competitive and well-prepared. The minimum required courses are not enough. 70% of successful applicants have taken biochemistry; nearly 100% have taken cell and molecular biology.
• Financial aid: Be prepared to fill out FAFSA forms. Most people get loans for medical school. You may have to give up some aspects of your current lifestyle and make do with less for several years. Previous credit problems can be trouble for getting loans, so clear up such problems before you need the loans.
• Poor science grades? If they were 1 or 2 years ago, work on a master's degree to show you are capable of higher level science work. If they were 10 years ago, consider a post-bacchalaureate preparation program and repeat courses in which you did poorly.
• Past GPA problems? Most schools have a minimum GPA for screening applicants. SIU focuses on the most recent 60 credit hours and looks for a minimum 2.7 GPA in undergraduate and post-bacch courses combined. Not all schools do that. If your overall grades are lower than the mean (3.56), schools will look harder at your MCAT scores.
• Calculus: Some schools require it; SIU doesn't.
• Most schools will not be concerned that you attended many different schools to get the courses you need to apply. It may be hard to find night offerings of upper level science classes, but keep looking (U of Ill Springfield offers some).
• Some schools worry if you have a large number of hours from a community college (Northwestern, for instance); SIU doesn't care so much.
• Graduate school: A master's program may be a good idea, but one in a "soft" science (e.g., public health, psychology) is not as helpful as one in a "hard" science (biology, chemistry, physics). If you didn't do so well (low GPA) in the sciences, you should have a heavy load of hard upper level sciences for your master's degree.
• Single parents will not be able to spend as much time with their family. They will need a support person that can become a surrogate parent even more than most parents during medical school and should choose a school closer to their family if possible.
• MCAT: Scores can be 2 or 3 years old for some schools. SIU considers scores no more than two years old, and especially the most recent set of scores. SIU doesn't mix subtest scores from different MCAT's; some schools may.
• Research: More important for research-oriented schools like U of Chicago and Northwestern; less important for SIU, which is more focused on primary care/family practice/pediatrics/internal medicine.
• Secondary applications: Why are you choosing that particular school? Research the school--particularly the curriculum. How does your choice reflect your personal characteristics?