The Premed Years | Medical School Headquarters | MCAT | AMCAS | Interviews

By Ryan Gray, MD of Meded Media

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The Premed Years is an extension of MedicalSchoolHQ.net. Started by Ryan Gray and his wife Allison who are both physicians, it is another means of bringing valuable information to pre med students and medical students. With interviews with deans of medical schools, chats with trusted, valuable advisors and up-to-date news, The Premed Years and MedicalSchoolHQ.net are the goto resources for all things related to the path to medical school. We are here to help you figure out the medical school requirements. We will show you how to answer the hard questions during your medical school interviews. What is a good MCAT Score? What is the best MCAT Prep? What the heck is the AMCAS? What is the best undergraduate program? What is medical school like? What so you do to volunteer and shadow? Get your questions answered here.

Episode Date
298: Professor to Premed, How Indentifing as LGBT Affected Apps
41:02

Session 298

Sarah is starting med school this fall and is excited to begin. Listen to her story and how identifying as LGBT affected her med school applications.

I helped Sarah with her applications. She took a nontraditional journey to get to medicine. As a college premed, she found another passion and then came back to premed. Ultimately, she's now starting medical school.

If you need any help in your medical school application, maybe we can help. Find out all the services we offer and let us be a part of your journey to medical school. Also, don’t forget to check out all our other podcasts on MedEd Media Network.

[01:30] Interest in Becoming a Physician

Sarah describes it as a long and winding road. Her mom passed away from breast cancer when Sarah was 7. At 11, her dad remarried a surgeon. So she was around medicine at a very early age.

Going to college, she was premed and shadowed her stepmom in high school and thought it was actually cool. On the other hand, her brother was accepted to medical school when he was a senior in high school. That said, she had a lot of medical influence from her family.

When she was in college, she started tutoring and discovered she loved teaching. So she decided to be a teacher than a doctor. Hence, she began to pursue a career in education. She then got her Master's and taught for three years. After which, she felt not as satisfied and started thinking again about going back to medical school.

Although the school got rid of this now, but part of the early acceptance program (which his brother got) was to initially give premeds more flexibility. This means no need for MCAT or they didn't have to major in science and take all the prereqs. Apparently, they could take whatever they wanted.

[05:40] Her Love of Tutoring and The Premed Culture

Sarah admits to really like tutoring and she actually got into it by accident since she needed a job. She saw an ad and applied for it. In the sense of seeking opportunities in the premed field, she wasn't very active.

"I thought I knew everything already about it having doctors in my family and so I didn't think that I needed to see more."

Sarah actually lived with a bunch of premeds in the dorm during her first year which she found to be very interesting. But she didn't really pursue going to the hospital and shadowing. Why? Because she thought she already knew everything about it having doctors in her family. But she thinks this is wrong. But at 19, it wasn't that surprising for her to think such.

Additionally, she really didn't think she connected well with the premeds she lived with on that floor. So she didn't feel like they were her people and this pushed her away from it. In hindsight, she realizes she may have found premeds that were her people.

"I didn't necessarily connect with some of the other premeds who lived on my floor. I didn't feel like those were my people. That kind of pushed me away from it."

By "not her people," Sarah describes it as it felt like everybody was out there trying to prove themselves and that they were more interested in medicine than you were. Also, she was curious about other things and to explore other parts of life, something those other premeds didn't have so she saw their personalities diverging.

[09:00] The Life of a Physician's Child

Interestingly, most people think that just because you're a child of a physician that you want to do that as well. For Sarah, she describes that having physicians in her family both helped her and also kind of discouraged her to do medicine. As you can really see from a close perspective of how much work it can be and how challenging of a career it can be.

So this has given her a lot of great perspective. But in as far as going through college, this pushed her away a little bit.

While she was tutoring, she was pretty committed to working in higher education. In fact, she did put medicine off the table completely. But the rest of her family didn't, encouraging her to take medicine every now and then. So for a while, her focus was on her higher education until she realized it's not what she wanted to do.

[12:10] The Aha! Moment

After getting her Master's she realized she no longer wanted to get PhD in Geology. And this has put her in a place where she wanted to move forward in her career but she wasn't happy with where she is. However, she doesn't want to get a PhD and move on in higher education. So she was trying to look for a career where she had everything she was looking for.

"What I love about teaching and I think there's a ton of overlap with medicine, is that you really impact people, you help people, you work with people everyday."

Seeing the commonalities between teaching and medicine, Sarah began to consider becoming a doctor. So she started having discussions with family members and friends. Then she also started to shadow and continued on to do volunteering and getting more involved to make sure it was something she really wanted to do.

She discovered that she loved everything she was doing that was medically related - shadowing, science, patient interaction, and impacting people. These were all important to her. She also volunteered in hospice to test if she would really like working in really hard situations with patients. She also found surgery as the coolest thing ever!

[16:15] Figuring Out the Next Steps: Call the Medical Schools

Being several years from being a "premed," Sarah went to one four-year university and talked to their premed advisors, who were negative about her application. They said her academic coursework was so old (nobody's going to accept it) and she was told to take a year to do some clinical or patient care experience, saying she didn't have very much of it.

True enough, some of the courses on the MCAT she took eight to ten years ago. Anyway, she did her research. She called other universities and asked them. She got different results from the medical schools. Some said it was okay, others were a bit concerned but they said they still wouldn't reject the application just because of that. Predictably, the ones that said they'd be concerned, she didn't get interviews from.

"I do think it's really worth listening well if you do call a medical school and talk to them to how they respond to your questions."

Sarah was interested in these two school and so called them and tried to build a relationship with them. For her, one school worked while the other wasn't very open to it. But she thought it was advantageous that she had not yet applied.

Another barrier she ran into is that she has been out of school for so long. She did her premed requirements back in undergrad, except for one class. But that was a while ago. Plus the fact that schools ask for two letters from professors. So she called and asked about this telling them she only had one letter and asked what else she needed to do. Again, some were open to it, others weren't.

Sarah recommends that if you're calling schools is that be mindful of when you are calling them. During interview season and during application season, they're very busy. So be  more polite as to not take too much of their time.

[23:30] Picking Schools to Apply To

Sarah only applied to MD schools. She did seek a lot of advice regarding this and she found out that there certain things more fluid at MD schools such as clinical rotations.

Okay, to help you understand this better, the majority of DO schools aren't affiliated with big, academic hospitals like the majority of MD schools are. And so it can make things a little bit more complicated for DO students.

Also, having two MDs in her family, she was told going to a DO schools i s great, although clinical experience might be significantly different. Also, they reminded her in terms of the bias in terms of the clinical specialties. So she didn't want t put herself into a position where she would have trouble matching.

"The majority of DO schools aren't affiliated with big, academic hospitals like the majority of MD schools are."

As far as geography, she wasn't opposed to the fact that she'd be moving since she's single anyway. She did look at midwest schools to be closer to her family. And then a few in the west, a few in the east, and a few in the south. In short, she applied broadly to a total of 20 schools.

As part of her sorting process, she read stuff like mission statements and looking at programs she felt were aligned with who she was as a nontraditional student. She also looked at places where she could do rock-climbing which she loves.

[28:11] Challenges During Medical School Application and Identifying as LGBT

For Sarah, the hardest thing was the waiting game as it could become a year-long thing and this was very stressful for her.

"I was just waiting and you don't know how long you're going to be waiting."

Moreover, Sarah identifies herself as and LGBT and this is a big part of an application. So many schools now for secondaries are asking questions about this. For her, incorporating this into her application was a very difficult decision for her. She was very worried how people would take it but she realized that identifying herself as bi and how it shaped her and her experiences has a lot of influence on what she wanted to do in medical school. She wants to be involved in LGBT groups and advocacy. And she wanted to be a physician advocate for obese populations.

"Identifying as Bi and how it shaped me and the experiences I've had with that really is going to influence my future career. It influences what I wanted to do in medical school."

So she really things being LGBT ties strongly with her career what she was looking forward to in medical school. Hence, it's very important to her that she did include this.

When she was doing her research on schools to apply to, she did look for this and got mixed results. Most schools have this statement that they have an LGBT student group. But she thinks you don't know what it really looks like. So it was something she didn't want to seek out the information for. It's funny even how one school listed that they had a group but when she asked some of students, they didn't even know about it.

Surprisingly, Sarah said no interviewer has brought this up. She thought this was interesting. In fact the questions she got about diversity were more general questions. So it didn't come up unless she directly brought it up.

Sarah recalls using a variety strategies. She had four interview by the way. In her first couple of interviews, she was open about it and talked about it. Some seemed to be positive while she felt the others were the opposite, saying the interviewing would cool off as they didn't really know how to respond.

As a result of the mixed experiences she got, she became more cautious about talking about it. So she didn't talk about it in her last interviews. So she only talked about diversity in general and how she wanted to be an advocate for underrepresented groups, without necessarily singling out one group.

[35:55] What Led to a Successful Application

"It's a multi-faceted thing."

Sarah explains there are so many factors going into the application. It helps to have good MCAT and GPA. It helps to work hard to fill in everything - volunteering, research, leadership. In particular, she found it very important to spend time in self-reflection thinking about who she was and how this was going to play out in her future career and how that formed her to be who she is today. By being really honest and spending a lot of time into this, really helped her a lot throughout this whole process. Sarah and I worked together on her personal statement. She actually had 15 or 16 drafts of it.

Sarah's advice for those who are part of an underrepresented group and wondering whether they should bring it up in the application or the interview is that you have to spend a lot of time thinking about who you are and what's important to you. Although it was scary for her to talk about it since it was really personal to her, she also felt it was something meaningful so she thought it was something she should share. Again, this all goes back to knowing yourself, do you want to do this, do you think this makes your application meaningful, and is this important for you.

"Spend a lot of time thinking about who you are and what's important to you."

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If you need any help in your medical school application, maybe we can help. Find out all the services we offer and let us be a part of your journey to medical school.

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Aug 08, 2018
297: What If You've Applied and Your MCAT Score Is Not Good?
20:42

Session 297

If you've not taken my advice and pushed your MCAT back until June or July, you may be in for a rude awakening when you see your score. What should you do?

A brief story, the MCAT scores were released at the end of this month (July) and two students I’m working with specifically got scores that aren't what they wanted,not what they expected it to be.

“Their scores weren't where they wanted them to be, not they weren't where they expected them to be.”

Meanwhile, don’t forget to check out all our other amazing episodes on MedEd Media as you walk through this journey towards medical school and beyond.

[02:10] Applying to Only One School

This a strategy several students do, for which I was used to be against this. But now, I'm starting to come around to it a bit. I can understand from the perspective of students the safety it gives you. That said, I'm not 100% sold on it.

I'm talking about only applying to one school when you submit your application because you don't have your MCAT score back yet.

Now, if you've followed my advice from the beginning, you would have taken the MCAT at the latest, March or April of the year you're applying. That means you would have your score back by the time you submit your application. You would know your score and hopefully, have the confidence to apply to more than one school.

But if you're not taking the MCAT until you submit your application, then you're lacking confidence in your score. But you know you have to apply early. So you end up only applying to only one school.

Talking with this student, she got a 495 and her highest score on the practice test was 500 and the other AAMC full-length exams were 494s. So it was the score she was supposed to be.

[04:40] Practice Tests: How Far Are They From Your Real MCAT Score?

I always talk about how practice tests being the best way to practice for the MCAT. And what you're scoring on the practice test should be about equivalent to what you will score on the real thing. But they don't take into account the obvious fact that stress happens. Real test day jitters get to you.

Walking into the library to simulate an MCAT test don't affect you the same way that the real MCAT will. Hence, it's not unusual to score lower on the real MCAT than you did in your practice test. So don't be surprised and think it's a glitch in the system. It just happens. Sometimes, some students score much better on the real test. But then again, you can't expect for a miracle on the test day.

"Your anxiety levels are different during the real test than doing the practice test."

[06:35] Using the URM Card

So this student had a mediocre undergrad GPA with great extracurricular activities, great background, great story. She's a URM (underrepresented in medicine) and that adds to it. So what do you do with a 495? Do you apply and hope there's something in your application medical schools will like? Are you a URM? Do you play that card?

"There's a reason we use race in admissions because we need diversity in medical schools. We need diversity with our practicing physicians."

Data shows, unfortunately, that because of the biases built into our system, that African Americans were significantly less or lower on the MCAT than Caucasians and Asians. But this doesn't mean they should be punished for it. That's why when you look at acceptance rates, MCAT score-wise they're lower. As to why, there a lot of reasons for that.

So what do you do then?

[08:40] Option #1: Apply.

One thing I always tell students along this process and in the Medical School Hangout Group is to ask the admission committees of the schools you're interested in applying to and lay out your cards. Tell them your story and that you're an URM. Ask whether they have minimum cutoffs for URM students. They may take a 495 and they'll look at you. Or they may say no.

"Ask the schools. Go to them. Don't ask your premed advisor. Don't ask Reddit. Don't ask SDN. Don't ask in the Hangout. Ask the schools."

Ask the school what to do next and where do you go from here. They may tell you to apply, or not. Or they may tell you to apply and retake the MCAT. Hence, the first option is to apply. Spray and pray.

"Spray and pray. Spray your application to as many schools as possible and hope that one looks at it and goes, we'll take a chance and write you for an interview."

[10:55] Option #2: Retake the MCAT

Since you've already applied and pushed forward, the other option is to retake the MCAT. This depends on when you took the MCAT, when you got your score back, and when you can retake the MCAT. Hopefully, you get to practice to raise your score otherwise if you get the same score in your practice test, there's no point in retaking the MCAT.

If you're scoring higher in your practice test and then you took the MCAT and got lower, then something went wrong on test day. Go and take the test as soon as possible. Refresh your memory if it's been a month since you've taken it. Go take some more practice tests. Take the test as soon as you can. Keep your applications going as well as your secondaries. Go and do the best you can do on the MCAT.

[12:00] Option #3: Withdraw Your Applications

The third option is to call it quits for this cycle. And it's just this cycle so it's not a failed attempt. This doesn't mean your dream of becoming a physician is over. It just means it's going to be delayed for another year. And that's okay. This may give you time to save up some money for the next application cycle and for some MCAT tutoring.You can save up some money so you could reduce your work hours so you can focus on the MCAT and do more volunteer activities, more shadowing, and more clinical experience. You have more time to focus to bolster your application.

"You're not a failure. Scoring low on the MCAT does not mean that you can't be a physician. It just means you didn't do well on the MCAT."

But since you're looking at your MCAT score and thinking it's not what you wanted to be, then obviously, focus on the MCAT. Don't distract yourself with thinking you're taking a year off to study for the MCAT, might as well do a Master's. You're supposed to be studying for the MCAT. That is your kryptonite, at least right now. So go study for the MCAT.

[13:41] Be Self-Aware and Get a Tutor

If studying on your own has proven that it didn't work for you then get a tutor. Have a tutor look at you, at your studying, your techniques, your test-taking abilities and have them offer you advice on how to move forward.

You can check out Next Step Test Prep and get a tutor. Use the promo code MSHQ to save some money. Ask them to help you figure out where you did wrong with your practice tests. Not all of you are going to need a tutor to go all over the content or the practice tests. While some of you need that, others don't.

So if you think you've got the content under control, maybe it's worth a phone call to Next Step. Tell them you need a tutor to go over a practice test or two with you to figure out where you're going wrong and help you break down the questions and see where your thought process is leading you astray. Otherwise, you're just shooting yourself in the foot and end up in the same place as you are right now, scratching your head wondering why and if this is meant for you.

"You have to also look at the process that led you to the score that you got, and that process needs to change."

[17:00] In Prep for the Boards

Keep in mind that once you're in medical school and you're taking the boards, there's no retaking it unless you fail. You get the score you get. So you need to start practicing to do really well in these kinds of tests. You need to figure out how to do well in large standardized tests and that starts today.

So as you move forward and you're already in the middle of the application and you've submitted your applications, there are several things to do.

[17:50] Why It's Great to Delay It to the Next Year

"Understand that this is not the end of the line for your medical career. This is just a hiccup in the road."

If you only applied to one school then maybe that's great, because when you apply to schools next year, you're not a reapplicant to them and they haven't seen your personal statement so you don't have to change that much. If you're prewritten your secondaries while waiting for the MCAT score, all that stuff is already done so great! You've already asked for letters of recommendation. So you're stress-free. If you're going to reapply next year, most of your work is done. You'd only have to focus on the MCAT.

But then again, you have to know why you failed in the first place. Do not go running to forums and strangers. They can tell you to go apply to a Caribbean school or a DO school. Anybody who doesn't have a say in the medical school admissions world, you should not be asking questions to.

"But unless you're hearing it from an admissions committee member at a school you want to apply to, ignore it. It's just noise."

Lastly, if you're taking some time off, continue to be consistent with your shadowing and with your extracurricular activities and all of that. Because since you're applying in a year, you still need to do all those stuff and you need to be consistent with it.

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Aug 01, 2018
296: What are Med School Red Flags & How Do You Talk About Them?
37:38

Session 296

Red flags seem to confuse a lot of students. They come up in applications and interviews and you need to be prepared to talk about them. But what is really a red flag? And how do you overcome them? Do you talk about them in your application? These and more in this episode today!

Do you need some help with your interview process? Start with episodes found in this podcast including Episode 19 with Dr. Norma Wagner, the former Dean of Admissions at three different medical schools. Then work your way through and find those interview episodes to get you going.

The Premed Playbook: Guide to the Medical School Interview is now available at Barnes and Noble and Amazon. If you need more help, check out the interview platform, an anytime mock interview platform where you log in and get access to it monthly. It records you as questions pop up on the screen in front of you. The key to interview prep is recording yourself and getting feedback. This platform allows you to record yourself. Just click a button and email it to a mentor, advisor, or whoever to get some feedback. It also includes a built-in assessment for you. Coming soon, we have an interview course. So stay tuned!

[03:35] What is a Red Flag?

There's this mentality that as a premed student you have to be perfect. Otherwise, your dreams of becoming a physician is all over if you get a C+. But a C+ is not a red flag. I see a lot of students applying to medical school and they have horrible grades. Then they work themselves back and they showed that they can handle it. So when you see one C+, don't worry about that. There are a lots of students who got C+ and they did just fine.

"Most of the students I work with are nontraditional students so they have horrendous grades. They have horrendous MCAT scores. Then they work themselves back and they showed that they can handle it."

So what is a red flag? What should you be concerned about as you're preparing your application? How can you start to think like an admissions committee member so that you can start evaluating your application from their eyes? Once you start thinking like them, then things get a little bit clear for you. Then hopefully, you anxiety levels come down.

The red flags I’m going to discuss here are potential red flags. They could be or not, it depends on your situation and whether you’re doing something about them to prove to the medicals school admissions committee that you own them and that you can handle the coursework.

"Own it, learn from it, and move on."

[07:05] Red Flag #1: Arrest

If you've been arrested for anything or charged or convicted of anything, all of those are potential red flags. Depending on how questions are asked of you in the primary and secondary applications and during interviewers, and anything you have to fill out, you may still have to say yes, even if you think it's been erased. Check out Episode 197, where Larry Cohen, a lawyer, talks about how to answer these questions, and what you can and should and shouldn't say. So if you've been arrested and you've been asked by the admissions committee whether if you've been arrested, even if you haven't been convicted, you still have to say yes.

"If you have a huge red flag in your application, you need to own it."

You have to own whatever red flag you have in your application. If you don't own it, you're probably not going to get an interview. I had a discussion with the Director of Admissions at an osteopathic school a few weeks ago when I was in DC for an advisors' conference. They cited one example of a student who got arrested but didn't own it so they didn't accept him.

Again, you have to own it. Then talk about what you've learned from it. Don't make excuses. How have you grown form it and how have you grown more mature? How have you learned your lessons? Tell them what you're doing to work on you as a person so that this doesn't happen again. Some of these red flags may be unavoidable, but at least they're explainable if something comes up. All these red flags are potential red flags because the school doesn't understand the whole picture, especially if they see gaps in it.

"Own it and talk about what you've learned from it."

Being a physician is all about judgment and being arrested for anything show potential poor judgment. As kids, we're expected to do so. But if they see you’ve been arrested over and over, then that’s a red flag.

[15:22] Red Flag #2: Disciplinary Actions for Cheating

If you had any cheating or plagiarism on your record, that's a huge red flag. Cheating your way to medical school is not going to look good. If it happened during Freshman year and you've learned from it and you've grown, with no other issues the rest of your time, then great. Again, own it. Don't make excuses. Say what you learned from it.

But if you got caught cheating in your Junior or Senior year, that's going to be a lot harder to overcome because now you don't have a track record of personal growth.

"Anything further back from the past is much easier to overcome than anything recent."

[16:35] Red Flag #3: Downward Trends

If you have a downward trend in your GPA recently or by around the time you're applying to medical school then that's a red flag. If you're stumbling into your application grade-wise then something is up. Are you burned out? Take some time off. Medical school is going to be a lot harder and you're just going to continue to do poorly.

But if you have a downward trend early on, for instance, you take on too many extracurricular activities during Freshmen so you're struggling with your grades, but then you rebound back up and finish strong. As long as you have a good track record past that, and long enough to appease the admissions committee so you can show them that you're okay and you can handle the coursework.

If you have a downward trend going into the application, that's going to be a much harder thing to overcome. And if you get an interview, you have to talk about what's going on.

[19:00] Red Flag #4: DUI

This is another judgment issue. But a lot of good people get behind the wheel and get a DUI. Do you tell the school?

Again, own it. You would rather that you told them about it than them knowing about it from the background check. Own it and learn from it. As humans, we make mistakes and schools understand that.

"It happens. We are humans. We make mistakes. Schools understand that. It just depends on how big the mistake is."

What the medical school is going to think about is the safety of you during school, your classmates' safety during school, and your ability to pass medical school and do well on the boards. They're also thinking about patient safety as you're rotating through hospitals. On top of that, they have to think about your ability to get a medical license after you graduate. As soon as you start thinking like that, and you get those kinds of questions thrown at you, just think about those things.

[22:20] Red Flag #5: Failing Semesters

Even if you have failures in a row, that's a red flag but if you're able to explain that and show them that you've grown from that and you can handle coursework, then no problem and move on. The goal is for you to be able to remove their fears, then they can just move on.

So if you failed out of college or got kick out of it, what are the issues? Own the reason behind it. Don't blame others. Own it. Again, if you failed earlier on, it's going to be easier to apply. But if you fail a semester right before you apply, it's going to be a lot harder to overcome that. You may need to take some time off and do a postbac to get that upward trend going again.

"If you fail a semester right before you apply, it's going to be a lot harder to overcome that."

[23:50] Red Flag #6: Too Many Withdrawals

Again, this depends on the situation. If you withdrew one semester or one year, then it's possible something went on in your life at this time and so you had to withdraw. This shows a level of maturity. Whereas if a student has 16 Fs, it shows a lack of maturity. But that's okay if you're able to give your reason and prove an upward trend.

It will come up of course, but that won't stop you from getting into medical school. Own it. What did you learn from it?

As long as you can explain what happened and the rest of your application looks great, then no problem.

But if you have a couple withdrawals after semester or that you've withdrawn from the same class a couple of times and then you took that same class at a community college and got an A, that is a red flag. Why did you withdraw from the class at a four-year university and end up taking it at a community college?

If you have a great GPA but you're withdrawing every semester from classes, are you just protecting your GPA? That's a red flag.

[26:06] Red Flag #7: Not Enough Shadowing or Clinical Experience

Not enough clinical experience, shadowing, or volunteering, those are red flags. How can they know that you want to be a physician if you don't have enough clinical experience. You have to show them that this is what you want.

Moreover, your application has to be able to show to the reader why you want to be a physician, not what. So you did all these extracurriculars, but why do you want to be a physician? Again, it's the why, not the what. This is a tough one as you may not know about it, until you go in and get grilled during the interview.

"When you're writing your personal statement or secondary essays, everything needs to point to why, not just what."

But what is enough shadowing or clinical experience? There is no set number. It's whatever you want. Just get enough and be able to show the interviewer why you want to be a physician.

[28:22] Red Flag #8: Big Gaps in Your Application

This could mean big gaps in your volunteering, clinical experience, and shadowing. Maybe you shadowed for 300 hours in your first two years of college and nothing since then. That's a red flag. This shows the admissions committee that you just aren't really dedicated to be a physician otherwise you've spent more time being around physicians.

"Consistency is key in all of your extracurriculars. And a lack of consistency with big gaps in it is going to stand out as a potential red flag."

Another example is if you've taken a prolonged time off school. You may have a reason but it's a potential red flag and that's going to get asked. So be prepared to explain why.

[29:39] Issues International Students May Face

These are just of the other red flags out there. But the key here is to put yourself in the shoes of the admissions committee member. Think about safety. Think about being able to pass the boards. Think about matching and are you going to be able to get a medical license?

As for international students where it's so hard to get accepted into medical school, one issue that could prevent you from getting a medical school license is getting a visa. Is this going to be an issue? You could graduate from medical school and you match. But there's an issue with your visa for some reason. This is a huge problem. And medical schools see this as a very big risk so they accept very few, if at all, international students.

[31:45] What is Not a Red Flag?

C+ is not a red flag. F could be a potential red flag. Again, it depends on what happened. Own it, learn from it, and move on.

Your poor first MCAT score is not a red flag. If you've done well the second time, then it's not a red flag. If you take the MCAT back to back or even with some period in between and you get the same score, or worse, that is a potential red flag. What happened that it didn't work the second time?

Below average MCAT score and GPA are not red flags. Be less anxious when going into your interview. If you are there for the interview, that means they've looked at your application, your GPA, and MCAT score. So they've determined based on your application that you are qualified enough to be a student. Not amazing, but not a red flag. They may bring this up but again, tell them about what you've learned.

[34:33] Are Community Colleges a Red Flag?

Community college classes are NOT a red flag. I really hope community colleges are going to be the norm in the future. Not every student knows they want to go to college right after high school. So community college is a good way to figure that out. It's inexpensive. And in some states, it's free. So taking those classes are not a red flag.

There's a lot of discussion in the admissions world that diversity of medical school classes are getting hurt because historically, lower socioeconomic students or minority students are going into community colleges. And the less affluent students are the ones going to four-year universities. But this is going away since many schools frown upon community college classes. So it's hurting the more diverse students coming in.

"It's not a red flag. The tide is changing in that world. So don't worry about your community college classes."

[36:40] Final Thoughts

Be prepared for anything on your application. Know your application inside and out. Have reasons for everything. Own your red flags. Talk about what you've learned from them and how you've moved forward.

Links:

PMY 19: Interview with a Medical School Admissions Expert

The Premed Playbook: Guide to the Medical School Interview is now available at Barnes and Noble and Amazon

mock interview platform

PMY 197: Can You Become a Doctor If You've Been Arrested?

Jul 25, 2018
295: Ignoring Advice, He Disclosed His Bipolar Disorder in Apps
46:37

Session 295

If you're struggling with mental illness and you're debating whether or not to put that in your application, today's interview is something you must listen to.

Logan is currently a rising second-year medical student at Pacific Northwest. He decided to reach out to me after gaining an acceptance and after originally being discouraged way back in Episode 194, where I interviewed Jeff who is legally blind and decided not to disclose his disability in his second application because he didn't get in the first time.

So Logan decided to ignore my advice of leaving off any huge red flags from the application. He was very open about his bipolar disorder.

[02:00] From YouTube to Podcast

Logan was originally a YouTuber, and his first taste of disclosing his bipolar disorder publicly was through this platform. But not being a tech guy and hating filming, he just felt he was putting a facade. And it was through a podcast that he realized he was being his natural self.

Logan likes to be a psychiatrist in the future and so he likes his future patients to be at ease with him in telling him their embarrassing, dark secrets.

[04:03] Interest in Becoming a Physician

Logan only realized he wanted to be a physician some five years ago. He got diagnosed with bipolar disorder at 22, right when he graduated undergrad. Then he worked in insurance and finance after it and hated it. He found it so depressing, even more so than he was diagnosed with the disorder.

So he knew he needed a change. He then started working as a public speaker in the mental health sphere and was giving his story to different institutions and he loved what he was doing. He also worked various roles within mental health but he wasn't sure what he wanted to do initially.

However, having talked with a lot of people, he saw the frustration they had with the medications they were taking as well as the diagnosis. So he wanted to take out a lot of subjectivity around mental health. And rather, find some objective means of understanding these mental illnesses and how to better correct them.

"What really led him to medical school is being able to take out a lot of subjectivity around mental health."

[05:40] The Motivation to Tell His Story

Logan was initially warned by the doctors and social workers about the stigma around mental illness. There could be discrimination and it could jeopardize his career and relationships. So they told him it's not a good idea to tell people outside of your most immediate circle. He was frustrated by this and listened to their advice. He was ashamed of his disorder and didn't tell anybody.

"I lived almost with this cloak of shame and I was really embarrassed about my bipolar disorder. I didn't really tell anybody. It was a horrible way to live."

He continued to live this way for about 18 months until The Sandy Hook Shooting. He grew up in Connecticut, about an hour north of Sandy Hook. So how after that incident gave a perception that people with mental illness were violent, and that they were ticking time bombs, he just found it to be so absurd. He knew it wasn't him. He's not a violent person, never been arrested and never been in a fight. He knew he was a good person and so he wanted to share his story. He wanted to prove everybody wrong. He then joined the Speaker's Bureau and started posting on YouTube about his experiences.

"I want to share my story and show that people with mental illness are not like this. They can be normal people that contribute to society."

[07:30] What Bipolar Disorder Looks Like

Logan describes his disorder as experiencing depression at first. He studied in Scotland and when he got there he was struggling with insomnia that actually lasted for months. He started to have really bad anxiety. He thought all his friends hated him and that his family was disowning him. He was having all these negative thoughts that weren't true and these kept him up late at night. This was what led him to alcohol abuse. He as self-medicating with alcohol to sleep, every night for a year and a half, still getting 2-3 hours of sleep every night.

He describes his moods being all over the place. Then when he graduated from undergrad, it was the same time he broke up with his college girlfriend, resulting in his first manic episode. He describes it being too weird, not sleeping the first night. And by the second night, his words and speech were all over the place. He was rambling. People would come up to him asking him if he was on coke or meth. Not having slept for so many days in a row, he started having auditory hallucinations. He thought the FBI was following him around and hacking his computer. Thankfully, his circle of family and friends was able to intervene and had him check into the psych ward. He also knew that gene existed in his family. His uncle had bipolar disorder who eventually committed suicide. So growing up, he always knew he was susceptible to something like that. It wasn't until that manic episode that he realized something was going on.

He thought it would have come out no matter what but at that time he was experiencing insomnia, he knew he needed sleep. He knew he wanted to sleep but he was still so ashamed of talking to a therapist, much less telling anyone. He didn't tell his parents or his friends about what was going on. But then had he told anyone sooner, it wouldn't have gone so acute. It could have been a little bit friendlier means of diagnosis.

"I wish I just would have talked about it sooner. And I think having that social support and network was really what helped me manage this disorder better."

[12:40] Going to Medical School with Bipolar Disorder

At first, Logan really didn't think he was going to be smart enough for medical school. He was initially looking into nursing programs thinking medical school was just far outside of his capabilities. Then he met a friend in Sacramento who took all the premed requirements at University of Michigan but wasn't sure if it was something he wanted. Dan also knew about Logan's disorder and his interest in improving medicine around bipolar disorder, that he encouraged Logan to try to be a doctor. He gave him some ideas about how to do it, especially that he wasn't a science major. So he began reading articles online. And this was how he eventually found this podcast.

Logan's favorite episodes were those featuring the nontrads who had a similar path to him, going back to school and applying. I fact, his friend told him that he was going to stick out being a nontrad because he might just have a great story to tell.

"You might not be the smartest kid in your class, but you'll be able to stick out in an application, so why not go for it?"

Not coming from a family of doctors, when he told his parents he wanted to abandon his career in insurance and go to medical school, they thought he was out of his mind. It was really that friend who never cast any shadow of doubt. He was super encouraging, telling him he could really do it. And he also realized this was also what he really wanted. Now, he's a year ahead of him Logan in medical schoo.

[15:45] Bringing Up Red Flags in an Application

Jeff, back in Episode 194, was diagnosed as legally blind and he applied to medical school the first time around. He wrote his essays and everything was around being blind and how it affected him that led him down this journey. Unfortunately, he didn't get in anywhere. So his logical conclusion was they must be scared of his disability so he decided not to talk about it when he had to apply again. He was able to see during the day that he really didn't need a walking stick so he was able to go through the entire application process and was accepted. It wasn't until the letters came asking if he needed accommodations that he revealed his condition.

And I've talked about this several times since, about bringing up red flags. I have always recommended trying t not disclose things that are going to be an easy out for the admissions committees.

So when you look at a disability or mental illness, DUIs, alcohol abuse, arrest, etc. they'd be thinking that there are 10,000 other applications here that don't have this so why should they even bother wasting a second with this application.

But Logan decided to tell his story instead. Logan was a voracious listener of this podcast. He describes listening to it every Wednesday when it gets first released. He was just always looking forward to it. And when that podcast 194 came on and he listened, he was just heartbroken. He didn't have any premed advisors but he considered just me and Dan as the closest things to it. In fact, Dan had the same similar stance that it wasn't a good idea to bring it up in the application.

This discouraged Logan that he stopped listening to the podcast for a while. But he bought The Premed Playbook: Guide to the Medical School Interview and he has already been listening a lot to this podcast about developing a personal statement. What he took away from this was that he needed to tell a story.

"Why do you want to go to medical school? That's really the key that every medical school wants to know."

So he sat down trying to figure out any way he can tell his story of why he wanted to go to medical school without disclosing his disability of his mental illness. But he couldn't find any. He knew he would be lying. Unlike Jeff who has always wanted to become a doctor even before his disability, really for Logan, the only reason he wanted to go to medical school was because of his own personal experience. So he thought there was no way he can do this without saying it. He knew it was a big gamble. But he also knew he wanted to be physician no matter what and he didn't care if no US medical school would accept him as he'd go to Canada or Mexico or wherever.

[21:15] Telling His Story and Dealing with Physician Burnout

Logan thought it would have been much harder to tell his story if he didn't disclose otherwise and put on the big face of being the perfect applicant. So during interview days, he would sit there with the other applicants, telling himself that they're not going to say what he was going to say. So he knew he'd be memorable, be it for better or worse.

"I just try to always put it in the perspective of patients. How am I going to be able to help patients feel better because of my experiences?"

His dream is to be able to sit down with patients and just say he's been in their shoes and they can do this. Speaking of the future, where you're being treated for depression and you need to get license by the state, this could be a red flag and there could be potential issues. As to how he would be dealing with this possibility, Logan just thinks of it from another perspective of physician shortage, and especially, psychiatrist shortage. He's aware he could be shutting his doors to certain opportunities. This could be frustrating but he also thinks that people like him are going to be ones leading the future who will be ending this physician burnout or medical student burnout epidemic right now.

In fact, he was so open about his experiences during the interview that he was making other students around him feel more comfortable to seek their own mental healthcare.

[24:40] From the Admissions Committee Standpoint

Logan says one of the things he got asked at almost each school was how he was going to be able to handle this, considering this is probably the most stressful thing he was going to go through. So he knew he had to convince them by telling them that he's not going to tell them that his disorder is perfectly managed. There are going to be days he'd feel depressed and days he'd feel manic. But by being open and allowing people around him, they could help him identify what's going on. He also credits his wife for being the biggest supporter and his family. He recognizes how it's so important to still have a relationship with his therapist and psychiatrist. He had to convince them he'd still be able to do all this.

"I'm not going to sit here and say I'm perfectly recovered because that's just not how mental illness works. But I really had to be strong and challenging when they would ask those difficult questions."

Out of around 28 schools he applied to, he got five interviews, all from osteopathic schools. He thinks this is because maybe they think he's trying to present a holistic recovery to his own recovery of mental illness. It's not just because of the pill that he got better. But he's seeing a therapist, he's actively participating in daily meditation and exercise, and just this holistic philosophy he wants to bring to psychiatry.

"So many patients show up at a psychiatrist's office and they think that they can get a medication that's going to make them feel better tomorrow."

Historically, osteopathic schools are more lenient towards nontrad students and students who have had issues. They like those stories and they think they make better physicians. And I would agree.

And for some reason, the MD world still doesn't value that experience as much, just based on anecdotal stories like Logan's. But I just came from a conference with premed advisors and admissions committee members. I had a conversation with a Director of Admissions for a medical school and we talked about mental illness. She said when something comes across their desk, it's prior drug use, alcohol use, mental illness, they have to think about "what if" or it's irresponsible not to. First thing is safety. Second thing is whether other students are going to be safe. So they think about safety for everybody, especially the students. Then they also think that if they'd give the seat, is this student going to be able to finish school? Otherwise if you had to delay the school for a year for some reason, that's going to be a black mark on the school since the student couldn't finish in four years. And schools are very risk-averse to this kind of stuff. So it's very easy for them to just pass on that sort of application.

[30:35] Being Aware of the Risks

At the end of the day, if this is your story then you have to tell it. I never tell the student not to talk ever talk about the mental illness or whatever. But only that if you talk about it, here are the risks.

"Is there stigma around mental illness? Of course. Should there be? No! We just need to be aware. There are risks."

Logan adds that identifying the risks in your application makes you become a stronger candidate because you're ready. Then you can practice those types of questions that you're going to get in the interview which you know they're going to ask. He recommends really taking an honest look at yourself and just be able to think of yourself as an admissions committee and asking why shouldn't they accept you. Then you yourself becomes a better interviewer.

[32:10] Framing the Story and the Interview Process

Logan admits having a hard time doing it himself, saying there's a lot of bias. So what he did was send his personal statement to as many people as he could. He asked them for the most honest feedback and told them whatever they say won't hurt his feelings. In fact, he did my webinar on interviewing and he got his butt kicked but this really humbled him.

"I got my butt kicked but it really humbled me. And it made me really develop how I want to tell my story in the best light."

For anyone struggling with mental illness or disability, if you're telling your story and you're going to write about it and you get an interview, I think you can relax since they're seeing you as a person and not as someone with a disorder. Sure, they're going to ask you about your disorder. They would want to find out if you're ready for this.

During his first interview, he didn't think he was going to be asked about his weaknesses. He was just too brutally honest saying he wasn't that good in Biology. So he redeveloped this response for the subsequent interviews.

Ultimately, Logan got in at Pacific Northwest. He actually got into a waitlist here as well as another waitlist at another school. But as soon as he got off the waitlist, he was just ready to go and got accepted right away.

Logan suspects the reason for being waitlisted at the school he's at now is that they're very regional focused. So they want students to be from the pacific northwest because of the huge shortage. And Logan is from Connecticut so he definitely didn't fill this aspect. As for the other school, he just really never got the call so he didn't have to go through any decision process in terms of selecting schools. That being said, he was happy with where he ended up.

[36:44] Disclosing His Disorder to His Classmates

In his YouTube channel where he talked about his bipolar disorder, he just posted this on their school's Facebook page. He was terrified aware that people might not like him after that thinking all his classmates around him were just perfect. But he found that there were also people around him dealing with mental illness but they just didn't disclose it to the admissions committee.

"I found there's so many other people around me also dealing with mental illness."

Then they started talking to him a lot more. This was what motivated him to start his podcast. His first nine episodes have all been his medical school classmates talking about various mental health challenges they've gone through. He has interviewed people with OCD, depression, PTSD, ADHD, as well as women who have dealt with sexual assault.

"One of the best things he has ever done is making other people feel that it's okay to not be perfect and not be this little square on an application."

[39:30] The Impact of Medical School on HIs Mental Health

Logan describes going to medical school as extremely challenging, especially they had to take Biochemistry early on. It was something he didn't do great it prior to medical school. Nevertheless, all the techniques he used to benefit mental health (meditation, exercise, family time, traveling, etc), he would sacrifice all of those things thinking he had to study and pass the course.

"I was sacrificing really everything that was proper to my mental health. I was sacrificing sleep. I was consuming way too much caffeine."

So he could see himself going down a bad road that even during the Spring semester, he injured his back that he couldn't exercise at all. Then he started to really feel depressed and so he knew he needed to go back to a therapist. He knew he had to get back to committing to exercising everyday. He had to schedule date time with his wife every week. He won't have to study as much but his mental health is going to be better because of this.

Aware that medical school is a marathon, not a sprint, he just continues on with this mentality that he just has to start preparing for stuff early. He also understands why medical students get burned out. Additionally, having prior experience using the mental health system, he was no longer ashamed. He already knew what he wanted to get back to his healthy state of mind.

If you're starting to go this path of not sleeping and too much caffeine and not exercising, and eating poorly, Logan recommends really looking at who in your life can you call up no matter what. People oftentimes go to their therapist when they start feeling depressed. But just start small. So just disclose and open up to someone you feel comfortable with and they're going to be able to reconcile with you and connect with you. Hopefully, you do get motivated to seek out therapy and a physician if necessary. But with that said, start small. Don't be intimidated by opening up to a best friend.

"I don't think people with mental health illness are the only people dealing with mental health challenges. Every single person has some sort of mental health challenge throughout their entire life."

Ultimately, Logan ends this interview with an advice to always dream big and to never give up even if you fail the first time.

Links:

PMY Session 194: Overcoming Disability and Biases

The Sandy Hook Shooting

The Premed Playbook: Guide to the Medical School Interview

Logan Noone’s YouTube Channel

Logan Noone’s Podcast: Talk Mental Health with Logan Noone

Follow him on Instagram @logannoone

Jul 18, 2018
294: Premed Hangout Q&A: Interviews, Mistakes, and Much More!
23:15

Session 294

For today's episode, we took a handful of questions that students asked in our Facebook group, the Premed Hangout. We cover a variety of topics. Join now!

If you're listening to this before August 21, 2018, the release date of my next book The Premed Playbook: Guide to the Medical School Personal Statement. Preorder it on Barnes and Noble and submit the receipt at submitbookreceipt.com.

Then you will get access to over $150 worth of stuff including a 5-day Personal Statement course I did with students where we broke down their personal statements and they asked a lot of questions. You will also get access to a private Facebook group where we do Facebook Live sessions every other week.

Get access to the Personal Statement Starter Package calls where a student comes on the phone with me as they try to figure out what they should be writing about. You get five of those recordings as well as the PDF version of the book so you can take it with you.

Back to today's episode, we're answering questions from the Premed Hangout group. It's a free group you can join. Facebook is actually doing a trial right now in charging for group access. But for now, we're not charging anything. The group has over 5500 students. Also follow me on Instagram @medicalschoolhq.

[04:05] Interview Prep

Q: Can you discuss the most common mistakes students make preparing for interviews and during the actual interviews? How can we avoid these mistakes?

A: Check out The Premed Playbook: Guide to the Medical School Interview. Go to your library and to your premed advisor. Ask and see if they have the book since I gave out 180 of each of book series (the personal statement book, the interview book, and the MCAT book).

Second, go and listen to previous podcast episodes I've done, starting back in Episode 19, where I interviewed Dr. Wagoner, the former Dean of Admissions at three different medical schools.

The most common mistake is not preparing for the interview. You need to prepare for the interview. You can learn skills preparing for the interview. Those skills are going to help you whether you prepare one month, six months, one year before your interview.

"The most common mistake is not preparing for the interview."

You have to learn how to talk about yourself and how to handle the stress of the situation. You're going to learn how you respond to that situation. Do you sweat a lot? Do you have nervous tics? You have to figure out how you're going to respond.

And the solution is easy. Go and do mock interviews. Find your advisor and a career counselor. Whoever you have access to, use them. If you don't have access to somebody, try to find somebody. If you still can't find anybody, go to go to the medical school interview question generator. Choose a topic, and click, Ask Me!

It just throws up a random question that you can use to practice. You don't know what questions are coming so it keeps you on your toes.

If you like that and you decide to keep it up a notch where you can record yourself and email it to somebody for feedback, use our Mock Interview Platform at $47. It's very similar but you will find videos of me asking you questions. Then your webcam will record you. Then you an use it to review your answer.

"The best way to prepare is recording yourself so that you can give yourself feedback or somebody else can give you feedback."

[07:35] Talking About Mistakes

Q: What is the best way to address essay and interview questions, asking you to explain a weaker portion of your application? More specifically, how do you recommend an applicant can reassure admissions committees that the "mistake" won't be repeated and doesn't define the applicant without sounding unprofessional or losing confidence, for example, in the case of a poor grade or weaker GPA?

A: When you have the ability to talk about mistakes in your application, whether it's an essay, your personal statement, or during interview, always, always, always offer up either what you've learned from it and/or what you've done to fix it so that's not a problem in the future.

A very common thing that students have a problem with they're in undergrad is that they take on too much - too many credits, too many clubs and organizations. And they fail to realize early enough that they are over extended and they have time management issues. They have organization issues. As you're talking about this stuff, then say that "from this experience, I learned that xyz, so that in the future, it won't happen again." This said, you need to throw that solution in there. Whenever you're talking about personality flaws or your greatest weaknesses, whatever it is, always offer up what you have done, what you're doing to correct the issue so that it's not a problem in the future. Now, if you only talk about why it's a problem and what happened, then the question is going to come up whether you're doing anything to fix it. Are you bound to commit the same mistakes over and over again? Is this going to be a recurring theme? So always provide that extra step.

"Always offer up what you have done, what you're doing to correct the issue so that it's not a problem in the future."

[09:46] Fee Assistance Programs

Q: As a financially independent student, how do you balance working full time and going to school full time? How do you manage to pay for all the fees associated with applying to medical school? Are there any programs to assist premed students with the medical school application process?

A: The AMCAS and AACOMAS both have fee assistance programs. They have a limited number of funds every year and so it's on a first-come-first-serve basis. So apply earlier. With this program, you get reduced MCAT pricing and reduced application prices, etc. Check out the Fee Assistance Programs if you're struggling financially. But there's a caveat with those programs is they'd ask for your parents' income.

"This is medical school applications 101. Whether you're looking for the fee assistance program or you're just looking to get into medical school, the earlier you apply for it, the better."

There is a process to appeal and to try to get your parents' income to not be a factor in the FAP determination. This may be a long process, but this might be worth checking out.

[11:15] Balancing Working Full Time and Going to School Full Time

As to how to balance working full time and going to school at the same time, it's chaotic. You don't balance it. It's crazy. You do what you need to do. The issues that come up with that is there is probably no time to do everything else you need to do such as shadowing and clinical experience, and volunteering, maintaining relationships, and being a good son and daughter, etc.

"A lot of things get pushed because you're working full time and going to school full time."

The question is, do you need to work full time? Or do you need to go to school full time? And you stretch out the process a little bit by going to school half time to save your sanity for a little while. Or you can go to school 3/4-time and use the extra hours for studying or for volunteering or clinical experience, etc. Then you can slow down in that way.

[12:15] Managing the Cost of Applying to Medical School

Soon we will have a tool on the website where we will have a slider as to how many schools you're planning to apply to and what the cost looks like. Applying to medical school is expensive. If you apply to 20-25 schools, you're looking at $3,000 to $4,000. So you need to budget. If you're two years from applying, divide that by how many dollars per month to start saving.

Other students will get a 0% interest credit card for 18 months and use it to pay for everything upfront with the hope of paying it off in the future.

"Credit cards are dangerous for a lot of people... be careful with that if that's something you have an issue with."

[13:30] Attrition Rates

Q: Something I see little data or statistics on is about medical students, intern residents who don't graduate, match, complete their program. I'm assuming some sort of exit interview is conducted. What are the primary reasons? Is it academic? How can we better prepare ourselves as premeds so we don't end up in that situation? If it's family issues, is there a common theme. I know depression and burnout are frequently mentioned but are they possibly correlated with those students who fail to thrive, match, or graduate?

A: The attrition rate once the student is accepted to medical school is less than 2% for the majority of schools out there in the US. If you're looking at Caribbean schools, the attrition rate is much higher because they're accepting a lot of students who probably shouldn't be accepted to medical school in the first place.

"In the U.S., attrition is very, very, very low which is why applying to medical school is so hard."

In the U.S., the attrition rate is very low that's why applying to medical school is so hard. Schools are trying their best to figure out which students are going to be the most successful. To do that, they need to find students who are going to complete their coursework, their boards, etc.

Once you're a resident, you're not dealing with academic issues anymore, but now you're dealing with the burnout, the stress, and the second thoughts whether this is something you really want to do. The attrition rate is not very high still. It may be in the single digit percentage. There are programs out there that are always looking for PGY2 spots because students drop out or they change residencies or specialties.

[15:37] Talking to Your Premed Advisors About The Premed Years

Q: How do you politely tell your premed advisor at your university to pull their head out of the sand and listen to The Premed Years?

A: When I was in Washington, D.C for the National Association of Advisors for the Health Professions National Conference 2018, my goal was to get in front of premed advisors and talk about collaboration, not competition. I'm not here to steal their students but I'm here to educate them so they're better informed when they come and talk to them.

There are going to be advisors out there who still won't like that because they may not agree with my message. So they will just shut it down completely. There are a lot of advisors, on the other hand, who love what I'm doing. I explain this to advisors that I started this 6 years ago to be the anti-Student Doctor Network. I wanted to put some positivity into the premed process and show to them that you don't have to compete with your classmates. I wanted to show them that if you do work together and you are good enough students, you can both get into medical school.

Use this sort of language to your premed advisors and let me know. If they want to reach out to me, I can send them books and whatever they need. I'm here to help them.

"I started this 6 years ago to be the anti-Student Doctor Network."

[18:07] Secondary Application Questions

Q: How do we know what the applications ask before applying? Can we see them somewhere?

A: I assume this is talking about secondary applications since the primary application is the same through and through every year for the most part. For the secondary applications, there are databases online that are available.

I am creating my own database of posts and resources for secondary applications. I created a form that as you are applying, go to medicalschoolhq.net/secondarysubmission, choose the school and submit the secondary for that school. This will help us keep our secondary database up to date so we can provide the most valuable resources to the students.

If you're applying to Texas schools, the secondary applications are through the actual medical schools websites. Whereas for AMCAS and AACOMAS, they email you their secondaries.

[20:05] When to Reach Out to Schools

Q: Is it a good idea to reach out to schools after you submit your secondary and before interview to show your interest? What's the best way to go about that?

A: As you're going through this process, once you submit an application, you're kind of off-limits for the most part for advice. So there's no point in reaching out post-secondary pre-interview. There are times where it takes too long before they contact you. Some schools don't want any contact. So follow the rules for each school. If you're clicking submit on your secondary and you're sending an email right after submission, don't do that. But if it's been a while and maybe you have an update and if they allow updates, then add that and say you're still interested.

The best is to reach out to the school before submitting your applications. They have different rules of engagement because you're a pre-applicant and not an applicant. So go with solid questions as you reach out to them.

"The best is to reach out to the school before submitting your applications."

Links:

Premed Hangout

The Premed Playbook: Guide to the Medical School Personal Statement

The Premed Playbook: Guide to the Medical School Interview

@medicalschoolhq

Session 19: Interview with Medical School Interview and Admissions Expert

AAMC Fee Assistance Program

AACOMAS Fee Assistance Program

Submitbookreceipt.com

medicalschoolhq.net/secondarysubmission

Jul 11, 2018
293: Can You be an Alcoholic and Still Get Into Medical School?
44:59

Session 293

If you're listening to this before July 6th, 2018, I'm giving away 100 copies of each of my books. 100 winners will get one copy of all three of my books. Text BOOKGIVEAWAY to 44222.

Michael joined me to talk about his struggle with alcohol since middle school, failing his first application, and what he did to succeed the second time. He was raised in a family that dealt a lot with alcoholism and addiction and he struggled from middle school through college until he got himself together to clean up his life and succeed on his journey to medical school.

If you're struggling from alcoholism or addiction, please seek help by calling the Substance Abuse and Mental Health Administration Helpline at 1-800-662-4357.

Ultimately, there's still hope and Michael proves that this can be done!

[02:50] His Interest in Becoming a Physician

With Michael's mom as an RN, he got exposed to medicine at a young age. He thought being a doctor was cool although he didn't really understand what it meant then. When he was a kid, he just wanted to be able to do what doctors do.

A very common story for a child of a healthcare. But as to asked why not a nurse, Michael recalls asking his mom questions about anatomy and physiology. Oftentimes, his mom wouldn't have an answer for him and would refer him to the physician. So that was put into his mind that if he was going to know those things, he would have to learn what the doctors knew.

[04:50] The First Stumble: Battling Against Alcoholism

Michael explains his first stumble was at middle school. Her mom was an alcoholic but she has been sober now for about 21 years. His dad, meanwhile, was a meth addict and moved away when he was 8 years old to get away from troubles in their hometown. His older brother also used to get into a lot of trouble. And for him, he was his sort of his role model. He was hanging out with him and so he got into drinking beer and smoking pot when he was in middle school.

At the same time, he always wanted to do good at school. He knew as a kid that if he wanted to be a doctor, he had to get the best grades. But he found himself not doing this in middle school. At this time, his mom was already sober and she noticed what was going on. She sat down with him and talked with him and encouraged him to get Bs. From then on he started doing it and his grades just took at upward trend. Eventually, he started to get straight As. This was his first turnaround.

By the time he got into high school, he was getting straight As and was in the football team. He was doing all sorts of extracurricular stuff. On top of this though, he was still doing alcohol. Good thing, Michael was able to relegate his drinking and smoking to the weekends or couple of times here and there.

Michael admits that his grades and being a student athlete actually took cover for him as people wouldn't be expecting him to be doing the wild stuff. But throughout high school, it got worse.

By the time he sent his college apps in and football season ended in Fall of 2004, he went on vacation. He felt he was working so hard while he had these friends he'd party with on the weekends who had it easy. He wanted the same. So after most of his responsibilities were done, he really took advantage of it. He went on vacation for 7 years.

"Alcoholism is a progressive disease. It got a point where I couldn't control it anymore. I didn't have the say and I lost the power of choice."

He got to the point he was cutting classes and just wasn't in control anymore. He hoped it was just a phase. He had friends who went through the same and they just got out of it and had their stuff together. They left all the drinking and drugging behind. But this was not the case for him.

He saw his mom got to AA (Alcoholics Anonymous) and got sober and she changed completely. He knew that if he got to a point she did, then he'd seek the same kind of help seeing how it works. But then got to the point that he no longer thinks he can ever quit and that if he ever will quit. There were times he wanted to but that's the cunning nature of that disease. He simply describes it as pure insanity.

After graduating from college, he squandered four years of an incredible education. He didn't realize how many opportunities are afforded to matriculated undergrads until he left. He graduated from one of the best public universities in the world and spent the next year putting tags on clothes on the back of a surf shop. It was his choice. He saw it didn't fit but he couldn't do anything about it. It wasn't in him to stop what he was doing and just found himself in this vicious cycle.

[12:55] Failing Grades

He graduated from college with a 2.59, not medical school material though. He also remembers during sophomore year, the last semester that he had taken premed courses. he spent his first three semesters on the premed track and failed miserably. He failed classes, getting Ds and Fs. Then he got sent to a "save your semester" workshop where they were guided as to what they can do to do better. Then he switched majors.

Another reason he did well in school is because he didn't want the party to end. He was motivated to keep his grades up because he didn't want to leave school and have nothing to do. It motivated him to keep showing up.

[14:44] Time to Change

In December 2010, a year and a half after he graduated, he was hanging out with his buddies and living in the pad with amateur skateboarders. As they went out to a bar, he had just enough money in his bank account to pay his rent. He had no savings. He then gave his rent check to his roommate and still wanted to go party. The next day, his friend cashed the money. He was then left with no resources. Until he just got to the point the point that he was tired of hustling and stealing. He was tired of lying and cheating people. And something inside him just changed. He realized he didn't want to do what he was doing anymore.

"My bottom wasn't any one particular point, it was just day after day, waking up to this terrible realization that all those great plans I had for my life were not going to happen."

He knew to his core then that it wasn't something he wanted to do anymore. So he turned to his parents and asked her for some help. They then got him hooked up in a program and it took him 6 months relapsing and drinking. But eventually, he got sober and he has been sober for 7 years now.

[17:50] Was There Still a Chance to Go to Medical School?

At that point, Michael just didn't know what he wanted to do. And he had convinced himself that becoming a physician was not an option for him anymore. But his AA sponsor encouraged him to do what he wanted to do, which was being a doctor. And so he pushed him to just try. So he went for it.

"Wouldn't it be worthwhile to just make the effort even if it took half a decade?"

He didn't really know how to go about it. He did some internet searches but didn't know who to talk to. He did find out what a postbac was and he only knew of formal postbac programs that had minimum GPA requirements which he didn't meet obviously. So he just started to go to a community college and took difficult classes just to prove that he could still do hard work. He also applied to a couple postbac programs and got rejected from all of them. He then found one postbac program that was informal and had an open enrollment. Unsure if it was legit, it turned out they were. At this point too, he was working full time. He worked with his father and they started rekindling their relationship as well. For the last six years, he has been working with him and out of that he was able to develop a relationship with him. While he was working there, he started going to this informal postbac program in 2013.

"I just took some difficult classes just at community college just to prove that I could still do hard work."

Moreover, he started volunteering at a hospital where he lived. And he did all of this for four years and at night on the weekends. The first two years, he took three classes and nonstop, every quarter, there were no breaks. He describes it as being crazy. The university where he did his postbac had a spring break but for some reason, they didn't. He took a final Saturday morning and the next Monday, he was starting his next quarter. Looking back at those two years, he was wondering how we were able to do all that.

[22:22] Applying the First Time and Failing

Luckily, Michael didn't have any criminal records. Reason for this is that at the back of his mind, he always knew he wanted something for himself in the future so he was always very careful. Whenever hanging out with his buddies, he was always the annoying kid who would stop them from doing crazy stuff. He still had that little voice in his head and it paid off because he never got caught.

Looking at his chances, Michael admits he felt overconfident. He thought that if could just great straight As then they're going to look past the 2.59 GPA and the lack of extracurriculars. But it wasn't the case the first time around.

Applying the first time, he applied to 21 MD schools and got zero interviews because he admitted his alcoholism. This is what he thought was the reason for it. And he was advised by many people to not include this part of his story. Not because it has no value but because there's a lot of stigma out there about mental health and about alcoholism in physicians and drug addiction.

"There's not a lot of faith in the plasticity of the mind and in the value of the lessons that are learned by somebody who's been to the bottom."

Michael feels like he can look at other people's behavior now and can understand them and that he gets them now. As to why everybody's advice and deciding to tell his story, he didn't know how else to explain his undergraduate performance. He didn’t realize 2.59 is not good, but you don't have to blame all of them on the alcoholism.  He also thought it made him a strong candidate since it shows resilience and that it shows a potential that he has a lot of compassion which he can have for his patients.

This is what I tell students that in the perfect world, it wouldn't matter. But if you have 8,000 applications and there's a potential risk of the stress of medical school that can cause a relapse of alcoholism or worsening a polar disorder, there is the stress of medical school is something you've never faced before, and this is a risk.

So he told his story and didn't get any acceptances. No interview.

"In the perfect world, being sober shows your resilience and that you've overcome, but it's also still potential risk for that medical school. Are you going to be a safety threat to yourself, to fellow students, to whoever?"

[28:25] His Second Time Applying

Michael reapplied without mentioning alcoholism. And reconciling this, he did feel a little disingenuous but at the same time, he felt he only needed to put down the most pertinent information. So he left that part out of this story and he got three interviews, two acceptances, and one waitlist.

"While it is my story, it may not be appropriate for this venue."

All his interviews were close files and in one of them, they asked for his resume where he put his GPA and MCAT score. So they asked him about it. And he told them he was a young man who lacked maturity and the fortitude to address his responsibilities. And this was true. He just basically did everything on his own. In short, he didn't mention about alcoholism during his interviews.

As to whether he will reveal his past struggles to future patients, Michael says he wouldn't want to jeopardize his position wherever he's working and potentially negate his ability to help other people in the future. But he would practice the principles he learned over the years like compassion.

"In order to respond appropriately to what's in front of me, I have to be able to perceive it accurately. I have to seek to understand what I'm looking at."

[35:30] How to Stay Away from the Temptations

Michael says that the temptations have been removed. After taking the course of action, he feels he's now at a place of neutrality where he no longer needs to shield himself from booze or difficult situations. He adds that he needs to keep an open mind and not tell himself how well he should be doing with something he hasn't done before. He will also take advantage of the support he has. He recognizes how this is a team effort. He knows he needs to be able to ask his fellow students for help and honor that relationship by coming up with his end of the bargain. In the last 7 years, this has been such a big part of his life being of service to the people he is involved with and this was very helpful for him. Additionally, he still is going to AA meetings and he is still going to be calling his sponsor everyday. There are three guys he sponsors and they call him everyday. He will try to maintain this over the next four years and be of service to them.

"It's a team effort. I need to be able to ask my fellow students for help and then also honor that relationship by coming up with my end of the bargain."

[38:36] Choosing the School and Specialty

Michael looked in a little bit as to which school to choose in a way that it can support him from a mental health standpoint in the future. Ultimately, he went with the school that when he went to the interview, he looked at how invested were the people in their students. The school he chose appeared to be the most involved, interactive, and invested in their students.

Also, he didn't have the chance to investigate the 12-step community in those areas but it's a global thing anyway so it's available everywhere you go.

Although he has dealt with alcoholism, he doesn't find himself interested in addiction medicine so far. As it stands right now, the approach he took is a spiritual one so he doesn't think it coincides well with what how medicine is addressing addiction. But the way he approached addiction has worked for him and it worked well in a lot of people's lives. He recently read a book by Michael Poland called How to Change Your Mind. It's about a psychedelic research going on right now. So this is something that interests him. As well, he likes internal medicine and he likes surgery. So eventually, he will have to make a decision.

[42:02] Final  Words of Wisdom

Michael had a lot of doubts and fears. And after getting 21 rejections and has done so well in school and on the MCAT and his volunteer program, it didn't make sense to him. And once he got his last rejection, he got sick for four weeks. He thought he wasn't able to do it again. But there's always somewhere deeper you can go to dig to find that energy and inspiration. It's there even if you can't see it at the moment. It's there, you just need to keep going.

Links:

How to Change Your Mind by Michael Pollan

If you're struggling from alcoholism or addiction, please seek help by calling the Substance Abuse and Mental Health Administration Helpline at 1-800-662-4357.

Jul 04, 2018
292: President of His Caribbean Med School Class to Failed Match
39:47

Session 292

Dr. Yousuf is starting his Emergency Medicine residency after failing to match. Learn from his failures and triumphs and how you can avoid similar mistakes.

If you're listening to this before June 30, 2018 and you're in or around the DC area, come to our meetup. I'm in town for the National Association of Advisors for the Health Professions meeting. It's a national meeting for the health professional advisors. And I'm having a meetup on Saturday, June 30, 2018. Go to the Premed Hangout for an RSVP or email me at ryan@medicalschoolhq.net to get all the details.

Last week, we had Dr. Buck Parker on the podcast talking about being an IMG, struggling with his studying, going to the Caribbean, and learning how to fix it. He's now offering his Secret Study Hacks course which you can sign up for and get a discount. If you want to know more about it, listen to Session 291, where I talked about it at the end.

Back to this week's episode, we have another IMG, a Caribbean graduate. Dr.  Ibbad Yousuf who is @dr.bad_md on Instagram. Ibbad when to AUA after struggling in his undergrad and he thrived in that environment. He still struggled with classes every now and then and still picked himself back up. But he was class president. He didn't match the first time and he talks about that today as well as what he did during his time off, until how he figured out how to match.

[02:40] Going to a Caribbean School

A lot of people think I am anti-Caribbean when I tell students you shouldn't go to a Caribbean school. I am not anti-Caribbean schools, but I'm anti-non transparency coming from Caribbean schools. They tell you a lot of things, similar to the military recruiters. They tell you what you want to hear, when in reality it's probably a lot different. This is why I'm bringing on Caribbean grads because they can talk about their experiences. There are a lot of issues with going to a Caribbean school. But you can go to a Caribbean school and be a great physician. "Going to a Caribbean school doesn't mean you get less education, but a lot of students who go to Caribbean schools aren't prepared for medical school."

[04:00] Interest in Becoming a Physician

Ibbad began having interest in becoming a Physician at 13-14 years old when he started taking an introductory to a science research course. Obviously, he likes science. But the human part of taking care of people came into the story when his mom got sick. He took care of her in and out of the hospital and the doctor's office. He realized he wanted to be able to scale helping people. By this, it means, he seeks to be able to help more than one patient at a time. His goal is to be able to help millions and billions of people. And for him, medicine was his way for him to get there - the influence and the ability to work with patients and having that clinical background is more applicable for the science he likes. And he once he got to  that, he wants to scale that to possibly a biotech startup or a wellness startup.

"I love the science and medication is the application of science to helping people."

[07:00] Undergrad Years and Premed Struggles

Ibbad thought that if he had to learn all this in med school so why would he have to take premed now. So he was trying to figure out how to get the most value from education. He started with Business and then shifted to Journalism, until he changed to Sociology and Health Sciences for his major. And ended up getting a Women's Studies for minor.

"The end goal was always getting into med school."

The biggest thing he struggled with as a premed student, he admits, was studying. He graduated from high school early and got into college. But he didn't know how to put together the volume of information. His undergrad courses were very large in the premed sciences. And this didn't help him with his own focus.

So he failed out after his Sophomore year after a combination of life and not knowing how to study. Plus, he was working at that time and partying. So he failed but got back in that same semester with the stipulation that he was going to have to do well until he graduated. He actually got that wake up call after receiving a snail mail telling him about the failing and dismissal. And he realized the process was getting in touch with the dean.

His parents didn't get mad but they were startled knowing how Ibbad used to do so well back in undergrad. Being asked by the dean about what happened and why his grades were low, Ibbad admits it took a lot of self-awareness in figuring out what he needs to balance better and focus more on.

And he remembers there was an organization that votes on your ability to come back and your maturity level. Again, being self-aware is critical here. You have to be able to acknowledge your mistakes.

From that point forward, he got a 4.0, a huge turnaround from failing. Ibbad accounts focus for this. He realized there needed to be certain levels and certain areas of focus.

"There needed to be certain levels and certain areas of focus."

[11:50] Taking the MCAT and Going to the Caribbean

Applying to medical school, he still had to show his grades and that he had that academic dismissal and overcoming that. Not having a lot of guidance, he just studied for the MCAT like he would have normally done in college. Study for three weeks and take it. Because that's what he learned to do in college. He didn't realize he still sucked at taking standard exams. This is aside from the fact, that the MCAT is a whole another beast. So he took the MCAT and didn't do well obviously.

As a result, he went the route of going to the Caribbean. As he went through the application process, Ibbad recalls receiving news about a new Caribbean medical school expanding. So he took a couple different applications and then he went from interviewing to getting admitted, almost within a month and then he moved to the island.

[15:00] The Course Correction

Ibbad says self-awareness is the key. He knows his weaknesses and he failed a bunch f his block exams in medical school. He realized he didn't know how to study properly. And medical school taught him how to do that. So every time he had to level up, he taught himself something new to bring up that weakness. So it's that self-awareness, determination, and drive are key. It's important to know this is where you want to get to, where you are right now, and how you can get there.

"I realized I didn't know how to study properly. But being in med school taught me how to do that."

Having known many people who have given up, he sees things as passing anyway. So what can you be doing in the mean time to allow you to get to where you want to be next? He adds that sometimes you need to take a step back from what you're doing to get a more wholistic picture of it. And this is what got him to course correct through time.

[17:50] The Caribbean Environment: Dealing with High Attrition

Ibbad describes the diversity in the Caribbean. A lot of people had careers before wanting to get into medicine. A lot of them didn't have the direction or physicians in the family. And he saw strength in this diversity.

The attrition rate for Caribbean schools is much higher than U.S. schools, and Ibbad explains there are two ways you can take that. You can see it and realize this isn't for everyone. And then you can also see how this is a survival thing and this, he used to drive himself. He saw the attrition was high, and part of what he was working on as a class president was working with the dean and administration to reduce the attrition rate. Their discussions involved troubleshooting, figuring out why their students aren't doing well.

"It's not like they take students and then not care. They're actively, and myself as a student included, we're working to see how can we make this better."

In fact, he remembers looking at a roster of a few hundred people and within the first two weeks, there were some who didn't show up to the island. Some may have been accepted or off of the waitlist to a U.S. school. So he realized that a large chunk was taken out that way. Then after the first two weeks to a month, they had their first lab exams. This was another reality check if this is going to work for you.

[22:45] The Hidden Number System

Many Caribbean schools boast their USMLE pass rate. But it's not really a real number because there are exams the schools give to see how well you're potentially going to do when you sit for the exam. And if you don't do well on those comprehensive exams, they'd tell you you're not ready to take Step 1 yet so they're not going to let you take Step 1. And they may never let you take it because you may never get to that point where you're going to pass.

The way Ibbad sees is like the quote, "Statisticians are just liars with data." That said, he thinks there are numbers that get moved around in their individual ways. Even premed offices do it. So for them, Ibbad admits having to take comprehensive exams before they were allowed to sit for the Step exams. But he didn't think it was a way to weed you out. Ibbad did pretty well in his exams at 90 percentile above.

"A lot of it has to do with, are you going to do well enough to secure the residency?"

[26:10] Not Matching the First Time and Realizing It's a Number's Game

For Ibbad, not getting a match was tough knowing he had dedicated his summers while he was 15 years old to doing good research and having leadership skills. He got the grades he needed to get on the boards. But this said, it gave him a different perspective of the overall process.

He explains that applying to Emergency Medicine is very competitive and he was aware of that. But he was also the kind of guy that's focused on one thing. The match rate for IMG in 2018 was 1.6%, which means there's a chance.

"Emergency Medicine is very, very competitive and I was aware of that. But I'm also the kind of guy that my focus was on one thing."

As to why he didn't match the first time he applied, Ibbad says one of the reasons is that it's a number's game. He didn't have enough interviews. He only applied to Emergency Medicine, with 170 plus programs. He also understands his limitations coming from the Caribbean. It was a matter of understanding those red flags. The optimum number to match was 13 as they say, and it's supposed to be higher for IMGs, but he only had a third of that.

So this year, he did something differently, He applied to other programs. After all, his goal was to become a practicing physician. He also had to put his ego aside, telling himself it doesn't matter what specialty you get into. And the numbers just worked out.

"I applied to other programs knowing that the dream was to be a practicing physician and wanting to pivot that into other bigger things."

[30:10] Opportunities Available If You Don't Match

Ibbad says there's different opportunities when you don't match. But you have to be realistic enough to create your own timeline and realize what you did wrong and what you can improve on. Otherwise, there are investment banks that love MDs on board, even without a business background. There are also a lot of educational companies out there where they need MDs to help create content and courses. So you can do this to either pass your time or make it your full time career.

Ibbad was one of the medical scholars at Techmonic. Having not matched, he was looking for jobs with pharma and business end. Good thing, a research opportunity opened up and he took that opportunity. But he knew he needed money to live.

"You figure out what you need to do get a monetary employment and then you get that research employment and you go out of it from every angle."

If you aren't in a program and you have student loans, you still have to start paying them back. It also depends on the loans. Ibbad explains that a handful of Caribbean schools have federal loan. He didn't have some leeways with the private loans but the schools have to be around for at least ten years to get that U.S. federal loan process in place. So his first few semesters were private loans. These were the ones that needed repayment. All this being said, the loan companies and the bank work with you, so it's not a massive hit that you'll be paying. Fortunately, it's doable.

[33:05] Reapplying for the Next Match

Being asked what he has been doing in the last year he didn't match, Ibbad was creating medical content so it was related. He was teaching students how to learn and how to troubleshoot and change paths like what he had done. And he was also working on some research. Currently, Ibbad is now transitioning and starting residency. He's also getting back into the study more a few hours of the day.

"You can speak about it passionately. That comes across in a genuine way."

[34:55] Ibbad's Advice to Those Going to the Caribbean

Try to reach out to other people who have been through the process (like Ibbad). He believes having that first person perspective is very important. Secondly, be extremely self-aware. Thirdly, know that your timeline may not work out the first time around for what you want to do. You can take a gap year for research. You don't necessarily get the first residency you want on the first try. Just know that and keep doing what you have to be doing for yourself. It's not bad on the other side when you finally get there.

"Keep doing what you have to be doing for yourself. It's not bad on the other side when you finally get there."

Ibbad would usually tell people that it's easy to get into the Caribbean but it's harder to stay in. He lived in the beach ten feet away from him but that was also his study break. Nevertheless, preparation and self-awareness are huge.

"You get into anything what you put into anything. I think that applies to anywhere."

Links:

National Association of Advisors for the Health Professions

Premed Hangout

ryan@medicalschoolhq.net

Secret Study Hacks

The Premed Years Session 291: Dr. Buck Parker: Academic Struggles to an 'A' Student

Jun 27, 2018
291: Dr. Buck Parker: Academic Struggles to an 'A' Student
39:20

Session 291

Dr. Buck Parker shares his journey of struggling during undergrad to success in medical school and his new course, Secret Study Hacks. Listen to his journey

If you're listening to this before June 24 midnight Pacific time, enter to win a giveaway prize from Next Step Test Prep. Get one free MCAT course from Next Step Test Prep (worth $1,600). We're celebrating the 100th episode of The MCAT Podcast. Visit www.mcatpodcast.com/giveaway or text MCAT100 to 44222.

Back to our episode today, Dr. Parker used to be on the reality TV show and now has a thriving Instagram account. He is also now helping students learn and study. He is a general surgeon who specializes in trauma and he talks about his journey today and why he started Secret Study Hacks program to help students learn how to study. Buck has a special deal for you for his program.

[02:20] Interest in Medicine: Failing and Learning How to Study

Buck's dad was big on hunting when he was younger, in fact, he began hunting at 10. Then he got into big game hunting. As he was seeing the organs of the animals, his curiosity grew and thought it was something he should look into. By 19, he saw a documentary about surgeons, which he thought was the coolest thing in the universe. Ultimately, being a surgeon has what he has always wanted to do.

Not getting good grades in high school, he also just went to college because his parents told him to. He didn't think he'd do well. He was a Biology major, but he didn't really believe in himself. He was just partying and he barely went to class.

It was during his second semester that he got a 1.7 and his parents told him they weren't sure if they'd still shoulder college. After failing chemistry, he knew he had to do something. So he started studying in organic chemistry, but he admits not to have done it right. Obviously, he still wasn't doing well in the tests.

"I started going to this guy and he just started teaching me some basics of studying and what not to do and how to prepare."

Then he decided to get a tutor for physics and he was teaching him the basics of studying and what not to do and how to prepare, etc. After taking the first test in class, he got the highest grades in the class! They literally didn't believe him thinking he was cheating. And the same trend went on test after test. Basically, it built his confidence.

"I'm the guy who aced Physics, I could do anything."

[09:45] The Culture of Studying

After medical school, Buck started reading other books besides medicine and he realized there is a lot of productivity area a lot of people have studied a lot. He explains that studying is very cultural, in fact, even micro cultural, which means on a family level. So for instance, your parents never really passed on that cultural information so when you go to college, it's almost random how you learn to study.

"The more I read about it, the more I think it's very cultural, even like microculture."

[12:15] Life as an International Medical Graduate and Not Having a Plan B

The counselors at college that he approached totally brushed him off. But Buck had a family friend from India and he talked with him one time. He told him he could go to any school outside of the U.S. as long as he comes back and that he's eligible to get a residency. True enough, he did just go to any school outside of the U.S. But looking back now, he wished he could have researched a bit more and found a better school. There are programs through in the Caribbean that are very strong.

As an international medical graduate, Buck wanted to do surgery and nothing else. And this was a challenge for him during interviews when asked about his backup. Too confident, he was so dead spot on surgery. Period. And so when asked if he didn't get in that year, he told them he'd still apply next year.

"It's not so much confidence. but it was that I had only one goal."

There's data that shows form a psychology standpoint that if you have a plan B, you're less likely to put everything into your plan A. With Buck, he didn't have any plan B and stuck with Plan A the whole time. He put his effort all into that.

Buck thinks the reason people ask you for a backup plan is they want you to be okay. But what they don't realize is by doing that, you're sabotaging the person. They want you to be the safe.

"The most unsafe thing you can do is go after something you don't want because you're guaranteed to be miserable."

[20:15] Buck's Study Habits During Medical School

Once he was doing really well, his study habits didn't really change a lot. Only that they've become more frequent. He says you end up incrementally improving. In fact, he was initially so scared that he was studying so much. Over time, you develop those very specific things as well as the motivational habits. You get to build on your momentum and use other people to help you.

But as for the big chunks like studying everyday and reading before the class, or getting some information and repeating it and doing some association in your mind - all those things have already been there. All he had to do was refine what he did for medical school.

[22:27] The Biggest Study Mistakes Students Make

Buck believes that students tend to underestimate everything. Personally, it was a huge problem for him to have underestimated the effort it would take to get a certain grade in a certain class. So you result in cramming for an exam. Another thing is that students can't do delayed gratification that what's happening around them can distract them from sitting down and studying.

"When something is further away, we don't feel the importance of it. We just have this natural bias as humans."

Buck adds there's this bias that we have just like the object in the mirror is farther than it appears.  And this is our bias as humans. So we have to bring that two months away to today. Today is imperative that you have to do x 100% today! Do today what you can do for two months. Develop that kind of "healthy paranoia" in studying because if you can develop that then you're like super focused that you're going to get this thing done today. And tomorrow is the same thing and so on.

"Develop that kind of "healthy paranoia" in studying because if you can develop that then you're like super focused that you're going to get this thing done today."

The easiest way is just to break it into small chunks and set them as what you're going to do today. Some days, you get more while other days, you're going to get less. Overall, try to keep that schedule then you're going to be in a lot better shape. Buck admits he wasn't keeping his schedule but he was still so far ahead of everybody else as he was still doing well.

"It's so much information, but it's even more if you take a break."

[27:20] Secret Study Hacks: Mindset Change

Buck things the reason studying is so hard for people is due to culture where we're just not taught, or that our micro-cultures have not delivered that while we were younger. And studying is really not pleasurable, for most people. Not everybody wants to do the delayed gratification. But you have to go through all this pain right now in order to get to your goal and be able to treat patients.

"Not a lot of people really enjoy everything they read in medicine but you've got to do it."

With Secret Study Hacks, Buck's goal is to inculcate in the belief of students that it's possible. Buck reveals that a lot of students he has talked with were speaking as if it wasn't possible. So first portion, step one is a change of mindset.

The second step has to do with building the correct habits and learning about habits and how our brain works. We have neural pathways and our brain automates programs. If you can build the automated programs to study the right way, then that would be that much easier. And you won't have to spend a lot of energy choosing between studying or not since you will no longer have any choice.

"Once you've built that habit, there's no choice. This is what you do everyday and it's less pain."

Next, figure out the actions and how you can get yourself to do that even if you don't want to do that. Again, think about how you're going to fix your mindset. It's like hacking your thoughts and emotions by "hacking" them so you'll be able to complete your task with less pain.

[31:14] Secret Study Hacks: Motivation and Environment

Buck stresses the importance of staying motivated for a long time and throughout the day. What's going to keep you in your seat when all your friends want to go out?

Lastly, the third piece of this is your environment and how your environment affects what you do, how you make decisions, how you study, and how can hack your brain in a performance sense. Buck says that nutrition has a lot to do with that and the things around you as well.

[32:20] Resources for Mindset Change

Buck recommends the book, The Power of Habit by Charles Duhigg. He thought that had he known about it before then he would have been able to set up so many more things to help himself, especially during residency, which for him was really hard. If he understood how his brain worked a little bit better, he would have set some habits for himself that he didn't have to go astray so many times.

[33:30] Final Words of Wisdom

Buck says that anybody with an average IQ can go into medicine. He was in a position he didn't think he was smart enough. But he learned that it's not so much about that. Instead, it takes dedication and the right kind of tools to pursue medicine. Anybody can do it. But you have to be able to study correctly first. Stay motivated and have a purpose.

[34:23] Review About the Secret Study Hacks Course

Buck gave me free access to his course. When you sign up for my link I get an affiliate commission. But let me do a quick review about the course. So you will find some videos on the site and you will notice how Buck breaks down everything he has learned about studying. You're paying to expedite the process of reading all the books he has read and learning the takeaways he has learned. Most importantly, you can put those into practice. So he's taking all the things he has learned and combining that with the knowledge he has gained from the books. He's breaking down all of that information and that's given to you in a video format to help you expedite the process of learning how to study.

The great thing about Secret Study Hacks is that they're all condensed into a course that Buck has put together for you. The program costs $97/year and with that, you get access to the course and some other add-ons and bonuses including weekly live calls with Buck and a membership to their Facebook group.

If you need help studying and you find you don't have the time to go out and read all these books about studying yourself, perhaps you can subscribe to his program for a year and get all those access. It's up to you. I've asked students about it and they said it wasn't new information BUT, it was all information gather together and packaged up nicely so you get it concisely and quickly versus going out and reading all the information yourself. Plus, you're getting it from somebody who has been through the process and been through medical school and knows what you're about to encounter. So he's framing everything around that.

Go to medicalschoolhq.net/studyhacks to sign up for Buck's program.

Links:

Follow Dr. Buck Parker on Instagram @DrBuckParker

Secret Study Hacks

Next Step Test Prep

www.mcatpodcast.com/giveaway

Follow us on Instagram @medicalschoolhq

Jun 20, 2018
290: How Do You Focus on Your Health While a Premed Student?
31:16

Session 290

Caroline is a second-year med student who runs the @carolinecooksclean Instagram account. As a former athlete, she tries her best to stay on top of her health. So her account is all about eating clean and eating healthy. Caroline shares all about how to prioritize health, eating right, and exercise before everything else, and why this is important.

If you've been struggling with eating healthy or exercise, listen to this episode. Remember, we can't be there for our patients unless we take care of ourselves first.

The podcast is part of the MedEd Media Network, which includes The OldPreMeds Podcast, Specialty Stories, The MCAT Podcast, Ask Dr. Gray: Premed Q&A, as well as The Short Coat Podcast, a production of the Carver College of Medicine at the University of Iowa.

[02:00] An Interest in Becoming a Physician

Caroline has always loved science throughout school and her grandpa being a practicing OB/GYN back was a great inspiration for her. The town he was practicing in was where she also grew up so she knew his patients. And those patients telling her how her grandpa changed their lives has impacted her.

It was a collection of experiences that she had throughout her life that continually just made her feel like becoming a physician is exactly what she was set to do. In fact, she talked about her grandfather on her personal statement because that was her "seed." She points how the personal statement is supposed to explain who you are so the admissions committee gets to know who you are. And not talking about it would just not be right.

"The personal statement is supposed to explain who you are and let the admissions committees get to know who you are."

Caroline adds that just because it's cliche but if that's what shaped you, then you should talk about it. That being said, she never second-guessed becoming a doctor. She was just so driven to becoming a doctor. Sure, it's really hard and challenging but this never swayed her from the thought of becoming one.

[06:55] Major Struggles as a Premed and the MCAT

Caroline admits inorganic chemistry was the biggest thing she had to overcome. She didn't put much effort on the first exam so she obviously didn't do well, in fact, having the second worst score in the class. But it was great that she acknowledged it was a mistake on her part for having taken it for granted, thinking it was easy but it wasn't.

"I did horrible on the exam... I think probably the second worst score in the class and I was used to being the top student so when I saw that was really shocked."

Again, it's a matter of figuring out where you went wrong and doing what you can to course-correct. So Caroline did a complete turnaround and worked on it 100%. So from the worst score in the class to getting 100% on the orgo 2 final was just incredible and from then on, she knew she could do anything.

This was also before her MCAT so she used this as her motivation to get a high score on the MCAT having gone thru failure and was able to get back up. Speaking of MCAT, she studied for four months for it, while she was still studying because she took it in January. It was hard for her to study the same stuff for that long and to see her first couple of practice scores to be pretty low or not near her goals. Additionally, she took a prep course which she thought really helped a lot. She even had a tension headache a week before the exam but she knew she had to relax but she took comfort in the encouragement from her friends.

"It's so easy to see your score after you just took an 8-hour exam and beat yourself up and be like what is all the studying even for them if I'm getting this, but you have to trust the process."

[11:55] Clean Eating and Exercising on Her MCAT Journey

While taking her classes and studying for the MCAT at the same time, she completely dedicated her time to MCAT study. And for health was very important. That said, exercise was something she looked forward to during the day since it was the one time she wasn't studying. It was something she set as her goal too that kept her motivated - both the MCAT goal and the fitness goal. So she found it helpful to separate herself from the MCAT while exercising, and that included eating healthy as well.

"Exercise was the thing that I looked forward to everyday because it was the one time that I wasn't studying."

She finds that when eating a diet high in vegetables or more wholesome ingredients, she notices she gets to have a clear brain. This is very important when you're taking an exam and trying to remember all those things. She also noticed that whatever she ate before practice exam, she had better stamina with the healthy meal. Caroline recommends you should find what works for you and focus on health during that time because it will definitely show in your score.

The truth is though is that students think that exercising would just take their time away from studying. But Caroline stresses that exercise helps in the consolidation of your memory, and this is proven.

"Exercise is helping with memory consolidation and it's proven that it does."

Aside from memory, exercise does help keep you more sane and prevent burnout. In fact, it's the number one thing to prevent burnout. Caroline adds, it helps reduce the risk of developing chronic diseases, which you should care about as future physicians. These are all good reasons to instill exercise in your daily routine. If you really feel the need to, then bike while reading. Nevertheless, it's really super helpful to get away from the information for a small amount of time.

[17:30] Struggles During Medical School Application

Caroline emphasizes the importance of having a mentor as well as listening to podcasts like this. For her, she found essays to be a real struggle (as anyone would). Writing a lot in a small amount of time is very difficult, but you have to remember your why. Always talk about that and make sure you're talking about things with passion. Additionally, Caroline initially struggled with finding words to express herself. She would have writer's block with her secondaries, etc. And then just dedicate a little chunk for a day, like three or four hours to write them since it's better to do it with a fresh mind.

Most definitely, don't submit a secondary after just one sitting. Make sure your essays are going to be clear and succinct and actually describe who you are. You want them to know who you are. So make sure it's explaining who you really are. Also, make sure you're addressing the question and making it clear that this is the school you want to go to, not doing the copy-paste thing. Or you end up with the mistake of copying the wrong school name.

"You have to remember your why. Always talk about that and make sure you're talking about things with passion."

[19:55] Starting the Medical School Journey

In terms of exercise and eating healthy during medical school, Caroline already made a plan of what she likes. However, med school is a different ball game, she admits. Especially with the way their curriculum is set up, their first 8 weeks are anatomy. So you're constantly in the lab and dissecting. You don't get to eat when you're there so when you come out, you're scavenging for food. It's hard to be healthy!

That being said, Caroline says she was fortunate to have friends who are also very health conscious. They fed off each other in a good way. She also packed her lunch to make sure she gets to eat healthy, not to mention it's a cheaper option. You know what's in them.

The biggest thing she's still struggling with is the late night eating, as this is bad and can cause gastric reflux. She tries to go to bed around midnight every night. But if she has to stay up late, she tends to eat more than she should. And it becomes a cycle. So this is still something she tries to balance. What she does is eat her midnight snack when she has an exam the next day and then sacrifice that for her exam day since she's able to focus better with snacks.

To add to this, she found planning to be very helpful. She buys her groceries and prepare her meals when she can. She has things on hand like frozen chicken burgers so she's not tempted to eat pizza.

"Any type of digestive issue can be exacerbated by eating right before you go to bed."

[23:22] Meal Preparation Tips

Caroline shares some tips to prepare your meals so you don't have to prepare them every day. She recommends getting a Crock Pot which is helpful for her. You can also roast vegetables on Sunday or Monday or whichever night you're free. Roast enough of them and put them inside your fridge and you can just microwave them. This is 45-min dinner turned into a 2-min microwave.

Also, be sure to make things that you like. If you hate broccoli and you meal prep it, you're not going to warm it up afterwards and order a pizza instead.

"Be creative with your health and figure out what you actually genuinely want to eat and then prep that."

Don't compare what someone else is doing to what you actually want to do. Just figure out what works for you. Caroline guarantees there is healthy food that everyone likes. Just search hard enough for it especially, now with so many health foods out there. Just make simple things since less ingredients are better anyway and it's easier to cook too. Salmon is also good.

[26:33] Taking Her Passion for Clean Eating into Professional Practice

Caroline says there's not enough research right now on nutrition and practical applications to nutrition and stuff. The reason being is that it's hard to get funding for it. And she hopes she could be a part of it in the future. But she wants to use exercise and nutrition recommendations as preventative measures with her patients. So it's definitely something she wants to continue in practice because she knows how this is very important.

"A lot of people reversed their diagnosis or help them prevent chronic disease in a huge way just by changing the way they eat."

[27:45] Final Words of Wisdom

Caroline wishes to impart to premed students out there that exercise and eating well will help you with your grades. It also helps reduce stress. And sleep has a huge role in decreasing stress and maintaining wellness, and memory consolidation. If getting a good grade is your main goal, you should also think about the implications of living a healthy life and how that will help you reach your main goal. If you're worried about your weight or struggling with that, don't be too hard on yourself. You can't judge yourself so hard, criticizing yourself so much because there is more to life than that. Don't get hung up on it. Just find what works for you. Don't take the MCAT so seriously that it would affect your health. We're going to be better physicians if we do take care of ourselves.

"Respect your body as much as you hope to respect others and take care of yourself as much as you hope to take care of other people eventually."

Links:

@carolinecooksclean

MedEd Media

@medicalschoolhq

The Premed Playbook: Guide to the Medical School Personal Statement

The MCAT Podcast

Hangout Group on Facebook

Jun 13, 2018
289: Stop Wasting Space in Your Personal Statement and ECs
33:42

Session 289

After reading hundreds of personal statements and extracurriculars this application cycle, I'm seeing the same mistakes over and over again. Don't do it too!

The Premed Playbook: Guide to the MCAT is finally available in Paperback ($9.99) and in Kindle ($4.99) formats. Also, stay tuned for The Premed Playbook: Guide to the Medical School Personal Statement, coming out soon! I'm actually giving away 100 books.

And if you preorder it on Barnes and Noble, I'm giving away a bonus, a personal statement course which I did with 30 students, where we broke down personal statements. You get access to this for free.

[04:10] The Goal of Your Personal Statement

It's important that you have someone look at your personal statement and ECs and give you feedback. This is crucial in the process. Your only goal when writing your personal statement is just to show who you are, in terms of why you want to be a physician. What has been your path to get to this point?

"Once you understand what the goal is, just knowing that will help you prevent the mistakes many students make."

Listen to last week's podcast, Session 288, where I interviewed Leila Amiri, the Director of Admissions at the University of Illinois College of Medicine. She talks about how their review personal statements. Your goal is to talk about why you want to be a physician. What has been your path to get to this point?

If your reason is a cliche reason like a family member getting sick, just because it's common, you really need to talk about this because this is your story. In other words, talk about that seed and when was it first planted that made you want to become a physician.

"Don't think that your story is cliche if it is your story. It may be common and that's okay as long as you highlight why that experience affected you."

While your story may be common, it's not cliche. Talk about why that experience made you want to be a physician or exposed you to medicine for the first time. You have to be true to your story.

[08:05] The Goal of the Extracurriculars

The goal of the ECs is to show the impact that you've had on each of your experiences. Tell why this meant something to you. It could be that the experience impacted you in some way.

Please take note that extracurriculars are not job descriptions. The admissions committee knows what a scribe does so don't write what a scribe does. If you really have to say what you do, explain it in just one sentence. And then go to impact.

Make sure you're showing through that and what does that look like in your life. How does that experience affect you? And how did you impact that experience?

[10:00] Personal Statement Mistake #1: Selling Yourself

Stop trying to sell yourself. You don't need to sell yourself in your personal statements or your extracurriculars or your interviews. The goal of this process is to show who you are, not why you think you're amazing or what amazing skills you have.

Here are some examples of students I've worked with where I saw some mistakes. The first is a student who was working at a suicide hotline. But he was trying to sell to me that he really cares for people. You don't need to write that. Tell the story that shows you connected with the person on the phone, and hopefully, prevented a suicide. Show how you actually cared by telling it through a story.

Another example would be trying to sell that you have to address the person's social support system. This is not telling the admissions committee anything.

One student says, they had to prove to themselves that they could solve problems in a medical setting. Saying you're a problem-solver is the same thing as selling yourself.

Remember, you're wasting space in your personal statement if you're talking about these things. I don't care what you learned from the experience. What I care at this point, is you're showing why that experience made you want to be a physician.

"The goal is to show why you want to be a physician, not that you have the skills necessary."

[17:40] Personal Statement Mistake #2: Wasting Space

Don't put double spaces in your personal statement after punctuation. Set it at single space after punctuation. So if you have 50 periods and you have double spaces after each of those, those are 50 extra characters you could get back that you need.

"Don't waste space with the names you don't need."

Don't waste space in your personal statement, talking about names of places where you're volunteering. Just say you volunteered at an emergency department. The names are going to be in your ECs anyway.

You don't have to name drop, either. This is also a wasted space. Personally, too, research is a waste of space to talk about in your personal statement.

Research is exciting. It helps you tie together science with the clinical side of things or patient care. It may help you understand things and see those connections. But it's not driving you to be a physician. You may want to do research as a physician in the future, but it's not driving you to be a physician. For the majority, if not all, the driving force of people wanting to become a physician is because they want to take care of people. Focus on the people, not the research.

"For 99.99% of people, the driving force behind wanting to be a physician is to take care of people."

[21:37] EC Mistake #1: Don't Sell

One student I worked with previously sold herself on her ECs. She wrote about her experience as a college athlete and its demands. Another example is working in a research lab. Again, don't sell all the skills you've learned. Don't sell the skills. Instead, focus on the impact you had. Focus on a story or interaction with a patient. Don't try to sell to the reader what's going to happen.

Another student talks about how this taught her to thrive under pressure. This is still selling. This just doesn't work.

"Don't sell your skills or traits in your extracurriculars... Focus on a story or interaction with a patient. Don't try to sell to the reader what's going to happen."

[25:33] EC Mistake 2: Wasting Space

You are wasting space if you compared what you're doing to what a physician is like. You can't really say this until after medical school. You can say this all afterwards, but not before.

So don't assume they're looking for anything. Don't sell yourself. Each EC is wasting space if you're putting a takeaway at the end of each of your ECs. This shows the readers what you've taken away from that extracurricular.

[28:55] Other Common Mistakes

Try to switch things around and putting your focus on the future, of what you hope to do, with all the knowledge you gained from this experience.

Repeating details is another common mistake to avoid. Don't repeat information in the descriptions that are already in detail section.

Instead of saying numbers, talk about the impact the physician had on you and vice versa. Don't waste space by selling, repeating information, or the number of hours per week.

Links:

PMY 288: This is How UICOM Reviews Your Medical School Application

The Premed Playbook: Guide to the MCAT

The Premed Playbook: Guide to the Medical School Personal Statement

Connect with us on Instagram @medicalschoolHQ.

Jun 06, 2018
288: This is How UICOM Reviews Your Medical School Application
01:07:27

Session 288

Leila Amiri is the Director of the Office of Medical College Admissions at UICOM (University of Illinois College of Medicine). We go step by step through the admissions process at her medical school.

Leila talks about how she has directed her team to evaluate applications. We look at day one, when your application gets processed and sent to the medical school. How do they look at secondary applications, the full application, and the MCAT score to determine who gets an interview invite? Once somebody is interviewed, how do they determine who gets an acceptance? Learn how all this process happens.

Additionally, if you're somebody who has applied to the University of Illinois and you've been rejected, now you can see behind-the-scenes, what goes on and maybe where your application fell short.

[02:45] A Brief Background About Leila and Her Moral Obligation

For Leila, it all started with her being a peer advisor as a Biology undergraduate, working her way through the ranks as an advisor and becoming the Director of Advising. Then she got really engaged with and appreciating the passion in the premed students. She began to look for an opportunity to be able to work with them exclusively. So once the position opened up in the admissions at the medical school where she was working, she took advantage of it. So she started working as an Admissions Director back in 2009 in Florida.

Being on the other side of the table is what Leila found as a struggle. Believing in her students, she knew what they needed was a chance. And if one medical school would give them the opportunity, they could go there and prove how great they are and how they can enhance the lives of everyone that they touch moving forward.

“We want good people and and who have traveled the distance. We want students who will really put their heart out there for their patients.”

Being on the other side, she realized the moral obligation with admitting students. They want good people and and who have traveled the distance. They want students who will really put their heart out there for their patients. And the other piece of it is looking at the student's capability to make it through the curriculum. This was the piece she says she really learned about once she came to the side of the table.

The fun part of being on the admissions side is interacting with students while letting those students who don't make it the first time, know that there's always hope. There are ways you can do to make your application stronger and better. Or submit it to the school that's the right fit for you.

[06:30] Behind the Scenes: What Should the Next Class Look Like?

Every year, the application cycle opens and medical schools get their first big batch of applications by the end of June so they can start sift through and see who they want to interview.

Leila works for a mission-driven school, specifically working for social justice and the commitment to the under represented and underserved communities. Every year, they have a process for screening applicants. But their committee sits down and revisits the process to make sure they're looking for the right intangible pieces of the application.

At their school, their faculty are okay with students who had some hiccups along the way. The records may not be outstanding but they've stuck to it and they've persevered and they've tried as hard as they can to make it through.

The other part of the application would be all the experiences and activities the student has spent and invested to make sure they understand what it means to be a physician. They should understand what the job looks like and who they will be serving. Do they understand that this is a lifetime commitment? This isn't a job, this is a lifestyle that they're choosing. So it's expected of them to be able to take care of people as long as they can.

"Do they understand that this is a lifetime commitment? This isn't a job, this is a lifestyle that they're choosing."

Leila explains that they usually start with revisiting their screening process from last year. The mission is the same but who did they accept last year, were they happy with who they brought in, and what they would want it to look like next year.

[09:25] How Students Can Align with the School's Mission

If you look at the mission of University of Illinois, they're similar to other schools where they have the 3-pronged mission relating to research, service, and providing care. What Leila likes about their program is that as they bring students in, about a third of them fit each part of the mission.

All this being said, not everyone is going to be interested in research. These are the students who have spent a lot of time and effort working with communities and patients. So they're meeting the service mission and the providing care mission.

"It's not that each student has to present themselves as excellent in all three areas of the mission."

As they looked at the students they've admitted this year and last year, they see that aside from the fact that they've seen a third of the students fitting each of their categories, they're also exhibiting excellence. They've had students spending thousands of hours doing research and have had couple of publications. They were awarded some of the grants in their institutions. They've had some time in the clinic as well as doing service. But those hours are much less compared to the time they've spent doing research. This is okay.

[11:30] The Step by Step Screening Process

Leila says they don't have a minimal threshold where below it students won't be considered. But they're one of the schools that doesn't release secondaries to all students. This is their first pass. If a student doesn't receive an invitation to complete a secondary, that signals to them that based on the academic credentials presented to them, they don't think there's a possibility that the student passed. Leila describes this bar as being very low. This would mean a student who struggled in every single science class they took, have had a few failures, had to retake them, and those repetitions weren't all that good.

Then they come to the students who have received the secondary. They're average was sitting around 3.6-3.7 but this range is so broad. They will see students with 2.5's and 2.9's who even got admitted as well. What they want is a student who's taken a broad range of science classes. They struggled in the beginning but they managed to understand how to do well in science and they've held an upward trajectory as far as they could until they graduate.

Additionally, they also have a postbac program. For students who have done well in terms of their service and have done extremely well in terms of their patient care but their life circumstances have prevented them from dedicating their time to their studies, they would invite students to join their postbac or prematriculation programs. This way, they have opportunities to learn with their faculty to give them the academic skillset they need to be successful.

"As far as the MCAT is concerned, we don't have a minimum threshold but when we're looking at percentiles or the single digits, those are the students we're not considering for admission."

[14:15] How They Look at a Low GPA

Leila explains there are reasons students don't do well in school. They could just be having a lot of of fun time in college. And a lot of times, these students could be involved in a lot of things like leadership, sorority or fraternity, service, etc. So basically they were spreading themselves too thinly. Because everyone is an A-type personality, they aren't willing to give those things up. They don't give themselves the opportunity to do well.

So if that distraction was removed from you and you only had the time to study, what will it look like? Either you're reapplying or maybe a couple years had passed and you want to do medicine now, you really need to take some science classes in order to show them what you have. Leila explains this is where the manual process begins. Because when they calculate the GPA, it includes all the undergraduate classes. And sometimes, it's hard to get that GPA to move. So once they see this separation, they look at it separately. They will calculate it manually just to see where the student's GPA is. This means looking at them one by one and looking at what they've done.

"Either you're reapplying or maybe a couple years had passed and you want to do medicine now, you really need to take some science classes in order to show us what you have."

One of the process their committee has approved is to remove a full year of course work from a student's record. So if a student comes in and freshmen year is really tough, and the GPA is bad but then everything is great, then they'll take it out. So they go from being a 2.7 to now 3.5 or 3.6 because they've removed all of that.

Then there's another scenario where if they have the good grades and all these extracurricular activities and the MCAT, they know it was just freshman blunder. What's important is for students to be clear with us. If there's a dip like that in their GPA or maybe a life happens along the way, let the committees know. Otherwise, if they don't give an allowance for you to make a mistake, you should be looking elsewhere.

"Not every school is the right place for a student. If that school can't give student a wiggle room for being a human being, that school probably isn't the best place for them to go."

[18:35] How to Improve Your GPA: When to Take a Traditional Postbac vs a Master's Degree and Other Factors to Consider

Leila describes the drawback to the traditional postbac in that the undergrad classes feed into the GPA. Getting that GPA to move is very hard. If you tried as hard as you could and still couldn't get the As then do a postbac. It's going to be a longer process but you need to figure out how to do well in undergraduate classes before you can move forward. But if the reason you had low GPA is because you weren't paying attention to school because you were to busy enjoying life, then think about the next level. This could be a master's degree. The beauty with this is that the GPA sits separately. So they no longer have to look at the 2.5 but only at their Master's GPA which could be 3.89. But this should only be done only if the reason you didn't do well was because you were spending time doing other things rather than studying.

"The beauty of the master's degree is that the GPA sits separately."

Now if you were studying, the master's isn't your best option because if you come in to the master's and do poorly, you've proven to the admissions committee that science really isn't your thing because you've tried it twice and it didn't work out. Then you know it's the issue of how bad was the undergrad GPA. Or is your master's enough or not.

If you jump into a master's degree right at the end of the undergrad and applies the same year, the master's isn't helpful because the transcript they get is the undergrad transcript.

Also find out if they school takes updates or no. If you apply to schools that don't take updates, there's no point in applying because you can't update anything. If they do, then you can consider this. But Leila points out that what does one semester of As (about 9 hours) do in light of the past 4-5 years where the student had not done well?

Also, is one year enough? Sometimes, the one-year master's degree only gives students only about 20 hours of science. Some committees will say 20 hours isn't enough. So Leila says the better option for that is to do a regular two-year master's.

For career-changers, they go for the one-year master's and if you're going to do fine in this, then move forward. But if you didn't do well as an undergrad, then you need to complete the one year master's and then apply the following year with the full transcript, which then becomes two years. Leila says it's all about the timing.

[22:00] Screening Process for the Interview

Their screening process, as Leila explains, is to look for mission-related aspects of the application. They look for certain attributes to show they're able to blend well with their community and have an appreciation of them. Academically, they will look at the times you were on the Dean's list, etc. And if you're as strong as the students they've admitted the previous year or even stronger, they'll invite you for an interview.

Another important piece for them is that having multiple campuses, two of which have different emphasis, they want to make sure the secondary really addresses the student's fit to any part of their community.

"The secondary really addresses the student's fit to any part of our community."

The things they ask of them to do are things related specifically to what they have available on the different campuses. After that, they want to make sure to look at the application as a whole - well-written personal statement, etc.

[24:25] What the Admissions Committee Look for in a Personal Statement

Leila explains that when she's done reading a personal statement, she wants to be breathless in wanting to meet this person. That being said, the personal statement should help the admissions committee understand where your motivation and commitment to dedicating your life and alleviating the suffering of others come from. And how do you maintain that? So you really have to dig deep. Do not regurgitate what you've done in your experiences since it's all there. But help them understand at the deepest level. So Leila wants it to be a conversation, almost, between the student and the admissions committee. They want the personal statement for you to really highlight who you are.

"When I'm done reading a personal statement, she wants to be breathless in wanting to meet this person."

Additionally, Leila reveals some red flags which you might want to avoid talking such as talking about the skills of a doctor and what a physician should be like or when you use an analogy that's not something you're not familiar with, this is problematic. Or when you talk about a bad experience you had with another physician and so how you're going to change the world of medicine. None of those speak to them because it comes from a place of lack of knowledge.

Until you've gone through the training and you've been there and you've held the hand of the dying patient, it's hard for them to say what the skills are.

It's different from saying you've been a patient and these are the things you saw and you'd love to emulate this, then this shows you have this understanding. Ultimately, it has to be a personal sharing of what it is that motivates you to be out there to take care of people.

"It's a risky perspective to take when writing a personal statement because there's always someone on the other end who's judging it."

Leila also goes on to say some of the best personal statements she has read are based on their experiences and the reflection that leads them to understanding it's where they have to be otherwise nothing else will work. So walk the admissions committee through how you reflect it on life and how you can use your special skills to make it better for the rest. The entire application shows reflection even when you write your experiences. Moreover, it's not all about you. Otherwise, the patients will be lost in all of that. So you need that reflection.

Leila says students forget about that because told to make themselves shine and to share  about themselves and they don't think the admissions committees can already look in the grades so you don't have to tell them this.

[35:38] How They Use Secondaries

Leila explains they use the secondaries for the interview invites and for inviting students into different campuses. Again, they're looking for the reflection piece and to make sure students know what the school has to offer. The school therefore needs help in order to figure out where they need to be placed especially that they have different campuses.

"The secondaries are very important for us to determine where the student will interview because it's very likely that they'll be placed there and how much do they really know about us."

The reason they ask applicants what they're interested in doing because they want them to be active members of their community. Ultimately, it allows them to determine whether they're the right fit. On the other hand, they're on their best behavior to prove to applicants that they do deserve them as students.

[38:10] Verifying the Truth: How Do They Validate What Students are Telling?

Leila explains they have rural county indicators in Illinois where they start all the way back from where they grow up, high school, and are they understanding of the rural community. They also have a specific program for rural medicine called RMED located in their Rockford Campus. They have a special application process separate from their regular admissions process. Students would go through both processes. Literature out there suggests that students who've been engaged in rural communities are the students who will have the greatest likelihood of going back.

Moreover, they ask for the student's history in their state, where they've lived, rural activities they've participated in. They usually conduct a committee interview with community members from all across the state including hospitalist, politicians, faculty members, care providers, members from the farming community. So there is expertise in this that goes beyond just the admissions office.

"What they're looking for is rurality. How much does this individual understand the needs of the local communities?"

But for students that don't go through this track, Leila says it's all about looking at the entirety of the application. So if you use the analogy of running a marathon and you haven't done that and if you talk about rural medicine knowing that's a big area of interest for them and there's no indicators in your application, it doesn't matter how strong you are. Leila admits it's going to be difficult for them to get you an interview invitation due to the disconnect between what you've done and what you're saying.

[41:45] What They Look for on Interview Day

As previously mentioned, they want you to match what they read about. It's that first impression when you come in. They look at your ability to communicate effectively with them. Interviewers are generally two faculty members and a student or faculty or staff member. The faculty will be looking at the student for fit as a future mentee. The same for the student there who looks at you if they can see you as a classmate. And for Leila, as an administrator, is she tells interviewees to think of her as a future patient. So she will look at you for communication. How well are you able to articulate your responses to the questions?

"The interview is just the chance to communicate with them and see how they are in person... a good part of it is recruitment because we know students have lots of options."

Moreover, Leila admits the interview process is also more of the recruitment side knowing that students also have their options as to which school to go to. So they will also try to prove to students that they appreciate everything they've done, they have the resources and the people who can help them get to the next stage. So it's both recruitment and making sure you're going to be a good fit with their community.

[44:20] Comparing Between Students and What to Do When You Don't Get Accepted

Leila explains they take everything they have at their disposal. So it's the entire application, performance during interview, and can the person come in and add to what they have or need in their community. So they basically look at the student who makes a better fit to them.

If you don't get accepted, Leila recommends that if you had the interview and it didn't go well, it's important to reflect on what happened as you were going through the interview day. You may have three really good interviews, but if you were unkind to a staff member or to another student, this might hurt your application. So you have to reflect on the entirety of the experience you had that day and what happened during the course of the interview.

The biggest comment she gets from interviewers, for which she feels the same, is that the person didn't give them the opportunity to meet them. You're sitting across them who are asking questions and you're so concerned about their opinions, well, you should have your own opinions. Whatever they are, you should be able to justify them.

"I promise, I really don't care what the answer is unless, of course if it's something really bad. But generally, no one cares what the answer is. We want to see why you have that opinion."

So for her, the worst thing that happens in interviews is if the student doesn't allow the opportunity to meet them. Plus, there are things like using bad words or not paying attention and fidgeting or on the phone.

She also recommends that you take full advantage of all resources available to you. Go to your advisors. Be honest about what happened during the course of your interview. Ask your advisor to contact the medical school as there are things that an admissions director may be able to tell an advisor and not the student. Then the advisor can help the student understand that.

[50:27] The Timing of it All: It's a Rolling Admissions!

Leila points out that timing is everything. Being a rolling admissions schools, as most are, it's easier to shine in 500 than it is 7,000. As applications come in and they're completed, students are invited and admitted. They reserve seats all the way through the process. But by that time, they've already seen a lot of students come through.

"They need to apply as soon as they can because seats fill up and while we reserve seats, I don't have 305 when I'm interviewing in January unlike I do when I open up the doors in the beginning."

So be sure to submit your application as early, but then you need to be ready. So don't just submit it just because people tell you to apply early. Request your letters way ahead of time. Keep reminding your faculty members and get the letters in. Leila says that every year, they have close to a hundred students whose applications are not completed and rejected because they didn't get their letter in time. It's true it's not your fault since you're not the one uploading the letter but it may be your fault because you asked too late. MCAT, for instance, you don't take it until September and you won't get scores until October. And many schools are done inviting for that year in October. So they're looking for Spring invitations.

"Apply when you're ready, but timing is really important for everything."

Nevertheless, it's not the end of the world if things can't happen this year and you wait to apply the following year. Have all your science classes in place. They will look at students who don't have everything in place. Have you met all the required classes and how did you do in them?

You have to understand the "deadlines" for applications for medical schools don't mean anything. Since students are so used to having deadlines, they think the applying to medical school is the same. But it's important to change that verbiage that instead of a "deadline," it should be that applications are open and it's first come, first serve.

Leila adds students shouldn't be taking a test after November because the score won't come in on time and they wouldn't have fulfilled all of the requirements. She doesn't really know how to change this culture.

However, this is reflective of the individual. If you can't follow very simple directives on how to do paperwork and when to send things in, then you might have it all together to be a great physician either.

"If a student is unable to follow follow very simple directives on how to do paperwork and when to send things in, I'm not sure they're going to have it all together to be a great physician either."

[57:30] CASPer for Screening Students

As with the CASPer, they haven't been using it explicitly in the admissions process as they're still studying it. But for those who use them, it's for considering students whom they might have otherwise considered just based on the metrics. But because they've got other great personal or ethical attributes, they could make a good addition to the class.

I would always like to describe CASPer as a personality test on steroids with a lot of moral ethical stuff and as fast as possible, you need to give your answers to the scenarios given to you. A lot of students are worried about it but there's really no need. Just give your initial responses to the different scenarios. For the most part, this could challenge your typing speed which is something you should start practicing.

Leila adds that non American students don't do as well on the CASPer because their responses are judged from an American lens. First generation or even second generation immigrant students with strong heritage presence in their home may not do as well. So this is something you may want to work on as well.

[01:01:30] Letters of Recommendation

Leila highly advises students to review their letters, meaning really think about who you're asking letters for you. They get letters from faculty members who don't really know the students well. They've also received letters from faculty members who haven't been supportive of the candidate's application. So think long and hard about who you ask to write letters for you. The letters are supposed to give them additional information. They are a pain to ask but they're so important because as she puts it, it's the only other thing they have to help them with the application. So make sure the letters are good.

At their school, their letter process is manual. Oftentimes, their application can't be competed because they've not yet manually reviewed them. So if you haven't heard from them in a week once your letters are complete, call the office and ask. With 7,000 students with three letters each, this is a huge amount!

[01:04:05] Final Words of Wisdom

Ultimately, Lelia says there are multiple ways to do this. This is your dream. And if you want to realize this dream, no one is allowed to take it away from you as long as you're doing the things you need to be doing. Don't give up. But there have to be enhancements. This means don't keep applying with a 2.5 and 498 on the MCAT and wonder what's going on. Don't keep applying when you haven't done the spot check. Look at the different parts of the application and see what's going on. There's a lot of opportunities for you to be a physician. Talk to them. Work with them. And good luck!

Links:

University of Illinois College of Medicine

May 30, 2018
287: This Student, and Dad, Overcame a Poor GPA to Get Accepted
38:16

Session 287

Nick is a former premed student-athlete who didn't do well in school and went into business but he knew he was always missing something. Now, he's accepted to medical school, multiple acceptances in fact, after fixing his GPA.

The Premed Playbook: Guide to the MCAT is finally available in Paperback ($9.99) and in Kindle ($4.99) formats. Also, stay tuned for The Premed Playbook: Guide to the Medical School Personal Statement, coming out soon!

[02:15] Interest in Becoming a Physician

Nick initially wanted to do medicine and then a total shift came until he finally found his way back.

Realizing he had a strong interest in healthcare as a kid, his grandpa had some obesity and health issues and took some interest in his health. Having followed his health journey, he took a great interest in making sure he's taking all his medications.

Then he worked in a nursing home as a teenager, which he considers as another formative event being drawn to people facing health issues.

Nick comes from a family where education wasn't really valued and he grew up in a small town in Iowa surrounded by blue-collared jobs.

[05:55] Transitioning from High School to College, the Business World, and Back

Nick was an athlete so he did get a little guidance and went to a college where he could play football. He had an early injury and not basically being prepared for college, he didn't have the study habits he needed to have. So his first semester was so bad and he was close to failing by the second semester.

"I didn't have the study habits that I needed to have to be successful in college."

Four to five years in, Nick realized the business world wasn't where he should be but it took him a long while to come to terms to it. He realized he took a wrong turn somewhere along the way. In fact, he processed this for several years before he decided it was really time to take the plunge. That being said, he worked for a couple different careers, one for three years and another one for six years before deciding to quit and go back to pursue medicine.

Nick admits he had to deal with a lot of fear having decided to go back to medicine. Since also at that time, his wife was pregnant. So there was fear as to how he was going to take care of his family. There was fear as to whether he had what it takes to be a medical student. And just that general fear of change.

So he had a hard time approaching the subject with his wife. But her support and enthusiasm really helped put him at ease. He also knew he had been successful at other things, both academically outside of undergrad years and in business. So he thought he was capable and he had what it takes. Plus, having the support of his wife was priceless.

"It's so continue doing what you're doing, especially if you're good at it and your road is typically successful. Why leave something you're good at even if maybe you don't totally love it?"

[11:50] Dealing with a Significant Other

I recently talked with a student whose significant other isn't as supportive as they should be and so this is hard as to where do you follow - your passions or the marriage certificate?

Nick adds there needs to be an open dialogue here. Figure out why you're thinking this or why this is dream. Then try to understand what the concerns are from the spouse and really break that down and see if there's somewhere you can meet in the middle.

There are times both Nick and his wife are questioning why they're putting themselves through this, and then something good happens along the way. So it's brought back to that idea once again that this is where they want to be. Additionally, there's that desire of changing his family legacy of impacting the community.

[13:15] Reach Out to Your Premed Advisors

There are two huge variables when it comes to thinking about potentially going back to become a premed for someone who's been through college already. Number one, is this what I want to do?

And the other huge variable, is that is this something realistic? Is this something that I can do? In Nick's case, it's from a GPA standpoint. His GPA undergrad wasn't very good but when he got on the phone with a premed advisor, he told him it basically depends on the schools. And that a lot of schools will look at what your most recent work is. His advisor had seen he has done some graduate work, his advisor said it can be done. This was they kind of encouragement every student needs. And Nick encourages students to reach out to their premed advisors and ask a lot of questions. Even better, reach out to the medical schools themselves, specifically the admissions committees and lay down your story and ask them what you can do. Just keep the lines open. Show them you're interested and let them know you want to go to their school because that helps a lot.

"Reach out to those premed advisors and ask them a lot of questions."

[17:00] Questioning the Decision

Nick did come to think and question this a lot. It could have been so much easier if he had just stayed at his job. Although he was doing great at his corporate job, Nick really didn't find much joy in it. He stresses the importance of really following your passion.

He does like to help people and he does like science - and if you're going down this path, then those reasons are the given ones of course. But the biggest setback for him as a postbac student was his Statistics class. He went in thinking he had to get all As due to his ugly GPA. But he realizes you don't need to get all As even with a bad GPA. It's okay since a good school will still be interested. Nevertheless, he was struggling in his Statistics class. Although he was able to work back from those and get a B. So this was his first downer.

"You don't need to get all As, even with a bad GPA."

Secondly, he thought he was studying so hard for the MCAT. But he didn't get the score he wanted. It was a good score but it actually hit him whether it would actually work out having gotten the score he really didn't want. It wasn't the score he needed to get to get into the schools he wanted to get into. He got into his first choice of school and his MCAT score was below their median (which is actually just completely normal).

[21:00] Studying for the MCAT

Studying for the MCAT, he got the books. He studied and set time aside. He took a light course load. Literally, he spent a big chunk of his time studying for the MCAT everyday. But he didn't see his score move on the practice test. And he believes the MCAT is a test on how to take that test, not so much the content. He even over performed on some of the sections that he struggled with his preparation. But he under performed on a section he normally did really well on.

"I think the MCAT is a test on how to take that test, not so much the content."

From his first practice test to his last, his score almost didn't change. And that's what he got on his MCAT. The diagnostic he took was one point below the actual score he got. He actually took a lot of the practice tests. And as far as reviewing them, he admits having reviewed all of them. For some, he performed well and for others, he didn't do as well. But his average was about the score he got which was what he started with.

Having figure it out, Nick says he wasn't taking the test the right way. So it's more of the method of taking the test. He think it's about managing the time he should have. And he admits there could be other things he could have learned from a class on how to actually take the test versus content.

"I don't know that I struggled as much with content as I did with the mechanics of the test."

So maybe a little help through a course or just a couple hours with a private tutor to help him work on his test taking skills might have helped. Nick encourages people to do this even if you think you can manage to study on your own. The change itself is challenging as well as the mechanics of the test.

[24:50] Choosing Which Schools to Apply To

Discussing this with his wife, the agreed he was going to apply broadly. There were also schools he interviewed at that his wife was not so sure about for geographic reasons. This means uprooting the family and going to a different region of the country. But in the end, she was very supportive of him. For most schools, she went with him during the interview to check out the place. But for his first interview in Arizona, she didn't go with him.

Nick recommends you let your significant other to go with you to where you're interviewed at so they too can have a glimpse of the area. And if you have kids, you can actually turn this into a family vacation.

"Bring your significant other. Drive around. Think about what it would be like to live in that area and logistically, what it might look like."

[27:30] Telling His Story on His Personal Statement

Basically, what Nick wrote in the beginning was nothing like what he ended up with. When your path is so long and there's so much to include, you don't do any of it justice. So he focused more on those formative experiences and those experiences that talked about why he wanted to be a physician.

During his interviews, he didn't think his personal statement ever did come up. Except for one interview where they looked at his personal statement and talked about his experiences and that he was a nontrad. But other than that, sometimes he often wondered if they do even read personal statements.

"Focusing more on those formative experiences and focusing on experiences that talk about why you want to be a physician, that's really where I tried to focus on the personal statement."

[29:00] The Challenges of Being a Nontrad

Nick explains there's a culture in the premed world where you're always questioning whether you've done enough or whether you've checked enough boxes. And he fell into this. He knew this is wrong but he still couldn't help but wonder if he did volunteer and put in enough hours.

He didn't put in as many hours as a lot of many people he was volunteering with. It's understandable since he has a family and a lot to take care of at home and his coursework. But he leaned on a lot of those experiences he has had in the past. For instance, he wrote about his work he did for Hurricane Katrina relief which was ages ago. But it was very impactful for him. But this being said, also show that you've still been volunteering and doing things recently. Try to talk about all of it.

"I think we put all these things on us that we haven't done enough, we need to do more. Especially as a nontraditional student, lean a little more on your experiences that you've had in the past."

[30:40] The Interview Trail and Early Acceptance

Nick admits going into the interview trail with a lot of fear. He got an early acceptance though so this helped him a lot. He got it back in August. He applied both in MD and DO schools and it was DO school that gave him the early acceptance. He felt really good having an acceptance so he had that as a fallback plan. It was a school he didn't know anything about but he found out he really liked the school but it was a long way from home. But he thought that if he couldn't get into some of those schools he was more interested in, then that school was still a great place for him to be.

So going into that first interview was the greatest fear he had. But realizing he put in all this work, he got an acceptance two weeks after the interview. Also, he said having had those experiences have made his MMI much easier.

Nick did wish he got his MCAT back but ultimately, he got into the top schools he wanted to get into from the beginning. Still, he knew he could still have improved on the MCAT. There could have been some classes he could have done a bit better in. There were some more classes he wanted to take that would have helped prepare him for the MCAT more. Also, had he done research, he thought he was going to get a lot in. There were times he spent too much time focusing on the studies that he wished he spent more time just with his family. In the end, your extra 2-3 hours probably doesn't matter as much and he could have spent that time with his family instead.

"There were times where I've probably spent too much time focusing on the studies and I wish I would have spent a little more time just with my family."

[34:40] Future Worries and Final Words of Wisdom

Nick says it's about trying to maintain a healthy balance between studies and family. Trying to get that time with family is a big fear for him. But he has been talking to people who have said he can make this work. It's about scheduling your time and setting time blocks for studying and then for family.

Finally, he wishes to impart to students to stop doubting yourself so much. Be persistent on the studies but take your breaks too. If you're really struggling with your classes, get help. Most schools have free tutoring or study sections that can help you get there. Take advantage of the resources available to you. Lastly, call the med schools you want to apply to and establish an early relationship as this can help you along the way. Make those connections early on.

Links:

The Premed Playbook: Guide to the MCAT

The Premed Playbook: Guide to the Medical School Personal Statement

May 23, 2018
286: Common Mistakes and More About Financing Medical School
33:29

Session 286

Travis Hornsby went from trading bonds to figuring out how to pay off his wife’s medical school loans as fast as possible. Now he makes it easy for every student.

First off, The Premed Playbook: Guide to the MCAT is now available on Amazon, Kindle, and Paperback. Just a reminder, you don't have to have a Kindle device to read a Kindle eBook. You can use a Kindle app on every device you have. It's $4.99 for the Kindle at this point and $9.99 for Paperback.

Today, Travis is going to help you figure out how to pay for medical school, how to pay back medical school loans, how to avoid common mistakes students and physicians make, and so much more!

Any questions? Reach out to Travis thru email at travis@studentloanplanner.com.

Here's the free student loan calculator that Travis site to help you figure out all the loans in this whole process.

[02:35] Money as a Taboo in Conversations Around Medical School

Money is such a taboo when it comes to medical school. Nobody wants to talk about it. How much loans did you take out or who did you get your loans from? Topics like the interest rates and options for getting it back are things no one wants to discuss - perhaps only except for their financial aid.

So it's important that the more you go out there and talk with other students about this and make it less taboo, the better it's going to be.

"Money in this country is a very taboo subject, not a lot of people want to talk about it. And that hurts us as we go through this process."

[03:10] A Brief Background

Travis is a former bond trader turned helper of graduate students, specifically medical students among others. He's married to a physician and has helped students with over $250 million in student loans.

Travis met his wife during her last year of Fellowship in Philadelphia. After dating for some time and having a serious conversation about money, he didn't really realize how big student debt is in the medical world. Being a bond trader, he made a model out of an Excel spreadsheet and figured out how he can help his wife then girlfriend. eventually she asked him to figure the same for her friends and just charge them for it. This snowballed when he actually put it online, garnering thousands of views and people reaching out to him and asking questions about it.

[06:25] How Long Can You Pay Back Those Loans?

Travis explains the two approaches physicians take when paying back loans, where they either work for not for profit hospital and going for a loan forgiveness approach. But for a person who is supposed to pay back the debt and working for private practice or trying to pay down as quickly as possible, the people making good incomes are paying it down for around 5-7 years. This is for the high-income specialties. While for the modest income specialties, he gives it around 10-15 years. His wife's boss even still have student loans and to think he's now on his late 40s.

"Because of the higher than average incomes, the people eventually become attendings, their payment periods on average are still reasonable and approachable."

[07:45] Live Like a Resident Even After Training

Travis considers physicians as low risk borrowers compared to business people for example. So banks aren't always going to make terms very attractive to lend you money. He stresses that you're supposed to live like a resident for at least a few years out of training. Say you're buying a house, just pretend you're a teacher and that's your income for the next four or five years. And live like that until your net worth is about at least zero.

"The adage with Jim Dahle that you're supposed to live like a resident for at least a few years out of training is super accurate and it's a big problem."

[10:55] For the Nontrad Students

Travis thinks that people in their 30's and 40's who feel like they haven't gotten out of the career they want and they feel like they have to work until they're 70s then that's fine. But if the decision is becoming a physician and working until your 70s or not becoming a physician and working until you're early 60s or late 50s - which one of these is more appealing?

"Make sure you have an absolute passion for medicine. You'd have so much regret if you ever haven't experienced a life for the rest of the career when you didn't become a doctor."

For nontraditional students, with limited number of years that you're going to practice, it basically boils down to a decision of the heart and emotions. But just make sure you have an absolute passion for medicine. You'd have so much regret if you ever haven't experienced a life for the rest of the career when you didn't become a doctor.

[12:25] For General Premed Students

Travis stresses that they keep very close tabs on the Prosper Act. Being debated in Washington currently, it's basically change in the student loan system. And the policies being discussed right now involve curtailing a lot of these loan programs that have made people to not feel the full cost of medical school.

Travis said the big changes would be repealing public service loan forgiveness for all students who start medical school after July 1st, 2019. This being said, this wouldn't impact anybody who's applying, accepted, and going to medical school this Fall. Instead, this could financially affect the folks that are going to fall after that.

If you don't have access to that program, you won't be able to work for ten years at a not for profit hospital and wipe your hands clean with your loan; rather, you'd be responsible for the whole thing.

And if you're thinking about going into primary care or one of the lower earning specialties, this could be a major financial burden on you if you're going to medical school beyond July 1st, 2019.

"Be very cognizant and really follow closely so you can make a fully informed decision about how you're going to finance med school."

Right now, doctors have access to this public service loan forgiveness and it's the most generous backdoor scholarship program in history. Just work 10 years and paying based on your income at a not for profit hospital. Then at the end, your loans are forgiven - without tax consequences.

[14:30] Determining Your Opportunity Cost

For example, you're an engineer and you make $90K a year but you enjoy your job and you like the lifestyle. Compare that to being a primary care physician and taking on a big debt and just pretend you invested money along the way, while you're working. It takes a long time for the break even math to make the physician's job win with a bunch of debt.

The finances could work with $300K and a $150K of income, the thing Travis would usually ask is what's the most optimal way to pay it back? You could pay the $300K back, living like a resident, being extremely frugal, getting really motivated with these debt pay-off programs. But what's the right thing based off of your lifestyle and the math.

Travis has run into a lot of cases of lower paying specialties where people will have that $300-$400K of medical school debt. They may be in a private sector job and they've hit that income they feel like they're going to be at for a while. But they went out of town and have kids or they want to work a few hours to have a more flexible lifestyle.

A lot of times, you can make the cost at today's dollars, like "pay as you earn" for 20 years. Even though you have to pay a tax bomb at the end of it, makes more sense than actually paying the debt off just from a pure number's perspective.

[17:40] Be Aware of Your Options

If you take out direct federal loans and this is a great question to ask your financial aid person before you go to the first dance class and get the big bill, "are my loans for the first semester going to be on the federal direct program?" If your answer to this is yes, then everything the government is saying, you're going to be locked in to being allowed to borrow in that program with all the sweet repayment programs and all the great stuff and you're going to keep it for the duration of your medical school career. But if you go to school and you're given what's called the Federal One loan or whatever they end up coming up with that's not a direct loan, then that's when you really have to run the numbers and think about how much you're going to have and know you have to pay all that back.

For some of the high cost private schools out there where you're going to come up with $400K, you can go look into other career possibilities like the military. Look at some other way to do a program to get some assistance. There's the HPSP, NHSC, and NIH Scholarships, where you can get assistance from them if you're doing research at a hospital.

"Be aware of your options. One of the difficult things with medicine is that the loan programs are so dispersed that there's no centralized source where people can really get access to everything."

[19:45] Where Loans Are Coming From and Where You're Getting Your Money

Travis explains that the unsubsidized Stafford loans are those you want to max out and take. They've got a 6% interest rate, origination fee is about 1%. This is good considering you've got all those benefits from the federal loans programs. That's about $40,000 a year that you can take out, so $20K each semester. Most people will need more than that. Travis suggests asking yourself, how do you come up with the answer to the questions of "where do I get that more than that money?"

So if you need more than $20k in loans a semester, where is that going to come from? If you're planning on having an academic medical career, you like the idea working at hospitals then make sure all of your debt is with the federal government.

You don't want to take loans that are not direct loans because those direct loans are the only loans that have access to the Public Service Loan Forgiveness (PSLF) program. This is a general rule, which means 40K a year of unsubsidized Stafford Loans and everything above that is going to be on the Grad PLUS program.

"If you're planning on having an academic medical career, you like the idea working at hospitals then make sure all of your debt is with the federal government."

If you're planning on going to private practice, then the Grad PLUS program, everything you need above $40K a year, that is at a 7% interest rate instead of 6%. On top of that, the origination fee (the amount of money they charge you upfront that they take into the loan) is about 4.27%.

[23:28] Private Loans

Travis warns students that you should only do this if you're 100% certain you're going to go into private practice. Because if there's any chance at all that you're going to want to go down the not for profit road with the hospital system then taking a private loan is a disaster.

"If you it ever does make sense to take up private loans, you would never want to take up the full cost of med school and private debt. You want to exhaust the Stafford resources first."

Travis goes on to say that the issue with private debt is that the payments during residency or fellowship could be troublesome. A number of them will refinance residents' private student loans to nominal payments during their training. The payments are not an issue because they'll keep it very low after the training for the private debt. And then when you come out, you can refinance the whole thing or part of it.

This is only a strategy Travis can suggest. It might save you $20K in interest, perhaps 10-40 if you go down the private practice route. That's the reward.

If you go on the not for profit road that you have private debt and you took out private loans instead, it could cost you hundreds of thousands of dollars to take out private single loans instead of federal student loans.

Weigh the risk-reward.

Weigh your future career goals. Think whether the way you're taking your student loans out reflecting how you think your future looks.

"Is the way that I'm taking my student loans out reflecting how I think my future looks? A lot of people just don't think about that."

[26:22] Travis' Advice for Premed Students

Be very cautious with credit card debt during training and during medical school in general. The student debt is better to have than credit card debt for a host of reasons. Resist the urge to equalize your consumption patterns with what you expect they're going to be as an attending.

"Be very cautious with credit card debt during training and during medical school in general."

Travis also suggests having $5,000- $10,000 in the bank even during training, during medical school. You always want to have enough financial cushion in case any crisis may happen to you.

"The general rule that keep your debt as low as possible still ring true."

Additionally, Travis recommends going to the lowest cost medical school you can get into to. Compare costs and think whether you want to have more options in your life or fewer options. A person with a $200 debt has definitely more options than the one with $400K. So every medical school places people into prestigious specialties. If you're checking out multiple places, go to the expect cost of attendants on the Financial Aid in each school's website and look for whatever the estimated cost of attendants is for four years. Multiply it by 1.25. You're growing that number by 25% and that's what you'll leave with in student debt if you borrow the full amount. Compare that number at each place and then heavily weigh the decision as to which one is the most attractive for your cost.

Links:

The Premed Playbook: Guide to the MCAT

HPSP

NHSC

NIH Scholarships

Public Service Loan Forgiveness (PSLF) program

Grad PLUS program

May 16, 2018
285: Hear How This Immigrant Got An Acceptance to an Ivy League!
55:00

Session 285

Fernando immigrated from Brazil and has been on the long, slow road to medical center. After some experiences in the LGBT community, he needed to be a physician.

First off, The Premed Playbook: Guide to the MCAT (Kindler version) is now available on Amazon. You don't have to have a Kindle to read Kindle books. If you have an iOS or Android device, Amazon makes that Kindle app for your device. Go ahead and buy the book right now for only $4.99. It's going to give you the information you need to know so you can better understand everything about the MCAT - when to register, how to register, getting fee assistance, how to best study for it, etc. This is a book I co-authored with Next Step Test Prep. They offer full length practice exams, they’re the second best next to the AAMC practice exams. Use the promo code MSHQ to save 10% off their practice tests.

Back to today's episode, Fernando took a long time to finish his undergrad. But through this application cycle, he has had multiple acceptances to amazing medical schools. He will be going to an Ivy League medical school soon.

[03:35] An Interest in Becoming a Physician

Fernando never thought being a doctor was for him until he was 26 years old when had to move to New York City where he became part of the LGBT community. He considers it as a calling that brought many different aspects of his life together.

Basically in Brazil, they were able to pick their major and he got impressed after touring a school of medicine there. But he didn't feel he had the discipline or that he was smart enough. At 18, he wanted to move from a small part of the city and wanted to see the world. And the thought of studying medicine in Brazil for six years in medicine wasn't something he could see doing. He knew he loved sciences but he also knew that if he had to study something, it had to be related to life.

Fernando came out of the closet at 19 when he was still in Brazil then he moved to the States when he was 21. He wanted to become more independent and be able to live in a country that wasn't homophobic. And moving to the US was eye-opening for him having been able to understand the problems his community was going through, particularly relating to HIV. Having friends coping with HIV and seeing the American healthcare system, he thought how fascinating it would be to learn the tools and bring that back to his community.

"I became more mature and I was able to face and understand some of the problems that my own community was going through. It was really related to HIV."

In Brazil, he went to a very good university with a GPA of 2.8. When he moved to the States, he found the system to be easier to navigate. He also became more mature and more aware of what he needed to achieve as a student. As a result, his grades started to get better and better. And so he thought he could really do it.

[12:20] Gathering the Resources to Begin the Process

Initially, Fernando didn't know where to start especially looking for someone that has the same background as he does - being a gay Latino. There was no role model for him so he began figuring out some resources - one of them is The Premed Years Podcast.

He could hear stories of other nontraditional students that really motivated him. However, attending college in New York, he didn't really find that tailored mentorship that he needed. But this has changed with time as he found great help from them.

Additionally, he waited a long time to tell people that he was a premed. But from the time he began sharing, it took him a year and a half in between looking for the resources and deciding where he was going to volunteer in and why there.

Fernando actually did three years of Biology in Brazil and then on his last year, he came to the states and so he quit college in Brazil. Then he had to start from scratch. He took two years off and resumed his studies at Missouri State University where he did two years there. Then he moved to New York City and decided to study something that was much more applied where he could impact society.

[17:00] Did Leaving School in Brazil Hurt His Application?

Fernando thought medical schools are going to laugh at his application for not always finishing what he stated. He thought they were never going to understand what he went through.

"Crafting my story was going to be very instrumental to my application and being able to explain what led me through the motions of my life and how I am where I am right now."

But Fernando was quick to realize the power of being able to craft your own story so you can well explain to the admissions committee what led you through the motions of your life and where you are right now. He adds that one thing he never compromised in this whole process despite the breaks in his education were his grades. They were consistently good so he could always say that his grades speak for themselves.

He even recalls one time where he was told to really make good on the MCAT to make up for his breaks in education. But he never let anyone or any advice get into his mind.  He has heard so many negative comments and have slept on them, but he knew he wasn't going to let those stop him from trying.

Because he went to undergrad in another grad, he didn't have to report those grades on his application. But he reported pass/fail so he put the classes there. Missouri State University accepted some classes from Brazil while Hunter College accepted all his classes from Brazil. After reading the MSAR again and again, he realized that he actually had to pick the school in the United States that accept most transfer credits from Brazil and then report the classes on that transcript. This way, AAMC could verify that he had actually taken the classes. All this being said, Fernando thinks he has benefitted from this fact knowing that he only had a 2.8 GPA. But to be fair, he started from scratch when he went to the US.

"The medical schools have the interest to know the depth of your education. Even though they might not see the grades but it's interesting for them to know what you've taken."

[23:00] The Struggles of a Premed

Fernando articulates that his whole journey was what made him who he is. The hardest part was juggling multiple jobs and schooling while still having time for family and friends.

"The hardest part was how am I going to tell my story so people think that I actually have something to bring to the table."

Another hard part for him was that question of how he was going to tell his story so people think he actually has something to bring to the table. Basically, I've worked with Fernando on his personal statement and he initially didn't some of my advice. In fact, he applied a little late in the cycle and his personal statement was what's keeping him from hitting submit. In his eyes, it was never good. But now thinking about it, he knew that was exactly what he had to say.

Now, he's helping other students in writing their personal statements. He stresses on what the personal statement is all about and it's to tell admissions about why you want to become a doctor. You can talk more about those other things in your extracurriculars, etc. And this is something I have helped him realize. Before Fernando was giving me this feedback of why I was't telling him what to write. Because my job is to ask the pertinent questions to get the information out of people so they can write about them.

"Students fail on understanding that that personal statement to tell admissions about your life and your drive relating to medicine."

[27:10] Where to Apply to Medical Schools

In figuring out where to apply to medical schools, again, seeing  the health disparities within his own community in New York City was very instrumental for him to decide that he wanted to become a doctor. And since day one, he has always wanted to stay in New York City. That said, geography was something very important to him.

And he also likes to live in a big city with a very diverse demographics. But he also opened his mind in other cities like Boston and Miami. Then as the application progressed, he was opening his mind to other great schools that are not necessarily in a huge urban center. Although he initially worried about MCAT and GPA grades, still he went on to pick schools he felt he would feel comfortable. Fernando's MCAT was at 76th percentile and it was one of his biggest sacrifices. At that time, he was coming out of a divorce and he literally had to move out one month before MCAT test day.

"I was a little bit worried about MCAT and GPA grades but I decided to just not worry about that and just pick the schools that I would feel comfortable in."

[31:10] Dealing with Relationships During the Application Process

Fernando explains that in order for a relationship to work, the other person has to be willing to be with you 100%. They have to be by your side during those four years and the years to come. They have to be just as focused and as driven that they would understand what it means to sacrifice so much. And he felt his husband at that time was not there with him. Although it was hard then, he realizes that it actually a good thing that happened.

"In this journey, you have to learn how to be selfish at times because it's about you. It's about where you want to go and where you want to be."

He adds that being a physician is more than just a profession and it's really about who you are. So the other person needs to be okay with that. They have to cheer with you and understand what it means when someone calls in the middle of the night and you have to work. And he admits this is hard to find since medical students have a passion that can be hard to find in other people.

[34:20] What Led to Getting Multiple Acceptances and HIs Thoughts on Diversity

Fernando believes that what led to his success in getting a lot of acceptances is the fact that he was just himself. He was truthful. He had to show how genuine he was throughout the whole process and how that translates into him wanting to become a physician was key.

Fernando's advice to premed students who think they're not as diverse as he is being a gay Latino, is to understand that diversity is much more about the color of the skin or your sexual orientation. Diversity is what makes you different. Everybody has something that is unique about them.

"Diversity is much more about the color of the skin or your sexual orientation. Diversity is what makes you different. Everybody has something that is unique about them."

By genuine, wear your uniqueness with pride. So you have to do the work to reflect on who you are and what makes you different than others. We all come from different places. We all have different experiences growing up. Those things are what's going to set you apart.

The more the admissions committee can see that you are truthful to yourself and that you did things because you really cared for and not just because you wanted to check the box then the better your application is going to sound for them.

[41:30] How to Become More Self-Aware to Create Better Personal Statements

To help you write your story better, you need to be more self aware. Fernando says you can improve your self-awareness by writing more about yourself. Look at the prompts for secondary applications earlier so you have an idea of what they ask.

Additionally, you have to ask yourself everyday why you're doing this. A lot of students can not actually answer this. They don't know what their drive is behind that activity. Most people do it because they think they have to. But the admissions committees can see through this.

So when picking activities, try looking for those that resonate who you are, your passion, and an issue you care about. Then it's going to be so much easier for you to talk about it and write about it. So when interview day comes, the admissions committee will really get impressed by how you know so much about this issue.

[44:40] Narrowing Down His Acceptances

Fernando actually ended up with seven acceptances including some great schools in New York City. But he decided not to stay in New York City as opposed to what he really wanted. So he chose Brown because he at Brown, he didn't feel like he was a number. Out of 10,000 applications, they always interview around 360 people whereas other schools interview a thousand people. So Brown picks who they're going to interview. And for him, this small number translates into a very tailored interview, application, and acceptance processes. He also thinks the school shares a lot of values that he wants in medicine - humanism, social justice, and other sensitive issues in medicine. Brown also offers some financial assistance. In short, he felt he's going to be at home at Brown. All this being said, he finds this as a very powerful, yet humbling experience. At Brown, Fernando plans to do an MD and a Masters in Public Health.

Fernando advises students to really take your time to write your application because your application is really going to tell your story. It's going to open that door for you to go. And if the schools like you and accept you, especially the schools of higher caliber, they're willing to fight for you.

Fernando also had a great offer from Cornell. In fact, he also did his shadowing and volunteering there. But he knew he wanted to go to Brown. So he laid this out to Brown and told them he got a financial aid offer from Cornell but he really wanted to go to Brown so they were willing to beat it.

"It's worth the effort because once you get that acceptance, you are really an asset for the school and they're willing to fight for you."

[51:30] Be True to Who You Are

Finally, his parting words of wisdom is to not let other people tell you that you can't do it or that it's not worth it or that it's too expensive. He thought he wasn't going to afford medical school. People would ask him how he was going to pay for it and he didn't know the answer. But he knew that if he worked hard enough, he's going to be able to do it.

A lot of people are going to tell you about how hard it is, but you have to stay true to who you are and to your passion. And if you do that, the world can see it and you're going to get there.

Lastly, it’s not about what you look like or where you’re from to get an acceptance to medical schools. But it’s about showing them who you are!

Links:

The Premed Playbook: Guide to the MCAT

Next Step Test Prep

May 09, 2018
284: What Do You Need to Do When Med School Applications Open?
29:39

Session 284

When this podcast goes out, the medical school application cycle for students wanting to start medical school in 2019 is opening. What do you need to do now?

The Premed Playbook: Guide to the MCAT Kindle version is available for preorder right now! It's $4.99. While the paperback version will be launched on May 7,2018. This is "the" book to help you understand what the MCAT is all about, when to register, how to register, how to study, what to look at, tips, and tricks of trade before even diving into the actual prep itself. If you're a premed student and you haven't taken the MCAT yet, this is the book for you.

Also, shoot me an email at ryan@medicalschoolhq.net and we will be giving out a batch of Bluetooth devices that sends out notifications on Android phones about our podcast. Help spread the word!

Back to today's episode, as of this recording of May 1st, the TMDSAS (Texas Medical and Dental School Application Service) for 2019 has opened up. It is application season! Listen in to find out things you need to know before even clicking on that submit button. Meanwhile, AMCAS (American Medical College Application Service) and AACOMAS (American Association of Colleges of Osteopathic Medicine Application Service) are opening up in the next couple of days as well. These three services are what you need to apply to medical schools in the United States. For Canada, there's the OMSAS (Ontario Medical School Application Service).

[05:10] Step 1: Don't Freak Out!

This is just another day in the process. Specifically for AMCAS, it opens on May 3rd and you can't submit until May 31st this year. And the applications don't get submitted until June 29. This being said, you have the whole month where the application is open. This means you can work on everything and not freak out.

"You have a whole month where the application is open that you can work on everything and not freak out."

However, for TMDSAS and AACOMAS, there is no separate open date and submit date. This means you can submit as soon as you want for these application services. Listen to Episode 245, where you hear about the common issues with applying thru TMDSAS. Some students out there are clicking submit before they put in the personal statement or extracurriculars.

Again, the opening of the application process doesn't mean you have to get everything in there right now and submit it right now.

[07:50] Step 2: Read the Instruction Manuals

Application services have their own respective instruction manuals and you have to read them. Find out what the nuances are between each of the application services so you understand. You want to make sure you're doing everything properly.

"The last thing you want to happen is to submit your application and get it kicked back because there's an error with it."

What's worse is if you submitted your application and has an error on it and then the school sees that error so they write you off for not being able to follow the directions.So you really need to read the instruction manuals.

[08:50] Step 3: Get a Transcript Request Form

Once you go into the application service, you open up an account. The first thing you should do is to get a transcript request form for this new application cycle year. Then you get this sent out to every school you've been to.

"Any place where you're taken a class or attempted to take a class, you need a transcript from that school."

Additionally, make sure that when you send off the transcript request for that you also get an unofficial one sent to you. You're going to use this to help you put in your grades in the application service.

You have to manually put in each class, each grade, all the credit hours, line by line in the application service. This is probably one of the, if not the most, tedious parts of the application service and is the longest thing to do.

One of the hardest parts with transcripts and putting in grades is putting in incorrect transcripts or classes. When you put them in and being reviewed by a human, they'll get kicked back to you if there's anything major. Or they will change it for you to review. Again, go line by line by line as you enter all the information you need to. Make sure you're transferring all the credits and grades properly.

Read the instruction manual based on how your school/s has/have given you grades. Read about how you can properly translate that for the different application services.

Should you wait to request transcripts until after your spring grades come back?

This actually depends on when your semester ends and when the grades are required to be submitted. So find out from your registrar and ask when the final grades required are to be in. Since you can't actually get official transcripts until those final grades are actually in the system and submitted by the professors.

If that is going to delay your application and you can't request an official transcript with those Spring grades until the end of May or mid part of June then maybe it's not worth it.

There a lot of variables in this. Are those grades important in your overall application? Do you need to show a strong upward trend and those Spring grades are going to really help paint that picture? You will have to think through this process. You have to look at your specific situation whether it's something worth waiting for you or not.

"There is no blanket advice when it comes to the application process. Every student is different."

[13:50] Step 4: Follow Up

Make sure you're continuing to follow up with your supervisors, professors, PIs, whoever it is that you requested letters of recommendation from. Follow up with them to make sure the letters are either in the Interfolio (if you have an Interfolio account). Or now that the application services are opening, you can give them the instructions to submit the letter directly to the application services.

"The last thing you want is a letter of recommendation to delay your application. That will hurt a lot."

[14:40] Step 5: Personal Statement, Extracurriculars, and Other Essays

Continue writing your personal statement and your extracurriculars. Just because the applications have just opened up, you don't have to have finalized versions of all this. Don't rush through the process just for the sake of having them done so you can submit your application tomorrow. Make sure you're going through the normal editing process and all the normal feedback, draft processes, etc. Also, check out The Premed Playbook: Guide to the Medical School Personal Statement to help you guide through the process.

Again, don't rush just to be able to get your application in. It's better to delay it a week and make sure your personal statement and your extracurriculars are polished and error-free before submitting it.

Additionally, take note that TMDSAS has extra essays - one is required, another is optional. The optional essay (I think) is actually probably a "required" essay so you might as well write something for that optional essay.

One of the common mistakes students make is in writing the required essay for TMDSAS. It's a personal characteristics essay and a lot of students misread or don't answer the question properly. The question is "how are your personal characteristics going to help the educational environment of your classmates?" If you analyze this, it's actually asking how you can help the educational environment of your classmates based on your history, skills, traits, experiences, and characteristics.

You may also need to write other essays such as when you're planning to mark a disadvantage on AMCAS, you can write that essay and get 1,325 characters. You have the most meaningful essays for three of the extracurriculars on the AMCAS application. If you've had any disciplinary actions against you, you'd have to write essays about that as well. So make sure you continue to go through that process as you are doing everything else that's required on top of probably school or MCAT prep, etc.

"All of these other things need to continue to happen to make sure that the application is ready to go earlier rather than later."

With regards to demographic information, you need to know what your name is, your siblings, your parents, their level of education, contact information, etc. So be ready to answer all of that. It's probably the easiest part of the application itself.

Also again, make sure all of the translations from your transcript to AMCAS, AACOMAS and TMDSAS are properly done. Even if you'd had a class removed from your transcript, if your undergraduate or community college have some sort of repeat policy where that grade is removed from your transcript, you still need to put that in your application service.

[18:50] Step 6: Complete Your School List

The school list is one of the last things you put into the application. Basically, you put in the schools you want to apply to. With TMDSAS, you only have to pay one fee so there's no reason to not apply to all of them. Obviously, it increases your chances of getting in. You will also have to pay secondary fees for most of the schools. It's just a bit of extra money but that's okay. Apply to all Texas schools. However, if you could never see yourself living in the Rio Grand Valley, then don't apply there.

School list is important. Rule of thumb: Do not apply to schools based on MCAT and GPA. Apply to schools based on location, class size, curriculum, and many other things outside the MCAT and GPA. On average, students apply to 14 MD schools and 9 DO schools.

A lot of students in the premed world are groomed on SDN and Reddit to apply based on MCAT and GPA. But I go against that trend.

"Do not apply to schools based on MCAT and GPA. Apply to schools based on location, class size, curriculum, and many other things outside the MCAT and GPA."

[20:28] Step 7: Make Sure There Are No Typos and Other Grammar Issues

After you're done with your school list, then you're basically done with your primary application. Now you need to go through the application over and over again. Check for typos and weird characters. Remember that if you're copying and pasting from Word or Google Docs, there may be some weird characters carried over into the text box of the application service itself. Generally, you can copy from Word or Google Doc into a plain text editor first. The application services don't have any sort of formatting options. So if you need to emphasize something, all those stuff will not be carried over to the application.

One of the tools I recommend is Grammarly. It's a plugin for Chrome and Safari where it checks for grammar. There's a web app version of it as well. Simply paste in your text and it will show you some corrections you need to do. As you're going thru the application cycle, it's recommended you get the paid full version of it because it will greatly help you in writing better.

"Having an app that helps you write better is invaluable."

[23:40] Step 8: Submit Your Application, Then Pre-Write Your Secondaries

After checking for typos and other issues, you're basically ready to submit. Again with AMCAS, you can't submit until the end of May. With AACOMAS and TMDSAS, you can submit as soon as possible.

Applications don't go out for AMCAS and AACOMAS until end of June or mid-June respectively. And then you'll get secondary essays. Don't wait to get back your secondary essays to start writing them. Go online and search for Secondary Essay Database, which we will have our own one soon.

"Most schools don't change their questions so pre-write those secondaries. Once you have your school list and once you submit, start working on those secondary essays."

After you do the first five or six schools, they tend to be repetitive so it will get easier as you go. That way, you're ready when secondaries start to roll out from AACOMAS (the first wave of application goes out on June 15) and AMCAS (the first wave of application goes out on June 29). For TMDSAS, you would have to go to each school's website and look for instructions on submitting a secondary essay.

[25:25] Step 9: The Waiting Game - Prepare for Your Interviews

Once done with your secondaries, then it's just a waiting game. You should be preparing for your interviews leading up to this point. Reach out to your premed advisor, your career counselor, mentors. Get mock interviews under your belt before you actually interview. Not preparing for the interview is like not prepping for the MCAT. You need to do it. Check out The Premed Playbook: Guide to the Medical School Interview. I have gotten a ton of feedback from students telling that it has helped them on their interview days. So if you don't have the time or resources to do private one-on-one interviews and if your school doesn't offer them, at least get the book.

If you want to invest, I have the $47/month Mock Interview platform where you sign in. Use your webcam or your phone and a video of me asking you a question. Then it records your response so you can watch yourself from there and critique yourself from there. There's an assessment afterwards so you can send it to somebody so they can give you feedback as well.

Again, this entire process runs from now (May) to next April and May. The process never ends actually. In fact, you can be accepted to medical school all the way through when medical school starts, which is in August of the next year. It's a very long process. Make sure you're staying sane through the process. And if you may have to apply again, that's okay.

"It's expensive so make sure you do it right the first time so you don't have to do it again."

Still have questions about the process? Let's continue this process on The Hangout Group, our free, private Facebook group made up of a super collaborative community of like-minded students.

Links:

The Premed Playbook: Guide to the MCAT

The Premed Playbook: Guide to the Medical School Personal Statement

The Premed Playbook: Guide to the Medical School Interview

TMDSAS (Texas Medical and Dental School Application Service)

AMCAS (American Medical College Application Service)

AACOMAS (American Association of Colleges of Osteopathic Medicine Application Service)

PMY 245: Why Does Texas Have Its Own App and More TMDSAS Questions

Interfolio

Grammarly

Mock Interview Prep

The Hangout Group

 

May 02, 2018
283: Common Questions Premeds Have About Osteopathic Medicine
41:38

Session 283

Today, I speak with Dr. William "Bill" Mayo, the President-Elect of the American Osteopathic Association (AOA) and a practicing ophthalmologist. He graduated from medical school in 1981 from Kansas City University of Medicine and Biomedical Sciences College of Osteopathic Medicine or also known as KCCOM. He shares things about osteopathic medicine - the merger, dealing with the stigma, residency, exposure, and so much more!

In 2017, I published The Premed Playbook: Guide to the Medical School Interview, which has been well-received by students. This year, we are releasing the second published book in the series called, The Premed Playbook: Guide to the MCAT. Visit the MCATbook.com to get notified. The Premed Playbook: Guide to the Medical School Personal Statement will also be out later this year. Check out personalstatementbook.com to get notified too or pre-order them now on Amazon and Barnes and Noble.

[03:20] Realizing His Calling

Having a father who was a doctor, Bill's mother died when he was three so he practically grew up seeing what his father was doing at the hospital. Then his father died when he was 17, reason enough for him not to do really well in school at that time but did well afterwards. Because of this, the admissions committee didn't really look at his application as favorably as he would have wanted. So he asked for a help from a doctor his family knew who helped him get connected with an osteopathic school. At that time, he didn't know what an osteopathic medical school was.

When he did his interview, the osteopathic school accepted him and he came to appreciate the humanistic approach of osteopathic medicine. Except for the manipulation part, Bill saw this in the way his dad approached his patients. As a result, he became an advocate for that approach to medicine due to his experience.

"I really came to appreciate the humanistic approach, the holistic approach of osteopathic medicine. They're really approaching body, mind, and spirit."

[09:10] An Interest in Ophthalmology

During his senior year in medical school, he did an elective in ophthalmology to be a better family physician and then he fell in love with it. He did try the ENT and liked the microsurgery but much of it didn't really appeal to him. As with ophthalmology, he saw some opportunities to create relationships for better patient care. In short, he fell in love with the field in 1980.

[10:55] DO Then and Now

Bill had an ACGME residency which was outside the norm at that time. He looked at residencies in his area and ended up liking the residency program at the University of Mississippi. He knew they didn't know what a DO was before as they never had one. But he also believed his education had the quality and caliber as their students. So he was able to arrange for an elective rotation for two weeks. During that time, he was really assessed for his knowledge. Then the department chairman called him in the end telling him he could have a spot if he wanted it out of 140 people who applied for four spots. He got one of those four and he was the only DO out of the whole bunch. Bill believed in his education and so he stresses that he was even able to do it a long time ago, much more so now.

"One in four medical students today is an osteopathic medical student."

At the end of the day, it's all about you, who you are as a student, what you've accomplished, how well you've done in terms of your grades, boards, and your elective rotations.

[13:45] The Roles of a President-Elect in AOA

As the President-Elect and the President, they lead the Board of Trustees of the AOA. They implement the policies that are informed by resolutions from their house of delegates.

The American Osteopathic Association and the American Medical Association each has a House of Delegates. made of representatives from each of the states as well as the specialties. They set the policy for what they believe in and what they want to support. It's then the role of the President-Elect and the Board of Trustees to carry it out. They also serve to address issues in between Houses of Delegates.

Their role also entails a lot of traveling, having to go to Washington, D.C. to testify and advocate for certain causes. They also visit state societies and specialty societies, as well as medical schools to make sure there is clear communication and ensure they're listening to what's going on.

As president, he appoints people to COCA or the Committee on College Accreditation for Osteopathic Medical Schools (the equivalent of LCME for MD programs). Both the COCA and LCME have the deaning authority from the US Department of Education to basically manage the osteopathic or allopathic medical schools.

Once the people are on COCA, the American Osteopathic Association has an arm's length relationship with it. This said, they cannot dictate to them what they will do. They can testify to COCA about the AOA would like to see but it's up to COCA to decide.

[17:12] What They're Looking for in Applicants

In general, their profession looks for that holistic individual. Bill also stresses that you don't have to have the perfect numbers to be a good doctor.

"You don't have to have a perfect MCAT and a 4.0 to be a good doctor."

There is this misconception that if you don't have good enough scores, then you just apply to DO schools. Bill disagrees and explains that it really depends on the individual. You could have the best numbers but you may still not be fit to be a DO. You may have the credentials, but Bill says, it's not what I look at people when he writes a letter of recommendation. Instead, he looks at the person.

That being said, you've got to have a certain level of grades or a certain level of MCAT to feel like you can make it through the rigors of medical school and your COMLEX or USMLE test to be able to get a license to practice medicine. Once you get past those barriers, they're now looking for good people.

[21:00] Haven't Heard of Osteopathic Medicine?

For students who have no prior knowledge of osteopathic medicine, just go to the AOA's website and look up Find Your DO. You can type in a ZIP code or a city to find DOs in that area. Then comes your challenge of cold calling and asking them if you could come shadow them to see what it's like. Then out of that can grow a letter of recommendation.

[22:30] Removing the Stigma Against Osteopathic Students

Prior to July 1, 2015, there were separate osteopathic residencies that only DOs could get and there were ACGME residencies that both DOs and MDs could get. In this regard, AOA and the AACOM had an understanding with the ACGME, the larger group of residency programs. They agreed that over a certain period, they were going to create a single system of residency programs.

"From a practice standpoint, we're viewed as equivalent. There's no discrimination there."

They're migrating all of the osteopathic residency programs into the ACGME system, which was made of five separate organizations. Now, it has become seven, with the addition of the AOA and AACOM.

Each group has four representatives on the board that runs ACGME. In addition, they have the residency review committee. It's made of specialists in that particular field that review and approve all the residency programs in the country.

Every residency review committee that had osteopathic residences now has DOs. So you've got MDs and DOs in the room, no matter which room you're in. They're all there working.

There are some program directors that may, for whatever reason, have given more preference to one over the other. But they see these barriers have fallen down over the years.

The profession has actually been growing so much in the last 30 years but the public just wasn't aware of it. So they've actually started a brand campaign over three years ago to get the name out, which they continue to do in the hope of becoming a household word.

"We actually started a brand campaign over three years ago to get the name out, just what osteopathic medicine is, of what we do, so that we are much more known now. We are continuing that as well so we are becoming more of a household word."

[26:30] Why Even Have Osteopathic Medical Schools?

Since they will be merging anyway, I raised this question of why not convert every medical school into an MD medical school and have OMM as a Fellowship. Bill explains that osteopathic medicine has offered something very distinctive with their approach to the patient.

A Brief History

When osteopathic medicine started by an MD, Andrew Taylor Still, there were no antibiotics. Medicine was very different and they used leeches in blood letting patients. He came up with the osteopathic manipulative techniques to enhance the medical care of the day. And when he couldn't get the allopathic medical schools to add to the curriculum, he started his own school. He looked at the body's natural ability to heal itself and how to enhance that and look at the patient at a holistic approach.

That being said, this is still something they do more so than the average allopathic medical school does. If anything, they'd like to see all of medicine as holistic like they are.

The Empathy Study

Moreover, Bill mentions the Empathy Study originally done in the Cleveland Clinic. They were comparing the empathy levels of osteopathic medical students versus allopathic medical students. They found there was more empathy among osteopathic medical students than the allopathic medical students.

Another longitudinal study is using almost all of the DO schools and several MD schools, looking longitudinally to see the long term effect on the students in terms of empathy.

[31:25]  What Students Should Be Worried About with All the Changes Coming

Bill explains that students need to be realistic whether you're going to be a DO or an MD. Be realistic about your future practice options. If you're thinking about a high demand specialty like Dermatology and if you're not near the top of your class and have very good board scores, the odds of getting in wouldn't be as good. It doesn't mean you won't, but it means you really have to work hard and perform well to get considered. But there's still that point of selling yourself in audition rotations. And if you get that opportunity, it makes a world of difference.

"There's still the point of 'selling yourself' in audition rotations because if you get that opportunity, that makes a world of difference."

However, this is not any different than an MD who has poor board scores that wants a competitive specialty. At the end of the day, it's about you. Moreover, what I was initially concerned about is if a weak DO student goes to osteopathic medical school and doesn't go too well. Then at the end of the day, they're applying to a relatively easy, non competitive osteopathic residency. But now with the single accreditation, the MDs can also apply to that residency program as well as the international MDs. So what may have been a shielded spot for a weaker DO student is now going to struggle. Again, it all comes down to the individual student but these are the students that are going to be the most affected.

[34:00] DO's Complete Transition by 2020

Bill explains that each year, there are some students, whether MD or DO, that just don't match for whatever reason. So they ended up having to try to get to match the next year which would even be more challenging. But 98% of DOs matched. And of the osteopathic residencies that were traditionally osteopathic residencies that are now transitioning, they already have 69% that have transitioned over. They're either accredited or pre-accredited. By July 1, 2020, everybody should be accredited, metric the use every year. And over the last 10 years, 44 programs closed on average per year.  If they didn't have residents matching for three years, they go away. And this trend has been the same since 2015, with a total of 119 programs closed. All this being said, they expect over 90% to transition. And looking at different specialties for instance, say for anesthesiology, over 72% of their Anesthesiology residencies are already accredited by the ACGME and over 80% of their Pediatric residencies.

[36:50] Canadian Residencies: Spreading the DO Love in Canada

A lot of students in Canada look to come to the US for medical school. The feedback they get for residency if they want to go back to Canada is that osteopathic students are less competitive than even Caribbean MD students.

Bill says that the AOA's legal counsel has worked with the Canadian Osteopathic Association where each of their provinces can have different rules as opposed to a national standard. In this regard, AOA has been assisting them to get the recognition. In fact, many Canadian stay in the states and do their residencies and want to go back to Canada to practice.

[38:40] Bill's Final Words of Wisdom

Bill's two cents for those wanting to be a physician is that if you want to go into this, then your goal is to help people. If you have a servant's heart, osteopathic is a great field to look into. You're there to serve your fellowmen. By and large, both DOs and MDs do a good job at that.

[39:30] Last Thoughts

The goal of this specific episode is to try to reduce the amount of negativity among the premed world towards osteopathic schools. The general consensus out there among physicians is that there's no difference. Among premed students, DOs are going to osteopathic medical schools only for students who can't get into an MD school. Or that applying to DO school is only something you should do when you don't have good enough GPA or MCAT score. And this is not the case.

If you want to be a great physician, apply to MD or DO schools. Osteopathic schools, apparently, start students earlier with learning that holistic philosophy of treating patients - mind, body, and spirit.

Links:

The Premed Playbook: Guide to the Medical School Interview

MCATbook.com

personalstatementbook.com

AOA Find Your DO

Empathy Study in Cleveland Clinic

AOA

AACOM

COCA or the Committee on College Accreditation for Osteopathic Medical Schools

LCME

Apr 25, 2018
282: Premed Q&A Coaching Calls - HPSP, Clincal Experience & More
30:58

Session 282

I decided to get on the phone with premed students and answer their questions about relationships, HPSP, secondary essays, and so much more!

By the way, The MCAT Podcast is put on by the Medical School HQ and Next Step Test Prep. Aside from this, we have written The Premed Playbook: Guide to the MCAT. This book is for a student just starting out on their premed journey. They're trying to figure out all the pieces of the puzzle. Just to clarify, this is not a test prep book to help you get a higher score on the MCAT (although there's some of that stuff in there). In short, this is a book you'd buy the moment you realize there's this thing called the MCAT. It's coming out very soon so get notified by going to MCATbook.com or find out how to buy it.

Back to our episode today, we're answering questions from premed students raised on our Facebook community, The Premed Hangout. Be a part of this community that's now close to 5,000 members. And if you have questions where you want to sit down and talk with me, we also provide some personal Premed Advising Services.

Let's get on with our Q&As:

[02:45] A Foreign Degree and Which Schools to Apply To

Question: What would be the first steps when applying to medical school if you have a foreign degree? How would you choose schools to apply to?

Answer: Assuming you are a foreign student (which is pretty much the general assumption), are you a foreign resident, a citizen, or are you just here on a student visa? A huge factor in applying to medical school is that if you're not a permanent resident or a citizen, it could be very hard. You can go and look up MSAR for schools that accept internationals students butt most schools don't.

Moreover, as a citizen with a foreign degree, have you done your prereqs here in the U.S.? This is also another huge factor for most medical schools. A lot of medical schools have this 90-hour rule where they want 90 credit hours of classes taken here at a US school whether it's a four-year university or a community college. However, every medical school is different, which is the most frustrating part of this process. According to the student who asked this question, he has seen some schools want other specific hours in in a four-year university versus a community college.

"Read the instruction manual for each of the application services you're using."

In regards to international transcripts, the instruction manual has changed recently. Previously, you needed to request the transcript if you had credits transferred to a university or a US school. But this has now changed and you no longer need to request a transcript. But if the credits are transferred then you need to get the grades and classes listed on AMCAS. Therefore, there are a lot of hoops you need to jump through as an international graduate of an undergrad institution.

As to what schools to apply to, apply to those that you want to go to. it's your home work to go to the MSAR. Contact the schools you may be interested in applying to. Talk to them about your situation and lay out everything and ask if there's anything else missing before you apply to their school. See what they have to say and if you're good, then apply.

Having had a degree from a foreign country added with a community college, some school may have a negative bias to this. But with a great GPA, you should be fine. Just do well on the MCAT and write great personal statements. Put your extracurriculars together well and tell your story well. And you should be good!

[09:47] HPSP and Air Force Surgeon Experience

Question: How do you think your time in the Air Force influenced you as a physician and how do you think it would be different if you had not done the HPSP?

Answer: I went through HPSP at a civilian hospital, not a military medical school. Then I did a civilian internship. So that was the only time I practiced medicine outside of the military. But looking back at my time as an Air Force Flight Surgeon, I think of it as that you're a physician - period. Your employer just happens to be the US government and the Air Force. That being said, I don't really know how much being in the Air Force has influenced me as a physician. If at all, I think being a physician influenced me a ton as an Air Force person.

Had I not gone through HPSP, I would probably have gone on to do an orthopedic surgery residency. So the military dictated whether you could move forward with the match or whether you do match in the specialty you want. They said no to orthopedics and this started my flight surgeon career.

"Doing HPSP limited me with my residency choices because you need to apply to the military match before."

Nevertheless, I do not regret my choice as I've made amazing experiences. I've flows all around the world at the back of different military aircraft. I have flown an F-16 - great memories!

Having no direct family members in the military, I was naive and didn't know anything. I assumed that the Air Force would fly over to places and they go home at night. While the army is on the ground and fighting the battle and the Navy is on the boat all day long. Hence, I chose the Air Force.

Then once I was in the Air Force, I was surprised we ran the military hospitals in Iraq and Afghanistan and everywhere else and we're down there. We were deployed with the army and on the ground. Either way, it worked out in the end since I love the Air Force.

[15:00] Should You Do the HPSP Scholarship?

Something as specialized as pain management, there are different ways into it such as Anesthesia, Radiology, PM&R, etc. But there are "issues" with going into a subspecialty in the military since usually, the specialities are few and far in between. It makes it that much harder to be able to do that.

So if you're a premed thinking that you're really interested in pain management, I'd caution you to pigeon-hole yourself so soon. Since 75% of students change their mind once they're in medical school. Secondly, I would caution you against an HPSP scholarship because of what happened to me. I went in knowing I wanted to be an orthopod.  I had a little hiccup going through OB/GYN but I applied to Orthopedics and the Air Force said no. Therefore, this depends on how flexible you are. If you're flexible and resilient enough once they say no, then you can do a flight medicine and do your four years as a military doctor then get out and apply to a residency and go do what you really want. Are you willing to do that? This delays your specialty training but you come out debt-free.

"Don't do it just for the money."

[17:35] Shadowing and Clinical Experience When You're Already in the Healthcare Field

Question:  What can count as shadowing experience when you're already in the healthcare field? Are there stipulations to it? Or does it never count as a shadowing experience and only clinical?

Answer: Even if you're already in the healthcare field, this still wouldn't count as shadowing. It's very specific. It's outside of your job. You're not working. You are going to a physician's place of business outside of your role as a nurse or a PA and you are observing and watching and learning.

While you’re already seeing what the physicians are doing, that is true about 75%-80% of the time because there is so much more that a physician does outside of that clinical interaction you have with them. Shadowing allows you to see that extra 15%-20%, whatever that may be. This could be phone calls with the insurance companies or the grand rounds where the physician is presenting or learning.

"Shadowing is very specific. It's outside of your job. You're not working. You are going to a physician's place of business outside of your role as a nurse or a PA and you are observing and watching and learning."

Shadowing is something that you need to do above and beyond what you're doing already if you're in healthcare. From a clinical experience standpoint, you've got that covered being a nurse. You're already interacting with patients all day, everyday. So you're fine on the clinical experience side.

[19:55] Dealing with Relationships

Question: How do you make it work when you're in a relationship with someone who's not a premed? How do you convince them that the journey is going to be worthwhile? How can you best prepare them for what's ahead with medical school, residency, and fellowship?

Answer: Back in Episode 251, I tackled how to protect your relationships as a premed and med student. i recommend you listening to that with your significant other, together. You'll get to hear from a spouse of a physician and how they made it work. That episode was with Sarah, a marriage and family therapist. She comes from a psychology standpoint of communication and all these other tools she's learned as a therapist. And what it comes down to really is communication.

"The question is what do you communicate? How do you communicate? I want to communicate but how do I prepare them?"

I honestly hope that you don't need to convince a significant other if it's worth it. A significant other should be there by your side. If you think it's worth it, you shouldn't have to convince them that it's worth it.

In terms of preparing them for what's to come, what medical school, internship, or residency is all about is your significant other supporting you probably more than they ever thought they would need to in the hardest times and the busiest times in your life.

It's about being there unconditionally for you and understanding that your busy. It's not all about them and you will try to make it about them when you can. This can be in between tests and those weekends when you come off of the test and you have a couple of days before you have to start studying for the next one. Or when you're in internship and on night float so you'd have to sleep all day long since you work all night long. So it's really just about supporting you and being there for you. Make sure they understand their role and that's what you need them to do.

When I went through medical school, a lot of relationships going into medical school, did not survive medical school. It's a very, very hard time. And it's hard when somebody either doesn't want to support somebody through it or doesn't think it's worth it. Maybe they don't want you to be a physician because they know physicians are busy.

"There are a lot of reasons for relationships not to survive medical school."

[20:07] Common Mistakes in Secondary Essays

Question: What is the most common mistake when writing secondary essays besides sending them in late?

Answer: Discounting sending them in late, which is the most common mistake, another one is not pre-writing them. Although this does go hand in hand with sending them late. But secondaries are one of the easier parts of the application since they're asking you a specific question. One example is how are you going to add to the diversity of the class. Or if you're planning on taking a break before you start medical school, what are you planning on doing?

"Secondary essays are probably one of the easier parts of the application process because you are answering a specific question."

So the biggest mistake is not pre-writing them. And when you work yourself backwards for why that happens, that's because most students are taking way too long to write their personal statements, to write their extracurriculars, to submit their applications. They're taking their MCAT late. All of that stuff is happening at the same time. And as soon as they submit their application, usually a little bit later in the cycle, they will immediately get back secondary applications from medical schools. Once you're past the first wave of applications that go out, medical schools see you applied to their school as soon as you submit, prior to being verified. And most of them will send you a secondary within a day or two. Imagine you're submitting your application, wanting to get your feet up, and then you start getting back 10, 20, 30 secondary applications. And you're behind at that point.

All this being said, I believe prewriting your secondaries is a must. And always, always, always, do story telling. That's the power of written and spoken words is through stories. So as much as you can answer the question with a story, then do it. It doesn't even have to be related to medicine. In fact, stories are more powerful when they're not related to medicine.

"Writing secondaries with stories becomes much easier."

Links:

The MCAT Podcast

Next Step Test Prep

The Premed Playbook: Guide to the MCAT

The Premed Hangout

Premed Advising Services

MSAR

PMY 251: How to Protect Your Relationships as a Premed and Med Student

Apr 18, 2018
281: What Does the Med School Application Timeline Look Like?
24:21

When should you start writing your personal statement, your extracurriculars, taking the MCAT, asking for letters of rec and more application timelines?

Apr 11, 2018
280: Finishing Prereqs Early, Nursing as a Backup and More Q&A!
21:37

Session 280

This week we’re taking questions directly from the MSHQ Premed Forums. If you’re not familiar with the forums, check them out and join the conversation!

For The OldPreMeds Podcast, we have a sub forum called the Nontrad Premed Forum. We also have the General Premed Forum where traditional students (nontrads welcome too!) can ask questions.

In this episode, we have pulled out questions from the forums and discuss them here. Also, make sure to register there so you can join an amazing, collaborative community of students and feel free to throw in some questions there.

Meanwhile, here are some special announcements:

First, we have The MCAT Book coming out soon! Go to mcatbook.com and click on the "Let Me Know" button. Put in your name and email address so you can get notified.

Second, I'm currently working on The Premed Playbook: Guide to the Medical School Personal Statement. Just go to the personalstatementbook.com and sign up to get notified once it comes out.

Back to today's episode:

[03:58] Nursing Major or Premed?

"I'm a freshman in college and I've been dealing with "which major problems" since high school. I'm indecisive once it comes to choosing a major. I want to choose nursing not because it's a shorter education route but because I plan on having it as a backup plan if medical school doesn't work out for me. Except, I want to go to medical school but I have lots of self-doubt about my ability mentally and physically to graduate from med school.

I also consider having my major be premed because I know if I don't get any prereqs done at the end of four years, I'll have to go back for another two and a half years of college to complete those prereqs before even applying to medical school."

You don't need to worry about your major. When it comes to applying to medical school, you don't need to worry about what major you have. It just doesn't matter. The thing that matters the most are the prereqs.

"A lot of schools are getting away from having prereqs but you still need those to prepare yourself, to give you that science foundation to do well on the MCAT."

Now, a lot of medical schools are getting rid of a lot of prereqs, but you still need to do well on the MCAT which means you still need to take the prereqs anyway And most of the prereqs are centered around doing well for the MCAT.

[05:30] The Backup Plan

This student has some self-doubt and that's normal. We all have self-doubt. But if you let that dictate having a backup plan, you definitely do as little as possible to succeed in your goal of becoming a physician. Being a nurse is a great career, but if you want to to be a physician, get rid of that backup plan and bite to the nail to achieve that goal.

At almost every point of the medical journey, there will always be that self-doubt - as soon as you start medical school, during clinical rotations, internships, or as soon as you becoming an attending. It doesn't end. It's called impostor's syndrome. So you have to let that go and fight through it. Know that if this is what you want, you would do whatever it takes to do it and not have a backup plan to fall back to.

On a side note, most schools don't have a "premed" major although there are a few schools that do. But most don't. You can just major in chemistry, biology, exercise physiology, history, Spanish. You can major in whatever you want as long as you get those prereqs.

[07:42] Taking Prereqs Classes Out of Order

"Some of the classes which I'm retaking were originally taking decades ago. And so, I've forgotten much of the material. Recently, I went to a premed admissions fair where several admissions advisors from some east coast medical schools told me to redo my course work to "prove" that I could still handle academically rigorous material.

For example, one advisor told me to retake physics. Because when I last took it decades ago, I got a B in the first part. I could never full understand forces on inclined planes. So to retake physics, I need calculus which I have forgotten. I originally took three semesters of Calculus back in the 80s and did well on all but the third part. That was for my first non-science degree. Then for my second degree, I had to retake these Calculus courses in 2006. I got a B in part 2. Although I realized that Calculus has not changed much, I found the material much harder to understand and comprehend during my second time through. I have been out of school for many years and this challenge to keep up with college students half my age.

Now I have the opportunity to retake Calculus I and III on the quarter system on a more rigorous school than the one at which I took the original Calculus courses. However, because of my work, Spring quarter which starts next month, I cannot take Calculus 1 before Calculus 2 and only Calculus 2 fits my schedule this spring quarter.

I could then take Calculus 1 during the summer. I've asked others in my program who have gone through the same sequence. Some took them simultaneously, some also took other measures of classes. For example, several students were taking Biochemistry and General Chemistry at the same time. Usually, General Chemistry comes before Biochemistry."

"You don't have to keep up with college students. Your only competition is yourself."

[09:39] Will It Hurt Your Application?

Can you take the out of order? Yes. Is it ideal? No. There's a reason there's a 1 and 2. Each class is supposed to build on each other. Of course, you can do it. You're going to have to teach yourself some of the concepts.

The biggest question is whether it will hurt an application? No. The admissions people are telling you to do it. It's only going to help your application assuming you do well in the classes.

This is common for nontraditional students. They take courses a long time ago. The go out and have their career and have their family. Then at one point, they wake up and realize they've always wanted to be a doctor. From that point forward, they seek out what they need to do to get into medical school. A lot of them will contact schools and a lot of them will advise to take more recent course work to "prove" that you can handle the coursework.

It's not wrong. Medical school is hard. Just because you were a good or decent student 20 years ago, doesn't mean that you have the same aptitude today or the same willingness to do it. Going to school and being a student are different than being an employee.

"Are you really that interested in being a student or is the idea of being a physician greater than the allure of retaking classes and being a student first?"

And this is where "prove it" comes from. You need to do well in the classes and succeed. You also need to get that upward trend going. At the end of the day, you have to show the admissions committee that you can still be a student and you have a semester or two of coursework to show them that. So this is not going to hurt your application (as long as you don't do poorly in those classes.)

[12:10] Clinical Experience in a Podiatry Clinic

This is another common question that comes up. What constitutes clinical experience for your application to prove to medical schools that this is what you want to do?

"I'm currently working as a medical assistant/scribe for a local podiatrist. I have lots of good experiences I don't think I would get a lot of other places especially because I don't have any special licensure (EMT, MA, CNA, etc.). I was recently in a discussion with my premed advisor who suggested to me that this experience might not be viewed as actual clinical experience by MD and DO admissions offices.

I was surprised by this due to the scope of my experiences. Is this true? Should I try finding a different opportunity to replace this one or will this be able to compare with other experiences in "actual" clinical settings?"

So is this clinical experience? Yes, 100%. But is it good clinical experience? No. But it doesn't mean you avoid talking about it in your applications. But it means you should go and try to get clinical experience with physicians (MD and DO). Podiatrists are physicians as well. They're allowed to call themselves physicians. They're as close to MDs and DOs as any other health professions. They just happen to specialize in a certain part of our body. They do surgeries, they operate. They go to medical schools. They have a long curriculum in medical school. They do clinical experiences.But it's still podiatry.

Medical school admissions committees are going to look at your experience and ask for the rest of it. Where's the time you spent being around non-podiatry patients? They want you to show them those experiences. Show them how those experiences have led you to want to be an MD or DO.

"There's a huge difference in how your actions are speaking to the admissions committee."

Scribing at a podiatry clinic, solely, can send a signal that you only want to be a podiatrist, not an MD or DO. Instead, you want to be a Doctor of Podiatric Medicine. There's a difference in how your actions are speaking to the admissions committee. So while it is a good clinical experience, it's not the right clinical experience for your ultimate goal of becoming a physician. It's the same thing for any other clinical experience - dentist office, chiropractic office, naturopathic office, etc. If you want to go to medical school, then you need to get clinical experience around MDs and DOs.

[15:47] Graduating Early and Applying Early

"I'm a first year premed nutrition student but I came into college with nearly 45 AP credits so I can graduate a year early with only taking 12 to 13 credits per semester. everyone has told me that I should a minor or take extra classes and graduate in the Fall of 2020 instead of the Spring of 2020 and apply for admissions for Fall of 2021 instead of Fall of 2020. I would really like to go straight into medical school after I graduate though. So I'm thinking about applying next Spring for the Fall of 2020. I'm just concerned about my extracurriculars. I'm just concerned about my extracurriculars. I didn't realize I wanted to be a doctor until this past Fall. So I haven't gotten involved in any premed clubs or shadowing or research or volunteering. I plan on starting research and volunteering very soon.

But I'm worried that if I apply in about a year, I won't have extracurriculars on my application. I'm also worried about the MCAT. I am planning on taking it next spring and there's really no room for error if I don't do well on that attempt since I'm trying to send in my application as early as possible. I'm not sure how setting is going to go yet since I'll be taking OChem 2 and Biochem that semester as well. I guess I'm just wondering what do you all think? I really want to graduate on time without taking a gap year but are my extracurriculars going to be too weak. Will it be too hard to study for the MCAT while taking those difficult courses next Spring?"

Graduating early is great. There's less debt that you're going to incur being a student for an extra year. But I also don't agree on applying that early.

As mentioned, you haven't done any shadowing, research, or volunteering yet. How do you know you want to be a physician? How have you proven to yourself that this is what you want to do? I would challenge you that you have no clue yet. It may sound great. You may have this great idea of what's next but you don't know. You need to go out and get some clinical experience. You need to go out and shadow. Put yourself around patients. Put yourself around physicians. And then start confirming that this is what you want and then start going down the path of when to take the MCAT and when to apply and so on.

I don't think it's a good idea to take the MCAT while still taking Ochem 2 and Biochem. That is a lot! Those are some heavy-hitting courses that are well-involved in the MCAT. To take those courses and to be studying for the MCAT at the same time is going to be very hard. So on top of not being super prepared for the MCAT because you're still taking courses, you're also rushing everything else. And you're still not sure that this is what you want to do. You may think you know, but you don't. You haven't proven to yourself through your actions that this is what you want.

Go out and shadow. Go out and get the clinical experience. And prove to yourself that this is what you want. Then after getting that shadowing or clinical experience, you can concisely state in your application - personal statement, extracurrriculars, interviews - explain why it is that you want to be a physician.

"Why do you want to be a physician? That is a key question that you have to answer. And it is only through those experiences where you will be able to formulate a solid answer to that question."

So go out right now. Take that gap year. Prepare for the MCAT. Get those clinical experience and shadowing experiences. Prove to yourself that this is what you want. Continue those things consistently through the application process and into matriculating into medical school. Taking a gap year is not that big of a deal. Travel. Go out and get some life experiences.

Links:

Check out the mcatbook.com

MSHQ Premed Forums

The OldPreMeds Podcast

Nontrad Premed Forum

General Premed Forum

Apr 04, 2018
279: From a Cocktail Waitress to Physician and EM Doc
35:24

Session 279

Dr. Elaine Reno is an Emergency Medicine physician. She joins us to talk about her journey to medicine and her role with the Wilderness Medicine program at CU.

If you're interested in working with me for your personal statements, essays, and extracurriculars and need any help with editing those, save 15% off my services using the promo code MAR2018.

Back to our episode this week, Elaine helps run the Wilderness Medicine program at the University of Colorado. Back in Episode 202, I had Dr. Todd Miner talking about the Wilderness Medicine program. He is not a physician but he's just one of those other kind of doctors. But Dr. Elaine Reno is part of the medical side of the Wilderness Medicine program.

Today, she talks about her journey into medicine, what she has learned, and her experience being on the residency admissions committees, and what you should be doing as a student.

If you're in the Colorado area, they're actually looking to give scholarships to students like you. Reach out to the Wilderness Medicine Program at the University of Colorado. It's actually run through the University of Colorado, Boulder, the undergrad program. So you get an elective credit for it for your university.

By the way, Elaine was also on our Specialty Stories podcast this week, so be sure to check her out there as well!

[02:50] From an Art Major to Molecular Genetics

As she finished her undergrad, Elaine was working in a research lab debating what she wanted to do next. She was considering MD versus PhD. Part of her job in the research lab was to consent patients where she gets tumor samples from an operating room. She'd consent patients to let them use their tumor samples. She then realized that the favorite part of her job was not the day to day bench research or the things they were learning fro the research. Rather, she liked the conversations with the families and getting to meet the patients. She loved getting to sit with them pre-op and talk to them. She felt her favorite part of her job is the human interaction.

So Elaine was at least a year out of college. She did two years of basic science research before she went to medical school. During undergrad, she really had no idea what to do going in. She started as an Art Major and switched to Molecular Genetics while still doing some of the Art stuff. So she had no idea what she was going to do with her degree. She grew up in a small town so she really didn't know a lot of doctors and she didn't know anyone who has gone to medical school.

But her plan growing up was going to college and so she did. And she thought that if she had been more talented, she would have pursued being a professional artist. But she really didn't think she was talented enough to do it.

As to why the shift to molecular genetics, Elaine explained how she has always like science and she liked art. So she simply took things that interested her in college so that's what she landed on.

[06:17] Interest in Patient Interaction

When she left undergrad, Elaine didn't have any idea what to do with herself. So she had no plan. She had no job. And her parents said she had to support herself. Her sister moving to Laughlin, Nevada, offered her to pay for her rent if she moved with her. Being a casino town for retirees, there were no jobs available except for being cocktail waitresses So she became a cocktail waitress in a casino.

Realizing it wasn't definitely a long term job prospect for her, she did undergraduate research as a summer job. She basically had two criteria. One was to live somewhere she could ski, and second, she wanted a job that didn't involve her wearing a corset and shiny tights to work. So she found a research job at the University of Colorado as a professional research assistant, she applied, and got the job.

[09:27] Her Transition into Medical School

Although she likes the research she did, she knew she had to obtain some graduate level education if she wanted some grant funding. For her, the best of both worlds would be a doctor that could obtain grant funding and do research but also had this clinical practice and take care of patients. And this dichotomy started to appeal to her and this is when she considered applying to medical school.

She was working full time at that time and she couldn't take the summer out to study for the MCAT. So only studied in the evenings for a year and then took the MCAT. She has been a Chemistry TA so this definitely helped.

The hardest part of medical school for her was to always be studying. And she believes in the importance of wellness. In those extra hours she spent studying, she thought she could have focused more on wellness. Because she felt that anytime she wasn't studying, she should be studying. And this was one of her biggest struggles in medical school. She also thought how isolating medical school was. The first two years were just the classical textbook lecture learning. So for her, it was hard to see how this biochemistry you're memorizing is going to be applicable to taking care of the patient one day. This is different from most schools now that are slowly adapting to problem-based learning.

"It just felt like anytime I wasn't studying, I should be studying. I struggled with that a lot in med school."

Initially wanting to be an OB, she thought she would love the operating room and wanted to be a surgeon. But she discovered she didn't like it. Then she was trying to consider between outpatient and inpatient medicine. She likes hospital-based medicine and the lure of the ER that everything is different and things are always changing. There's always new things coming in and there's always things to learn. There are busy and slower times. Practically, she loves how Emergency Medicine can be different everyday.

[14:55] Interview and Personal Statement Tips: They Just Want to Have a Conversation

As part of the admissions team for their residency program, she remembers being a premed and going to her medical school interviews and being a med student doing residency interviews. She was always nervous and she'd get really quiet. And one thing she learned while she was interviewing people was that they're looking people with great communication skills of course and so on. But when you're in those interview settings, you need to relax. This person is not micro analyzing every single word you say.

They already know so much data about you based on your application. So the interview is done to see if the person is nice, normal, and can communicate. It's less about you trying to "sell yourself" in the interview and more about you just making a connection with that person.

"They're just trying to figure out if you're a normal person and if they feel you're someone that can sit and talk to patients."

In fact, one of the best interview conversation she had was talking about gardening and their mutual pain in trying to grow strawberries. Totally unrelated to medicine, but Elaine considers it as one of the best conversations she had. Again, how well can you communicate? This is what's in the minds of admissions committee.

In terms of personal statement, what she really doesn't like is when people tell you what it is like to be a doctor. When she went to Costa Rica with students as part of their Wilderness Program, she'd sit down with each of them and review their personal statement and make them rewrite it. But for someone who doesn't really know what it feels like to be a physician, and you're saying generally what it's like to be a doctor, she doesn't like this kind of answer. That said, students can get some appreciation from shadowing or scribing, but until all the pressure is on you, you have no idea.

[22:00] Interest in Wilderness Medicine

Aside from being an outdoor lover, Elaine says there's a big Wilderness Medicine group at the University of Colorado. So she was basically drawn to this due to her love of outdoors and skiing. A PhD, Dr. Minor, who was here on the show previously, he was starting a course for undergraduates where students get elective credits.

The idea was to spend your time in your premed years, first, to get clinical knowledge and experience in younger students. So getting clinical knowledge to students much younger and getting them through medical experience much younger.

Secondly, she recognized how students before had limited resources to advisors. So they've developed this class that combines these two things. Feeling having no idea what to do and now having an idea on how to navigate it, Elaine feels this is important to create that framework for them and allow them to explore this career. And so she wanted to be able to created an elective curriculum for them that could help them.

[26:03] What is an Elective Credit?

They tend to work with each student but they've had students from all over the country do this. They do an aversion twice in the summer and once in the winter in Colorado. In the winter they promise to big. Then they go an aversion in Costa Rica and do hiking, white water rafting, ziplining, etc. They're pretty remote from the town being a small surf town.

This course is for students from all of the disciplines. She even had a student who wanted to get a PhD in Toxicology but wanted to learn Wilderness Medicine skills, so it draws pre-health students of all different varieties.

And for people who love the outdoors and just want to gain some skill t o be safe in the wilderness, Elaine says that this does the whole gamut. They work with each student to make sure they're getting what they want out of the class.

[29:00] Writing Personal Statements

As to when you should write your personal statement, you should start writing personal statements depending on different factors. Elaine thinks each student comes in with a different goal. When do you want to sit down and get new skills get some actual critical care, knowledge and the ability to take care of other people.So when do you really want to expose this.

If you're a Junior or Senior and still have no idea about what to do next, she thinks this is the right time to take the class. For her, the best time she would have taken the class was after she graduated and while working as the lab. Nevertheless, she thinks this is an individual preference.

[32:10] The Biggest Takeaway

For Elaine, she felt like she really had to pursue the things she wanted to be on her application. She had that mindset of always checking the box. For her, it all boils down to pursuing your passion. Lastly, she wants to imparts to students to pursue your passions and pursue them aggressively rather than to check each box. It's important to pursue the things that's really drawing you.

"Pursue your passions and pursue them aggressively rather than to check each box."

Links:

Save 10% on Personal Statement and EC Editing

Episode 202 with Dr. Todd Miner on Wilderness Medicine Program

Wilderness Medicine Program at the University of Colorado

Specialty Stories

Mar 28, 2018
278: Your MCAT and GPA Don't Matter As Much as You Think They Do
25:30

Session 278

You shouldn't be surprised to read online that a student with near perfect stats didn't get an interview invite or acceptance. You're more than your stats.

Today, I'm sharing my insights into stats and school list, which is contrary to what you may see out there, specifically, I'm sharing my thought process on how to choose your schools. By the way, check out all our other podcasts on MedEd Media.

[01:52] Your Stats Don't Matter: They Do, But They Don't

I've heard of students applying to schools with great MCAT scores and almost perfect GPAs, decent extracurriculars, but the students didn't get interviewed anywhere. Looking at their school list, they applied to four California-state schools. They're California residents going to school in the midwest area. California medical schools are really hard to get into.

Your stats don't matter. Your stats don't matter and to think, California medical schools are so hard to get into. This may seem counterintuitive. But really, in the end, they don't. They do, but they don't at the same time. Now, these students also applied to several east coast schools, which are also very hard to get into. Your stats don't matter. They do, but they don't.

And in another website, a student posted his stats with 4.0 GPA, 525 MCAT score, and then gives out their school list. Then they ask whether they should add more "mid-tiers."

"There's no such thing as mid-tier, high-tier, or low-tier. It's a premed thing."

Are there programs out there that will discriminate you based on the medical school you go to? Yes, there are. However, I strongly disagree with painting broad strokes about residency admissions based on the medical school that you've gone to. If you're concerned about the residency program you're going to, stop! You shouldn't be worried right this minute as a premed student about the residency program you think you want to go to.

First, your choices of specialty are likely going to change. Based on the last AAMC data I could find, 75% of students change their mind when it comes to specialty selection. The majority of students change their mind, so you shouldn't be thinking about a very specific residency program right now as a premed student.

Even if you do stick with that residency program you're interested in, getting into one of those top programs shouldn't be your goal. It would be nice or great. You shouldn't decide what medical schools you're going to apply to because you have one specific residency program in mind.

"Getting into medical school is hard. Don't make it harder by limiting your chances, because you're limiting the schools you're applying to."

You can get into Neurosurgery by going to a "low tier" school. There's no data out there that shows that you have to go to a top medical school to get to a competitive residency. Your medical school doesn't matter. Don't make it harder for yourself by only applying to top tier medical schools because you think you have amazing stats.

[08:40] Do Stats Really Matter?

Your stats don't matter. Your stats open the doors to places. They matter up to a certain extent or point in the application process. And then everything else takes over. As an applicant, you have to work on the rest of your application as they matter even more than your stats. Once that door is opened, if you have a bad personal statement, your door will shut quickly. It's the same way if you have bad extracurricular descriptions or if you can't talk about why you want to be a physician. If you can't talk about the activities you've done and how they've impacted you, those doors will shut, regardless of your stats.

"Your stats don't matter. Your stats open the doors to places. They matter up to a certain extent or point in the application process."

Now if you're applying to "top tier" medical schools, that doesn't mean they're better schools than "low tier" schools. When you're applying to medical school, you need good enough stats to pass through the digital shredders, the filters the school set up. If your stats are good enough to pass those filters and to be sorted in a way that your application lands on the desk of somebody, your stats have to be good enough to get to that point.

[11:25] You're Just Like Everybody Else: How Do You Stand Out?

And when you apply to these top tier medical schools because you have great stats, guess what? There are a lot of other students who have the same stats. So when you start comparing yourself to other students who are also applying to those other "top tier" medical schools, you now all of a sudden look like a normal student. Because they're comparing you with other students with 525 MCAT scores and 4.0 GPAs. And when your personal statement doesn't line up or hold up to the personal statement of another student, then you're probably not going to get an interview.

Your application matters as well as your letters of recommendation, most importantly, your personal statement. Speaking of which, check out The Premed Playbook: Guide to the Personal Statement.

Your personal statement is probably the most important thing outside of your stats. Your stats open the door. Your personal statement gets you through the door. Your secondary essays land you a seat. And your interview hopefully seals the deal for that acceptance. So when you start looking at your school list

"Your stats open the door. Your personal statement gets you through the door. Your secondary essays land you a seat. And your interview hopefully seals the deal for that acceptance."

[13:35] Things to Consider When Preparing Your School List

So when you're looking at your school list, don't look at MCAT and GPA. Instead, look at schools where you want to apply to. There are so much more out there that you need to consider - the culture of the school, mission/vision, programs, clubs, activities, support, etc.

As you're preparing your school list, consider where you want to live, weather, proximity to family, class size. And as you're going through this process, try to visit schools so you can see firsthand what it's like. There are several students who had a school ranked as their top choice before interview day and then ranked it at the bottom after interview day. And students who ranked it at the bottom before interview day, now ranked at the top post-interview day. All because they saw how amazing the school was after visiting it and after talking to students.

The MSAR (Medical School Admission Requirements or the College Information Book (CIB) don't do justice to what you will see when it comes to the medical school and what you will experience at that medical school.

"There are several students who had a school ranked as their top choice before interview day and then ranked it at the bottom after interview day."

[15:31] You Have No Control Over Medical Schools

You have no control over what the medical school is looking for. So when you look at creating your school list, you have no control over how medical schools are going to look at your application. There are students who have the same stats and apply to the same school and one gets immediately rejected while the other one got an interview and accepted. If it was all about stats, this wouldn't happen. But it's not all about stats. It's about who you are.

It's about how you're able to add to the diversity of the class. Show that through your extracurriculars or secondary essays. If you can't do that, then you're probably not going to get interviewed.

"It's not all about stats. It's about who you are."

Let's just try to paint a broad brush and talk about students with 4.0 GPAs and 525 MCAT scores. They're probably super nerd. And if you picture somebody like that, maybe they don't know how to write a good essays or personal statement. They just talk about loving science and helping people. They've proven themselves in their stats. So they should get accepted. They think that because they have the stats, that medical school application is as easy as offering the acceptance now. They probably think they don't need to be interviewed.

But there are also those "normal, non-nerd" students out there who are getting 4.0 GPAs and 525 MCAT scores who are able to write amazing personal statements and secondary essays. They show that diversity through their extracurricular descriptions. Those students are getting those interviews and get accepted.

All this being said, it's so much more than MCAT and GPA. You can not apply to medical school based on your stats alone. You can not choose the medical schools you're applying to based on your stats alone. Your stats should have zero bearing on the schools you are applying to. Do not apply to medical schools that you are not going to be happy at because you have the stats that you think will get you accepted there.

"You can not choose the medical schools you're applying to based on your stats alone. Your stats should have zero bearing on the schools you are applying to."

[18:42] Every School Is Different

Harvard Medical School has a very different culture than the University of Florida Medical School or that of University of Kansas Medical School, and so on. Every school is going to be different. This may be hard to understand but you need to do your homework and find out what that is like. You won't know if you're truly going to be happy at a certain school unless you go there. Step foot on the campus and see what it's like. Even then, it's hard to gauge so you need to also talk to students. Talk to people and talk to graduates and the alumni of the school. Ask them about what they like and didn't like.

As you're going through this process, hopefully you've got great stats. However, don't mistake those stats for an acceptance to whatever medical school you want to get into. Getting into medical school is hard even with amazing stats because there are so many other pieces to the puzzle that you are probably not thinking about. The biggest part of that puzzle is who you are and do you fit with that medical school. And if that medical school admissions committee looks at your application and determines you're not a fit for their school, you're not going to get interviewed even with amazing stats.

"There are so many other pieces to the puzzle that you are probably not thinking about. The biggest part of that puzzle is who you are and do you fit with that medical school."

[21:21] Don't Be Discouraged!

So don't be surprised or get alarmed as you go on these websites and forums and students are posting about how great their stats are. Don't look at that and determine that you're now not good enough to get into medical school. They are amazing stats for sure but they don't guarantee an acceptance.

One student I helped with during interview prep ended up only receiving one interview even when he had great stats. Reading his application before me helping him out, I told him why he wasn't getting any interview at first. His personal statement was terrible and it's why he probably didn't get any interview. What you put in your application matters. The MCAT and GPA are important. But beyond a certain point, they're not important anymore. The rest of the application is just as, if not more, important as those stats.

Links:

www.personalstatementbook.com

MedEd Media

Join our Facebook group

MSAR (Medical School Admission Requirements)

College Information Book (CIB)

Mar 21, 2018
277: This Student Didn't Let Her Fear Overcome Her
44:03

Session 277

In this episode, you will hear about another success story of a premed student who got into medical school on her first try after not doing very well in undergrad and more specifically, on the MCAT.

Before we move on to the interview, please don’t forget to subscribe to this podcast in whatever your device is. And checkout all our other podcasts on MedEd Media.

Back to today’s episode, Holly initially didn't think she could become a physician and let her fears dictate her path. She then conquered her fears and has been successful. Holly is a perfect example that you don't have to be a perfect student to get into medical school.

She found a school that matched what she was interested in. She allowed her goals to overcome her fears. And if you find yourself in this situation where you fear something and you don't think you can do this, this is a must-listen episode for you.

"My goal was more important than my fear."

[02:20] Her Dream to Become a Physician

Growing up, Holly didn't have any aspirations of being a doctor until she was working as a caregiver when she was in high school. This was the first introduction she got with patient care. A couple years of working, and she decided to go back to school, still around health care being a lover of the sciences.

"I fell in love with patient care but I just got really frustrated with the lack of knowledge that I had."

Holly would describe living in a "low socioeconomic status" and not many people in their area ended up going to college or having those big career aspirations. So it just never occurred to her that being a premed was an option.

[05:20] A Slight Detour and Going Back to School: Pregnancy and Getting Family Support

A couple of months into working as a caregiver, she got pregnant with her son. So she felt this was holding her back from pursuing any sort of big career. She wanted to but she didn't think she would have the time to go full board doctor while raising a son and all the things that went along with that.

Then she started working as a cashier at a local grocery store and one day, she just realized it was not she really wanted to do, nor would she want to do this for the rest of her life. So that week, she quit her job and took a risk. She registered for school and took classes in the Summer, which were accelerated classes. Instead of taking them in a ten-week quarter, they're reduced to five weeks. Seeing she was doing pretty decent, it gave her the confidence that she could do this.Once she jumped in, she didn't feel it was really hard as she thought and she could actually manage her time and do it.

"This is not what I want to do. I don't want to do this for the rest of my life. And if I don't get up and do something now, that's what I'm going to end up doing."

Holly feels lucky for having a husband who's 100% supportive of her career goals and she considers him as a huge rock in her journey.

[08:25] From Poor to Great Advising

So when she signed up to take classes at a community college where she was still pre-pharmacy, they were made to talk with an advisor. And one of the things the advisor told her was she needed to think of a different career path because there was no way she was going to be able to accomplish it since she has a family. Holly took this to heart and sadly, she didn't really get any that much of a help from her advisor.

A year into community college, she decided to switch over to premed, thinking that being a pharmacist just didn't feel right for her, also having shadowed a pharmacist and realized it wasn't something she wanted to do.

Then Holly got into Portland State University three years later and she got a premed advisor who guided her and pointed her in all the right directions. The school worked really closely with the local medical school OHSU. And they were strict in terms of what classes you need to take. But what she like about her advisor was the fact she was very supportive and very aware of going for upward trends.

A year before she graduated with her bachelor's was when she stumbled upon this podcast which she has found as very helpful.

[11:11] Juggling Family Life and Medical School

Holly says that while this may not be the path for everybody, what you really want to do is to make sure you're taking classes with professors who have either worked there before or that you know their teaching style works with your learning style. Or make sure that her schedule worked where she gets to go to school full day but only two days a week. This would give her three days out of the week to study and make sure she was doing her homework.

Luckily, the community college she went to had a Head Start Program. Due to this, she's able to bring her son with her to school and drop them off there. She'd also visit them on lunch breaks, on the days that she needed child care, while she was at school while her husband was working.

Moreover, the hardest thing for her was the transition from working to going to school. Holly explains that most of the schools have that delayed gratification where you have to put in the time. But sometimes you kind of lost sight of why you're doing it. At the same time, Holly was feeling this guilt from being away from her son. So it was hard for her to keep the end game in mind. But once she had the clarity and constantly reminding herself that she was doing this for her family, then she was able to overcome some of that difficulty. In addition, time management was something she needed to relearn.

"It was probably one of the most terrifying decisions I've ever made in my life... but I just hit a boiling point with my current work."

[15:55] Finding Time for the Extracurriculars

Holly admits having had very little direction on her first three years while at community college. And then it took her three years to start out there. She realized she was pretty behind in high school because of her full-time work so she had to relearn her techniques. That said, she had very little direction until she got into a university.

It was actually a year and a half when her advisor was asking her about when she's going to do these extracurriculars. So she found some volunteer opportunities at the premed fair they had at the score.

After finding some volunteer opportunities at a premed fair they had the school, one of them being The American Red cross. And as someone who donates blood often, this just drove her to it. Another thing that drove her to this was how flexible they were. They on'y had a minimum requirement of 4 hours a month.

Then she got pregnant again, now with her second child about a year before she graduated from the university. Feeling unsupported, she was taking a gap year and it was the bulk of her extracurriculars done. So Holly decided to get work with direct patient care, and her degree, which she has been doing for the last two and a half years.

Holly did a year working as a psychiatric technician for a nonprofit, specifically in the mental health sector. She worked with youth just below hospital level and did patient care with kids which she did for a year.  Then she landed a job at the company she's still working at until now. It's another nonprofit mental health company, but this time, she's working directly with a child mentalist and psychiatrist as a psychiatric care coordinator. She has been doing this for the last year and a half. It still involved direct patient care as she would have to room patients in the same way you do at a primary care doctor's office. She also does medical case management.

[19:40] Taking the MCAT Twice

Holly didn't register for the MCAT until a year after graduation because she just gave birth around that time so she had to juggle several things, taking care of the baby which meant being sleep-deprived most of the time as well as some personal issues. So she made that decision to take a gap year. Six months into her job, she decided to register for the MCAT. At this time, she didn't know that you have to register early. The soonest day available was, say, May 19 and she didn't study that much. Apparently, she did the MCAT twice.

She knew she didn't do well the first try since she tried to cram everything into a month before she took the test so she ended up getting a 492. Around this time, she discovered The MCAT Podcast after randomly searching for MCAT resources. She then learned all the things she should have learned before she took the MCAT the first time. Take it early and don't procrastinate studying. Take the practice tests.

"I didn't take any practice test so I didn't really have any idea of what I was doing until I got in there. I would not suggest this route for anybody."

So the second time she took it, she registered for it again, taking a May test date to give her time plenty of time to study. And she crushed it this time. She also had to change jobs at this time which gave her a lot of flexibility. She was able to study during lunch breaks. She also developed a good working relationship with the doctor she was working for, who kept her motivation up. After over two months studying for the MCAT, there was construction happening in her apartment, so she and her family had to move out to a hotel. They spent a month there with her husband, two kids, and her MCAT books.

In the end, she reckons she didn't study as much as the content that she would have wanted to. She debated pushing the test date but she couldn't afford it financially. So she pushed through with it anyway, took it again. Not having reviewed any of the psychology stuff, putting it off at the last minute and confident that she was a Psychology major and worked at a mental health institution. But this was another mistake she's now pointing out.

[26:25] What Went Wrong?

There a a few factors that she thought was wrong in her planning. First, living in a hotel set her off by about a month. So she really had a hard time finding quiet with what was going on. Though she knows this is just her excuse. She had a study plan and she was really doing well sticking with it until that point she had to move and she got behind it. Then she decided she was going to focus on the areas she struggled with the most - Physics and Chemistry. And she also focused a little bit more on Biology, being a bigger chunk on the MCAT since every section has a little bit of Biology in it, as well as the CARS section since she got a low score in that section the first time. She decided to do a "smart" study instead of a "bulk" study.

"I focused a little bit more on Biology, since there's a bigger chunk of it the MCAT because every section has a little bit of Biology in it."

In the end, she didn't get the scores she was looking for. She had gotten off track her study schedule. Then two weeks before the test, she noticed something about her mom's health. And right before the test, she found out her mom had severe COPD. This bugged her when she went in there. It was what was running on her mind on the first section.

Although she got the score that she didn't really want, she ended up applying to medical school still. She talked with her advisor and she was just very supportive of her. They can say yes, no, or maybe, but at least you've got to reply.

[29:27] The Application Process: Choosing Schools to Apply To

Holly says not limiting where she applied to just because of her MCAT scores otherwise she would have applied to many more places. She got a 499 her second time. Part of her thought process in picking places to apply to was choose those she was passionate about and where she thought her personal statement would resonate with. Basically, she picked places that she thought would fit her personality. Alongside, she applied to places where she knew she wasn't going there but she applied anyway. She did take a couple of rejections but as they say, it only takes one acceptance.

In doing her research on schools to see her personality fit, she looked to MSAR that had all information about GPA and MCAT. Then she narrowed it down. The top tier ones were out as she describes it as a level of "self-described prestige" which she doesn't think her personality fits with.

Some of the things she looked for in the programs were international medicine, the ability to go abroad. She also researched more into the school like volunteering opportunities. She's passionate about working with underserved populations and homeless populations. So if she saw it was something they allowed or encouraged in their volunteer opportunities, then she included them into her list of schools she was interested in applying to.

[33:17] Writing Her Personal Statement

Holly finds herself talking about her kid in every job interview. But when it came to the personal statement, she listed all the things she has done. She presented this with her premed advisor and told her not to do it. And it was the same thing she heard on this podcast.

She then attended an event from an osteopathic school in Oregon, which was a personal statement workshop. They were reading out loud a couple of the personal statements from some of their students who got accepted. Although they had different styles, one thing she learned was that it's about you and your personal style.

Holly wrote so many versions of her personal statement that she even struggles to remember what ended up making into the final cut and what didn't. Especially that she applied to both MD and DO schools so she had to cut some of that personal statement for the AACOMAS.

Nevertheless, she started with a story about a patient she interacted with at the place she worked with. But her premed advisor gave her a feedback that it was all about the patient. And asked her it should be about her and why she wanted to be a doctor and why this is relevant to her.

"This is a wonderful story, but where are you? This is all about the patient and I want to know more about you. Why do you want to be a doctor? Why is this relevant to you?"

So she started out with her story and what had held her back from starting her journey until what really pushed her towards becoming a doctor. She talked about that moment she wanted to be a doctor and blended it with the story of the patient about how this shaped the kind of doctor she wanted to be. She talked about how patient care was her passion.

[37:07] Talking About Her Family in the Application

It was a long process but when she talked about how she got to where she's at from where she came from, she had to talk about it and she talked about her family as part of her story because it was who she was.

She got two interview invites and one was an MMI. Molly explains how there are specific questions that you kind of expect to pop up like why medicine and what got her to that point. So she had to talk about her journey.

As with MMI, although there are lot of different stations with questions on ethical debates, but a lot of them can be very standard interview questions as well. She was so nervous about her MMI. She had a bulk of her time practicing the ethical questions so getting a very basic one as her first question got her choked up a little bit. But more than anything else, it was just more of her nerves. But by the time she got to the 6th to 8th station, she was getting less and less nervous.

"Instead of practicing what to answer for a specific question, I spent more of my time practicing how to answer just random questions that I wasn't expecting."

[40:10] Holly's Advice to Students

"My goal was more important than my fear."

Holly admits having questioned many of her steps. But in the end, her goal was more important than her fear. Though she knew that had she been more confident about herself and what she wanted to do with her life, she would have started the process a lot sooner.

She's now 31 years old and was one of the oldest people in her interviewing group. She doubted herself along the way, in fact, so much, but she just kept pushing forward. At the end of the day, it's not about the little moments or the quiz you failed or even the three Cs you got. But it's about looking to that bigger picture. Shadowing and clinical experience are a huge piece for her to push forward because it just reminded her that it's what she wanted. Her end goal was working with patients and being a doctor. Keep that end goal in mind and keep pushing forward. If this is what you want, it doesn't matter if you're the smartest person or not, it's all about the hard work. Just keep working. Break it down into smaller, obtainable goals.

"If you don't try, that's an automatic no. But if you do try, there's a chance. And even if it's a small chance, it's worth it."

[42:40] Share Your Success Story with Us!

If you have a success story you want to share on this podcast or you know someone who has overcome some obstacles, let me know by emailing ryan@medicalschoolhq.net. If you know any dreamers out there in medical school and working as physicians, let us know too!

Links:

MedEd Media

The MCAT Podcast

MSAR

ryan@medicalschoolhq.net

Mar 14, 2018
276: Q&A From the Premed Hangout Facebook Group
27:57

Session 276

Today, we're talking MD vs PA, DO shadowing, physician letters of recommendation and other questions premed students have asked in the Hangout!

The Hangout is our private Facebook group for amazing premed students like yourself. With almost 4500 students currently, the group fosters a collaborative environment. If you're used to online communities of premed students packed with fighting and narcism that you don't want to be around, then the Hangout is the place for you. Join the group, ask questions, and we will get you approved as soon as possible.

[02:35] Some Amazing Books to Help You on This Journey!

If you are struggling or thinking about preparing for you medical school interview and struggling with how to prepare for it, check out my book, The Premed Playbook: Guide to the Medical School Interview. It's available on Amazon, Barnes and Noble, and wherever you buy your books.

Also, make sure you pre-order my next book, The Premed Playbook: Guide to the Medical School Personal Statement. Its paperback version is coming out in August and the eBook will be out before then.

Just to also give you a bit of a teaser, I've been working on the next book for 2019, The Premed Playbook: Guide to the Medical School Application which will cover all about the application process.

Now, let's move on to some questions posted on the Hangout that I want answered here on the show today.

[04:18] Taking Credits at a Community College

Q: "I'm a non-trad premed looking at summer classes. I did my first year of credits at a community college but I'm now at a four-year college. Would it be okay for me to take those summer classes, Physics 1 and 2 at community college? I will still return to my four-year college in the Fall. But the summer classes at the community college would fit into my life schedule better."

A: This is a super common question for students. They worry too much about "too much" minutia, all the little details. Stop worrying about all the small details. They will not keep you out of medical school. Rather what will keep you out of medical school is having a poor GPA, poor MCAT score, applying late to medical school, applying to the wrong medical schools, poor extracurriculars, not having the right extracurriculars. Those are the big picture items that you need to make sure you handle when it comes to applying to medical school. Then all those other questions beyond these are minutiae that you shouldn't be focusing on

"Stop worrying about all the small details."

So yes, you can take classes during the summer at community college. Understand that there may be some medical schools that may question that. They may never ask that question during the interview. They may wonder why. But a lot of students actually do this. They go to their university during Fall and Spring. And then for summer and winter break, they will take something at home. And a lot of times, they go to a community college.

[06:58] Will It Hurt Your Chances to Get Into Medical School?

Most likely, this will not hurt your chances in getting into medical schools. There will be 3-4 schools that will prefer all premed prereqs be taken at a four-year university.

"There are going to be some of those schools out there who are going to put their nose at community college. That is changing though, so you shouldn't worry about this."

Yes, you can do all your prereqs at a community college. This may pose a bigger red flag to some schools. But yes, you can. In everything you do, do well. Whether that be taking classes at a community college or a four-year university, however you're studying for the MCAT, whatever it is, do it to the best of your ability. Again, stop worrying about these small details.

[08:08] Shadowing a DO Physician

Q: "I've never shadowed a DO physician before, but I will be applying to several DO schools this cycle. Will I be at a significant disadvantage?"

A: This is another common question for students applying to DO medical schools. The CIB (College Information Book), which is the DO equivalent of the MSAR (Medical School Application Requirements), will tell you some application requirements for DO medical schools.

"A lot of the osteopathic medical schools want you to shadow a DO physician."

A lot of the osteopathic medical schools want you to shadow a DO physician and on the CIB, they would, for instance, state that they strongly recommend that you shadow a DO.

While you don't need to shadow a DO to apply to DO schools, you probably should. I talked to a student before here on this podcast, where she applied to DO schools. She was given a conditional interview that stated that she can only interview at their school provided she shadowed a DO prior to coming to medical school to make sure this is what she wanted to do.

[10:10] DO vs. MD

Being a DO and MD are very, very similar. But osteopathic/DO medical schools often have an inferiority complex They want to make sure that you understand what an osteopath does. Even though at the end of the day, an osteopathic physician is a physician. And there are a lot of osteopathic physicians out there who don't practice OMT (Osteopathic Manipulative Treatment). So if you go to find a DO to shadow and they don't practice OMT, then you're practically just shadowing an "MD." A lot of students will ask themselves this.

I don't believe in the DO holistic philosophy as they sell it. I think that to be a good physician, MD or DO, you need to to treat patients holistically. That's not a monopoly that DO physicians have. They may have some secret sauce in their curriculum that helps students do that. But at the end of the day, treating patients holistically is something that good physicians do whether you're an MD or a DO.

"To be a good physician, MD or DO, you need to to treat patients holistically. That's not a monopoly that DO physicians have."

Back to the question, would you be at a significant disadvantage if you don't shadow a Do before applying to DO schools? Yes. But there are students who get accepted to DO schools without shadowing a DO. But a lot of the DO schools want you to shadow a DO. A lot of them want a letter of recommendation from a DO. So don't limit yourself by not shadowing a DO.

[12:50] How to Find a DO to Shadow

Google the state osteopathic medical society in the state you're in. Contact them and tell them you're a premed student. Tell them you're interested in shadowing a DO and ask if they can put you in touch with one. Google around and ask. Ask your friends and family members. Call hospitals.

"Finding a physician to shadow is hard. Finding a DO is a little bit harder because the majority of physicians out there are MDs."

[13:50] At a Crossroads: PA School vs. Medical School

Q: "I'm currently at a crossroads. Do I want to go to PA school or do I want to go to medical school? I have all premed prereqs done but I haven't taken the MCAT. I have taken the GRE but don't have all PA prereqs done depending on the school. Something unique about my situation is that I'm actually married to a physician in residency. The prospect of adding toward debt and my not contributing to the family income for four years is quire daunting. I just have so much regret that I let a false friend sway me from applying to medical school while I was in college. I feel like I wouldn't be that stellar of a candidate for either path just because it has gotten so hard to gain entrance to either type of school. I have a B.S. in Biophysics with a 3.73 GPA and an MPH 3.51 GPA. I don't have a ton of volunteering hours in the last few years. Also currently, I am underemployed as a tech at a hospital and a substitute teacher since we are only in our current city for one year for my husband's intern year. And there were no job openings in my field. Has anyone been in a similar situation? What has been your thought process?

A: After four years, you're either going to be a physician in residency or internship or you're going to be a practicing PA. Now, sit down. Close your eyes. Picture what your life looks like. Which one feels right?

You have to ignore the debt as it's going to be there as a physician. And the debts will go away as a physician. It could take five years to get rid of medical school student loans. If you plan appropriately and don't overspend, you can pay off your loans very quickly as a physician. You cannot be concerned about the debt. This is actually a big point of contention I have with how expensive it is to go to medical school.

A lot of underrepresented minorities are thinking about debt and not going to medical school because of that. However, you should not worry about the debt. It will be there but it can be easily handled as a physician. It does add an extra layer of stress in your life, just like mortgage and car payments.

"It's a debt so it can be stressful. But if you manage your money properly, it can be handled."

If you want to be a physician, be a physician. Don't be a PA just because you don't want to not contribute to the family for four years. Or just because you don't want to add to the debt burden of your family.

[18:10] Letters of Recommendation

Q: "Is having a letter of recommendation from a physician we shadowed an important thing for medical school apps. I've seen some schools that ask for it and some that don't."

A: A lot of DO schools want letters of recommendation from DO physicians. While a lot of the MD medical schools don't specifically mention letters of recommendations from physicians.

I talked with a Dean of the Admissions Committee one time and he thought letters of recommendation are basically pretty useless. Who isn't going to write a letter of recommendation that isn't positive? You're actually hard-pressed to go find somebody that's going to out of their way to write you a bad letter of recommendation. So the majority of letters out there are going to be positive.

All this being said, students worry too much about letters of recommendation. Go and get what's required. Start thinking about the schools you're planning on applying to. Then look at what they require.

The general rule of thumb: Have a couple of science professors. Have a non-science professor. Have a physician (have a DO if you're applying to DO schools). Research PI is not that important. But if your PI was a science professor who taught you, then that's a good letter. But outside of that, the research letter won't really matter unless you're applying to MD/PhD programs or DO/PhD programs. So it's not a big deal.

In a nutshell, get a letter of recommendation from a physician just to have it. So if the school requires it, you have it. It's probably not a big deal if you don't have one unless the medical school you're applying to, requires it.

"Every medical school will requires something a little different so make sure that you have the required letters of recommendation for what the schools that you're applying to want."

[21:05] When to Start Studying for the MCAT

Q: "I'm a current undergrad sophomore, when is a good time to start studying for the MCAT? I was thinking of starting this summer. The only premed prereqs that I have left to take are Biochemistry and Physics. Also, has anyone taken prep classes? Were they helpful?"

A: Although it's not required, a prep class with will help you. And based on the data I saw, about half of the students who apply to medical school have taken a formal prep course from Kaplan, Princeton Review, Next Step Test Prep, etc. While half of the students are doing okay without it. The best thing you can do is to listen to The MCAT Podcast.

Additionally, one of the best ways to prepare for the MCAT is by forming a study group. Find those students around you. If you already have the date for the MCAT, search for MCAT Study Group on Facebook. Find the date you're taking it. Find the study group date that you're taking the MCAT. And you'll find a group of students there who are taking the MCAT the same day as you. So you guys can help each other.

The best time to start studying for it? The summer of your sophomore year is probably too soon. It really only takes three or four good months of studying for the MCAT to be prepared for it. You can start earlier. Buy the books and go through the outline. Go to the AAMC. Buy their materials. Get that and look at the outline as well as the topics it covers. And as you're going through your classes now that you now what's probably on the MCAT, then you can look into them a little bit more.

"It really only takes three or four good months of studying for the MCAT to be prepared for it."

But if you still have a lot of prereqs, it might be harder to actually start doing questions and full-lengths and reading all the content as you're still trying to learn materials. But you can follow along while you're doing your classes and use the MCAT material as supplemental information.

Again, get a good three to four months depending on your other time requirements. What else is taking up your time can play a factor in how much time you have to study. Work that all in. Try to take the MCAT by March or April of the year you're planning to apply, which is the year before you're planning on starting medical school. Taking it at this time gives you time to get your score back and figure out what to do next. It gives you time to not worry about studying for the MCAT so you can focus on your primary applications, secondaries, interview prep, etc.

[25:30] About Next Step Test Prep

If you're looking for full-length practice exams for your MCAT prep, the Next Step Test Prep is where you want to look. I regularly get feedback from students that the full-lengths from Next Step are, hands-down, the most accurate outside of the AAMC full-length exams. Use the promo code MSHQ and save 10% off of any of their full-length practice tests or on anything they have to offer.

Links:

Join the Premed Hangout

The Premed Playbook: Guide to the Medical School Interview

The Premed Playbook: Guide to the Medical School Personal Statement

CIB (College Information Book)

MSAR (Medical School Application Requirements)

The MCAT Podcast

MCAT Study Group on Facebook

AAMC Study Materials for the MCAT

Next Step Test Prep

Mar 07, 2018
275: From Nursing to Accepted Premed, A Story of Lost Confidence
37:07

Session 275

Ayesha is a successful applicant to med school after she initially lost confidence due to poor grades and became a nurse instead. Her dream never left her.

An avid listener to this podcast, Ayesha is now on the show to share her stories about her premed journey, or reboot to her premed journey after doubting herself while in undergrad, dealing with self-doubt, and then finally in transitioning from nursing to medicine.

Special Announcement: The Premed Playbook: Guide to the Medical School Personal Statement comes out in August 2018 for the paperback version and the eBook will be released earlier than that. Stay tuned to be notified!

[02:07] Her Interest in Medicine

Although she thought she has always wanted to be a physician when she was younger, she really never thought it was something she wanted to do back in high school. But she knew she still wanted to get into healthcare. Her family has influenced her, being her mom who is a nurse and as well as her aunts. So she always grew up hearing stories about the different patients in the hospital.

"Health is an equalizer in way. Regardless if you're a president of the free world or you're a janitor of a building, if your health is not intact, you cannot be a contributing member to society."

Attending Georgetown in her undergrad, she met a lot of premed students that had strong convictions to medicine. It wasn't the same for her since she had a lot of interests such as international health and international affairs. She didn't know at that time that she could really incorporate within medicine specifically. But she knew she wanted to explore that field more.

Her transition in interest from nursing to medicine actually occurred the moment she became a nurse. When working as a nurse in critical care in D.C., she worked intimately with the residents, attendings, and interns. And through interdisciplinary rounds, she got exposed to the thought process behind them in terms of management plan and treatment of care. She also realized that a lot of the questions she had was deemed out of scope of practice for the nurse since she was more into the in-depth pathology and treatment plan and management of care.

"Regardless of your field, such as nursing, if it's in your heart to be a physician, you're not going to be happy with any other career."

She was also able to talk with friends that were residents or medical students and premed students. Additionally, she did an introspection and began questioning her intentions whether she's going into it for the right reasons. She also reflected on some of the academic struggles she had in undergrad. She began questioning her own personal abilities. So through deep self-reflection and deciding where to go in the future without any regrets, she just concluded that medicine was for her.

[07:01] Planting the Seed

When Ayesha was transitioning from undergrad into a real adult life or adulting, she wanted to journal what she's been experiencing in the hospital as well as what she wanted for herself and her future. She was in Barnes and Noble and found a magnet saying "What would you do if you knew you cannot fail?"

Immediately, the first thought that came to her is being a physician. This actually shocked her because she didn't know it was strong in her subconscious. So this was that point in time where she had to really dig deep into what she could get from medicine that she can't get from nursing.

And she realized she wanted to be a physician to serve underserved and vulnerable populations both domestically and internationally. Being a daughter to Kenyan immigrants, she can identify strongly with her Kenyan heritage. She actually went through the different internships she did during undergrad, working with UN aids and doing clinical rotations in Ghana. Then she realized she wanted to have this ability and autonomy the physician has to provide patient care the best way she wanted to do so.

"I wanted to have this ability, this autonomy that a physician has to really provide the care for patients the best way that I wanted to do so."

Speaking of autonomy, she looked up other master's program for nursing being a logical transition. But through it all, she really knew in her heart that she wanted to be a physician. Otherwise, she wouldn't have been happy had she tried another career when she really wanted to be a physician just because of fear.

[10:00] Self-Doubt Due to Undergrad Academic Struggles

During her freshman year at Georgetown, she considered it being a humbling experience. Excelling in high school, she thought she was going to easily do the same in college. But she found herself struggling in Human Biology during the first semester. And it came a point where she had to withdraw from the course since she didn't want to end up with a horrible grade on her transcript. She thought she was a failure and it got stuck in her subconscious. So she began questioning her abilities and whether she was smart enough.

"At that moment, I realized that it was me really stopping myself from pursuing medicine because of fear of not being able to perform well on the sciences."

Ayesha adds that she got overly involved that it took away the time she needed to study. Having gone through a rigorous high school as well, she thought she could make through the classes at Georgetown. So she came in with a chip on her shoulder and not really evaluating that she's in a different setting.

[14:00] Resources, Myths, and

Ayesha talked to a lot of people. She enjoys hearing other people's stories. So she did a do-it-yourself postbac after making a connection with someone who was on the same path. Additionally, she talked to other friends who were medical students or premeds and just picked their brain. She also search for other information online.

Moreover, Ayesha mentioned about some of the myths that she was able to break free from after listening to this podcast. One of those myths is that if you don't have a 4.0 GPA and a 515 on the MCAT, you're never getting into medical school. You have to be stellar in every single aspect of your application.

Medical schools want excellence but it has to be genuine and that your passion must be real. They want good numbers but not really to the point how a lot of premeds talk about this.

"Med schools want excellence, but they want it in a way that is genuine to you and that your passion for medicine is real."

[16:38] Collaboration, Not Competition

Ayesha did her postbac at the University of Maryland Baltimore County, where she enrolled as a non-degree seeking student. She was interacting with students younger than her and going to college for the first time. She saw the sheer level of competitiveness that they brought to the table. This actually shocked her since working in the real world, you realize that in medicine, teamwork is a huge component. At times, this wasn't reflected in all students, although she found a great group of students who displayed teamwork and collaboration. She considers them as instrumental in succeeding in her postbac program.

"Working in the real world, you realize that in medicine, teamwork is such a huge component. To get to where you want to be, you need to be able to collaborate with others and have good spirits."

In finding these people and putting out the message, she would interact with them in classes in an informal way. And she'd usually invite them to study with her together in the library. So she simply goes up to someone she sees that understands the material which she doesn't. In the same manner, she does bring something to the table too in sharing her knowledge.

[21:20] Fitting It All In and Making It All Work

Ayesha finds it a struggle to having to fit everything in. As a nurse, she would work 3 12-hour shifts a week. There were times she would work a night shift and then have to rush to class. She lives in Baltimore and works in DC so commuting was pretty difficult too. She would do her 12-hour shift then stay up until 2 am to study so she can prepare for class the next day. It was exhausting but she found strength in time management and prioritization skills.

"What really strengthened during that time period was my time management and prioritization skills. I learned how to say no and not feel guilty."

Additionally, Ayesha underlines the importance of time management.As life goes on, it's going to get busier and being able to develop time management skills is really something you should hone in on.

Thanks to great managers too who have supported her through this journey. She was able to transition from full time to part time during the second year of her postbac so she could better accommodate a life balance between work and school, while keeping her sanity.

What she considers as the biggest challenge through all this transition is self-care and making time for herself. She was putting everything else before her, not realizing that she wasn't at her best. She couldn't be her best in all those other things she's juggling.

That being said, it's hard being caught up in the premed world and med school application that you forget to take care of yourself, something which Ayesha needed to make a conscious decision to do so. And once she became more conscious and more deliberate in her actions, balancing was still difficult but it was more manageable.

[25:00] The Challenges of Application: Personal Statement

Ayesha found writing the personal statement as the hardest part during her med school application process. With her long commutes, she was listening to this podcast and all our other shows on MedEd Media, specifically about writing personal statements. And she was constantly practicing and saying it loud. She realized that shaping her story is difficult.

She had to compress all these years of being an undergrad and transitioning to nursing and being a medical student. And putting it all together in one nice personal statement was hard. She spent months working on it, it took her awhile to get to a personal statement she was happy with.

Outside the podcast, she leaned on family and friends who really knew her. She would write a ton of drafts and would ask them to check it for her. Thankfully, her friends were so honest to tell her whether she needed to go deeper.

On the flip side, she also like having individuals who didn't know her too well to read her personal statement. That way, she could ask them what they were able to get from the personal statement. They could give them the characteristics and values they had gotten away from it.

"Without them knowing me so well, it also helped me fine tune where I need to better improve on within my statement."

Check out my book, The Premed Playbook: Guide to the Medical School Personal Statement to learn more about how you can write a better personal statement.

[27:45] The Interview Process: Tell Me About Yourself

Ayesha got interviews at a number of schools and she got multiple acceptances. She has read the book The Premed Playbook: Guide to the Medical School Interview. What she liked about the book was a transcript of me working with students and when I had them redo their answer to a certain question after I have given them feedback.

It's different when you're reading a book where they're just giving you the various types of questions that you may be receiving within interviews. But having that real conversation and hearing their first response, then the feedback, and then the revised response, you would be able to see the difference in how they responded. Ayesha found this to be very helpful especially when it came to the very generic yet essential Tell Me About Yourself. You can take that question in so many different ways and it could really set the tone for your interview.

"Especially when it came to the very generic yet essential Tell Me About Yourself. You can take that question in so many different ways and it could really set the tone for your interview."

What she also learned from the book is to be able to bring up different values or themes within the Tell Me About Yourself Question versus just reading off the resume. In her case, Ayesha highlighted the values of family and building a community, which was emphasized throughout her upbringing. She found herself always searching for a community in every place she went. She always felt the need to find a strong community that identified what she wants in terms of working for the underserved and vulnerable populations.

So being able to bring this up to the Tell Me About Yourself question, it led her to talk about a lot of the community service work she did as well as the different populations she worked with as a nurse. They also got into the areas of the interview that she wanted to talk about which she wanted to highlight during her interviews.

[31:10] Achieving Success: How Do You Do It?

What she thinks that led to her success in her medical school application is prayer, first and foremost. Faith is a huge aspect for her. At times she felt nervous and questioning the process but she realized some things are out of your control. If you know that you put your best foot forward then you can't blame yourself. So when she got to the point that she had reviewed everything, she knew that she had put her best foot forward and God will do the rest. Being able to just not overly stress over things also contributed to her success knowing there's a higher power in place.

Ultimately, Ayesha leaves us with great advice that you need to trust the process and appreciate the journey. She realized that her journey has been so meaningful because of having that strong sense of why and her purpose was clear. She wouldn't have had that clarity and that immeasurable sense of integrity if she had not gone the very non-linear path to medicine. Keep thriving and striving and all things will work out in the end.

"Trust the process and believe in yourself. Surround yourself with folks who will uplift you and empower you to be the best version of yourself."

Links:

MedEd Media

The Premed Playbook: Guide to the Medical School Personal Statement

The Premed Playbook: Guide to the Medical School Interview

Feb 28, 2018
274: 5 Common Mistakes Premeds Make with Extracurriculars
26:40

From taking on too much, to not doing enough, we'll talk about what you can do to avoid the common mistakes premeds make with their extracurriculars.

Feb 21, 2018
273: Let's Talk About Osteopathic Docs and What You Need to Know
34:32

Session 81

Dr. Daniel Clearfield is a Family and Sports Medicine trained OMT doc. We talked about his journey to DO school, some struggles that DOs have and much more.

The Premed Playbook Guide to the Medical School Personal Statement is now available for preorder on Amazon, Barnes and Noble, or wherever you buy your books. If you haven’t yet, also check out The Premed Playbook Guide to the Medical School Interview.

If you're still trying to figure out whether or not you want to apply to MD schools or DO schools or both, this is a must-listen episode. If you're hesitant in applying to DO schools or don't know about DO or osteopathic manipulative medicine (OMT), again, listen to this podcast.

In this episode, Daniel discusses OMT and about how he approaches OMT. Find out how he has been able to add it to his toolbox in helping his patients.

[02:25] An Interest in Kinesiology and Eventually, Medicine

Having a father as a doctor, Daniel saw how hard it was to be one. His high school guidance counsellors even encouraged him to follow the path of his dad but he didn't initially liked the idea. For college, he did mechanical engineering for a year and a half. Realizing the kinds of peers and the things he'd be doing, he stumbled upon Kinesiology as a major. At that time, he was already working as a personal trainor since high school. So he was looking at the different paths he could use with it. Nevertheless, he didn't see this as challenging enough. So he went on his journey and realized becoming a sports medicine physician was something he would want to do. Eventually, he started doing some externships in college and got to work with an orthopedic surgeon that specializes in Sports Medicine, as well as a primary care sports medicine doctor who later became one of his mentors. He also worked with a physiatrist, Physical Medicine & Rehabilitation Specialist.

"Even though going into college, it was the last thing I was thinking about, medicine ended up finding its way to me rather than me finding my way to it."

It wasn't his dad being a negative influence that held him back from being a doctor. His dad never really brought work home, but he was tired and would get called in the middle of night. So he just saw the negative effects in terms of lack of presence at times. He was a big cholesterol expert so he was flying around the world frequently. He'd be gone at times, and he felt having an absentee father. So all this drove him away from getting into medicine. It was more of seeing his lifestyle that initially turned him off.

However, when he got to do the shadowing experiences and with the primary care sports medicine physician, he found it very cool. They were treating not just athletes but people of all ages who had various ailments. Osteopathic manipulation was a part of it and he got fascinated by all the stuff that involved kinesiology.

"Here is a practice where we are directly taking everything that we're learning in college in this Kinesiology degree and we're directly applying that into medicine, into practical use."

In fact, none of Daniel's friends back in college who also got a Kinesiology degree was using any Kinesiology degree to the extent that he is using it now. That said, he loved his major.

Moreover, Daniel pointed out one characteristic he had that other personal trainors had, which was having that humility to say he doesn't know. And this bothered him a lot. He had more questions. He wanted to dig into more info and this is what got him started to look into medicine.

[08:35] Allopathic versus Osteopathic

Daniel explains that typically, allopathic physicians would look at xrays and MRI's and tell the patient the diagnosis and just present them with options as far as surgery or therapy. So he didn't really see having too many options.

Not meaning to generalize, but a lot of times, the MD physicians would excuse themselves and he'd find himself being left behind with the patients in the room. And they would still have a lot of questions. That made him feel very powerless and helpless to do anything. And having worked with DOs he has worked with, he saw that DO model of partnering with the patients.

"I saw more of that behavior model of partnering with the patients, sitting down, touching the patient just so they know that they're actually being listened to."

He felt that time spent with the patients understanding them and answering questions was just better quality time regardless whether OMT was employed or not. In short, he saw better patient interaction he was seeing with the osteopathic physicians.

Moreover, his father has also helped him identify those individuals who are respected in the profession. While he found the allopathic individuals he worked with on his own.

Daniel applied through the TMDSAS (Texas Medical and Dental Schools Application Service). He applied to one osteopathic school (which was the only one at that time) and then he applied to another school.

[10:55] What Is OMT?

Daniel explains that it's common misconception to compare osteopathic manipulative treatment (OMT) to chiropractic treatment. But they want to keep it separate. The founder of chiropractic manipulation, D.D. Palmer, was the pupil of Andrew Taylor Still, who was the founder of osteopathic medicine. Still was an MD who was a surgeon during the civil war times. There were just a lot of bad treatments where he suffered the loss of several of his family members. And he look at medicine thinking there's gotta be a better way they could be doing things. Hence, he came up with the manipulation. It was mainly a philosophical difference between what was being practiced at that time.

Meanwhile, Palmer took his own direction and does a lot of thrusting type techniques. There was not much work on the myofascia. But from Still's teachings came the osteopathic professions which still works in parallel with the allopathic profession in regards to the type of things you're being trained with. Additionally, you're being taught a different philosophical approach and more of a holistic type of approach in terms of patient interaction. You're also taught osteopathic manipulation and how that could be a part of being able to help your patients.

"It's not an absolute as far as all DOs have to use osteopathic manipulation. But all DOs have been exposed to osteopathic manipulation."

This being said, in addition to the routine medical classes allopathic medical students are exposed to, osteopathic students would be doing classes in osteopathic manipulation. They would have to take didactic classes as well as some lab courses 1-2 times a week where they get to practice their hands-on skills.

"One of the first things that we learned is how to touch a patient, how to actually create that somatic connection where we're actually putting our hands on somebody."

Once they had their clinical rotations, many of them just got more comfortable in terms of patient interaction. They were finding their flow in the hospital setting much quicker than some of their allopathic colleagues due to their hands-on experience.

[14:50] Should You Apply to DO Schools?

Daniel explains this is not for everybody. For instance, going through the TMDSAS, they had several students who ranked allopathic medical schools and trickled into osteopathic medicine. And when he started teaching for six years at the medical school he went to Fellowship to, they saw those people who weren't motivated enough to get involved with it.

When looking to going to an osteopathic school, there are several people who want nothing to do with OMT, but they still embrace the osteopathic philosophy. Daniel says this is okay.

For example, if you know that you want to be a dermatologist and the use of OMT and dermatology is their use, for the most part, you're not typically doing OM in a dermatology type practice. But if you embrace the principles and practice of what osteopathic manipulation is about and you want to pay attention to those aspects, if you want to understand how the bodies are more interconnected and how that affect disease processes, then that's were DO schools can offer great advantage to you.

Additionally, Daniel mentions there are several individuals out there that are Osteopathic Manipulative Medicine Specialists and this is the only thing they do in their practice is osteopathic manipulation.

"There are several individuals out there that are Osteopathic Manipulative Medicine Specialists and this is the only thing they do in their practice is osteopathic manipulation."

[16:30] His Decision to Teach

Many of these physicians are brilliant with their hands. But at the same time, when they speak about what they're doing, Daniel would describe it as like "diarrhea" coming out of their mouth. He considers them to be silent mentors since vocally, they could make you down where they speak out of concepts that are not evidence-based.

When Daniel went through his manipulative medicine courses, he saw the value of learning how to do it while also seeing the frustration of many of his classmates. They got quickly disenchanted with the profession as a whole because they didn't see the point of learning OMT to become a doctor. And they just wanted to go to medical school and be a doctor. This said, they never got the whole picture and they became those disenchanted physicians that totally turned away from the osteopathic profession. That if they had the option, they would quickly convert to an MD profession.

Daniel saw this so he decided to really learn his stuff and he did an extra fellowship so he would have further understanding of it.

"I wanted to go back and make sure that people aren't getting so frustrated with the profession, that they see that there is value as to what we're learning here and how they can apply it to any field that they have."

[19:28] Limitations versus Indications

Daniel explains that OMT is an elective treatment. There's no stat for an OMT but it's an optional thing you can do to better help the patient. There are several ways you can use it and there are also several ways they can't. For example, this can be in cases where you can see that the patient is going to be a liability. Especially in the current day where inappropriate touches are a highly controversial topic. So you don't want to have anything that is slightly off the standard beaten path. In this scenario, Daniel would avoid any kind of OMT.

From a sports medicine standpoint, OMT is an elective procedure. So he has to apply this to someone who gets injured in the field. But if they're a minor, he would need a parental consent for him to do it. This is another potential limitation of OMT.

Conversely, in terms of what he can do with OMT to help people, there are several situations that you can do it. He recalls an experience that he got to use OMT, which although not necessary, it was able to better help the patient. From a sports medicine standpoint, when he did residency in Ohio, he worked with an orthopedic surgeon. They would see athletes and he'd be asked to do OMT. So while the MD got out of options as to what to do, he was able to find other things that were able to help that athlete out at that time.

[25:40] The Subjectivity of OMT and the Lack of Research

Daniel that a big part of the lack of data is that subjectivity part of OMT. He participated in some OMT research protocols and when he did his Master's degree, the first year he was working on his thesis, he was trying to do a clinical trial with it. After doing a lot of research background, he realized it was going to be very difficult for him to do a trial like that.

"It's hard to have a placebo-controlled trial where you're really evaluating the efficacy of OMT and to standardize how OMT is done."

Another thing Daniel believes osteopathic schools aren't strong with is research. Although this has gotten better. His father is a big osteopathic researcher. But he feels that a lot of his allopathic colleagues have a better background in terms of conducting research, how to do clinical trials benchwork type research, etc. This is not a strong point among osteopathic schools however although some are trying to get better at this.

Research was something that was taught but compared to some of his friends who went to allopathic school, it wasn't taught at the same level where they would feel comfortable as conducting their own research going into practice.

Moreover, he refers to OMT as a very subjective thing in terms of feeling for different kinds of tissues and looking at different kinds of outcomes. With OMT, you're not a technician but a physician. So there is an art of medicine in what you're doing. That said, you may come up with different treatment plans based off of different factors related to the individual. But this is hard to standardize in a research sense.

"Research has its value in medicine. Evidence medicine definitely has a lot of value to it. But if you only go off of that, that's where you're only limiting yourself and you stay close-minded to other things."

[29:18] Better Patient Care: An Additional Tool in your Toolbox

Ultimately, what medicine all boils down to is that it centers around the patient and doing what's best for the patient. Daniel believes that by knowing things like OMT, he feels much more capable that he's able to help patients out. He has been able to figure things out on certain patients where other doctors have failed. He has been able to offer other different treatment where other doctors have not. So he feels he has this additional tool in his toolbox that he can offer and that's extremely helpful in patient care.

"I have been able to offer other different treatment where other doctors have not. I feel like I have this extra tool in my tool box at all times that's extremely helpful in patient care."

[30:00] Ways to Get Exposed to the DO World the Right Way

Daniel recommends to students looking to get exposed to the DO world is to find a good physician, be it an MD or DO doctor. Sometimes too, you can go based off recommendations of other students. Learn what type of physician you're thinking of doing and try to find a good mentor in that. Some people are not only disenchanted with the osteopathic profession but also with medicine. So if you shadow with them, you're not going to have any interest and influence to go into medicine at all.

Daniel adds that not everybody is a good teacher and instructor. Not everybody has that passion to pass along what is going on with them in medicine.

"It's not just finding somebody you can rotate with, but finding somebody good who's going to really answer the questions that you have."

All this being said and if he had to go back all over again, Daniel would still have done this all over again since he loves what he does. He wants to make that people getting into this are truly about wanting to do this.

Ultimately, whatever specialty you want to do, if you want to be a DO, you can do it! At the end of the day, if you want to be a physician, apply to both MD and DO schools. Since you can do anything you want to do as a DO. Be open-minded. You have to go through the OMT training and learn but you don't have to do it in practice if you don't want to or if you don't believe in it.

Links:

The Premed Playbook Guide to the Medical School Personal Statement

The Premed Playbook Guide to the Medical School Interview

Feb 14, 2018
272: How to Start Brainstorming Your Personal Statement Draft?
30:48

Session 272

Writing your personal statement is hard. Where do you start? What do you write about? Check out the The Premed Playbook: Guide to the Medical School Personal Statement preorders!

If you're applying this cycle in 2018 to start medical school in 2019, hold off on the preorder and take a look at the eBook version which is set to be released in April. Check them out on Amazon or Barnes and Noble.

Please do check out all our other podcasts on MedEd Media including The OldPreMeds Podcast, The MCAT Podcast, Specialty Stories, and Ask Dr. Gray: Premed Q&A. Another part of our network is The Short Coat Podcast, a production of the Iowa Carver College of Medicine.

In this episode, learn how you can start looking at your personal statement and how to start it.

[02:02] Why Students Delay Writing Their Personal Statements

So many students delay and delay and they don't know why. The reason is as a premed student, you're most likely a very Type A personality. You're used to doing everything as perfect as possible. So you don't want to start your personal statement until you think it can be perfect.

This the same problem students have with the medical interview. (Also check out The Premed Playbook: Guide to the Medical School Interview) When students practice for the interview, they keep it in their head and they don't want to say anything out loud. And this is mainly they're thinking of perfection in their head.

The same thing with the personal statement. You try to keep everything in your head until you think they're perfect. Then you send it to somebody to get their feedback. And usually, the feedback isn't very good because the majority of feedback students get is grammar. However, most students get the critical feedback they need.

"The personal statement can't live in your head until it's ready because it will never be ready."

You are constantly editing your thoughts, trying to get the perfect personal statement in your head before you ever write a word. This is not going to work. You need to get it out of your head.

[05:45] Scared of Getting Thoughts Out of Your Head? Use Rev.com!

Invest in an app called Rev, that costs $1 per minute of transcription. You simply open up your app, hit record, then start dictating into the phone. This is a good practice since when you become a physician, you would have to dictate your notes.

So start dictating your thoughts. It's much harder to edit your thoughts as you're talking than it is to edit your thoughts as you are writing. You need to get those thoughts out of your head.

[07:05] Strategies for Gathering Ideas

What most students do is open up their word processing app and start typing without ever thinking. No outline. Remember when you were writing your essays in middle school or high school. You start them with an outline. It helps you gather your thoughts. And that's what you need to do when you're starting your personal statement writing.

You need to gather your thoughts, your ideas. Where are you going with this personal statement? If you don't have an idea of where you're going in your personal statement, it's going to show since the story you're going to be telling them will not be coherent.

One way to gather your thoughts is mind-mapping and there are plenty of free mind-mapping apps online. Or just do this old school. Grab a pen and paper. Draw little bubbles and put in your thoughts and draw lines to connect things. It's just the same thing as outlining things.

"You need to prepare to write the personal statement before you start writing it. You need to gather your ideas."

[09:04] What to Write in Your Personal Statement

The Goal of the Personal Statement First, understand the goal of the personal statement. The goal is to tell the reader why you want to be a physician. It's not to talk about you're going to be an amazing physician or why you have the skills necessary to be a physician. It's not to talk about how your path as a nontrad student has contributed to your ability to be a great physician.

The goal of the personal statement is to explain to the reader and show them through your writing why you are following this path.

Initial Exposure to Medicine

Where did you get your initial exposure to medicine? A lot of students start it by a story about being an EMT and then go from there. They say they want to be a physician so they can do the things they want to do which they can't as an EMT. This sounds great. But why did you become an EMT in the first place?

You need to start at Day 0, when did this thought first pop into your mind? It can be your parent who's also a physician or your own illness or injury or your family member's injury. Sure, you might say this sounds cliche. But if it's your story and you're telling your story, it's not cliche.

"If it's your story and you're telling your story, it's not cliche. It may be common, but it's not cliche because it's your story, your experiences."

So you need to tell your story and show the reader your experiences and the emotions behind everything that has happened and how that's motivated you. Again, not just what happened, but why. Why has it influenced you to come this far?

[11:43] Following Experiences that "Watered the Seed"

Think about the initial experiences that drew you into this. What were some following experiences and some extracurricular experiences after the initial one?

What was that first seed that was planted? And what experiences after that watered the seed and helped that thought grow into where you are now and getting ready to apply to medical school. There has to be something substantial that has propelled you down this path to go to undergrad and get to this point of writing your personal statement.

Show that journey. Don't show it by talking about the things you love. You may start to talk about educating patients, but there's more to that. Or you may want to be an entrepreneur and that writing about that will show the reader you're unique. But the reader is not going through a checklist when they're reading a personal statement and trying to figure out if you fit different boxes. They're looking at it to try to understand your reasons for going down this path. They want to see if you're interesting enough to bring in for an interview.

"The goal of the personal statement is to get to the next step, which is an invitation for an interview."

It's not the goal of your personal statement to write an essay about all the experiences you've had on this journey. You have your extracurriculars (ECs) in your application to write about them. The ECs are your opportunity to talk about whatever you've done. But the goal of the personal statement is to talk about why you want to be a physician.

This being said, you need to start gathering those ideas. And if you're still a couple years away from applying to medical school, that's great. For now, you should be journaling all of your experiences. If you shadowed a physician, journal what you learned that day and how what you saw impacted you. Were there emotions when you left? Write down those thoughts.

Whatever you're doing, journal everything so that when it comes to applying to medical school, you're able to write about it and talk about it.

[17:19] What About Research?

As you're in this first step of gathering ideas, don't think about everything you've done and try to fit that into your personal statement. Think about those very few experiences that have left that impact on you that made you decide this is what you want to do. They should be clinical experiences. Otherwise, if you want to talk about research, they may think why don't you just go get your PhD.

"Being a physician is about clinical care, not about research."

Again, if you want to do research, go get your PhD and do research to impact patients. But why do you need the MD if that's the impact you want to make. The impact that MD and a DO make on patients is direct clinical care. It means putting hands on the patients and stethoscopes on them or poking them with needles to draw blood. It's direct patient contact and patient care, not research.

Research is important. But don't make that the goal of your personal statement, to talk about how much you love research if what you're hoping to do is become a physician.

You can do an MD/PhD or DO/PhD, but then again, your personal statement doesn't change that much. In fact, you get an extra essays to write about the research you've done and why you want to be a researcher. So you have that opportunity.

"It's not a list of what you've done. It's not a resume. It's not a timeline. It's a story about your journey and figuring out who you are and why you want to do this."

[20:55] Get It On Paper and Wait! Get Feedback

Now that you have an outline, you need to get those ideas out on paper. It can be in the form of a physical paper, typing a computer, or dictating all of your thoughts through the mind map.

Just get all your thoughts out of your head. The next step is to wait. You need to just let it sit for a bit and then come back with fresh eyes. You can give it to somebody to get their feedback.

When you buy the Guide to the Medical School Personal Statement, there's a link there to an outline or worksheet. You can give this to somebody giving you the feedback so they would have a guide on how to review it for you. This way, you get critical feedback.

"The goal of the first draft is to get something on paper to overcome the barrier of being scared to start writing or waiting to be perfect."

You've done the first step of getting it started so next is to get feedback. Take the feedback and apply it even it means sometimes that you need to start over. Don't take that as a slap in the face. Instead, take that as good, constructive feedback.

In some schools though, such as NYU, they don't use secondary essays over personal statements to determine who to invite for an interview. Secondaries are much easier to write than personal statements since you're answering a question. So it's not as vague as why you want to be a doctor.

[27:30] Getting Critical Feedback

When you get an critical feedback while you're writing, it's okay. It's doesn't mean anything other than you should probably tweak some things. It's like you're course correcting. And that feedback will show you some directions on how to correct your course and go back to where you want to go.

Now your personal statement could go through different people giving you feedback. Get feedback. Absorb it. See if it's something you want to do and change it. Get through the process.

Again, check out the The Premed Playbook: Guide to the Medical School Personal Statement and learn the dos and don’ts of writing your personal statement as well as some examples of personal statements with feedback so you can get ideas from them.

Links:

Rev Transcription

The Premed Playbook: Guide to the Medical School Personal Statement

The Premed Playbook: Guide to the Medical School Interview

Facebook Hangout Group

MedEd Media

The OldPreMeds Podcast

The MCAT Podcast

Specialty Stories

Ask Dr. Gray: Premed Q&A

Feb 07, 2018
271: Don't Talk About How You Know What Being a Doctor is Like
25:03

Session 271

Allison and I talk about a subject that came up in the Premed Hangout Facebook Group about students talking about what it's like being a physician.

One of the common pieces of feedback that I give on personal personal statements and mock interviews is don't assume what being a physician is like. Just because you've shadowed, you've got clinical experience, or just because you're a nurse, PA or NP, don't assume you know what being a physician is like.

And lately in the hangout group, something kind of sparked some interesting conversations from Allison, which leads into the discussion today.

If you haven’t yet, check out the Premed Hangout Facebook Group and join over 4,000 amazing premed students there, collaborating everyday.

[03:45] You Don't Know What It's Like to Be a Physician

Allison was on the Hangout and she saw some posts of individuals and she appreciates each position in the profession. So she greatly respects all the time and effort these premed students have put in. And for someone who is doing their job as a nurse for 25 years means you have enormous knowledge.

So Allison noticed that some individuals were either directly saying or insinuating what's it's like to be a doctor. And it comes as ignorant, egotistical, uninformed, and assuming. This is the last thing you want to convey when you're trying to get into medical school.

Having worked in healthcare doesn't give you the knowledge or experience you need to be able to make claims or thoughts and say thing about what the job is.

"If you have not walked in the shoes of someone with an MD or DO, or an engineer, or a lawyer, or a teacher, you cannot say that you know what it's like or make claims."

That said, you don't know what it's like to be a physician. You haven't spent four years in medical school or sleepless nights during your residency for 3-5 years and fellowship for another couple of years. You haven't been the one who has had those conversations with family members, being the physician in the room, telling them that their loved one has passed.

You may have witnessed it as a student shadowing or death as an EMT or a nurse. But until you go through that process, and until you are the one where the responsibility lies on, you can't know what it's like.

[10:10] Are the Doctors Entitled? and the Concept of Empathy

Allison explains that the way medicine has been constructed for the last several hundred years and especially in the modern day, the physician is the team leader. And there's a reason behind it. Your job is to lead your team successfully to take the best care of the patient and their family.

As an EMT, your role is huge as you try to bring people in so they can get medical care and stabilize them. Your job is huge!

"That doesn't mean that because you've worked with physicians everyday and you bring patients to them, that you know what it means to walk in their shoes."

And the concept of empathy comes in here. You cannot assume you understand someone else's life. You can think or try as best you can to imagine what it would be like to walk in that person's shoes. But the minute you start saying you understand or you get it, that's not good.

Moreover, the last thing a patient wants to hear from you is that you understand what it's like. But no, you don't. You don't understand what it's like to have a ALS and be dying or to be leaving a family of young kids behind. You don't understand to be dying of cancer when you're pregnant, and so on.

Therefore, it's unethical to say that you understand what it's like for them. It only creates distress, anger, and pain. Don't say it otherwise you're going to make people frustrated.

[13:00] Saying It on Your Personal Statement or Interview

From the interview or personal statement side of things, this comes off less as being insulted but more of being funny since it has no bearing in anything. You're not going to believe it.

Allison adds that if you're doing things that are going to put yourself in the position to fail or to not succeed, then they want to help you re-adjust your mindset or at least educate you on why that mindset is not going to be useful.

With the unbelievable challenges of physicians nowadays, physicians are asked to do more and more all the time. For instance, there are physicians who are working till 11 pm and going asleep for a few hours and getting back the next day. And many of them are literally breaking their backs to just make it all work.

So when other people say how doctors are making big money, they're failing to recognize how hard that job entails.

[17:00] The Challenges of a Physician and Dealing with Burnout

Several physicians have gotten burned out to some degree, whether if you're married, or have a family, or is single. Hospital administrators and insurance companies are telling physicians how to practice. They have to spend 80% of their day on the computer or on the phone trying to get things authorized by insurance companies. Physicians also need to deal with their livelihood and their wellbeing, which are not even prioritized. They need to deal with the constant pressure of continuing medical education credits. And so on.

"Don't forget that if a physician you're working for is having a bad day, there's probably a reason for that."

[19:20] Physician and Ego

There are plenty of physicians with huge egos. But to paint all physicians as egotistical is not a good thing. Also, there's a difference between begin arrogant and being confident. You can have an ego to the size of the moon but if that's going to get in the way of clinical care and how you interact with the clinical team then that becomes a problem.

Ultimately, Allison wants to encourage everyone that whatever point you have in your life, it's important that you have good mentorship and you have good, positive support, and feedback.

This all said, there's something special about giving back to other people. For Allison, contributing to other people is like breathing. So as a physician, you would want to contribute to other people. At the end of the day, all she really wants to do is to bring light, positive energy, hope, and acknowledge all of you in all the hard work you to do to get to where you are in this journey.

Lastly, continue to find that inner strength. It's going to help you survive the premed process, get into medical school, and survive medical school and residency, and being a physician. But you just don't want to survive, you want to thrive. Find that inner strength and be a force of positive energy in this world. Be collaborative and supportive. Shine your light on other people.

"You've got to find that inner strength and just hone it because you're going to need it in life and you're going to need it as a physician."

Links:

Premed Hangout Facebook Group

Jan 31, 2018
270: From the Oil Fields and Poor Grades to an SMP and Acceptance
46:29

Session 270

Jonathan is a medical student who landed his dream school after struggling as a premed and working in the oil fields.

This episode shows you a journey of a student who needed to reboot and figure stuff out. He got to medical school and it took him longer than he wanted and even more money than he wanted, having to do a postbac.

But he's now a medical student and will be a physician soon. This is to show you that you don't have to be perfect. You just have to be willing to figure out how to course correct, figure out what you're doing wrong, and improve on the way.

This 2018, we will be releasing The Premed Playbook: Guide to the Medical School Personal Statement. Go to personalstatementbook.com and sign up to be notified when it comes out. Meanwhile, check out all our other podcasts on the MedEd Media Network.

[02:00] His Interest in Becoming a Physician

Jonathan's interest in medicine started back when he was ten with his dad being his biggest influence since he was a physician. He'd bring him along in the clinic and he'd see procedures. He also had him help with the charts. As he got older, his father encouraged him to go into computers instead of medicine. He told him to try other fields like business and engineering, but not medicine. However, Jonathan always found himself drawn toward it.

"I always was drawn to it. There was nothing else in my heart that I felt I wanted to do with my life."

When asked what he wanted to do through school, he's always say he's getting into medical school. He did get to shadow since he wanted to see other aspects of medicine outside of family medicine. But his dad never made any phone call for him. So he had to call the doctors he wanted to shadow himself. Good thing they were always more than welcoming to have him shadow them.

[06:15] The Challenges in Undergrad and His Relationships

Jonathan shares his mistakes in life to the point that he thought he'd never be able to pursue his career in medicine. He fell in love with his high school sweetheart. Then they got married during his sophomore year of college. But not listening to the advice and wisdom of others and wanting to have that instant gratification, it was a mistake.

"Life has a way of taking you in different directions and different paths you never thought you'd go down."

Then once he got married, everything just got downhill. He admits being so young and being not ready for it were the reasons for the failure. His wife left him. And while trying to salvage the marriage, he wasn't separating his issues with is personal life and school issues. So when he first started off with college, he was having A's and then his grades just went downhill again. When the relationships was over, he was all getting Ds and Fs. So for him, the biggest mistake in terms of medical school was not the divorce but having failed to step back and withdraw. He didn't actually realize how deep getting Fs was and when he did, it was already too late.

Additionally, a couple months after they decided to part ways, his dad gave him a call telling him his dad and his mom were getting a divorce after 25 years. So his whole support system was destroyed. Then a couple of months later, a close family member died in a horrific accident. All these personal issues were going on and he didn't have the tool, the life experience, and maturity to handle. He failed to compartmentalize things, focus on studying, and then focus on personal issues.

But Jonathan owns up to his mistakes. And he says it was his fault for not withdrawing. He adds that if there are issues going on, either take care of the issues right away or withdraw. Do not take an F. If you had to withdraw from school, it's okay.

"It's better to take a break from school and deal with life and then come back than to keep taking Fs and digging yourself so deep in the hole."

So at that time he decided to take a break from school, he had a GPA at 2.2. He was placed on academic probation and they were going to kick him out. So he decided to withdraw.

[12:40] Working in the Oilfields and Creating a Game Plan

After he withdrew from school, he went working at the oilfields. He knew he needed that break to heal himself and come up with a game plan as to how to get himself out of the hole. He did think for a time that it was too late for him and he just had to move on from medicine.

At the time he did decide to go back to school in 2012, grade replacement for osteopathic medical schools was still an option. So he met with his premed advisor and she help him figure out his game plan. He pulled out his transcripts and from there, decided on retaking every single class that he earned below a B in.

He went back and re-enrolled and he got a part-time to almost full-time job as a phlebotomist. He began volunteering with Big Brothers Big Sisters. Then he retook all 20-26 of his classes.

While retaking and coming up with the game plan, he didn't know about the AACOMAS policy change. And it was just pure luck that he was able to finish retaking the classes before they got rid of the grade replacement.

His game plan?

Re-enroll, save as much money as he could from working at the oilfields, reenroll, job in a hospital drawing blood on in-patients, take his classes, and volunteer when he could.

Once he got his GPA above 3.0 and at that time, he already had over 6,000 clinical hours and lots of volunteerism, he thought he had met the minimum cutoff of the schools. He knew he just had to try.

[16:10] Taking the Old and the New MCAT

Jonathan actually took both the old and the new MCAT. The first take he had was a 25 - not great.  He admits to preparing poorly for it. Then he took the next one and earned 504 - still not great. But it met the bare minimum to apply.

The first time he took it (old), he didn't do enough practice questions. He just kept reading the books and doing practice questions at the end of the day. At that time, classes have ended and he was working on the weekends only. Plus, his boss at that time was very understanding. So although he had enough time, he just didn't have enough practice questions.He felt he was all over the place too in terms of which resources or study materials to use.

[18:00] Failed Application and Getting Feedback from the School

He first applied in 2015. He received one interview at his instate school and he got an immediate rejection five days later. In total, he applied to 20 schools.

After going through an unsuccessful application cycle, he was set to have a plan B and work the problem. He figured what his problem was. He called his instate school to ask what he needed to do to improve his application to get accepted. The school advised him to have a stronger science GPA. They wanted him to prove to them that he could handle medical school. The last thing they want is for their students to drop out. So he just didn't have enough proof that he could handle it.

"They want people with great stories, with life experience, but you've got to be able to prove to the medical school that you can handle that."

[19:50] Special Masters Program (SMP) and Course Correction

As Jonathan would put it, he needed to divorce himself from his undergraduate GPA. So he decided to do special master's program at a medical school. And the admissions offer at that time said that if was able to do the master's program and smash it, it was going to be a game changer for him.

"If you can't handle a master's program, how are you going to handle medical school?"

Luckily, the medical school that had their SMP program accepted his AACOMAS application. He applied to about 10 programs and got accepted to a couple of good ones. Nevertheless, his goal was to take a master's program that was at a medical school to be able to take, if not the same courses as medical students, at least take the ones as similar as possible. That way, he could give a good evidence to the admissions committee that he took the same classes as in medical school and he did well.

Once he was at the SMPs, Jonathan says that doing it would mean taking your game to a whole new level. At first, he still didn't well. But after her advisor told him that he only had so many points left to do well, otherwise it's game over. So this lit the fire in him to do much better.

Additionally, several of these master's programs that connect with medical schools have learning specialists. He consulted with one of them and they talked bout his studying strategies. What was working, what was not, what the chunk was.

"I think that's one of the biggest things - keeping the phone away."

Now, every time Jonathan sits down to study, he would go to his game plan and tell himself that he's studying for his life and for his future career. So he had to get those A's. This said, he was fighting for his life in each of the studying sessions. He left his phone in the apartment so there would be no distractions. He also turned off the notifications when studying.

He also uses the Pomodoro Method where you study as hard as you can for 30 minutes and take a five-minute break, walking around. As a result, Jonathan's grades from Cs and Bs to straight As. For Jonathan, the SMP was the best decision she has ever made. It helped him get a wider grasp of the biomedical sciences.

Furthermore, the SMP helped him figure out how to study more efficiently. For him, the SMP was worth every penny. It was a game changer. In fact, he was offered eight interviews.

[24:45] The Second MCAT and the Interview

For Jonathan, (and most students probably), the MCAT was beast. There was no way around it. He actually took the MCAT before his SMP. Jonathan ultimately admits having taken a gamble for this. Also, he enrolled in the Princeton Review MCAT Course, along with all the books and all practice problems. Still at that time, he still wasn't able to recognize his studying style. And for the MCAT having turned into an 8-hour experience was very tiring for him.

At that time, he knew it was his last chance so he had to do well. So he did tweak a few things and let his personality come out. And he sought my help with the interview prep. After having gone through an interview the first time at his in-state school and the second time around, Jonathan thinks the biggest thing between the two was his own confidence and the ability to relax. He did get an acceptance from that school. And when he went to interview at another school, they called him a couple days later with an acceptance. He was only able to get one spot for the mock interview, but it still paid off.

[21:40] His Thought Process in Picking the School

A big part of it is that he wanted to stay in his home state, being able to be nearest to his relatives and family. He also was able to already build the connection with his school since he kept bugging them so much. So he felt he was home and it was where his heart belongs. As soon as he got the phone call, he decline all the other interview offers remaining. Since he was living off loans for the master's program, there was also that financial aspect of not being able to fly all over the country for the interviews. But in the grand of scheme of things, Jonathan says he's where he's supposed to be at.

[33:30] Transition to Medical School versus SMP

"The medical school is like an SMP on steroids."

As Jonathan would describe it, the medical school is like an SMP on steroids. To where he went to for his SMP, they didn't have lab time so they went to class in the morning. Then he was off the rest of the day to study. But in medical school, you've got to be in the lab for at least eight hours a week. Then you still have to study and you've got clinical skill labs as well as other mandatory meetings you had to go to. So for him, the SMP helped him have a good foundation. But medical school still is so fast-paced. Not that it's super complicated, but it's just the sheer volume of it especially for anatomy.

"SMP did help, but medical school, you've got to be ready to take it to the next level."

He knew he did well on his SMP but he couldn't be too complacent so he had to step up his game. Jonathan specifically stresses how critical time management is in medical school.

[35:30] Talking About His Past Challenges During Interview

Jonathan remembers the admissions committee wanting to know more about his SMP experience. They asked him how he went from doing poorly in the undergrad to SMP. And they didn't actually ask him about the MCAT. This is just based on the two medical schools he did interviews at post-SMP. And they seem to have really loved his SMP grades and he was thankful for it.

He was weak in the MCAT and weak in undergrad, but great in clinical experiences, volunteering, and shadowing, and his SMP grades. He was just thankful he took it at the same medical school where they had the same medical professors and the same classes as medical students except for the labs.

It was indeed proof enough that he could handle it.

[37:00] What Prepared Him to Be a Medical Student

He says that being able to focus on medical school and put life when there's distractions, to let that put that to the side. Try to figure out whether it's something important that you need to take care of now, or if it's something that can wait. If it can wait, then he'd deal with it after he's done with his day.

"Nothing is going to get i the way of my studying for the day. That's why I don't take my cellphone with me. That's why I turn off the notifications in my computer."

Once he's done with his study goals for the day, then he'd take care of the other issues, even the smallest of things like laundry or paying bills. He also adds that self-discipline is key in medical school. He also had to take some communication time off his family and friends for him to be able to get things done.

[38:55] Jonathan's Advice to Those with Poor Grades

Although he was lucky to have applied where grade replacement was still going on, Jonathan admits it's hard to get out of the hole. But one thing he's sure of is that it's not impossible. It can be done. It may take longer now and it may be a harder climb but it can be done.

You have to ask yourself how much time, work, dedication, and sacrifice are you willing to take to make it work out. At the end of the day, the one thing we all have in common is we'd end up six feet under the ground. We have only have one life so you might as well do what you love and what you feel you're called to do.

"If medical school is what you feel you're called to do, then do everything you can to focus yourself on reaching that goal."

Lastly, if you have poor GPA, crush the MCAT. If it's not good enough, take the master's program or postbac. Separate yourself from the past with a fresh start. Use that fresh start and crush it. No excuses. It just all comes down to time, patience, and a ton of hard work.

Jonathan admits there were plenty of days that he thought it wasn't going to happen and he'd have to go back to the oilfields. But he believes that if he can do it, than anyone else can, too!

[41:45] Carle Illinois College of Medicine

Back in episode 256, we did an interview with Dean King Li of Carle Illinois College of Medicine where he talked about the four Cs - compassion, competence, curiosity, and creativity. Being a new admissions committee, they're looking for the 4Cs in applicants.

What they ask from each prospective students is to prepare a portfolio and they're free to send anything that highlights how they exemplify the four Cs. So they're free to demonstrate how they interpret those qualities and then use the portfolio to support it. For instance, they can be anything from an artwork (if you're an artist) or if you do volunteering or you're helping your next door neighbor because she has an Alzheimer's disease and you've devoted hours to take care of them. These can be written or you can have people write support letters. Regardless of how you document it, just show that your activities exemplify those qualities.

They also ask their applicants to shoot a very short video. They're not going to assess the technical quality of the video, but they only want to hear them talk about the four qualities for five minutes and how they interpret what each quality means and how they demonstrate each.

Carle Illinois College of Medicine is accepting their first class to start this year in 2018. All 32 students will receive a full scholarship to go to medical school. They're still accepting applications through the AMCAS system. If you're interested go back and listen to the episode. If you think you fit well with their philosophy and curriculum, go reach out to them and apply.

Links:

MedEd Media Network

The Premed Playbook: Guide to the Medical School Personal Statement

PMY 256: Interview with Dr. King Li of Carle Illinois College of Medicine

Jan 24, 2018
269: This Physician Talks About Imposter Syndrome and Her Journey
37:14

Session 269

Dr. Danielle Jones is @mamadoctorjones on Instagram. I read her blog post on Mind on Medicine about impostor syndrome, something a lot of premeds struggle with, and wanted to talk.

By the way, go check out all of our podcasts on MedEd Media Network.

Impostor Syndrome is something that comes up a lot on your journey to becoming a physician, and even after you're a physician. This can either come in as premed or a medical student, an intern, as a resident, attending, or a fellow - wherever you are on your path. This is not an unusual thing that you may encounter.

[02:20] Her Journey to Med School

Danielle initially majored in Psychology until realizing she wanted to explore other paths. Although her mom is a nurse, she never really considered getting into medicine. And she suspects it's because she has seen her mom work so hard and how stressful it was. Still, she ended up getting into medical school.

And part of the reason she created a community on Instagram is because she remembers feeling not being able to find someone who had a life that looks like what she wanted to have. And she didn't really have any role model that she wanted to emulate.  Danielle follows people who are posting positive things and those that are able to give her a perspective in to the other lives of other people in the medical field. So she purposely filters them although it's really possible that some people can take it too far.

She didn't consider becoming a nurse either. And she stayed with Psych as her major. She realized that what she really wanted was interacting with people on a daily basis. She also considers herself being a doer. She likes to work with her hands too which is something she didn't find in Psych. So the transition happened here.

"I thought Psych gives me that person interaction but it doesn't give me the "working with my hands" aspect that I'm looking for."

Added the fact that her stepdad had undergone a double lung transplant when during her sophomore of college. This was what actually gave her the initial exposure to seeing the inside workings of the hospital. She also saw how people could affect how he was doing just based on how they interacted with him. And she thought she could do it.

So her goal everyday whenever she interacts with her patients is either interact them in a way that makes it better or worse for them. And her goal is to never make anybody's day worse by her bedside manner. And having watched all this sort of led her to the path of medicine. This was the "seed" in her journey.

"My goal is to never make anybody's day worse by my bedside manner."

Additionally, she had a mentor in medical school that she looked up to. She describes her mentor as having put in her the fire that women's health could be so fulfilling. And that she could make a difference. And this was what sparked her interest in OB/GYN. In fact, 95% of why she chose the specialty is because she wanted to go into fertility.

[10:55] Not Getting into Medical School the First Time and How She Course Corrected

Danielle says that one of the major challenges she encountered was not having anticipated the difficulty of applying. She didn't get in the first time and she had her unpreparedness to blame. So she then had to reexamine and decide whether or not to apply again. Or whether she should just choose a different route. For her, it was the hardest decision she had to make at that point in her life.

Applying the first time, she actually turned in her application early in the cycle. Her MCAT score was mediocre since she didn't do much to prepare for it. She also got some feedback from places she applied to and interviewed to learn more about things. She also had some people in college who reviewed the application over. This said, she knew when she applied what her weak points were. She also knew she had less shadowing and clinical experience compared to other people. So when she considered reapplying, she was looking for ways to improve her application. She retook the MCAT and did some shadowing. She got a job for her gap year as a medical assistant doing allergy testing.

"I keyed into my weak points in my application and tried to work on those."

[13:50] The Biggest Shock in Medical School: Impostor Syndrome

The first time she remembered feeling the impostor syndrome was in the anatomy lab, which to her was very challenging. She remembers questioning herself whether she could do this. She thought how other people were so much more prepared than she is. She was standing there at the lab and just thought how everyone else was just so much more capable than she was. But everybody felt the same basically. This said, her first semester in medical school is what was so challenging for her.

As she would personally define it, an imposter syndrome is that feeling of being "here by accident." You're questioning yourself as to whether you're capable of doing these things that you're about to do or just did.

And she admits to having had this feeling multiple times through medical school, residency, and out in the real world. It happens randomly and it's recurring. You know you're clearly ready, but it's that in your head of still doubting what you can do at that point.

Danielle describes it as a fleeting feeling. But she just tells herself that she's prepared for it. She just had to figure out her studying style back in medical school for instance, and even through residency and even now.

"Just review in your head what you're doing and that you are perfectly capable and trained and that you've worked really hard for that."

As to whether impostor syndrome is aggravated by the advent of social media, Danielle thinks this could actually be the case. Considerably, most people only post things on social media that shows the good life. So sometimes she posts things that really reflect her reality. Although she also highlights the positive aspects of her life, you have to step back and realize that as long as you're working hard and putting everything you've got, then that's all you can do.

Personally, I had an impostor syndrome back in 2012 when I was just first starting this out. But you just have to go do it. Danielle adds it's that feeling of not wanting to let people down so it's a lot of pressure. But then again, it's about telling your message.

[21:45] How to Keep Yourself Motivated and Asking for Help

Being a goal-oriented person, Danielle sees it as a double-edged source. You have to figure out your next steps, but then you also have to enjoy what you have now.

Danielle's advice is to make sure that everything you're doing everyday at work is int he best interest of the patients. At the end of the day, that's why you're there and they're the reason you have a job. And they're the reason you love your job.

For her, the most stressful thing about being a physician is how nerve wracking it is to operate alone for the first time. It's a lot of responsibility and she feels a very strong desire to connect with her patients and help them. And it can feel personal not to be able to help someone. And even if there's not anybody in the whole world that could fix it, you almost feel like you're letting them down.

"It can feel personal when you can't help someone or you can't fix it."

Danielle also adds it's helpful to debrief. You basically learn this when you do simulation in medical school and residency. This is important that after you've gone through some stressful event, to debrief with people around you. She feels lucky to have awesome partners who she can talk to about these things. This is important for overall mental health. We have to recognize that people are not doing the best they can to maintain the mental health of physicians and students. So we have to do better with that and open doors of conversation to say it's okay to ask for help. It's okay to say you're struggling. One of her attending physicians told her that the marker of a good physician is knowing when to ask for help.

"The marker of a good physician is knowing when to ask for help... you have to know when to ask for help before it spirals out of control."

Moreover, there are physicians, especially the older ones who think not being able to ask for help makes them very able physicians. Danielle thinks people should not have this kind of mindset that they're better than nobody else. There has to be a room where you meet in the middle. That said, she has learned so much from her older mentors which she's very thankful for.

[28:40] Danielle's Message to Male Physicians from a Female Perspective

Danielle says everyone should supportive of one another. So we can't let the pendulum swing too far to the other side. It's not good to see these people saying that the "Future is Female" and all these things. It's not good either. We all have to meet in the middle. It doesn't matter what your gender. You are an equal part of the team and you're bringing something unique to the table.

Just support each other and accept each other. Don't write people off if they say like they're not listened to because of their stature or their sex, etc.

[31:10] How to Fight Through Impostor Syndrome

Danielle explains you have to ground yourself. It's a process of repeating truths to yourself. If you feel it's really affecting your ability to think about what you're doing, practice this grounding method. Tell yourself some truths. Say, you're nervous about doing this particular procedure. So tell yourself your truths. You got into medical school. You graduated from medical school and did 150 procedures. You're not only capable but more than capable of doing this.

"Remind yourself what the facts are and not letting feelings or thoughts of whatever is leading you to that point get in the way."

Lastly, surround yourself who believe in you and who support your dreams. There could be people who are negative, even people in your family. But you just have to ignore it and keep working on your goal.

For the premeds out there, Danielle says you have to keep the big picture in mind. You don't want to miss the forest for the trees. But at the same time, know that you have to take it one step at a time. Just get done what you need to get done today, tomorrow, and this semester and keep moving forward.

Life doesn't stop for medical training. Just keep going one step at a time and life keeps happening, good and bad. You just live your life. Enjoy each step of the way and enjoy the journey. Enjoy the grind!

Links:

@mamadoctorjones on Instagram

Mind on Medicine

Read Danielle's blog on Imposter Syndrome

MedEd Media Network

ryan@medicalschoolhq.net

Jan 17, 2018
268: This Nurse Practitioner is on His Way to Medical School
34:01

Session 268

Matt has been accepted to multiple medical schools after realizing that he wanted to do more with and for patients. After working as an NP, he's starting med school.

Medical School HQ has a new forum for you to ask questions and collaborate with other students. If you don't already have one, go register for an account. The forums were actually taken from the OldPreMeds.org forum which have now been put together in the same site. Use the search function to find the answers to your questions. If you don't find it, then ask a question to get it answered.

Back to today's episode, Matt is on his way to medical school. He is an NP and he talks about his journey, why he chose to be an NP and why now he's choosing to go to medical school. If you're in a similar situation, maybe you're a nurse, a PA, a NP, whatever you're doing, and you're contemplating a career switch, be sure to listen to this episode to get some insights.

[02:40] Coming from a Nontraditional Background: Deciding to Become a Nurse

At 17, Matt had no idea what he wanted to do while one of his best friends was finishing nursing school and going to nurse practitioner school. So he got sold on the idea of job security if he chose the NP route. He'd be able to write prescriptions and make money.

His uncle owned an ambulance company and his brother was a firefighter and a paramedic. So basically, he was around the field of healthcare and would hear people talking about it. But it wasn't anything he too seriously.

Initially, he wanted to take International Business but he felt there was a lot of uncertainty in the field considering job security is important. On the other hand, if he became a nurse, he would be able to pay the bills while figuring out his real passion, which eventually came to be medicine.

As a nursing student, he found the courses to be generally easier but he admits not being too focused, not setting himself up for success. He ended up finishing with a GPA of 3.01. He was doing just enough to pass the classes and to get into NP school. So got into nursing with the intention of becoming a nurse practitioner.

"I got into nursing with the intention of becoming a nurse practitioner and I actually didn't do much research to figure out what would have been expected of me."

Not having done research as to what was least expected of him to be able to get into NP school, he found out in Junior year that he wasn't actually making the cut. So he realized he had to focus and he ended up going above the 3.0 threshold most schools were looking for.

[06:22] The Desire to Become a Physician

It was during his second year that he thought of becoming a physician. He felt he can really do it. At that time, he was enjoying what he was learning, although he wasn't necessarily doing well. So he reached out to a couple of his professors. Within the nursing community itself, there are teams of physicians and nurses. And the nurses in their faculty responded that he could actually do what most physicians do as an NP unless he wanted to do surgery. They have CRNAs so they could do anesthesia too. But this is not true because there are limitations to what NPs can do. In short, they were questioning why he would want to commit himself to being a physician. At that time, he thought of giving it a shot to see if he'd enjoy it. And so he did.

There are plenty of nurses there that could become great physicians but it doesn't mean they want to or should go on to medical school. Ultimately, what really triggered him to want to apply to medical school was back when he worked (and still is) as an NP at a cardiac surgery ICU. He describes the attending physicians as very inspirational where you get to see patients and so he got to be intimate with patients.

"I felt like if I'm trained, I can offer even more to people."

Matt started as an NP when he was 23 and made the decision to pursue medical school when he was 25. His thought process behind this was what he'd be doing over the next ten years. And he saw himself still doing the same thing day in and day out with the same skills. At some point, he'd be working with younger physicians and figured he'd get frustrated later on in his career. And he doesn't see himself doing administrative stuff either. Additionally, he's a family trained nurse practitioner so he does critical care. That said, he had to do a lot of self-learning.

Students need to understand that when you go to a hospital, you get credentialed by an office that does it. They'd list everything based on your training what you can or can't do. And based on one's training as an NP and the PA's training or the physician's training, everybody is credentialed and privileged at a different levels. This alone, limits you, based on your training. On one hand, you can self-direct knowledge and learn it yourself. You can just go online and buy all these books. But from the activity standpoint, there's still a lot that you're going to be able to do.

Matt adds that they have a great setup for the PAs and NPs. They have a lot of autonomy but the degree of autonomy at their facility was more than most facilities. So if he wanted to switch, he'd be taking some steps back as far as his privilege is.

[12:40] Letting People Know You're on This Journey

Matt actually kept it a big secret that he was going to apply to medical school. But he had to set up his schedule in a certain way just so he could take classes. And eventually, he told people and they were happy for you

He started asking his attending physicians for letters of recommendations and they were all happy for him. He thought he was going to get grilled but they were just very excited for him. Matt stresses that in choosing your career, you have to consider lifestyle balance. And for him, as an NP, it wasn't enough. And although physicians are very busy, they're still happy and making money. They're able to travel and do all those things. That being said, you'd have to go through the rigorous process of being a resident and all that stuff.

"A lot of the people I work with, the PAs and NPs, they couldn't understand why I wanted to do it."

Now that Matt has gotten three acceptances to medical school, he believes the letters of recommendation played a big role in getting accepted. He adds that candidates have to have a level of maturity But it's hard to gauge. And nontrads have the opportunity to showcase what sets them apart from the more traditional student. And Matt feels lucky enough to have people who understand the process and writer letters for him. They've watched him and observed him at the bedside, interacting with patients. "Nontraditional students have the opportunity to showcase what sets them apart from the more traditional students."

[16:20] Course Correction

Matt did a do-it-yourself postbac and finished nursing school. And although he got a 3.01 GPA , he crushed his postbac. And this was because he already had an end goal in mind. He knew what he needed to do to get there. And he would have had himself to blame if he didn't. He says having that sense accountability really helped him.

"I knew what I needed to do to get there. And if I didn't perform I had no one to blame but myself. So holding myself accountable really helped."

Additionally, he thinks being older has helped him understand what worked for him as a student. And balancing this while working, he says working has actually helped him develop time management skills. As your patient list is piling up and you still have a hundred other things you need to do, you figure out how to get things done. So he simply made sure to take care of things that need to be taken care of and when it needed to be done. This wasn't something he had during his undergrad.

Matt admits having questioned why he was doing this at some points. Whenever he'd be asked why he's doing this, he would have to reflect on why he was actually doing it. He had to convince himself that it wasn't an egotistical thing. And that he really wanted to do this for a living. Then he realized he was investing everything into this but there's a light at the end of the tunnel.

[18:35] Public Service Loan Forgiveness

There are different pathways you can take to pay your debts off. And so Matt thought of taking advantage of one of them. For instance, if you work for nonprofit for ten years, you make income-based repayments. After ten years, whatever left is forgiven. Matt says this is actually offered in a lot more places than people realize. Matt worked in Washington, D.C. and they're not missing doctors. But there are programs that just because it's not underserved, their nonprofit status makes it eligible for these forgiveness programs.

*Our current administration is trying to get rid of public service loan forgiveness. So for a lot of students going through this process who may be hoping to work for ten years and getting the rest of it get wiped out, it's very likely that it will be gone.

This being said, Matt points out that you shouldn't let the cause of this influence your decision to do it. The regret is a worth a lot more than whatever you're paying in student loans. You'll pay it off. It's not going to happen quickly. But once you're there, it just becomes part of your monthly bills and you're done."

"The regret is a worth a lot more than whatever you're paying in student loans."

And it can happen pretty quickly if you continue living like a student on your attending salary. So it can happen. To add to what Matt said, I want students to understand that if this is what you want, then do it. Don't regret it in ten years that you didn't pursue this.

[21:35] The Interview Experience

Matt recalls his first couple of interviews to be close to his application. They only found out their pathway once they started asking questions. He describes the conversation as being so fluid and very comfortable for him. They would ask more clinical questions from medical students which he was surprised about. Being comfortable with his first interview just kind of added to the momentum he had on his other interviews.

Having had multiple interviews and acceptances at this point, Matt says what has been the biggest key to his success was by doing well in his postbac and on the MCAT. HE also tried to tell his story as compelling as he could. Everybody has a story when they're approaching this but he thinks having had the background that he has, his story is interesting. So it's all about telling a good story and letting them understand that he's into this and that it resonates with the,.

"They're interviewing people who are academically capable of doing it. They've already weeded that out. They want to know who's actually going to embody their philosophies."

In framing his story, he saw being a physician as an evolution of his career. And having learned from every experience, he critically reflected upon the good and bad decisions and was able to grow from that. So he made this very clear to the people he was interviewing.

One of the biggest mistakes students make is they talk from the standpoint of knowing what being a physician is like and they're prepared for it. But you don't really know. And even as an NP, there are probably things they wouldn't know at the back end of things.

[26:07] Working as an NP While in Medical School

Matt is considering working on the weekends once a month or so just to have a little extra spending money. He has always worked days and nights so his body is used to being awake at random hours. Also, whatever he learns in medical school, he could probably apply into the clinical setting early on. Nevertheless, he intends to make a little bit amount of money while in medical school.

[27:15] Matt's Hopes in the Future

Matt foresees himself going into surgery, not knowing what exactly. But he loves doing procedures, like he's doing his procedures now. And he gets a lot of gratification from seeing things that work and that don't and then find a resolve. For now though, he is loving cardiac surgery, where he is working for four years now. And he finds the specialty to fascinating. But he feels it's still too soon to tell.

[28:40] Dealing with Negative Feedback from Other People

Matt did receive some discouragement from getting into medical school. But he thinks these attendings are reaping the rewards. One suggested he was doing it for the money. But he didn't want to argue since you're not making any money until much later anyway and you've already invested so much. He has never been motivated by profit.

Money shouldn't be a concern for Matt considering that he has already been working as an NP. He adds that you can't do this for the money.

"You definitely can't do this for the money. And if you try to do it for the money, you'll become exhausted and frustrated about the whole process at some point."

Finally, Matt says that if you're more interested in what you're going to do day to day, physician is the way to go especially for the more intricate subspecialties, particularly surgical subspecialties.

[31:10] Matt's Finals Words of Wisdom

For those thinking about becoming an NP or PA or looking at medical school and questioning the path they're on, Matt's advice is to do a lot of shadowing experience to see what the different professions do day to day. Just see what's out there and what's available. Then be honest with yourself. Are you willing to commit the time it takes and sacrifice the time, money, including your weekends with friends and the vacations. It's going to be a lot of sacrifices for a very long term investment.

The most rewarding thing for Matt so far is when he got accepted, having waited so long for it. And eventually, you grow as a human along the way as you're helping patients and their families.

Links:

The General Premed Forum

Jan 10, 2018
267: First Year Med Student, med_kat28, Talks about Her Journey
41:09

Session 267

Katherine is a first-year med student and popular premed Instagrammer. We talk about her struggles, social media for premeds, and more. Take a listen & subscribe.

Find Katherine on Instagram @med_kat28 and engage with her. She has over 19,000 followers right now! Also check out @medicalschoolhq.

[02:00] Desire to Become a Physician

Katherine wanted to become a physician at 10, after having watched the House. And the idea just stuck with her. But looking back now, she can barely watch it realizing how ridiculous it was.

The defining year for her was during her junior year of high school. Her dad had a TIA (Transient Ischemic Attack), which is basically a mini stroke. Being her first time witnessing an emergency, it was traumatizing for her. Later that year, she saw an open heart surgery for an anatomy class she took. And she loved it. In fact, she wrote her college essay on that open heart surgery. It took 7 hours and the entire time, she couldn't take her eyes off the surgery. She thought it was the coolest thing she had ever seen.

Right after that, her dad had a surgery and two days after, he had a heart attack. He's fine now though. But this was one of the first times that Katherine had a knowledge base and had an experience earlier with a TIA so she was able to handle this differently than the first time. She called 911 and was calm the whole time. But the only part she was not comfortable with having zero control over the situation. This is when she realized she wanted to be a doctor. She was 17 years old at that point.

"I was not calm about the fact that I had zero control over the situation. And that's when I realized that I was 100% going to be a doctor."

[07:00] Telling Her Story in Her Personal Statement

In writing her personal statement,s he actually embraced this story. A good part of it was the defining moment when her dad had a heart attack. It was a crucial part of her story and so she had to tell it for them to know who she was.

"If you're worried about your personal statement, don't worry about your "generic" or cliche journey. If it's you're journey, it's your journey. Embrace it and tell it."

Katherine noticed that most personal statements she has read were not really personal and it's the same basic thing without any personal story to them. Ryan's book on writing personal statements is going to be out soon so watch out for it.

[09:20] Choosing Her Schools

Not having great experience at high school, Katherine knew she was going out of state. She wanted to go to the University of Pittsburgh because of their neuroscience program. She knew she wanted to do something with neuroscience. But she did apply at random schools UConn was one of them. She got in and got a scholarship. Ultimately, she fell in love with the school. Katherine says that money actually is more important than the name of the school. She adds that you want to feel home in college.

"Money and feeling at home are the two most important things for choosing school."

Many students look at the prestige so they think they need to go to a more prestigious institution. What Ryan tells students too is to go wherever you want to go. Katherine adds to go where you're going to be happy, otherwise you're not going to do well.

[12:20] Dealing with Premed and Application Struggles

Katherine was dealing with the pressure of it with so many things to do. But what she loves about medical school is a lot less pressure because you're already in med school. Whereas being a premed, you have to be a volunteer and join clubs and be in leadership positions, research, do well in school and so on. So she had to get all of that without being overly stressed.

Katherine was very involved with their premed society and so she got a lot of help from it in terms of seeking out resources. She admits being horrible at seeking out help for figuring things out.

And considering the premed could be a cutthroat environment, it's about finding the right people. Another good thing probably is that majority of her friends were not premed so she never really experienced the cutthroat environment.

When she was applying to medical school, the hardest thing for her was the waiting game. She was done by July, there was nothing much to do but just waiting and hoping to get an interview and get into a school. She got four interviews and went to three. She turned down one since they had compulsory research which she didn't want to do. She also got wait-listed in the two schools. So the five-month period was hard for her.

From not being her first choice of school to now being happy with where she ended up, she went back to the school for a second look day. And she found everybody was so welcoming and helpful. She realized it was the environment she wanted to be in. People would stop her in a hallway and give her tips.

[18:55] Transition Into Being a Medical Student: Figuring Out Studying Techniques

For Katherine, she has been struggling with her transition since she has to overcome some habits she has had from undergrad. One of them is figuring out how to study. Studying in medical school is completely different in undergrad because of the sheer volume you get in medical school.

"The transition really has been a struggle for me because there are habits I have form undergrad that I'm still trying to overcome."

Also, she had to get out of the habit of not asking people for help. She has been trying to not continue to do this. For instance, she struggled at one class and realized she needed to talk to the dean, who was a "mom" at their school. She adds that it's not having to be smart at medical school but it's all about the work that you put into it. The problem is either mental health or studying habits, but it's not that you're not smart enough. She knew it was just her studying technique that was not working. The way she was learning was just not compatible with her brain.

Their school supports their students. They have educational specialists come in and give them an outline of things to work on. Katherine recommends taking a step back and looking at it from an objective standpoint. What are you doing? What are the habits? What could change? So just being able to recognize is the first step. Then take that to somebody else who could help you and who knows more about this than you do.

Being in social media, Katherine doesn't really think this affects the way she studies. So she intends to not make it a distraction and she just puts it away. Good thing, she's able to handle it well. Ryan adds that there's study that shows that the it takes 20 minutes for your brain to get back to the level of focus you had before the distraction.

[25:00] How to Stay Motivated

Katherine says she's not always motivated. She worked a desk job full time over the summer. And she didn't like the job. It doesn't mean she should stop showing up. You just have to go and do it. So when she's not motivated, she gets out of bed. She turns off the TV and study. She says you don't have to be motivated to do something, you just do it.

For instance, if she's been studying for several hours, and she feels she's not motivated, sometimes she will take it as a sign that she needs a break.

"Nobody should ever believe everything that's on social media. Just because somebody seems motivated and perfect all the time doesn't mean that's true."

Ryan adds a quote on motivation, where you don't smile because you're happy, you're happy because you smile. So you're not always going to have the motivation. But once you take that first step and go and study even if you're not motivated, you hopefully get more momentum. You get a little bit more motivated to continue down that path.

Katherine's strategy is if she doesn't feel motivated, she will try to study one lecture that she felt was really interesting and then it would help her get into the groove. Ryan also shares this fun exercise. Do one push up. And if you're already down, there, you're not going to do just one and you're going to do a couple, So if you're stuck in the motivation thing, just do one and you'll find you would want to do a couple more and you're good.

[28:33] What If You're Not Doing Well in School?

Motivation and doing well kind of go hand in hand. You feel super happy and extra motivated if you're doing well. But if you're not doing well in the class, Katherine's advice is to not give up. A C is not the end of the world. You will eventually be taking higher level science classes and that's where you can make up for it.

"A C is not the end of the world. When you're older, you're going to be taking high level science classes and that where you can make up for it."

Katherine got a Cumulative GPA of 3.48 and his science was a 3.4. A lot of students may think to take a postbac when they get this but Katherine didn't even consider this. Ryan advises students to let the medical schools tell you no. You can't assume that you're not going to get in.

Additionally, Katherine hates the tier system of medical schools since it says nothing about the school. It's based on research and people don't realize it based on how much they publish. The same thing with that stigma of going to DO school. There's no problem with it since you're going to be a doctor anyway.

"Let the medical schools tell you no. Don't assume that you're not going to get in. Then figure out what you need to do to fix that."

[31:45] The Tiered System

Ryan explains the tier system is a premed thing. Everything is anecdotal once you're in medical school. You can't prove anything from where somebody went to school. They have to still work their butt off to get great grades and be AOA and get great board scores. And you can do that at any school.

And Katherine proudly says that the quality of education at her "low tiered" school is just as good as it's going to be at Harvard. In fact, one of their deans wrote Step 2 CS. So just because they're ranked doesn't mean it says about the quality of education as well as the matching. Residencies are objective too so there are so many factors to it than just name.

[33:55] You're Don't Have to Be Perfect

Katherine considers that the biggest myth around being a premed and getting into medical school is the idea that you have to be perfect. Do things you love to do. Don't just sacrifice something just because you don't have the time for it.

"If you didn't get great GPA scores, there are other ways you can make up for it by being an interesting person. Grades are not everything."

The best premed extracurricular Katherine did was field hockey during her junior year. And she did it for her own enjoyment. This actually came up in one of her interviews. One of the three was a traditional interview while the rest are MMIs. For the traditional one, the things the interviewer asked her was about the non medical stuff on her application.

Katherine had a job for three years before starting medical school. She was doing tech support. So you don't have to have a job in the medical field.

[36:30] The Role of Social Media

Katherine says that keeping a social media account in terms of journaling your journey could be a lot of hard work. If you don't want to do it, don't do it. But if you have the heart and you're willing to put your soul into it, then do it.

There's this crap talking about Instagrammers saying that you do posts to get sponsorships. But Katherine only does it for the things she believes in. And she doesn't get paid. She only gets the product for free.  So this should not be your reasons for doing social media.

Through social media, Katherine has had the opportunity to engage with other people and being able to share more with more people. She's able to share her wisdom which she loves doing.

Finally, Katherine recommends to students who are interested in this premed  journey to get more experience in the field. In the end, it's worth it. Don't talk yourself out of anything. Just never give up and just do it.

"If this is something you truly want, then the only person standing in your way is going to be yourself."

Links:

MedEd Media Network

Specialty Stories

Jan 03, 2018
266: From the Military to Medical School with an Upward Trend
50:36

Session 266

Today, we have a great story of a student, Dillon, who overcame a lot of obstacles. From getting a 0.67 first-semester GPA and coming from a military career, he eventually learned how to be a premed.

Good thing, he figured it all out and is now being a successful premed. Listen to this interview and learn from his mistakes. Realize that you don’t have to be perfect to get into medical school.

Also, check out all our four other amazing podcasts on MedEd Media - The OldPreMeds Podcast, The MCAT Podcast, Specialty Stories, and Ask Dr. Gray: Premed Q&A.

[01:38] Interest in Becoming a Physician and Joining the Military

It was only four and a half years ago that Dillon realized he wanted to be a physician. He had thoughts about it growing up but it wasn't anything serious. He did want to become a chiropractor when he was 18. But he always wanted to join military, so he went to college a couple of years but eventually pulled out to join the military. Dillon had 3 F's and a C in his first semester, resulting in a 0.67 GPA. Second semester, he had 2 B's and 2 A's. So he got himself off the academic probation.

In hindsight, Dillon says he shouldn't have been in college at that time. He didn't have the drive to be there or any real sense of purpose. He was just floating through and thought it was just the next thing to high school. Eventually, he withdrew and did a self-assessment. He figured he was turning 20 and if he didn't join the military now, he's going to regret it. So he pulled out and enlisted to take the Summer and joined in August 2007. 

He enlisted as a Special Forces candidate. He went to assessment and broke his foot. At that point, it was right in the surge of Iraq and Afghanistan a couple years later. They couldn't hold them around to rehab so he just went to the line, meaning he went to the infantry. This terrified him because he saw the way those guys worked being a private in the army. Then a recruiter came by and was looking to sign people up and fill their classes. Dillon was active duty for almost 8 years and still in the Guard right now.

By his first military appointment, Dillon got married and he was never going to stay in the military indefinitely. So there was that finite time in mind. Two years before the last contract was going to end, he was already working towards completing a business degree a couple of times. But he hated those. Between his third and fourth deployment, he knew he wanted to get out and go into the workforce.

[08:10] Tapping Into Resources

Getting ready for the next deployment, he had a lot of office time to research things. So he briefly thought about chiropractic for a week but decided not to do it having a different perspective on it now. His research then drew him towards osteopathic schools. He never really heard of them.

Knowing now about osteopathic schools, he also learned about grade replacement, which was still honored at that time. Dillon knew his grades would always haunt him but thought maybe he'd have a shot at osteopathic schools. He then talked himself into it throughout the course of Fall 2013. It was also at this time that he found Ryan's podcast. He found a good library there to get started with. And it gave him a confidence boost that he could really do it.

Then he did another four-month deployment. Before he left, he downloaded a bunch of episodes from this podcast so he could listen to them. He was also taking classes online. He refocused and made a plan to get out and get in by 2017. All fell into place and he's now on pace.

[11:17] Dealing with Fear and Working on His Grades to Have an Upward Trend

What he says as he's most scared of his habit of being a slacker as he was growing up. He remembers not having done any homework in high school or work that hard in college. Not even in the online classes he was taking at that time in the military. So he was nervous about not having the actual, honest study habits.

When he came back from deployment, for his last nine months in the military, he committed to 12 hours of face-to-face at a state school. So he went to school during the day and did night training. He just threw himself into 12 hours of Gen Chem 1, Bio 1, and Physics 1 with the labs. And he treated this as a test to himself that if can do this then he should be fine. He ultimately figured out how to develop good study habits.

In terms of talking about his grades on the application, Dillon doesn't recall writing about it in his secondaries. But he did address it on his personal statement. It was never addressed in the interviews he attended. Dillon admits the grades have held him back from getting interviews at some schools.

For his AMCAS GPAs, his cumulative undergrad GPA was a 3.29 and his Science GPA was a 3.49. Good thing he hasn't taken too many science classes during those first semesters so that helped. On the other hand, his AACOMAS GPAs were a bit higher. His Science GPA was 4.0. Since he made that decision to apply, he made one B. Nevertheless, he had this upward trend.

He recalls one of the interviewers that was supposed to address grades didn't bring it up having seen only one B in recent history. So the interviewer said that he didn't see the need to talk about grades. Not only did he figure out the study thing, it was also 70 hours of grades in between him deciding and graduating and matriculating medical school.

Dillon adds he did a lot of degree planning as to what paths he should take. And no matter which way he took it, he figured out he was two years from getting out of the military to matriculating in 2017. And with those two years, he thought the best course of action was to pivot straight to a STEM degree. This way, he had to take all those extra sciences to graduate. He could have done the business degrees but he didn't like it.

[17:13] How He Told His Story on His Personal Statement

He walked them through his decision process as to why he wanted to go to medical school. This means talking about his transition from what he was doing in the military to how he thought that prepared him to go to medical school.

In getting feedback on his personal statement, he remembers one school telling him he wrote well and told a good story.

He describes his introduction as jumping in your face. His intention was to grab their attention to actually read it. Ryan actually used this as an example in his book for great openings.

Additionally, Dillon cites a systematic approach to getting those materials ready for the application. Aside from buying The Premed Playbook: Guide to the Medical School Interview, he had a bunch of people to look at the personal statement for different reasons. He had four to five people read it. His wife best friend who is a physician read it for the medical school content. Then he had his best buddy read everything including personal statement and emails. His friends works in state politics and writes policies. He's a chief of staff right now for a senator. So he had someone who was very good with the written word. They in fact shared a Google drive just for this. He would move things into a draft folder while his friend would move it into a revised folder.

With a lot of things to say, Dillon did a mock interview with Ryan. He found this very helpful because there were a couple of red flags raised during that mock interview. He spent too much time trying to relate the military experience to being a medical school applicant, instead of saying why he wanted to attend. So he focused keenly on working with many men and women in a really vulnerable time. He stressed how that was important to him and it made the job special in a way. He also related the challenges of trying to challenge himself in the military to the academic rigors of medical school.

[21:44] Medical School Interviews: Challenges and Highlights

Dillons says he never really had a rough question during his interviews. He describes all his interviews as being really conversational, which is the goal. As the interviewee, he allowed it to be conversational.

Dillon adds you should get a vibe from the school as to how it would be. Many schools he interviewed at were upfront. And they told him ten more times during interview day.

The MMI interview he did was very tough though and he found it exceptionally challenging. He wasn't offered an acceptance at that school. He felt like all the questions were ethical dilemmas. The questions were just above his level and that he needed more information than he was given. He just wasn't prepared for it.

The most memorable interview he had was the two attending physicians that were formerly in the military. He thought it wasn't by accident. The first was conversational and the interviewer related to what he did in the military. He was able to flush everything he wanted to have them hear and it lasted for over an hour. It was his number one priority for the schools he applied to and felt it was the place he wanted to attend.

Ryan adds that schools will try to look at your experiences and look at your past. They they'd see who on their admissions committee or on their roster of interviewers would match up with your talent or research, etc. They'd try to pair you together based on the availability of the interviewer. This way, it makes it a much more personal interview.

Dillon further says that interviewer was the most prepared among the others. He had his whole application on his laptop so he was scrolling through it. But he also read through it thoroughly. He took a full page of notes, front and back.

The second interviewer didn't have time to read the application thoroughly being the department chair so he was probably busy. It was obvious that it was the first time he had laid eyes on it when he opened it. This is what Ryan tells students all the time that even though it's an open interview doesn't mean they've looked at your stuff. The interviewer also got late so he was open to saying that he didn't get the chance to read it. The interview was basically over after five minutes and they talked for another 45 minutes about nothing medical school or application-related. 

[28:20] Studying for the MCAT and Applying to Many Schools

Dillon says he would have liked to have a higher MCAT then he would have a little bit less stress going into it. He thought once the MCAT was over and he would have the test back, it would be on a downhill. But he realized putting the application was very stressful.

Learning from this mistake, he recommends finding a partner in crime to share the suffering with studying for the MCAT since it can be lonely time. He didn't anybody at his school that was taking the MCAT and applying at the same time as he was. So he went the road alone.

Check out MCATstudygroups.com and they will hook you up with people that are taking the MCAT at the same time you are. Dillon did a Kaplan course but he didn't really find is as helpful as you'd probably would when you'd join the study groups.

Dillon's original list was at 14 schools. This was a healthy number. But when he got the MCAT score back and was working that summer away from home, it was a combination of having time and having money to burn that the number got up to 29. He finished secondaries at 27. With the original 14 schools he applied to, he got interview invites at 10 of them. He thought he should just have applied to only those instead. In choosing the schools, location was his primary preference. He was specifically looking for those within four hours from Tennessee.

Dillon thought there'd be no way he'd get into WashU, but Ryan challenges him as well as many other students who think this. Sure, it may be another fee, but with a unique story, you don't really know what the school is looking for to build their class. Their averages are ridiculously high but 50% of the class is below the average.

[34:30] Early and Late Interviews and Acceptances

Dillon says he was fortunate to have gotten very quick interviews and a few very fast acceptances. His first interview was at the very end of August, which was early. Then he had an acceptance a week later to that school.

Then he was doing six interviews in four weeks. Then no more interviews after that. He turned down some other interviews after he got into the ones he had ranked higher in his list. But after that, no news. The second highest school in his list, he didn't hear from them until February, which was a long wait. During that interim, he sent them a letter and he found he got wait-listed. Then he sent another update letter after the Fall when his grades came out. He wrote the letter in a Word.doc and sent it as a PDF.

The last interview he got was the first week of April. He heard that if you do secondaries to the state school, you will get an interview invite. There's no money involved, just more information and a headshot image. He was already having those acceptances but this school would have been better for several reasons for him. He also sent his Fall grades to them in March and called the school about it. Then he found out they were set to send him an invite the following week. Then he got the acceptance a month later.

Dillon admits he wasted a lot of stuff looking at apartments at the other schools he got acceptances in. But this particular school was just great for him. It wasn't that hard for him moving to this place since he gets to live at the house of his wife's best friend.

[41:05] His Medical School Experience and Being in the Guard

Dillon would experience at medical school as great and exciting. Obviously, he had to adjust. Now that he's on first year, he wished he knew about the time he had to crunch all this stuff. The first exam, he was doing 16 hours a week of honest class and study time. But he figured it wasn't enough. He's right in the middle of the pack while his buddy is right there at the top. They study with the same amount of time but he's just better at memorizing than he is, he guesses. Listen to last week's episode PMY 265: Learn How to Better Retain Information with a Memory Master  for some memorization techniques.

Handling both medical school and being in the Guard, he's still able to make it work somehow. It's tough. In fact, he could not believe he could still continue to be in the Guard and be a medical student. Having had ten years of service, he decided to stay in the Guard for health insurance reasons. Though he's going to try on his fourth year to do a military elective through the Guard. But he has no plans of being an active duty doctor whatsoever.

Dillon talks about his GI benefits. He was in a state school that covered 100% tuition and he still gets the housing allowance. It's for 36 months. He came to school with 32 months remaining. He uses tuition assistance from the Guard, so it's 16 hours for one semester. This covers all except the fees. Then on the next semester, he pays out of pocket and work on it to make it happen so he could save for the medical school tuition.

[48:25] Final Words of Wisdom

Figure out why you're messing up in the first place. For Dillon, he just didn't have the drive to be in class. Looking back, college is not that difficult if you put in the honest amount of work it takes. If you can establish that to do well in school then it will work out for you. And if you're also in the military, it's not easy but he believes he got into the interview to the school he's in now because he's in the military.

Links:

MedEd Media - The OldPreMeds Podcast, The MCAT Podcast, Specialty Stories, and Ask Dr. Gray: Premed Q&A

The Premed Playbook: Guide to the Medical School Interview

MCATstudygroups.com

PMY 265: Learn How to Better Retain Information with a Memory Master

Dec 27, 2017
265: Learn How to Better Retain Information with a Memory Master
43:58

Session 265

Luis Angel was a Memory Master Champion on FOX's Superhuman Show. Luis also wrote a book called Better Memory Now. Listen in as they talk about how you can learn to retain more information to improve your grades!

Several students are having study technique issues. They can't study well and need better study habits. So Ryan went out and found Luis. He has competed in memory competitions and has written a book about it.

Today, Ryan and Luis discuss how you as a premed can better prepare yourself to learn and better learn what you're already studying.

[01:15] Becoming a Memory Athlete

If you thought Luis was born coming out of the womb memorizing a deck of cards, you're wrong. He actually struggled a lot in high school through college. Even up to the point that it drove him to discover this. That's what drove him to discover this because he was failing in his English and Science classes.

Then his English teacher told gave him a D minus so can move one. It was that grade in high school that got him to pursue to be able to graduate high school.

When he got to college, he was looking forward to having a fresh start. But having the same blueprint he had in the past and expecting a different result, he obviously didn't get the results he wanted. He got on probation and got kicked out of the semester.

"When you go into a new situation with the same blueprint that you've had in the past, expecting a different result, you normally don't get that."

Not doing great at school he was told he had ADD (Attention Deficit Disorder), His psychologist gave him the meds. Luis thinks that while some people need them, he personally didn't prefer that route. He wanted the natural fix. So he went the memory training route of improving his memory. Now, he competes all over the world. He was on FOX's Superhuman Show.

[03:30] The Biggest Thing He Has Memorized

For Luis, the biggest feat for him was on that show. He had done for hours in huge competitions. But for the Superhuman Show, he had to memorize over a hundred people's names. This includes their first name, last name initial, their home towns. He obviously had to memorize the faces and something special about them. He was under pressure with all the lights and the celebrities out there and family members. So for him it was the biggest thing with over 500 pieces of information he had to memorize that day. It wasn't like he wasn't given months or weeks to prepare or get that information in his head. And he got everything correct!

In actual memorizing memory competitions, he has memorized thousands of numbers in a matter of an hour, doing over two hundreds in five minutes.

[05:10] Moving Short Term Memory to Long Term Memory

Luis explains there are three steps to memorize anything quickly. This depends on the type of material you're trying to memorize and what it's going to take for you to commit that to memory.

When you're memorizing elements or anatomical structure, this technique is easier to apply and commit them to long term memory. First, you need a location. Be able to store the information on a specific place. They call these memory maps or mental journeys in their minds. Second, visualize.Turn the information you want to retain into an image or story in the text to the location. Third step is review. If you don't review the information, it doesn't matter if you're the best memorizer in the world or you're just getting started. If you don't review, you're going to forget.

"Apply the memory techniques and then do the review aspect of that to retain that information."

[07:38] Before Anything Else: The Mindset Change

The first thing to do is to change your mindset. Tony Robbins was a great inspiration for Luis. Before he even got to the memory side of the world, he first  got into personal development. He went out there and sought individuals who are performing at an optimal level. He learned how they got to that point.

One of the things Tony talks about is having these limiting beliefs that we place on ourselves. Or it can be our environment, the people we grew up with or we watch online that are placing these limiting beliefs on ourselves. So we have to break through those. What he usually does in his events is walking through flaming hot coals. It challenges you to overcome that and come to their side.

"For me, it was all about having these limiting beliefs and destroying them. That's what really got me to focus."

[09:00] The Sledge Hammer of Positive Intent

Luis further explains he can teach people to memorize very quickly or how to compete in memory competitions. But at the end of the day, if you're not really motivated and you don't believe in yourself that you can do it, you're going to do you no service.

If you have that wall of limitations that you place on yourself - that you can't do it, you're slow and you're stupid, you can't read, etc., build a huge sledge hammer to destroy that wall and bring it down. That sledge hammer was made with positive intent. So you have to tell yourself that you can do this. You're smart. You can learn quickly. You can read this material and retain it for a longer period of time. When Luis goes to schools, working with students, he has them going through these positive incantations that they can, they will, and they must.

"Before even getting started with anything else, even the memory techniques, is building that foundation of positivity that they can and they will achieve their goals."

Resources Luis recommends to help you include reading the book, Awaken the Giant Within by Tony Robbins. Luis wrote a book called Better Memory Now. He does some exercises and some meditation. There YouTube videos you can watch Les Brown is a huge inspiration for him as well as Jim Rohn.

Even if you can't surround yourself with individuals that always stay positive and always motivating, you can always read these books or watch the videos. Or you can follow anyone in your field that you can connect with. If they're uplifting and motivating, listen to them or read their books. Jim Rohn has the famous quote: You're the average of the five people who surround you.  So it's really important to surround yourself with positive people to help support you.

[11:55] More Strategies to Become a Memory Athlete

Again, Luis discusses creating this memory map or memory palettes in your mind. You ca write this down first but you're going to want this in your mind when you're learning the information. You can just easily store it along this route.

Luis practices this with Ryan. Imagine you're at the front door to your home. Open the door and what is the first room you walk into into? Look around the room and look at everything in there. Ryan is imagining walking into his child's playroom.

Then go clockwise and choose five different locations or things in the room (ex. toy chest, lamp, painting, etc). Starting from the left side of the room going clockwise, imagine the first thing you picture. Then to the write, imagine the second thing you see. The third, fourth, and then five. Ryan sees the easel, drawer system for toys, kitchen play set, dollhouse, his daughter's picture eating cake on her first birthday.

From one through five, just go through those again. Then go backwards. Then what is number 2, number 5, and number one. Just go back and forth. Now, you've memorized five things. And Luis explains we've got thousands of these in our heads whenever they compete since they have to memorize a boat load of information very quickly.

[15:50] Do You Have to Be a Visual Person to Do Well at This?

Luis has found that this technique embodies all of learning ways (visual, auditory, etc.). Because when you're visualizing, you're not only visualizing the space you're in, but you're actually imagining you're there. You're creating the sounds, too.

You sense everything that's happening in that space. So he doesn't really think this is just for those really good at visualizing. This works for almost everyone. In fact, he was worked with a blind person and in their way, they were able to visualize the information.

Moreover, activating the senses is a huge memory booster. Hence, you need to add as many senses as you possibly can with the stories you're creating. Don't just visualize it. But imagine what you see, hear, smell, feel, when you're seeing that information.

"Place yourself in these rooms and visualize yourself actually interacting with these locations because that's going to cement them deeper into your memory bank."

[18:13] Review in Chunks

Luis explains the reason you have to memorize it forwards, backwards, and by number is because of the review aspect. Whenever you review something, you're building on the myelin in your brains to cement this into long term memory, in that specific order.

"When you're creating these locations on your own, do them in blocks of five. Do them forwards, backwards, by number. Then we move on to the next five."

Once you do this a few times, then you group that into blocks of ten. The general tip is to not learn everything all at once or cram everything the night before the exam. Do it i block and in chunks. Then take breaks in between as well. Whenever Luis learns something new, he does it in chunks and blocks. Then before moving on to the next one, he reviews the next chunk.

[19:37] From Memorizing Images to Memorizing Stuff

Luis then gives basic words and images to apply. Luis wants Ryan to picture out right there on the easel is a bone inside of an envelope. On the drawer, picture a toad playing with poker cards. Then add more animation to it to help link them together.

Then on the third location, Ryan is made to picture berries in the kitchen area. Imagine how you associate them together. Ryan imagines opening up the fridge, seeing the berries and squishing them to get the juice dripping down on the side.

For the fourth location, the dollhouse, picture a very dry towel coming apart. Then associate that with the dollhouse. Ryan imagines one of the dolls tearing it apart. 

On the picture area (fifth location), picture a dog with an oxygen mask and eating a big dinner plate of turkey. He's trying to melt it down with nuclear acid. Then Luis asks Ryan the first thing he memorized. And Ryan's answer is the dog with the bone in an envelope on the easel. The word here is benevolent. Whenever he's memorizing a word, he asks himself what the word reminds him of when he's looking at it.

Bone for "bene" part and envelope for the "volent" part. The he creates the story and pictures dogs around. So his dog is being very kind with the chihuahuas, the dog is giving the bone in the envelope.

So when you're trying to memorize your material, try to be playful with the information.

"Create these stories in a playful manner because it's going to make it more entertaining and more fun for you to actually sit down and learn the materials as well."

[24:20] Making it Personal or Using Other People's Stories?

Luis recommends creating your own stories because you're more connected with the material. Other students might create some metaphors and analogies you're not too fond of. So do your best to create your own. But in the same sense, if you want to get ideas from other students a bit, you can do that too. At the end of the day, however those stories have been created, it's going to be a much better way to learn the materials and have it stick to long term memory than if you just try to do it the usual way of repeating information over and over again.

"Our brain learns best when it can connect in the story form, in the metaphorical form."

Then Luis goes on with the exercise. For the second location, the word is Pulchritude. So the toads are playing cards and one of them got a Royal Flush and one of the toads turned into a beautiful princess. So he was trying to link the "Pulchri" for poker and "tude" for toads to link them together.

On the kitchen, Ryan earlier pictured berries. And then the dry towel is the last. the word here is "tawdry," which means cheap.

And the last one is the dog wearing an oxygen mask, eating turkey on a dinner plate and melting it down with nuclear acid. This was lengthier for a purpose. This is especially useful for medical students when they have to memorize a lot more information. They require a little more creativity but at the end of the day, this works. This represented the word, DNA (deoxyyribonucleic acid).

So if you want to remember an acronym, create these images and stories to help you out.

[27:57] Review, Review, Review

You can do this whether you block ten off and sit down. Then solely focus on reviewing this information. Once you actually put this into your memory bank by creating the location and stories and placing them on the locations. You can do this from wherever.

"In order for this to be cemented to your long-term memory, reviewing is essential."

So you can review the information wherever you are, whenever. Do this whether you're sitting down when you're doing nothing but just focusing on it. Or this can be done during your NET (no extra time) needed. This means you're doing other activities that don't require your conscious mind to be present at that point. Then review your information while you're running or working out or cleaning your room.

[29:40] Reusing Locations

Luis says you could reuse locations as long as you want to retain these information for longer period of time, you want to review that particular chunk on that location. If you memorize everything about the skeletal system all in your living room. As long as you memorize them, you actually get to the point that you no longer need the location to access that information.

For example, whenever Luis tries to memorize names, say Heather. He pictures a feather for Heather. He's picturing himself tickling her nose with the feather. The next time, he might need that trigger to remember her name. But after a few occurrences of interacting with her, he might not going to need to picture a feather on her nose anymore. He's just going to know her name since it's moved on to long term memory.

This is the same thing with the actual information. Once you've reviewed enough time to where you don't need the locations anymore to access information, then you can chunk other new information in that same location.

In competition setting, Luis says reusing locations is a must. They give themselves two to three days to review. Then store other information there.

[31:48] Breaking Down the Brachial Plexus Structure

Luis does the memory palettes for this. Say, in the living room, the first location is probably the couch and he would picture the actual term, brachial plexus. So he pictures brake pads and squishing the pads. Ryan would steal the brake pad thing. But then he adds picturing squeezing five pillows together.

So you see here, you can link more things to the original story. The pillows are a perfect add-on to this. It helps you remember that there are five nerve endings coming out.

Then the next location or area in the living room is the table area- there's the table top or the chair, vase, etc. So use everything in the area to help you remember everything about the roots. For the roots, you picture the plant and the roots just growing out of the table. Then based on the structure, you see the dorsal scapular nerve that comes out and long thoracic nerve coming out in the root section. Another thing to remember is that dorsal scapular is from C5 and the long thoracic is from C5, C6, and C7.

For this, Luis recommends creating the image or representation for each one of the terms. He would picture a door with a scapula. C5, he'd picture it as a dynamite. So maybe the door with a scapula is going to cut open and is explosive. Sever the line before it explodes.

So this is what you can do if still don't have a system for numbers. For Luis, his picture for door number 5 is a cat with a hell ball. And for 5 maybe a hand. It's something you can picture to each of the number.

For long thoracic nerve, you can picture out a long neck. Then he'd use the images he has created for the numbers. A 7 looks like a hook and 6 would probably be a smiley face, and 5, the robot movie Johnny 5. So you can link those together. Johnny 5 has a smiley face and he has a hook and slicing down a long throat for long thoracic nerve. So this gives the trigger for C5, C6, and C7. Then visualize all these on the table.

Having these triggers does help out even with the review aspect of it because you're creating these no cards in your mind. And then you can review this material by just looking at the table and see what you picture.

Luis thinks that to memorize everything specifically with all of these terms in the structure, he reckons somebody getting started would probably take them around 30 minutes to an hour to have this information in your memory bank without needing to refer to any type of notes later on. Additionally, the more you do this, the faster it becomes for you.

[39:47] The Limitations of the Technique

Luis says the limitation of this technique is having the locations you need to memorize the massive amount of information. People don't like to spend that much time creating these locations and do more but that takes some time to create. Plus, people give up sometimes after the first trial. They think it's too long to create instead of just doing it the old-fashioned way of memorizing.

It's like learning a new language. At first, it does seem like it's going to take more time. But the more that you practice it, the easier that it gets and the faster you are at creating these stories and images.

Moreover, have a good set of 100 to 200 locations to start off with. You can do this from your home or from places you visit, the local pizza shop at Walmart. Or walk around Walmart and create a hundred locations there - right from the entrance all the way to the cashier area. Use them right away to memorize information.

"It's like learning a new language...But the more that you practice it, the easier that it gets and the faster you are at creating these stories and images."

[41:30] Better Memory Now and Other Resources

Luis mentions his mentor Ron White who has the Black Belt Memory program. Other memory trainors include Nelson Dallas.

In Luis' book, he goes deeper into how to create these locations because it's the greatest hiccup for people is to just sitting down and visualize all these things. So he gives you a step by step guidance as to how to do this.

One of the biggest things is memorizing numbers. He goes and gives his pictures for his numbers and he will teach you how to memorize that over one block at a time. He's going to give you images for each one of the numbers. This going to help you tremendously to create these images faster.

So if you want to apply these techniques and take it to another level, check these out.

Links:

Better Memory Now by Luis Angel

Awaken the Giant Within by Tony Robbins

Black Belt Memory program by Ron White

Dec 20, 2017
264: Dean of MSUCOM Talks About Mission to Increase Canadian DOs
38:37

Session 264

Dean Bill Strampel from Michigan State University College of Osteopathic Medicine joined us to talk about his school and what they are doing for Canadian premeds.

Michigan State University College of Osteopathic Medicine has an interesting mission, which is to increase the awareness and the availability of osteopathic physicians in Canada. The school reserves a certain number of seats for Canadian students. If you're a Canadian and you want to come to U.S. medical school and interested in osteopathic medicine, this episode is a must-listen.

We also cover topics around AOA and ACGME merger, which he clarifies through a good history lesson.

[01:45] His Interest in Becoming a Physician and Overcoming Hurdles

Bill has always wanted to be a physician even when he was younger than 4 years old. But as he grew up and went through college, he thought he couldn't do it right away. So he worked for the U.S. Department of Labor for a couple of years but hated it.Then his wife suggested that he went back to medicine and so he did.

"I technically probably always wanted to be a physician. But you really don't know until you get admitted to medical school and then you go to do that."

The main reason he was so hesitant was the thought of being married and having kids. So he didn't think he could afford to go. But he's a great example that it can be done. Bill goes on saying that his wife runs the organization for the spouses of married physician. There is an end in sight and you can get through it but you've got to work at it. It requires both people to work at it.

Back in Episode 251, I had Sarah Epstein who is the author of Love in the Time of Medical School.  Sarah is a marriage and family counselor intern while her husband is a resident. So she wrote a book on how to keep that relationship going through med school.

Bill agrees how this is an important issue which requires a lot of work since there are stressors in all levels.

[04:00] The Biggest Changes for Getting Into Med School

Bill explains there are four generations involved in medicine. The Traditionals, who are still running hospitals and being involved, the Baby Boomers, the Gen Xers are those that have a participation trophy, and the Gen Y.

The biggest change Bill has seen is that medicine is so competitive that desire isn't what takes. You've got to be able to accomplish, not that you desire to be a physician. It doesn't matter how good of a person you are with people. But you have to be able to get to the gates of the medical boards and licensing exams.

"Medicine is so competitive that desire isn't what takes. You've got to be able to accomplish."

Bill adds that there is little percentage students that go to foreign and Caribbean schools that get graduate medical education in the U.S. Back in 1960, you could go out from medical school and go practice. You could be a general practice doctor without having to go to an internship. But there's no state now that would grant you a license to practice medicine unless you have at least 1-3 years postgraduate medical education. The last state that allowed doctors to practice right out of medical school was Indiana and that was 25 years ago.

[08:05] How to Prove Yourself to a Medical School: Minimum Scores and Personal Statement

Bill explains that the admissions committee of any medical school is generally made up of 10-12 faculty members and staff. They establish in their own mind the screening criteria for the applications.

In their institution, they get about 7,000 applications a year for 300 spots. The committee looks at that by establishing a minimum GPA science GPA, and overall GPA. Second, they look at how well you did on the standardized test like the MCAT.

This won't make you a good physician. They know that. But with 7,000 applications, they have to have a screening criteria. Otherwise a person that falls below a 500 MCAT score won't be looked upon. And they're thinking of moving that level up. Other schools won't look at an application with an MCAT less than 505. They tell you they will, but they really don't. They screen out half of two-thirds of those applications right away.

Then they start looking at the application in detail. The look at how well you did in specific courses. In the old MCAT scores, they have 30 years of history looking at those numbers where if you get lower than 6 in Reading, 90% of the time, students won't do well in medical school. So they wouldn't look at those who scored 6 in Reading, no matter what your total MCAT score is.

As the application moves down, they read the personal statement. Bill says that about 80% of the personal statements would say they know someone who had this disease and they watched them suffer or die. So they wanted to help people because of this and decided to apply.

"80% of the people write a similar statement. And you are trying to make yourself out of this massive people."

You really have to make it a personal statement. What is really going on with you? Why do you really want to do this? And that makes a difference. People will read that and would be interested in that. He has also noticed that they'd interview 500-600 for 300 admissions. So you've got one in two chance if you get interviewed.

Bill says one common mistake students make with their personal statements is they don't have someone proofreading it. The grammar sucks or you use the wrong word, whatever that is, you have to be able to present in a way that it's more than just an afterthought that you wrote the thing down because you were filling up space to do that.

"You've got to have a presentation that looks like it was more than an afterthought that you wrote this thing down because you were filling up space."

[13:45] A Look Into the Osteopathic World

Bill explains that the osteopathic medicine has been around 140 years ago. The five original schools in Kirksville, Kansas City, Des Moines, Chicago and Philadelphia are still in business and exist to this day.

Michigan State was the sixth (seventh, counting the Los Angeles school that closed) that came. It was formed by the Osteopathic physicians in the state of Michigan.They decided they wanted their own school. They've been practicing a long time. They've been granted full practice privileges of Michigan since 1902.

They decided to raise the money. They taxed themselves. Back in 1964, they've decided that every osteopathic physician in Michigan would give $2,000 a year for five years. Back in 1964, you could buy a brand new Thunderbird convertible for $1,700. That would be the equivalent of the state organization you may belong to, giving $50,000 to $60,000 a year to the state organization for five years.

It's not a lot, but they actually did it. They put together this osteopathic fund and started the Osteopathic College in Michigan as a private school in Pontiac. Then state politics intervened by making a state law. So Michigan State University became the first university to publicly recognize an osteopathic medical school as a state supported school. So they've been removed from Pontiac, Michigan to Michigan State University in 1969, And they've been there ever since as a full member.

With that, Michigan State University has caused the explosion of osteopathic medicine across the United States. And there's four of them now, all directly related in the last 30 years. It became recognized that this wasn't just something in the background but it's what people wanted.

"This wasn't just something in the background but it's what people wanted - 25% of all of the medical school students in the United States right now are DO."

[17:07] Applying to MD and DO Schools and a Merger in the Works?

Bill has come across students who said they're only applying to osteopathic medical schools. And he asks them whether they really want to be in medicine or they want to be in a specific school.

He explains that the real issue is that if you really want to be in medicine, then you take every advantage you can get to try to get there. That being said, you apply to both MD and DO schools.

"I am not afraid of the competition. The competition should be afraid of me."

Bill clarifies that it's not a merger but the integration of the residency programs in the United States under one accreditation standard. So this has nothing to do with a merger of the professions.

The reason they call it residencies is because you used to live in the hospital and you could not be married. When President Johnson and Kennedy created the Great Society, the same argument was there in terms of the Medicare and other issues. And in order to prove that Medicare is a successful thing, they need to create more physicians that were trained in this issue. So under Medicare, they decided that for the federal government for the first time would fund residencies.

[19:52] A Brief History: The Big Boom in Residencies and the Federal Government Wanting Control

Between 1964 and 1984, residency programs exploded in the hospitals across the United States because for the first time, they got 100% for every salary and benefit for every intern or resident. They also got an indirect medical education payment for every intern or resident that run somewhere between $80,000 and $140,000 a year, depending on your location in the country.

MD programs went crazy and some DO programs too, although they didn't have as many being smaller programs. But over the years, they wanted as many people in graduate education. Until the government realized this was costing too much at about $11-$12 billion a year to do this. So they started looking at it, particularly the Congress. They're asking whether they're getting a bang for their buck. And the Institute of Medicine then, produced a paper that said that graduate medical education wasn't producing people to do primary care. Instead, they're producing left-brained neurologists. The problem is that this does not take care of the vast majority of people that need to be taken care of.

So the institute said that the House of Medicine (MD and DO)  was doing a terrible job at how they were training people for the future. So there was a big push against giving money to the AOA and ACGME. These are the organizations that ran the money for the federal government. Since they wanted more bang for their buck, they decided to take over directly.

As a result, everybody panicked and the House of Medicine wanted to have control over what they're doing in training rather than letting the federal government running it directly. This was the impetus for combining the education piece.

[23:15] The Effect of the ACGME and AOA Integration on Training

The combination of the ACGME and AOA should not affect your training. Bill says that if you're good, you will get accepted. They've had DOs who were the sergeant general of the army. So there won't be any problem with that. In fact, Bill was the senior commander in the army for 30 years.

"You've got to decide what medical school fits your needs best."

Speaking for their institution, Bill says they have 40 hospital partners and 1,968 intern/resident spots in 210 graduate medical education programs affiliated with their institution. So there is more than enough spots there.

Somehow, it's affected in a way that competition has gone higher because now, for the first time, DO's would already have competition fro the foreign medical graduates. In the DO program, they never took a foreign medical graduate into an osteopathic residency program. Now, moving into this new change, they have to take all comers since that's the ACGME standard.

That being said, the competition has gone stronger. Although he's not worried about it, they're paying attention to it. They point out to the students that the pool got a lot bigger so they can't rely on their degree only. They have to be able to produce and they have to meet the standards. He reiterates that there's no participation trophy for this.

"The pool got a lot bigger so they can't rely on their degree only... they got to be able to produce. There's no participation trophy for this."

[25:45] Turning the Spotlight on Canada

Bill gives a little backstory as to why they're specifically allotting seats for Canadian students. He explains how osteopathic medicine exists in Kirksville, spreading to other parts of the country and then to London and New Zealand, Australia, Italy, France, Germany, Russia, and Norway.

So osteopathic medicine per se, is all over. But osteopathic medicine in the American model is different. Canada is similar to the American model. Prior to 1920, there were more osteopathic physicians in Canada than there were in the U.S. Then the Practice Consolidation Act in Canada decided that they only wanted osteopathic physicians to just do manual medicine. This made a lot of osteopathic physicians in Canada very unhappy.

Michigan was a direct beneficiary. Many of the hospitals in Michigan were started by Canadian physicians that came back across the border to practice in Michigan where they can still practice full privileges. The first female dean of the medical school in Los Angeles was a Canadian physician. She went to the osteopathic school they started in Los Angeles.

Bill got involved with Canada as a consultant. The Ontario Osteopathic Association and the Canadian Osteopathic Association called him to ask if he could advise them on starting a school in Canada. So he did some consulting in Canada to listen to their story. He then realized they didn't have enough horsepower because of the way their residency programs in Canada are controlled. The 12 Canadian medical schools pay directly to the hospitals and all the money run from the hospitals to the universities.

"There was no way they're going to have third and fourth years slots to run a medical school in Canada."

So what Bill proposed was for the Canadian school to start with 50 students that they're going to train for the first two years. Then Michigan will take them for their third and fourth year medical spots. Then the schools can decide on what they want to do.

To run a graduate school program in Canada, you've got to be certified by the MInister of Education. However, after talking with other medical schools in Canada, he was told the Minister of Education in Canada was never going to approve this.

First, Western Ontario University doesn't want Michigan State University across the border having had enough competition with this. Second, when they raised the slot in Canada, it cost the taxpayers about $1 million per slot. And Bill coming in with a model where they can fund this for about $44,000 a year and if this got out, he'd be putting all 12 Canadian medical schools in jeopardy.

Instead, he talked to the board of Michigan State and asked for 25 slots for Canadians. He never advertised this but they got hundreds of applications every year. And they have been very successful for the last eight or nine years.

"I believe that people in Canada deserve that kind of access to that kind of medicine."

[32:00] Canadians as Foreign Grads with Their DO

In one of the provinces in Canada, they assumed that Michigan State was just like anything else so they'd be considered as an application. Bill requires all his Canadian students when they go there to take the Canadian equivalent of the foreign medical graduate (FMG) test. He also helps them take the Clinical Skills portion of that exam so they all remain qualified for the same pool of Canadians coming back in, having training either in the Caribbean or in Michigan or other schools outside their country.

"Canada trains a lot of physicians outside of the country because they do not have enough spots in the Canadian system to train the people that want to be in medicine in Canada."

[34:25] Shadowing Experience for Canadians

Many Canadians complain they're not able to get as much shadowing experience in Canada as students would in the U.S. Bill says that Michigan being close to Canada, Canadians can easily cross the border. So there are lots of Canadians that go back and forth all the time.

Additionally, Bill has a relationship with two hospitals in Canada where if students want to do rotations, they could go back to Canada and work in the Canadian hospital as part of their clinical rotations. He restricts this to just Canadian citizens going back.

[35:56] Why Michigan State

Bill prides on the fact that the Michigan State University College of Osteopathic Medicine is one of the leading medical schools. They've been ranked as the fifth school in the whole nation. And they've been in the top 10% of that list for the last 15 years. It has to do with the faculty and the clinical faculty. They have in the state with about 6,000 clinical faculty members that take their students, mentor and train them because they love what they're doing and the love what the students are doing. He considers this as their single biggest strength.

If you want to practice medicine and you want to learn medicine, Bill believes this is the place to go because they have the exposure of both DOs and MDs. In fact, many of thei MD students take manual medicine course as an elective because they want to learn the same thing DO students are doing, and vice versa.

"We're the only university in the United States that has both an MD school and DO school. And we're right next to each other."

Links:

MedEd Media

Michigan State University College of Osteopathic Medicine Love in the Time of Medical School by Sarah Epstein

Episode 251: How to Protect Your Relationships as a Premed and Med Student

Dec 13, 2017
263: He Figured Out How to Overcome His 2.75 Undergrad GPA
41:36

Session 263

Michael struggled through his undergrad with a 2.75 GPA and realized afterwards that he wanted to be a physician. Listen to his journey and what he learned.

A couple of weeks ago who went through her undergrad as a premed with a 2.7 GPA and is now a first year medical student. This week, we have a very similar story of an undergrad with 2.75 GPA and is now a first year medical student.

First off, subscribe to this podcast as well as all our other podcasts on your mobile device. We’re also now on Spotify! Just search for MedEd Media. Of course, you will find all our podcasts on our website MedEd Media.

Now, let’s go back to our episode today as I talk to Michael.

[01:17] Meant to Be a Physician

Michael was out of college by the time he realized he wanted to be a physician. He was around 24-25 years old. But he has always been interested in nutrition and the health and performance aspects of physiology. He studied Biology in college and had some struggles.

When he got out of college, he started working as a trainor, thinking it was going to lead him to the path he wanted to take. But he started to question that path. At that time, he'd be working with clients who had a lot of medical problems. And he was struck by how little he knew and how little he was able to help them. He thought he had known so much. He had taken certification and studied biology in college. But he still realized how little he knew about the human body.

This was the first moment he thought he wanted something more intellectually. But he also wanted a career that was going to be centered around people. So he thought medicine may be right for him. But he was still hesitant at that time given the struggles he had back in college and having had poor grades. He wasn't sure medicine was going to be available as option.

Michael studied science since that was what he found interesting in high school. However, he really didn't have a plan. He had interests and hobbies but the academic part didn't go the way that he had really planned.

"I really didn't do a lot of deep exploration at that point. I was in a very immature state."

So his thought process after college was just going back to what he was interested in and hoping he was going to find something that would push his interests further.

[04:20] Exploring the Medical Field

Michael explains that you can google any condition but these are very complex processes. He had a biology background and he understood how complex the body was. He was struck by how much he missed the academic studying part and how much there was still left for him to learn.

However, the thought of having those academic struggles held him back. He didn't know where to go from there. But he knew working with these clients that he wasn't as intellectually challenged.

He knew that if he were to extend and extrapolate such career into the future, it wasn't going to provide him with the level of intellectual challenge that he wanted. That being said, he was enjoying the interactions he had with his clients which is why he found the job so much satisfying. But he also knew personal training was not in his future.

Then Michael had a client who was a PA, which was the first time he ever heard about. He assumed the entrance requirements to getting to PA school but he was wrong too.

"It's very hard to get into PA school, especially now."

So he thought he wanted to explore medicine. But since he didn't have the grades to do it, he considered getting into PA school.

He also knew about a scribe job back in college. His mom was a nurse who worked at an emergency room that had scribes. So he applied to a scribe company and got the job. He thought if he could jump in there, then maybe somebody can give him the mentorship he needed at that time.

[09:30] The Biggest Mistake and Resources to Figure Things Out

Michael was in a Biology program as an undergrad, many of which were premed students. And was under the impression that if you weren't a perfect student that there was no opportunities available to you. So he didn't even ask the question oftentimes. He had a 2.7 GPA in college in the science curriculum so he just thought he had no other way in.

Even when he was already working in the emergency room, he wasn't completely honest with the physicians and his co-workers. He was ashamed of it for having done so poorly. That was the mistake. Because it wasn't until he started to open up that he got so much support from people. They were so encouraging about him to pursue it. But they were also so honest to him that he had to perform.

"I was very much embarrassed by having done so poorly. But that was the mistake because once I opened up to them, I got nothing but support from people."

To figure out how to get things done, he did a lot of reading and research on the internet. He talked to physicians and scribes he was working with. He had several friends who went to medical school so he somehow had the general idea of what he needed to do. But he had no clue about DO grade replacement. Thankfully, he got it just before it ended.

So he did a lot of research on his own and formulated his own plan. Maybe not the smart thing to do, but he wanted to build some credibility before going to his advisor telling them he's serious about it.

[11:05] Grade Replacement and Grade-Enhancing Formal Postbac

His total GPA when he applied to medical school had gone up by almost six-tenths, which is a big jump. He retook several classes.

"Below a 3.0, you're at risk of getting cut from just the first run through of applications."

Michael reckons that if he had to go through all this without any grade replacement now, he would almost have to do a formal postbac. Now he thinks he could have done this in the first place but he chose the grade replacement route anyway.

When he was looking at the process, the first thing he did was take the MCAT. He thought that if he took the test and did really well then it could boost his confidence. And it could allow him to apply to a grade-enhancing postbac program. And a lot of those programs require an MCAT score as a screening method to get in.

It's actually confusing as to why postbac programs have this requirement. But Michael thinks maybe they want to know how competitive you are.

[15:14] Preparing for the MCAT, Staying Motivated, and Getting Support

So he decided to do the MCAT first. And without a solid foundation, he actually scored so high. He self-studied for it. He used a program on the Student Doctor Network, a four-month plan that you review, and Examkrackers.

He was already studying the content and he felt like there were concepts he was just learning the first time. So he took the time to really go back and understand the concepts. It was trial and error in terms of finding the strategies and the things he had to incorporate, which was a great learning experience for him.

"It was actually where I solidified my study habits and I learned a lot of really valuable things. It was a huge confidence booster."

To stay motivated the entire time, Michael made sure everybody around him knew what he was doing. He was very open about it and he was talking about the path and the struggles. Once he did this, other people started to open up too.

Secondly, he was just so motivated to prove himself to everyone around him who were surprised how he struggled so academically. He felt like if he could do well in the exam, that it was going to be the first step he needed to get the ball rolling.

Out of college, he was so ashamed he didn't want to tell anybody about his poor academics. But he went through an evolution out of self-reflection and introspection. He tried to understand how he got to that point.

"You're not defined by these singular failures."

Michael adds that people are not going to talk about their struggles too unless you're open about yours. So he took little steps. He began telling his friends and they were just so supportive.

[20:12] Community College vs. Four-Year University

Once he had the MCAT score, he started community college during the first semester. Then he decided to up the difficulty. He took biochemistry among other classes at a four-year university. Then he took a full boat of classes including retakes. He spent two years of classes after the MCAT. After finishing his do-it-yourself postbac, he applied in 2016.

I was asking Michael whether his ability ever came up considering he went to a community college after not doing well in a four-year university. He knew this could have been a red flag. But he clarified that he only took a couple classes during the first semester. The rest, he took at a four-university.  And it would have been a different story if he had done all the retakes in a community college.

He actually went back to the same college he had issues before just to prove to himself that he could do it. He had to prove to himself that he had the ability. He wanted to make sure that if he got to medical school, there was no question or doubt that he belonged there academically.

[23:53] Struggles Through the Application: Personal Statement

Michael describes writing his personal statement was one of the biggest challenges. He felt he had done enough academically. He was wondering how he could tie in the fact that he was a 2.7 student and was able to get to 3.9 and a good MCAT score. He needed to explain it. He also knew he had to dig his past which he found uncomfortable.

"I felt like I have done enough academically that I'd be at least considered but then there was the question of how do I tie this all together?"

This was the time I stepped in and worked with him. He describes how I grilled him but it was worth it. He said it made him so confident going into the process. He actually followed my advice to transcribe his thoughts. He felt weird at first. But I tell students to just let it go and don't hold it back to try to make it sound perfect.

When you're writing, you're trying to put the best version of your own thoughts onto paper. But when you're trying to dictate, you're just word-vomiting and letting it go. Then try to find a little thread you can pull and follow them.

[26:15] Preparing for the Interview

While preparing for the interview, Michael accused me of grilling him. Kidding aside, he was most concerned about was when he was made to explain what happened in college. He thought that if he took the long route as to why he was doing medicine, he felt he came to it organically. He thought if he just told the story in terms of what he was interested in along with the anxieties, it would just come together. And it did.Again, he had to get to that point since it was initially difficult for him to tell that story.

Although this is something you could do on your own, Michael appreciates the importance of finding other people that you can tell your story to. You're going to be applying and people are going to evaluate you on a piece of paper. So that needs to come through to them.

"Even if you have this great story and you certainly deserve to be in medical school, it still has to come through to people that are evaluating you."

Michael stress the importance of having mock interviews and having them read your statement. It's a great way to get the feedback you need to make sure you're hitting on the emotional points and other things you need to be effective.

[30:05] Choosing Which Schools to Apply To and Transitioning to Medical School

Location is top of his list when it came to choosing which schools to apply to. He wanted to stay close to family and friends.

So he ended up applying solely to osteopathic schools, primarily because of their grade replacement. Secondly, he thinks there are a lot of things that overlap between his interests in prevention and nutrition with the osteopathic philosophy. And he felt comfortable with this. Last factor is the cost. He got two acceptances and the cost was the deciding factor in his decision.

Michael describes medical school as a whole different animal than undergrad. But it's not that the contents are hard, but the volume of materials is just overwhelming. That being said, you have to have the discipline in how you approach things.

"I found a lot of undergrad classes to be harder in terms of the content. But the volume of material is just so much. They just keep throwing it at you."

It's been hard for Michael, but manageable. He's still able to exercise, eat well, get sleep, and take care of himself. He credits this to all of those years he took to get to this place. All of those things were invaluable for him in preparation for where he is at now. To him, it was all worth the steps that he took.

[32:40] Time Management Tips

To manage his time, he likes doing the Pomodoro technique in terms of studying. People study for four or five hours but how much of that is spent sending text messages or doing other things.

Michael explains that what's important is that the time you're actually studying has to be for studying. You also have to be ruthless in moving past material.

"In medical school, there's so much material that you can't possibly know everything, so you have to move on sometimes."

I want to add to what Michael said about taking away distractions. Once you hear a buzz or a ding, it actually takes 20 minutes for your brain to get back to where you were pre-interruption.

Moreover, Michael is in a problem-based learning curriculum so he's part of a group of students. In the group chat, they'd joke around because he'd be doing the 50/10 thing. So he's studying for 50 minutes and then take a 10-minute break.

[35:22] Final Words of Wisdom and What the Future Holds for Him

Michael's advice to students who may be suffering from poor GPA but really want to become a doctor so they're doing a postbac, is to rely on the support of students around you. You're feeling the same stresses and the same obstacles.

Be ruthless in analyzing what's holding you back. You can't be afraid to really analyze what's holding you back academically, for instance. You have to be honest about where you are falling short. Whether you need someone else to analyze what you're doing and to help you, or you just do this yourself, you have to be objective about what's working and not. People can throw at you so many techniques. At the end of the day, use what is useful for you and then discard what doesn't work.

Currently, Michael is happy with the people he is with and with the problem-based learning they have at their school. So he's just looking forward to continue to do well. He's excited about everything and he feels really good about things.

[38:30 Prepare for the MCAT with Next Step Test Prep

Lastly, if you have an amazing story to share, or you know somebody who has a story to share, shoot me an email at ryan@medicalschoolhq.net.

If you're preparing for the MCAT, check out Next Step Test Prep. I also work with them on The MCAT Podcast every week.

The feedback I get is they're the most realistic and the best predictor of your real MCAT score. Buy up to ten full-length exams and save some money by using the promo code MSHQ upon checkout.

Links:

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Dec 06, 2017
262: The Physician Behind #LifeofaMedStudent Shares His Journey
33:45

Session 262

Dr. Charles Cochran is the founder of #LifeofaMedStudent, a Twitter account which he started to help students figure out what's going on out there in the medical school world. It's a place for students to gather and share stories. Now, this has grown into a successful website as well.

Take a listen to learn why he started it, and what you can learn from the med students talking about their life.

Share this podcast with a friend as well as all other other podcasts on MedEd Media.

[02:00] Interest in Medicine

Charles knew he wanted to be a doctor when he was still little. His dad being a small town chiropractor, he got an avenue to medicine through this. He has also like interacting with people. His dad always pushed him to go to a DO school or a medical school to have a more expanded license.

In fact, he didn't have a different career that he thought about. he always thought it was a good fit for him. So from day one, he always thought he'd be a physician.

"I like working with people and medicine was a great way to mix the kind of science I enjoyed."

And he didn't really look at other things to challenge himself if this is something he really wanted to do. In college, he applied to a rural health program designed to get you into medical school. So right from day one of college, he already been on the premed track.

In high school, he did some shadowing which he enjoyed. So he practically never thought of other career options. As a premed, his degree was in Chemistry. His plan was that if for some reason medical school didn't work out, he'd get into pharmaceuticals. He was thinking of pharmaceutical sales since he was interested in business too. But he never really pursued it because he was able to keep going along the track which he wanted.

[04:55] Struggles with the MCAT

Being a premed and being in medical school are hard. So there were days he was being hopeful. He took the MCAT twice. His first take was okay but it wasn't good enough. So he was agonizing on whether he should take it again. And if he did, what he'd do differently to make sure it's not the same or worse. So he had those days as a premed being part of the normal process.

"If you do take it again, what are you going to do differently to make sure you don't do the same or worse."

The first time he took the MCAT, he actually just showed up and took it. It's amazing how like Charles, many students think it's just another test. He "studied" for a summer, but he really didn't study. He did well in undergrad so he thought he'd do well on the MCAT too. In short, he didn't have that burning desire to really do the study needed.

So he admits to having had poor guidance and poor individual responsibility. Then when he went on to take it the second time, he spent the next summer studying each day. He was now doing more practice tests and a lot of practice questions. And he was happy with the result.

[07:15] Guaranteed Acceptance to Medical School Through the Rural Health Program

Charles was part of the state's Rural Health Program, that had partnered with Indiana University. The average for their matriculating class a year before, you are pretty much guaranteed admission if you did all the things the program wanted and scored the average on the MCAT, which at that time was 30. So he knew that if he got it or better, he didn't have to apply to other medical schools and worry about it.

But even the first time he thought he'd be fine as long as he showed up, he got a 27. It was good enough to get you into medical school. But it wasn't going to be a slam dunk. So he was disappointed in himself for taking what could be a guaranteed thing. He considers that one of the most stressful times of your life is trying to get into medical school. Unfortunately, he didn't achieve it.

"One of the most stressful times of your life is trying to get into medical school."

So it was important for him to go back and get that score. Luckily he was able to the second time around. The school was able to accept his second MCAT score. They didn't care if you took it twice. They just wanted to see the number on a piece of paper. Plus, he had to do the research that was part of the program as well as shadowing and a minimum GPA of 3.5. All those was easy for him, but it was the MCAT that many people would have trouble with. Charles explains how hard it is to get admittance to medical school so a guaranteed acceptance was very important to him.

The Rural Health Program is still being offered today. People from small, rural designated areas in Indiana can join and if you get into that program, it comes with a scholarship. But you need to do everything asked of you. Get the MCAT score and the GPA. Then you're guaranteed admittance into the IU Medical School.

The great thing about this, Charles says, is that there is not catch whatsoever. There are no requirements that you have to be a primary care doctor or whatever, even though this is really the goal of the state. Charles is a practicing anesthesiologist now. He didn't end up going to primary care. But he's now practicing in the program's state. So in some ways, they got their money's worth with him because he's back practicing in a rural area.

[10:35] Going Through the Actual Application Process

Now that Charles got 30 on the MCAT, he still had to formally apply. At that time the program was relatively new (6-7 years old) and they never denied anybody. It was on paper that you're guaranteed acceptance if you did everything. This was pretty cool.

Charles recalls getting his letter of acceptance from the IU in the mail. But he wasn't as nearly excited that day as when he actually got his MCAT score. Because that was the moment he knew it was going to happen. If you're interested in Rural Health, Charles says it's a very nice program.

[11:30] The Hardest Thing About Being a Premed

Aside from the MCAT, the hardest thing about being a premed for Charles, is making sure that he checked all the boxes that things medical schools are interested in seeing.

Again, the program had some of it lined up for him. But you've got to get research experience as well as shadowing and get good grades. The entire four years was challenging. Nevertheless, Charles described college as an enjoyable experience. So ultimately, it was the balancing act that was very challenging for him.

"It wasn't just trying to get into medical school. That balancing act can be difficult to pull off. I didn't want to look back and regret that I never really had fun in college either."

I know I always tell students that there are no checkboxes. But there are things you have to do. Charles agrees in that you don't have to do all of them but have to do most of them in some shape or form.

Understand that they're not things you have to do to get into medical school. But they are things you have to do to prove to yourself that you want to be a physician. That's the big barrier.

The other component of this, Charles adds, is trying to figure out if you want to do an MD/PhD if you're more interested in the research side of medicine. Charles quickly found out he didn't and that he hated doing research. But he still thinks it's important and some are doing it. And he didn't regret doing it a bit because he knew then on that he needed to be around people.

"You don't have to do research but you should just to see if you like it."

[13:50] The Decision to Be an Anesthesiologist

Charles started off thinking he would go into Family Medicine. His dad was a small town chiropractor and he wanted a small town rural medicine. He liked being people and seeing them on a day to day basis. So for his first two years of medical school, that was the path he was on.

Between first and second year, he did a rural shadowing program for the summer. He went to different rural hospitals and shadowed different primary care doctors. He describes it as a great experience. But he also thought that pain management was interesting. And he thought anesthesia was a really good avenue to go through it. Although there are other routes such as Neurology or PM&R, but he thought anesthesia was the most interesting. And so he did.

Being in the operating room, he likes the pace of it with much technical skill. And what he lost in patient long term contact, he got with being able to use patient skills to make really good first impressions. Since most patients don't get to know their anesthesiologists until that day. So he uses his people skills to get patients to trust him in a short amount of time. He loves the day to day workflow as it seemed faster.

"What I lost in patient long term contact, I got with being able to use patient skills to make really good first impressions."

By second year, it was all anesthesia. Then once he got into it, he realized he couldn't go back and do pain management. That would mean going back to clinic life for a lot. And he liked being in the O.R. Hence, the transition. In fact, he considers this as one of the best decisions he has ever made.

[16:05] From Premed to Being a Medical Student

Charles describes that being a medical student is harder but you don't know it when you're premed. So you don't really understand that it's going to get harder. You don't fear it yet.

Being a premed where you check the boxes, there are a lot of things you need to keep track of to make sure you get a good application. Whereas being a medical student, you need to keep track that you're studying consistently, everyday. You have now basically dedicated your time to where you're just being a medical student. You're not shadowing. You're just showing how to be a medical student. He didn't really have a job during medical school. He didn't do much else outside of that.

"Once you're a medical student, it's pretty much, that's what you're doing for the next four years."

If there was something he would have changed about his premed journey, Charles admits he would have tried to do better on the MCAT the first time. He still gets disappointed about that. But overall, he was was really happy as a premed through the Rural Health Program and what it allowed him to do.

Being a small town Indiana boy, he never really wanted to see the world, so to speak. So another thing he could have done was to study abroad to expand his point of view at that time. Otherwise, it was still a happy premed experience for Charles.

[18:14] The Origin of #LifeofaMedStudent

Charles started #LifeofaMedStudent in December of 2011 when he was a third year medical student. He has always found social media interesting. So he got curious what sites are available for medical students at that time. He did found some, but what he really wanted to do something different. He wanted to be more interactive. He wanted other medical students were helping to promote it and share their ideas and humor. So when he started it, the name #LifeofaMedStudent was what he came up with.

His goals was that through this hashtag, other medical students could find tweets and share them. Then his site would retweet them and promote them so that a medical student in England could share an experience with a med student in the U.S. And that all medical students across the U.S. could share what they're going through as well as the funny and sad aspects of medical training.

At that time, it became quickly popular. While a lot of other sites when he started kind of died out. It's so great that Charles has actually kept this going until now. Since most students who  have done this and then stopped were actually hit hard by residency. They realized realized that residency was harder than medical school.

So Charles made sure that he was at least sending out some retweets and tweeting a few times a week even through residency. Although there were times when he went weeks without tweeting, especially during the early parts of residency. But he kept with it. While a lot of those other sites have not tweeted for five years. As with Charles, he explains that he basically made time for it throughout these six years.

Another good thing to know is that his followers grew from 20,000 to now 50,000. This also motivates him knowing that people enjoyed the site and they're sharing it. So he felt obligated to keep what people like going. Hence, his Twitter account stayed active throughout these years. Now, they're also on Instagram and Facebook.

"I felt that I was obligated to keep what people like going. That's how our Twitter account stayed active throughout these years."

[22:20] The Biggest Struggles Students Tweet About

Charles says most students tweet about just the day-to-day grind of being a medical student. It's years of just studying and studying. And the second half would be days trying to learn as much as you can in the hospital. Then you'd come home and study again.

So it's that grind that can take its toll at times. This is the reason Charles would sometimes describe a physician's life as "hilariously sad." Because it's funny how medical students around the world all have these shared experiences. This means long hours and daily study grinds and trying to do well. You basically try to constantly improve.

So the struggles with relationships and lifestyle you give up for to try to be the best medical student you can be. And people find that as something they want to share with other people to feel it's never just you. So he sees the need for people to share this.

"It's not just me. In medicine, it's never just you. And so I think people like to share that."

[24:15] His View on the Work Hour Regulations

Charles believes there should be some work hour regulations. He doesn't think anybody should be working more than 80 hours a week. With the nuance, people can work for 16 hours or 24 hours. He's not as picky. He thinks working 24 hours is fine. But he doesn't like how they're putting this four-hour period where if you're doing 24 hours and doing a 4-hour hand off. He doesn't think it takes four hours to hand off your patients.

He adds that the thing about residency is you're doing what you're told 99% of the time. And for residents that don't do this, things can be difficult. Charles points out how residency programs could abuse that four-hour rule. He thinks that if you want it to be 24 hours, it should only be 24 hours with just a little leeway for handing off patients.

Ultimately, he thinks that 80 hours a week is plenty to both getting the experience you need. He stresses the importance of work-life balance and you shouldn't lose that.

I wanted to add to this that a lot of medical students don't realize that you could be fired from your residency. Charles says you have to do what you're asked. And when residents don't do that and don't study at the same time causing them to do poorly on the exams, you can be fired. It's rare but he says this actually happens every year to residency programs.

"You can be fired. It's a job. You've got to show up and do good at your job. Do well or there can be consequences."

[27:18] What to Expect from #LifeofaMedStudent

Charles dishes out some things you can get from checking out #LifeofaMedStudent. You will learn about what you're getting yourself into. It's the broad adventure that going into a life in medicine is. You're going to see what it's like to be taking a 24-hour call surgery or about internal medicine. He shares why he chose anesthesia. He also has a couple guest posts for why they became a surgeon.

They also have posts directly geared towards premeds. He shares his story about why he took the MCAT again and what he did differently. Was it the right decision? He also shares some tips for shadowing as a premed as well as the four pillars of great med school application.

Additionally, Charles tries to tailor some of it directly to the premeds. But he also has a lot of guest posts who are in medicine. This way, premeds can see what the future looks like for them and what they're getting into.

Charles accepts guest posts and he's happy if premeds want to participate and talk about their struggles. He'd be happy to hear about some stories of what it's like to be taking the MCAT now or being a premed now. If you're interested in sharing your story, go check out their website.

"That's what you see on the site and you'll see a lot of different voices that share what it's like."

A recent post they have is when is the best time to have a baby. Is there a best time? Charles' daughter is now one. They had her at the end of residency which he thought was a great time to do it. A lot of premeds are worried about families in their future. While this may not be on your top list of concerns, but soon this will be one of your concerns.

[30:35] Final Words of Wisdom for Premeds

Charles wishes to share with premeds that his biggest struggle was during the first semester of medical school. During this long journey, you will have days where you will doubt yourself. Everybody does and that's normal. That's part of the experience. So never think you're alone. Premeds and medical students have the same experience and have the same doubts.

The second thing is that it's worth it, both from a lifestyle standpoint to financial and just the happiness standpoint. Charles feels so honored to call himself a doctor ad be able to take care of people. Even through those hard days, he couldn't really see himself doing anything else.

And if you're at a hard time and can't see yourself doing anything else, Charles encourages you to stick with it. Sometimes, part of the struggles is just sticking with it. So don't give up on it!

"If you're on the path, you're smart enough to do it. And if you're smart enough to do it, you can eventually achieve it."

Links:

#LifeofaMedStudent

#LifeofaMedStudent Twitter Twitter

#LifeofaMedStudent Instagram

Rural Health Program - IU Medical School

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Nov 29, 2017
261: From a 2.7 Undergrad GPA to First Year Medical Student
47:05

Session 261

Nneka is a 1st year med student who didn't think she had a chance. After a 2.7 undergrad GPA, poor MCAT scores, and a failed application, learn what she did to succeed. She is now studying at an allopathic medical school in New York.

First off, I went and talked to Dr. King Li from Carle Illinois College of Medicine about how they're looking at shaping their first class.

[01:08] Be Part of Carle Illinois College of Medicine's First Class

As the dean of college of medicine, when they're looking at their first prospective class, they try to communicate their vision to the admissions committee. This way they would understand the types of students they hope are going to build the future of the school.

Dr. Li says he's looking for the 4 C's from students, namely: compassion, competence, curiosity, and creativity.

They're using an innovative way to assess this. For instance, prospective students would be asked to do a profile and answer questions on how they define compassion for example. They would also be asked to give examples to support this.

He adds that another important thing they want students to have is to be a good team player both in the active learning mode and in helping them develop this new curriculum. Their feedback is therefore critical for the school to keep on improving their curriculum.

Lastly, Dr. Li cites how these students could potentially be productive members of the society that can make tremendous positive impact in the future. To learn more about Dr. Li and Carle Illinois College of Medicine, listen to episode 256.

AMCAS is now accepting the primary application for Carle Illinois College of Medicine. Go to AMCAS and add the school if you're apply this cycle.

Don't forget, if you're applying right now to start in 2018, the first class of 32 students will be getting 100% free tuition!

[03:35] The Fire Hydrant Analogy Is Real

Back to our guest today, Nneka had a 2.7 undergrad GPA. She took the MCAT multiple times. But she was finally able to put it all together and tell her story to ultimately get accepted to medical school.

As a first year student, she describes everything to be moving so quickly. The fire hydrant analogy is very real according to her. They have tests every month. Their first unit was split into two. The first half was about three weeks and the second half was about four weeks. They have separate exams. And now they're on their third unit with about five weeks.

Nneka has always wanted to become a doctor. And when she reached out to me, I told her there was a lot of things in her way. But she finally had the opportunity to get all the documents she needed. She got all of her transcripts and she had the second chance to apply to medical school since 2010.

This time, she wanted to do it right. She didn't want to leave any holes in her application especially that her undergrad GPA was low. Although better, her third MCAT score was still on the average range. So she wanted it to be an airtight application.

[06:31] Her Struggles Through Undergrad

Nneka graduated from high school with really good grades. In fact, she was a good student. Science came easy to her. But when she got to Cornell University for her undergrad, she realized her study skills from high school were not going to cut it. She was also told during her freshman year that she was going to have trouble getting into medical school.

So she found herself working very hard for a very long time with remedial results. She tried and tried to get her grades better but she just found it very hard. Not to mention, there was a lack of advising during undergrad and the methods she was using weren't up to par.

"In trying to improve, I didn't really sit down and assess what was wrong with how I was studying."

Another things is that Cornell University is in New York, which offers students a great opportunity to get involved both in and out of campus. Nneka was engaged in the student community and volunteering outside of school a lot. She felt she need to have that balance between academics and extracurriculars because it made her feel good.

[09:55] The Advice She Got from Her Premed Advising Office

Nneka admits being bounced around with academic advising. There was a premedical advising dean. And to her, it seems like she had a very clear cut formula as to what students are supposed to take in specific semesters and how the grades are supposed to look. Unfortunately, Nneka didn't find her advice to be encouraging.

So early on, she decided not to listen to her. She understand that some advisors have a tough love approach. But it just didn't sit well with what she had to offer her. Her advisor told her that she's probably not going to graduate premed. And that she's probably not going to get to medical school unless she did things the way she thought were appropriate. But Nneka didn't see it helpful for the way she wanted to take classes or where she wanted to be by the time she graduated.

Nneka admits having been stubborn but it was that spirit of stubbornness that got her into Cornell. She remembers applying to Cornell and a bunch of other schools. Her high school counselors told her not to apply to those schools. She actually threw away her Cornell application but her mom found it in the garbage. She picked it up and yelled at Nneka for it. And so she carried this into Cornell if somebody tells her something they see on paper but they don't know what she's capable of. She was stubborn to disagree with her and what she had to offer but she knew how hard she was willing to work. So she decided to see a different advising dean.

"To be honest, I was being stubborn. But it was the same spirit of stubbornness that had gotten me to Cornell in the first place."

On the college side, there was another faculty advisor assigned. In fact, she had changed advisors three times. It got to the point where they didn't have anything helpful to offer. They were helpful in a way that they were checking in to see how she was doing. But not in terms of knowing when to look for anything associated with a premed conference or how to start studying for the MCAT. She felt lost because she didn't have access to different resources.

She wasn't sure if it was intentional or the system was set up not to be informative. Seeing it now on the back-end, she found navigating in undergrad to be very tough. She was actually surprised that the information wasn't readily available.

And it's basically the reason for this podcast is to help students who feel lost. Nneka doesn't know if the podcast app was a thing when she was in college. Well, she graduated in 2008 and the iPhone came out in 2007. And it didn't have apps on it. podcasts were a thing back then but not as popular as they are now.

[15:00] What She Would Have Done Differently

Looking back on her undergrad time, Nneka would have applied to the College of Arts and Sciences. Whenever she talks to somebody in the application process for undergrad or their premed, she would say the best thing any student can do is apply to a college where the advising is well-stacked for premedical students.

"I know there is the rhetoric that you don't have to be a specific major to be premed and you don't have to be a specific major if you want to be a physician."

When she went to college, premedical advising was not available to the College of Arts and Sciences. She feels other colleges at Cornell had better advising. She actually spent a bit of time trying to transfer out of it. The requirements to graduate were a lot and to add to that, the premed requirements were a lot. So it can be a slight distraction especially if you don't know how to navigate the premed track.

If you're a high student listening to this or at a community college, this is good advice. If you're interested in doing arts and science major, go ask those questions.

[17:11] Her MCAT Experience Failing Two Times

Taking the MCAT, the first time she did it, she remembers going on a trip to upstate medical university and won a free MCAT course. She tried taking it while she was an undergrad. She didn't feel prepared with the content review so she ended up not using the materials she had won until after she had graduated.

When she finally graduated from Cornell, she studied for the MCAT. And she did sit with the content and tried to fill in the gaps where she felt she was missing. This was great for somebody like her who didn't have a strong foundation in her sciences with a poor GPA. Working on that content foundation was a definitely important step for her.

"The general consensus out there is the MCAT is not a content-based test. But you need to know the content to do well on it."

Looking back now, Nneka knows she didn't spend enough time with the questions. She was conscious with her undergrad experience that she transferred this to the way she studied. It was content-heavy. She didn't pay enough attention to analyzing why she got the questions right and why she got them wrong.

When she got her score, she wasn't really shocked considering she was doing it the first time and on her own. But at the same time, she knew it was a place for her to improve on.

"I didn't really pay enough attention to analyzing why  I got questions right, why I got them wrong, and building up endurance on even taking the questions."

The second time she took the MCAT was during her master's program. Her first score got her into her master's program where she did a master's in forensic science in Truxton University. It was an eighteen-month program. And on the second year, there was a bit more time to dedicate what you wanted to do. Nneka says that about a half of the class was premed so a lot of people were studying to take the MCAT individually. At that point, the program for a lot of people was not explicitly postbac premedical. So they didn't have resources for students to use.

So she had to get back to the materials she had and she ended up seeing a tutor offered by the school once or twice for some of the content review. In her heart, she thought she was prepared. But looking back now, she knows she wasn't prepared. Again, she didn't spend enough time with questions.

She actually got a lower score on her second test which she took back in 2010, a couple of years after graduating from college.

[21:35] Getting Support from a Mentor

After failing the second time, she got bombarded with questions from family and friends as to why she's still doing this. But she had already done the exercise of imagining herself in a different role. But she still felt in her heart that she'd still probably be trying to be a physician.

As to why she got a lower score the second time around, she thinks it had a lot to do with not sitting with questions effectively as well as test anxiety.

Before she got her score back, she already applied to a medical school. And she didn't get any interview with that application cycle.

So she studied while applying and took the exam. She sent off her application before receiving her scores. She was confident everything was okay and that she had improved her grades. She thought she was doing very well in her master's and she was confident in that.

"I thought I was dedicating the amount of time that I needed to study. I was "confident" in the fact that I had dedicated time to the MCAT."

But by the time they went out, she had spent time on the secondaries. She had spent a great deal of student money applying and she had not heard anything back. Seeing her scores were a lot worse, she felt so bad that she stayed in bed for two days. She was working in the lab and her PI checked on her. Coming back, she told her what happened. From then on, her PI became her mentor because she believed in her.

"There as always another reassuring voice that echoed what I felt internally. I knew to be true that this was for me and I'm supposed to go to medical school."

She also relied on close friends who were in medical school or graduating from medical school about to enter residency. They were very anchoring and encouraging. So Nneka felt she had a better time with them as a circle of advisors than she did in undergrad trying to figure it out on her own. So she didn't get in but they offered a good support network when she was at her extreme low moment. And they worked together to see how she was going to improve her MCAT score.

[26:15] Getting Kicked Out of School and Working at a Pharma Company

After her second MCAT and failed, Nneka stepped back. Because she had the proper support network to stay positive, she reached out to a faculty administration at Drexel. She tried to find out if there was another postbac program she could participate in. This was, considering that she did so well on her master's program that wasn't geared toward premed students. So she got into their premed postbac program. It was supposed to be two years to do basic science and to focus on studying for the MCAT. She talked to several people in faculty and her friends reassured her that it would look good to reinforce some of the undergrad classes by retaking them. It would be good to show that she had mastery of the intro basic sciences.

And so she got into the postbac program. Unfortunately, there was an issue with Drexel and their financial aid. So she got kicked out of school due to a financial aid mistake. In the meantime, she had to figure out what she had to do. She couldn't afford to work in the lab and not be a student. So she had to get a real job.

Nneka wanted one where she could use her master's degree and an undergrad degree in biology. A close friend of hers worked at Merck Pharmaceuticals and she applied for a job there for contract scientist positions and she got that job. She worked on clinically relevant research in vaccines. This kept her encouraged to still want to pursue medicine.

Seeing everybody at Merck to advance medicine inspired her. Additionally, working in corporate America and the pharmaceutical industry made very clear to me that she wanted to be a practicing clinician.

[30:55] Preparing for the MCAT the Third Time

Nneka's boyfriend was an excellent test taker and he advised her to do questions. She needed to sit with the questions and figure out why she's getting them wrong and right. And him showing her how to do it helped her.

Every morning before work, I would spend three hours doing practice questions. And on lunch break and after work, she would spend that time reviewing why she got the questions wrong. She would cross-reference whether it was because of a gap in content or because she wasn't thinking of the question properly. Additionally, she bought all of the full-length tests to not run out of material.

"I would spend time reviewing why I got the questions wrong and cross-referencing whether it was a gap in content of because I wasn't thinking of the question properly."

[32:55] The Medical School Interview and the MMI Experience

Finally, she got one interview. That's all it takes!

Nneka recalls spending the first half of the day learning about the school, the faculty, and the curriculum. They went on tours. The second part of the day was the MMI format.

"The MMI format, it was geared more towards getting a feel for how you communicate with people."

She practically wasn't able to discuss her struggles during the interview since it was an MMI format. But she was able to speak from an angle of having that desire to want to be a physician and not giving up. After the interview, she felt great. And the interviewer understood where she was coming from, which was the point of the interview in the first place.

Nevertheless, Nneka felt she was able to pull from her experiences to answer some of the MMI questions. You're thrown in sort of these make-believe situations. And she felt she was able to pull some things that she did during her work as a contract scientist and as an analytical chemist. Also at this time, she already had the opportunity to travel to different places and interact with other people. So she got to pull in some of her life experiences to show that side of her. This being said, they got to see that she's a multi-faceted person and that she's more than just the academics.

I want to add to what Nneka has just said. If you received an interview, they obviously know your GPA, MCAT scores, and past struggles. And they are okay with it enough to bring you in and talk to you to see if you're a fit for their class.

[37:00] How Much Focus Do You Put on Your Struggles

Nneka recalls that in working on her personal statement, she showcased that beyond her scores, this is her dedication and her passion for the dream. This is how long she has been serious about it and how long she has been working for it.

"I used the story to help bring them into the mindset that I was in when it clicked that there was no other way for me to go than to medical school."

In writing her personal statement, where she and I worked on it together, Nneka made six drafts. She describes it as one of the hardest things to write since you can't cite anything but your own life. But she's glad that one school gave her a chance. Moreover, Nneka also followed my advice of reaching out to schools before and after submitting.

For the extracurriculars, she spent a lot of time trying to showcase what she added to any experience she was involved in. She showcased what the impact she had on the position.

[40:15] Dealing with the Struggles in Medical School and Her Future Plans

Nneka mentions having that impostor syndrome which is actually pretty common in medical school. But she a lot of the studying techniques that she did as she went to improve on her master's program are things she's relying on now. But she also finds how medical school is a different beast and that if she wants to get better, there's a way to be efficient.

Although she's still able to carry the stubbornness over, she's now reaching out for help a lot more proactively and sooner. Nneka stresses the importance of learning when to ask for help and how to reach out to faculty if you're not understanding something.

"I'm learning to reach out early, sit down with people during office hours, and ask for help."

In the future, she's still uncertain as to what specialty to go into. But she knows that it's good to approach the clinical years and third year rotations with an open mind. this way, you get to experience everything with a full, open heart. So she's looking forward to whatever might catch her interest in the future.

"I'm encouraged to know that it's good to approach the clinical years and third year rotations with an open mind."

[44:00] Final Words of Wisdom

Nneka leaves us with an important note to have that good support system. Make sure you're hearing the things that are echoing what's inside of you. If you know in your heart that this is what you want to do, stick to it. Stay positive. Find the people who are going to sponsor or mentor you to keep you positive and encouraged. If there's anything you need to fix or change, change it. There's always room for improvement for everyone.

Just like I helped Nneka in shaping her application, I can help you with your application too. Shoot me an email at ryan@medicalschoolhq.net. Or check out our website to see how I can help you with your personal statement, your interview prep, or your application in general.

If you're applying to medical school to start in 2018, take a look at our interview with Dr. King Li of Carle Illinois College of Medicine. Find out all of the amazing things they're doing to merge engineering and medicine. Their first class will enjoy 100% free tuition!

Links:

Carle Illinois College of Medicine

The Premed Years Podcast Session 256: A Look at Carle Illinois College of Medicine with Dean Li

AMCAS

ryan@medicalschoolhq.net

Nov 22, 2017
260: This Doc Is Proving You Don't Have to Follow the Rules
28:37

Session 264

Dr. Denise McDermott is a psychiatrist in private practice who is doing things differently. Listen to her story and see what you can do differently on your journey.

Go to www.MCATBook.com and sign up to be notified when our next book will be released. I'm doing a book with Next Step Test Prep. We're publishing The Premed Playbook: Guide to the MCAT.

[02:05] Her Interested in Medicine

Denise wanted to be a doctor even back in kindergarten and she spent until third year in college, challenging herself whether she should do biochem or molecular biology. She got a scholarship to possibly get a PhD. And so she thought it was a better fit for her.

Denise saw her uncle as a huge role model. His uncle is a dermatologist and he was hoping that she would come in to medical school. As a pleaser that she is, she remembers going to her medical school rotations and she did an article so she could shine like a start and become a dermatologist. But that topic just sat in her backpack because it didn't excite her.

"The most important thing when you're going through your rotations in medical school to keep an open mind."

What drove her to pick psychiatry is another story. Denise says that if you're going through your rotations in medical school, you have to keep an open mind. She envisioned herself doing pediatrics. She also loved Emergency Medicine and as she got through the rotations, she got an A in surgery.

Then one day as she went through her Peds rotation, she met a little girl complaining about stomachache. And when she started talking to her, she started telling her she's being bullied at school. She had just moved to the States from Africa. She had other kids just making fun of her skin color. And she told her that she was trying to kill herself that morning and that's why her stomach was aching.

And what happened was all her rotations started being like this.

If you're just really being human and really connecting with someone on a soul to soul level when you're taking their history and they trust you, people will tell you what is going on. The through her internal medicine rotations, a man lost 40 pound and no one knew why. It turned out he was an alcoholic.

So Denise would come out of the rooms and a lot of these patients had a lot of behavioral health issues and some are suicidal. This being said, Denise stresses the importance of picking a mentor that you look up to and see if during that rotation, you can get guidance to really help you have some clear path to make that really important decision.

"Pick a mentor that you look up to and see if during that rotation, you can get guidance to really help you have some clear path to make that really important decision."

[06:02] The Hardest Part of Medical School

Denise describes her first semester of medical school as a huge shift from undergrad. She had straight A's in high school. It was tough for her doing the gross anatomy since she wasn't much of a 3-D learner. So she thought it was really hard.

Her mom knew that she was having a tough time so she drove eight hours to see her. And she brought her this little plant. And she thought how could she take care of patients when she doesn't even know if she could keep a plant alive.

But now, she has three kids, two cats, two rats, a hamster, and a full-practice. And she's now doing all the other things. So even if you go through a tough time, it can get better.

The second other time that was really tough for her was during her first internship. It was first year of medical school transition and she started those first set of rotations. She had a hard time dealing with patients who were dying. And they had thirteen people to die that month and they were supposed to.

Denise says you have to take care of yourself. When you're dealing with that many sick patients and you've never been around that much death, you need to prepare yourself. You need to get out and get fresh air. You need to get exercise. You need to make sure you eat well.

"A lot of times doctors don't take the best care of themselves. Start your routines now and know your own weaknesses and strengths going into it."

This being said, she couldn't imagine doing any other way. She has seen 40,000 hours worth of patients and she has been in the lives of a lot of people. She loves it. She knows that the next step of her career was bigger than her.

[09:39] Where She Leaned Into for Information

Denise explains that she just followed her own inner voice. She had her uncle. And honestly, her uncle discouraged her to go into medicine with all the changes. But at that point, she just knew she wanted to be a doctor and she wanted to help.

Her father's alcoholism and he almost died. He was in the intensive care unit and he had delirium tremens. So she grew up in a home dealing with alcoholism. And seeing her dad  getting sober when he was eleven years old and living for another thirty years was something that inspired her. So she had this natural inclination to take the shame away.

Ever since, all her friends would call her for advice. So as to why she decided to get into medicine. First, she loves science. Second, she loves helping other people. Third, she had the experience of her father getting sober and she just loved helping when people called.

[12:15] Keeping Herself in a Different World

Denise loves her practice where she has two offices. She did this for quality of life. She has been in practice since 2001. She sees 60% children and teens, and 40% adults.

"Make sure you set your intentions of how much fitness you want to get, how much fun you want. Prioritize your family when you're making different career decisions."

Denise also acknowledges the shortage of psychiatrists in the U.S., especially child psychiatrists. There are only 8,300 child psychiatrists for millions of children. So they really need an intervention because 50% of all lifelong mental health issues start before age 14. So if you have any inclination to psychiatry, Denise pleads that you consider adult and child psychiatry because they need more people.

From doing a really lovely private practice, Denise went into this path where she met a publicist and she wanted her to go to CNN. What she did was she built a content-driven site, DoctorDeniseMD.com. It has blogs and videos. She co-produced the meditation and psychiatry documentary this year. She also feels very fortunate to be invited to go to India in 2016 where she went to Dalai Lama's Mind and Life Conference. She got to spend ten days with the coolest humanitarian monk. She went to a children's orphanage and donated money there. She got to see how people are treated in India as well as the holistic approach of prevention, good nutrition, and sleep. Denise is very passionate about holistic health and prevention. She seeks to help people stay out of her office.

And she wanted to meet other cool people, who are movers and shakers in the world. So she wrote out a spiritual missions statement. She wanted to integrate more kindness and compassion into medicine and into everything they do in their lives. And as she started to write these down, she thought of how she can integrate these ideas into schools, and hospitals. It's essentially about being mindful and being kind and loving.

Since she started her podcast, she now has 32 shows. Then she took her blog post and made them into a book called, Mental Health and How to Thrive. And she set an intention to have some blogs about India. She cites the importance of being a western medicine trained doctor to go to India. And so she wrote an ebook about this.

"The goal is to change the way we think, talk, and act about mental health and collective well-being."

[16:28] Cool People She Has Met and Her Biggest Inspiration

Denise's first guest was an MMA fighter, Gary Goodridge.  And many men don't want to talk about mental health. Gary had a depression and dementia because back in the day, he had three fights in one night. So on this journey of doing this podcast, she had interviewed a professional athlete. She's also good friends with an NBA player in China right now who's doing a yoga and fitness documentary. She also met with the oracle of Tibet.

In short, she's doing what she set out to do which is meet other people who don't want to talk about what they're doing but just want to be the change and inspire one another. So she cut back her practice to do a much bigger calling. And for her, the biggest teacher in her life right now is her son who has inspired her to take care career to the next level. She adopted her son at birth.

"I'm walking the walk. Not only am I a child psychiatrist who trained at UCLA... but then I went eyes wide open into adopting this beautiful boy."

For people with different learning styles or behavior, Denise doesn't like the word "disorder." It was very illness-focused instead of wellness-focused. But she now likes to use words like neuro style. The other thing she had done is that she has always imaged assets with different words that vibrated on a non-judgmental level. So she wants to reach people on a global level.

[19:10] How You Can Figure Things Out as a Premed

Denise highly recommends starting your LinkedIn account. Build your brand now. Pursue something you're passionate about. It doesn't necessarily have to be medicine-focused. If you're really working hard at your academics and churning out the A's you need to or doing your fitness but you want a creative outlet, you can start your own show at any time. People are doing YouTube videos at such young ages. Be true to yourself and don't do it just for the sake of doing it. But do it because that's what you want to do.

"When you're studying that hard to get into medical school, you need to take care of yourself. The more you take of yourself, the better doctor you will evolve to be."

[20:30] Dealing with Negativity and Getting a Strong Support System

Denise says her husband has always called her a corner case because she doesn't talk about what she's doing to other people. Growing up in the mid-west, she was brought up not telling a lot of people. She doesn't pitch herself. She hasn't had any resistance but by the nature of her being on her own solo, she hasn't drawn attention to it. She's just happy for having amazing colleagues but she thinks that if she had been working full-time at Kaiser or something, people would probably judge her. But she wants people to understand that her site offers a lot of education.

"For people who can't afford to come see me, you will find so much information on my site  - what to do, what to expect. I feel like this is an act of public service."

Denise's husband is very supportive of her. He works from home and has done some startups. An incredibly devoted father as she would describe him, he is at home at all times. And she is very happy about this since they have the flexibility they wouldn't have had if he was working 9-5. But the way their family system is lined up is they set their priorities to be there for their kid.  So when she went to India, he watched over their son. And she's just thankful for her husband for helping her out, including the tech stuff, and for believing in her.

[23:45] How She Sees Medicine to Fit Into Her Life

Denise hopes to keep her long-term patients. She just turned down 25 new clients in the last month because she was pitching a show. So she sees herself continuing seeing her existing patients. And she hopes to see them about two days per week.

Additionally, she's very passionate about getting the word out . She's about to do some YouTube videos with her childhood friend who won an Emmy for her journalism. And they're just about to record their first podcast, Staying Sane. So she's doing this aside from her other show, The Dr. Denise Show. With all the crazy things happening around us, she wants to take what her friend knows as a journalist and what she knows about tips in mindfulness and mindset strategies.

"I really want to reach a global audience. I see my private practice being there but I see that this other part of my career is really where it's at right now."

[25:40] Final Words of Wisdom for Premeds

You need to make sure this is the right path. She remembers this man named Trevor in her medical school class and he got into third year not wanting to be a doctor. He was doing it due to family pressure. So he picked a career path based on what his parents wanted him to do.

"Really make sure that this is what you want to do, not what someone is telling you what you should do."

That being said, know that everyone struggles. Everyone doubts themselves no matter what kind of incredible grades you're getting. You're going to have a tough day. Remember that it's not always going to be positive. You're not always going to get the A's that you're maybe used to.

Having played varsity soccer all four years in high school, her athletic mindset of discipline and perseverance has really helped her through medical school and through residency and fellowship.

[27:05] Sign Up for My New Book!

Don't forget to go to MCATBook.com and sign up for the wait list to be notified when The Premed Playbook: Guide to the MCAT comes out. It's coming out soon!

Join us next week as I talk to a student who went from a 2.7 undergrad GPA to now being a first year medical school at an allopathic medical school. I know some of you are still worried about getting into an MD school versus a DO school. So stay tuned.

Links:

www.doctordenisemd.com

Mental Health and How to Thrive

www.MCATBook.com

Next Step Test Prep

The Dr. Denise Show

 

Nov 15, 2017
259: How Can I Improve My CARS Section Score on the MCAT?
43:08

Session 259

CARS (Critical Analysis and Reasoning) on the MCAT seems to give students the most trouble. Jack from JackWestin.com is here to help you crush your CARS and score higher!

Check out our new podcast, Ask Dr. Gray: Premed Q&A. The episodes have actually been recorded on Facebook Live, which I do when I'm home in the studio at 3 o'clock Eastern. Join me on Facebook Live.

I'll answer your questions and hang out there usually for 20-30 minutes. And few of those minutes are set side for the actual recording of the podcast. Also, don't forget to subscribe to Ask Dr. Gray Premed Q&A.

[01:25] The AMSA PremedFest Experience

Last weekend, I was at AMSA PremedFest in Tampa, Florida. I gave a talk at the event on the medical school interview to an audience of about 120 students. It was a room full of people with tons of great questions. After my talk, I stayed for another 45 minutes to hang out more and answer more questions. I also gave 60 books and had a great dinner meetup with fifteen people. I wish to thank those who met me there. We had people coming from California and Indiana.

I would love to meet you at the next conference I'm going to the MAPSS Conference of California State University in San Bernardino on January 27, 2018. Hope to meet you there! If not, here's a list of other conferences that I will be attending:

AMSA PremedFest UC Davis Conference in October 2018

AMSA Convention in Washington, D.C. in March 2018 [03:20] Crush Your CARS Section on the MCAT Jack Westin is helping students of all shapes and sizes as well as all skill levels to improve their CARS (Critical Analysis and Reasoning) Section on the MCAT. It's the new version of verbal reasoning, which used to kill people on the MCAT. CARS still kills people on the MCAT, especially if you are an ESL student.

Today, he's going to share with us his thoughts about ESL students and the CARS section. He shares with us how to best prepare for CARS, the biggest mistake students make with CARS, and so much more!

Stay up to date with any future deals or specials for his CARS training on www.medicalschoolhq.net/jackwestin.

[05:16] Who Is Jack Westin?

Jack describes himself as someone who seeks to help students get to the next level and get into their dream medical school. He helps you get there whether it's through CARS or the MCAT or just advice in general. He want to be looked upon as the older brother or the mentor that you may not have had.

Jack says he has never liked memorizing even as a premed. And he thinks that CARS is one of those sections where you don't have to memorize a thing. You don't have a know a thing from the outside other than common sense. It's all logic and based on critical thinking. It's very intellectually stimulating. Jack admits the reason he has done this for so long is because it challenges him to explain very difficult concepts to very smart students. And he finds a lot of joy from that.

"CARS is one of those sections where you don't have to memorize a thing. You don't have a know a thing from the outside other than common sense."

[08:08] What Is CARS? Why Is It Important?

CARS (Critical Analysis and Reasoning Skills) is basically another way of saying, read the passage and answer questions based on the passage. It's only one of the four sections on the current MCAT.

You have 90 minutes to complete a total of nine passages with about 53 questions.

Jack lays out a couple of reasons why this particular test matters. First, it's a test to see how committed you are to medicine. If you're simply interested, this entire test will eat you alive, as Jack puts it. You're not going to want to study for it. You're going to stress out and give up eventually. So they're putting this test out there to test if you can really study for four months and endure a struggling exam.

It's a very difficult time in your life. But this can result in a lot of good outcomes. You're going to become stronger, wiser, and smarter. So it's a good way to test whether or not you really want this.

"It's a test to see how committed you are to medicine. Are you committed or are you interested?"

Another reason CARS is important is that it's based on thinking on your feet. And as physicians must do, they must be able to think on their feet. You're given new information you've never seen before. And you're supposed to use that information to help your patient or solve the problem. So that's another component of the exam.

[10:40] How Soon Do You Need to Study for CARS?

Jack says you can start studying for CARS immediately primarily because it doesn't require any science knowledge at all. As long as you can pass 12th grade English, basically a senior in high school can start studying for CARS.

Jack recommends students to look into this sooner rather than later as it doesn't hurt to start reading everyday. It doesn't hurt to getting accustomed to reading text. Just reading everyday can drastically improve your score two years down the road. This being said, Jack explains you don't have to read three hours a day for two years. But it means picking up, say The Economist or The Atlantic or any of those journals. Or even simply reading on things you may not be interested in can help you.

"It's something students should look into sooner rather than later. It doesn't hurt to start reading everyday."

[11:56] Understanding the Author

Jack says it's an innate thing that you require through practice. You may not know what is going on as you're reading those journals, but over time, you're going to get a sense of the author.

"You're going to start understanding what the author is trying to convey and that's a great starting point."

When you want to actually start practicing, Jack mentions a few things to look for. First, what is the author trying to tell me? Every single passage or article you've ever read in your life, there is a message. And you need to find that message. Understand why the author wrote it. Find out what they're trying to convince you.

The CARS section is designed to test whether you understand the arguments of the author. As a physician, your job is to understand your patients. You may not understand them all. Some may not know English or maybe they know English better than you. So it's your duty as a physician to understand your patient. And that's what they're trying to get you to with this section. Can you understand the author?

[13:34] Prepping for CARS = Prepping for the Rest of the Test

Comparing both tests, Jack considers the SAT to be a lot easier since it focuses more on vocabulary and not as much as ideas and thinking ability. Still, there is a component to that. For him. MCAT is the harder version of the SAT in terms of reading. The passages are denser. The questions are a lot more difficult. But it's not based on vocabulary.

If you're worried that English is your second or third language and that you don't read a lot or your parents didn't force you to read or don't like reading, you don't need to. Jack stresses it's about being how sharp you are. If you are sharp then you're going to do well. You're going to understand the pattern of the test, especially for CARS since the whole test is reading-based.

"It's how sharp you are. If you're sharp then you're going to do well. You're going to pick up things."

Jack adds that even though CARS is all-reading, the other sections involve reading too. You're going to be reading passages for the other sections. And that's the name of the game. Can you read and understand things on the spot?

[15:00] How Can an ESL Student Prepare for CARS?

Historically, the MCAT destroys ESL students. As an ESL student, you may struggle with this section the most. But Jack says it's not because of the reason most people think, which is because of their reading ability. Rather, it's more about their confidence.

"If you're not confident, you're not going to do well."

So what Jack tells his students is you don't need to know these words. You don't need to know what the sentence means. If you can understand the gist or the tone, then you can answer all the questions.

If you're an ESL student and doesn't like the CARS section, that's okay. But that doesn't mean you can't do well. Jack has students from various countries that barely speak English and they ended up doing very well. They got 127 or higher with consistent effort and practice. They may need a bit more time to get used to things like an extra month of study time. Jacks adds that if you can read someone's Facebook new feeds or comments or just basic English, you won't have an issue with reading. It's more of a confidence issue.

"Overall, I don't think your reading ability is going to stop you from doing well on this entire test especially for CARS."

To start building that confidence, Jack recommends daily practicing. Because when you're doing this everyday, you won't be thinking that you wished you practiced more. It's like taking an exam. If you practice and tried your best, then you're not going to sit there during the exam and ask yourself why you didn't try harder. So try everyday. Work on reading. Work on understanding what the paragraph is saying.

[17:44] What to Read and Why Students Blank Out on the CARS Section

Your textbooks don't count. You have to read argumentative articles and dense, boring things. Read about things you may not be interested in because those are the kinds of things they'll put on the test. So it's about being accustomed to reading boring stuff. Also, pick up things you may not necessarily read often and try to understand it.

"Your textbooks don't count... You've got to read things you normally don't want to read about."

What you see on the CARS section are boring passages. The reason students blank out halfway through the passage or at the end of passage is because they don't like what they're reading. Second, they're uncomfortable reading it since they're being timed. So there's too much pressure on you.

But if you prep yourself with what you're going to see on test day or how you're going to feel on test day, then you're ahead of the game because you know what to expect. And if you know what to expect, you'll probably do well.

[20:00] Being a Slow Reader: Is it Good or Bad?

Way back in the days when the MCAT was still on paper, we had the verbal reasoning instead of CARS. And there were only three sections instead of four. I got 10 in the sciences (old scoring system) and a 7 in verbal reasoning. My excuse to myself is that because I'm a slow reader.

Interestingly, Jack points out that being a slow reader is actually a good thing. You want to be a slow reader. He clarifies that reading slow is not a bad thing. Half the battle is understanding what the author is saying.

If you're reading too fast because you're worried about the timer, you're not going to understand the author. You're not going to pay attention. You're disrespecting the author. It's like having a patient come into your room and you're looking at the clock. You're not paying attention to them. You're not giving them the time they deserve. So you need to slow down and actually understand the author. Understand what's going on.Jack adds that half the battle is training the students to think the right way about this test and changing bad habits.

"It's like having a patient come into your room and you're looking at the clock. You're not paying attention to them."

Moreover, when you read a sentence, read it like you normally would. If you read it at that pace and you don't get it, that's not your fault. That's the MCAT trying to scare you. They're trying to intimidate you so just move on until you understand. So no slower nor faster can dramatically improve your score.

For instance, when you don't understand a sentence you're reading, re-reading it is a mistake. Jack explains doing this would be wasting your time. You're doing what they want you to do. When it comes to answering the questions, there's only five to seven questions per passage. So you don't need to understand each sentence, but only 25% of a passage to get everything right. The key is to know what to look for, how to look for it, and how to use that information to answer the questions. Being a scaled test, all you really need to get into medical school is 129.

[24:26] Breaking Down the Anatomy

First, Jack wants you to understand what you think the MCAT or the AAMC wants you to do. Why would they put the passage on the left side if they want you to read the questions first. This said, Jack recommends to be normal when reading it. Just approach it how you normally would. Don't do any tricks - first paragraph and last paragraph. Don't read the questions first. Jack sees these as mistakes because that's not what the test wants you to do.

If you literally read the direction, they say read the passage and answer the questions. So just read the passage. Understand the author. Then use that information to answer the questions.

[25:44] The Most Common Mistakes

Jack says the most common mistake students do when prepping for CARS is using the wrong material to practice. Non-AAMC material is decent practice if you're two years ahead. He further says that nothing comes close to reading and answering the questions the AAMC provides. They have a bank of questions you can buy on their website.

Another big problem is students love to save material for the end. That's your lecture material, the stuff you need to use to learn. If you're saving that stuff till the last week or two, you're, in effect, cramming. No one does well when they cram for this test. So you need to start looking at the AAMC material.

[28:03] Getting Started with Your Prep Journey

First, Jack advises students to read often. Read boring stuff. Buy the AAMC materials and start looking at those passages. Start reviewing them. There's a pattern that the AAMC follows. They're a very logical, unique pattern on'y developed by the AAMC. So start to find those patterns early on, even a year in advance. It's something you can do everyday for 30 minutes which can dramatically improve your confidence and your score.

Another tip Jack has shared is to time yourself when you're reading. Then you'd have an idea to read it in that time. But don't rush yourself. Don't try to finish in that time. The reason for timing yourself is simply to get used to that timer. Time yourself so that you don't get nervous when test day comes around.

Have a warrior mentality. Jack admits you have to do so many practice passages and timed passages so that over time, your brain gets accustomed to it. You don't necessarily need to write that data down. But the act itself is actually changing your habit and the way you're adapting to this test.

"It's more about adapting to the style of the exam that's why you're timing yourself."

A good thing to do after each paragraph is to write what the paragraph is about. What is the author trying to convey in this paragraph? In the very general way, write it in a way you explain it to your best friend or family. Make it very informal. Write down two to four words that describe that paragraph. Figure out the main idea. Jack says this is a great strategy you can use both during prep and on prep day.

"Don't write down the details. The MCAT doesn't test the details. They test for big ideas, big picture."

[33:03] The Power of Visualization

Jack mentions one thing most students don't do is they don't visualize what they read. When you read a sentence or word, what comes to mind? Does it register? If he said the word "elephant," what's the first thing you imagine when you see an elephant? Now what do you see when Jack says the elephant is flying? What's that picture in your head? So what you should see is an elephant with wings flying in the air. What you shouldn't see is an airplane.

You're essentially morphing your visualization based on the next word. Not only is this helpful for the CARS, but also for the sciences because you're given a lot of experimental passages. You need to visualize pathways. And getting used to thinking that way is essential and critical to your success.

Moreover, I know somebody who's a wizard in memorizing long digits. And he says that people that can memorize a deck of cards or long digits visualize every piece of data. That said, visualization is huge for keeping things in memory a little bit longer.

Jack likens this to reading a book wherein your turning the page because you're so immersed in it. You see the character. You see the plot. You understand what's going on. You visualize it. And when you see the movie, normally, students don't like the movie as much as the book if they've read the book first. That's because the director's vision is different than what they pictured.

"Not only is this helpful for the CARS, but also for the sciences because you're given a lot of experimental passages."

[36:15] What to Expect from JackWestin.com

The course is designed to not only help you in CARS but also to help you understand the MCAT. It helps you understand the logic of the test and what you need to do in order to do well. The course helps you understand your job as a student and what the MCAT expects from you. Through this course, you get to understand questions you're not accustomed to. As a result, you become smarter, less biased, more logical, and an objective thinker. This can even help you in your Step 1 or board exams. In any case, this can help you with any test you're taking in your life. You're essentially learning how to look at things in a very objective manner.

Jack's course is a very self-paced oriented course. He recommends that students take it around five to six months in advance before they even start studying for the MCAT. Give yourself more time so that you're not pressured or stressed. The last thing you want to do is rush so signing up sooner will allow you to gain the skills you need to tackle the entire test.

Other services Jack offers are CARS practice exams. That said, he still doesn't think anything comes close to the AAMC. So again, use the AAMC practice exam as your primary resource. But having been in this business for ten years, he has been teaching a long time and has so much experience with students. So he thinks he really understands what they're trying to get at. So he believes his questions are very similar, if not identical, to the logic they use. In the coming weeks, it's free for students to use.

Jack also offers CARS Passage of the Day emails where you get an email featuring a CARS passage of the day that looks like what you're going to see on your test. Subscribe to that free email list if you want to practice reading passages everyday. One a day for two years is going to be insanely helpful.

[40:05] Jack's Final Words of Wisdom

The CARS sections is not the be all and end all. If you don't well in this section, it doesn't mean you can't get into medical school. So if you feel you really can't do well on CARS, shoot Jack an email as he can show you the way to get into medical school. There are other ways to get in other than having a high CARS score. With that being said, he still believes everyone can do well on CARS. Whether or not you sign up for the course, speak up if you're having problems. Get the help you need. Don't avoid your weaknesses. Don't go into the test unprepared. But if you can devote yourself for three months and try your best, you're going to be okay. As long as put in the effort, did the practice exams, and you tried your best to understand your weaknesses, you're probably going to do well.

"No one will be fully prepared. That's another thing you have to realize. Everyone is stressed out equally."

Lastly, please share this podcast to your friends. Do them a favor of subscribing so they get this episode every week on their phone.

Links:

www.JackWestin.com

www.medicalschoolhq.net/jackwestin

AAMC Practice Materials

AAMC CARS

Ask Dr. Gray: Premed Q&A

MSHQ Facebook Live

AMSA PremedFest in Tampa, Florida

MAPSS Conference of California State University in San Bernardino

AMSA PremedFest UC Davis Conference

AMSA Convention in Washington, D.C.

Nov 08, 2017
258: Director of Admissions Talks About the Admissions Process
56:44

Session 258

Stephanie Petrosky, Director of Admissions at Nova Southeastern University - Dr. Kiran C. Patel College of Osteopathic Medicine joined me to talk about how her team reviews med school applications.

Check out our newest podcast Ask Dr. Gray Premed Q&A. The episodes are basically taken from our daily Facebook Live where I answer questions. Also, take a listen to our other podcasts on MedEd Media.

A couple of months ago, we did a behind-the-scenes look at the TMDSAS application service. It got some great feedback from students. We're doing the same today, this time, with a medical school. Specifically, it's an osteopathic medical school.

[02:45] Becoming the Dean of Admissions with a Business Background

Coming from a business background, Stephanie cites being able to bring a sense of customer service and customer focus. You have to have an eye for business operations. You have to be able to look at systems and process since it has a lot of translations to other business models. The biggest challenge is being able to translate the needs of the students in this professional program.

In general, Stephanie describes this as a career progress for somebody who's just really been out there creating success. People who want to be in a position like that would really emerge as a leader and keep issues on the forefront. There also needs to be attention to the potential and future business needs.

"Traditionally, physicians are trained to be physicians."

They're not trained in these complex scenarios of running large academic organizations. Or maybe in the accreditation process of how a school maintains its status and how it moves and improves through the use of trending and data. So this is data analytics. Not to mention the attributes important in the business sense and on the financial end. That said, it takes a complex setting and skills. There are deans of admissions that come into the setting where they are the physician. Then they also have some natural skills that can be trained and developed along the way more in succession planning. So this may work too.

But even though she's not a physician, Stephanie admits having very strong healthcare background. She has been a colleague and a friend among physicians for all of her career. The other piece of it is the modeling of the education process. Even in their college, they have a lot of physicians in their faculty. But they also have education experts who have high credentials and experience in the development design of education program. Stephanie describes it as a very complex school and a complex array of leadership that helps them on many different levels. Their physicians are intimately involved in meeting their candidates and setting criteria. They help them look at data together with the faculty. Non-science, physicians, clinicians, researchers, they all get together and look at it from their point of view when discussing files and choosing the best student that works in their program.

[07:20] Nova Medical School Has Got a New Name

Nova Southeastern University College of Osteopathic Medicine has changed its name to NSU Dr. Kiran C. Patel College of Osteopathic Medicine. The college is a recipient thereby to the Nova Southeastern University of Dr. Kiran C. Patel who made them a significant gift to the university. With that, they're going to help the school build a second regional campus in the Tampa area. This will house many of NSU's health profession programs. But they're going to keep everything consolidated. So through the normal process of applications for all osteopathic medical schools, they use the AACOMAS system. It's a universal tool that all of the colleges participate on the national level. That's the first step in the process.

They are still going to stay at the main campus in the Fort Lauderdale, Florida area. And during the admissions process, everything will be coordinated through their main campus. It's under the direction of their current team and structure. They're doing more interviewing and processing of applications.

"Even though our name is changed, nothing about our values and our location, our people have changed."

[09:55] Behind the Scenes in the Application Process at KPCOM: From AACOMAS to the Medical School

According to Stephanie, think about it in more of a checklist or step-wise process. An applicant is preparing to apply to medical school several years before the day actually comes that they hit that Submit button. Applicants can do to connect with Pre-SOMA or pre-application of advocacy groups. They can even reach out to schools to learn who may be that person to help guide them in the application process. Look at the websites and try to educate yourself on the steps.

From a school level, Stephanie says they don't get involved until the applicant has completed and submitted the application through the AACOMAS systems.

"That involves really understanding the software. There is a huge pipeline involved to the AACOMAS process."

Stephanie explains there's a third party vendor operates the application system for all the osteopathic medical schools. In that, the applicant has to attach all of their documents and pay the fees accordingly. They can designate certain schools so they can do it one time and they can just have the applications sent to all the different areas they prefer.

Then on the back-end, Stephanie describes being in the waiting zone. They have an interface with the AACOMAS system at the school level. So they can actually see who might be in process or who's now completed but waiting to be verified. This is another step that hold things up.

[12:57] AACOMAS Announces Faster Verification Turnaround

Having returned from the OMED Conference and got a first-hand update. AACOMAS is saying that their verification turnaround has gone down to about two to three days on average. This used to be weeks of people double-checking transcripts and everything. This is great news in the system.

So once the applicant is in the system and has submitted, this verification timing could delay or up-regulate if there's a lot of good documentation sent in advance. But they don't even see this application, until everything is submitted and has been verified by AACOMAS. And once a week, their school "goes to the mailbox" to check and download system to system. They don't receive ongoing downloads. They do it once a week by the volume of applications they take in for all their health profession programs. Wednesdays as their designated day, they go in and check for all of the status changes in applications that have now been verified and ready for the school to pick them up.

[14:15] KPCOM's Application Cycle

Then they do an internal process of them collecting all of the additional pieces. The secondary application is sent out to applicants once they have the application from the AACOMAS site. So they fill out all the more customized information for NSU and the school they have. And they also have to submit letters of recommendation or any additional attachments that may didn't get into their original application.

For instance, they understand that faculty and physicians are busy as much as they want to help applicants. So sometimes, the application is ready to go and they would hate for an application to be waiting. So she would usually advice students to go ahead and submit and then send the letter of reference directly to the school. Then they would match everything up, check off the checklist. Once it's ready for review, then it's expedited to their admissions office. And their admissions counselor will be down with their reviewing process. This is when they apply their criteria and some of the characteristics they really feel are good match for their program.

"From there, decisions are made out of certain number of applicants that we are targeting to interview."

They have a certain schedule of interview dates and certain number of seats they can offer. Then they begin the interview process, which goes on all the cycle. They work in a rolling admission process. So from May 4th when AACOMAS application opens, they start interviewing and calling people about mid-August. Their secondaries don't go on until June. And by that time, they're just sending out invites all the way through February or March. The year is almost complete in activity for them.

[16:32] What's Happens on the Back End

What they find on the back end are those that are late to the cycle or they interviewed but they weren't the first offers that came back from the school but they're on the waiting list. Then you start the formal deadlines of maybe somebody who may be in an allopathic program or away of the state. And now, they're considering offers coming closer to home and they're making their final decision. It's a very tensed and stressful situation so Stephanie feels like she's working at a booking agency at the end of the year.

"It's very tense and stressful. It's almost like I feel like I'm working at a booking agency at the end of the year."

So it's in the end of the cycle that they see a lot of movement and that's when the fun starts. These are the candidates they get to contact that they've really been diligent in staying in touch with the school. They've been able to rank them and put them in order they know they're going to come back and get them. Typically, they see 50-60 drops at the end of the cycle. These are people who have given them their full deposit and they've reserved their seat all the way through that process. And then at the last minute, life happens or they need to defer or for some any other reason. This said, Stephanie says there's a lot of settling on the back end of the year. It's gotten less and less but it's a good opportunity for a candidate who may not be strong in the academics to attract that offer right upfront. But they have shown perseverance or they've gone back and strengthened their application by adding an update. They have updated their academic record to show them your perseverance.

According to Stephanie, their goal all the time is to find the right balance of students with drive, tenacity, passion, heart for medicine but can complete successfully the rigor of the academics.  They also found that by using their magic formula with what they're looking for in applicants is that they have had a tremendous success at helping the students avoid the failures. They move on together collectively and get past their board scores.

[20:20] Number of Applications Coming In

In the last few years (except 2016 and 2017), there has been a huge upward trend. The osteopathic medicine has really been a very strong profession program that has been drawing a lot of candidates from other areas. But they've seen the peak nationally. Then the whole other piece of it is that everything stops. When things go up, they kind of rescind a little bit. And there are new trends within the health professions and the academics.

Two years ago, they had over 10,000 applications. This year, they have about 9,000 applications. Last year was a small stabilization. They didn't grow nor drop. But this year, they're looking at a bit less.

[21:47] Looking at the Secondaries

They have an established process that they follow being in a university scenario. They have applications done on a secondary basis. Once the application is complete, they do not evaluate, which means the whole review process can delay an application. So leave it up to the applicant to decide, based on their criteria. But pretty much, it goes out to everybody who has submitted a complete application.

There are about 1,200 or so that start their application but don't submit it because that's the part the applicant usually has to pay a fee for. So sometimes people would designate and they can see those applications on their side in the AACOMAS. But they don't pay the fee unless they submit and go forward with their applications.

The same thing is true on the NSU side is they have the opportunity to submit an application and secondary if they've gone that far to apply to NSU. They typically want the secondary as well, which is a smaller fee. At KPCOM, their fee is $50 for the university to cover the processing of it internally. Then they look at the full complete application together to decide whether this is an applicant they're interested in interviewing and meeting.

Additionally, the option of wrapping the secondary into the primary application has been given to them. Stephanie thinks this would be ideal because it's mainstream from an applicant perspective. The downside, however, is that there's so many different processes. Not just AACOMAS but all of their application services. They're interfacing with so many different programs and so many different universities and policies and procedures and processes. It's mind-boggling to think how this could be streamlined. That said, it's an option. At their university, they could participate in the wrap around. But their university does not control their final handling decisions being under a big university. They have a division of enrollment student processes which already make the decision. Hence, they decided to do it separately.

"Sometimes the school is subject to larger operating procedures and decision-making that may not be in our hands."

[25:28] Apply Early!

Stephanie advises students to make sure they follow directions when they enter in the AACOMAS portal because there are a lot of details. Really watch the time frame and make sure to apply early. There's always a group of students that the minute midnight strikes, they're in the application system. The big bulk is out there. 75% of the best applications or the most competitive applications are out there. But there's a great group of applicants that tend to come into their attention in between January and March. It gets her because they're really great candidates but they just apply right before the deadline. At this point, their response would be there's no room. So they're put on the list as soon as they'll have the cancellation. You can't be offered admission if you don't interview. So it's about managing the interview opportunities.

"They're the ones that just apply right before the deadline and it just gets me every time because they're really great candidates."

Having gone from the conference, Stephanie has interacted with admissions officers for two days. They're all telling her they set their schedules in April and they're interviewing pretty much all the way through January or February. And final decisions are already out there.

There was an occasion that they added four more rounds of admissions interviews late in April. It was an interesting place for her to be because they had all these candidates who were still open, active, and waiting to hear And it was late in the season. They were all willing to pay the money. They came to Fort Lauderdale and spent the whole day with them. They fell in love. At lunch, Stephanie let them know that they wouldn't have invited them there if they weren't really holding seats for the right candidates. So it was important for the students to let them know of their top choice. And they look for that during the whole day.

[28:09] It Goes Beyond the 30-Minute Interview

People think that they just have to pass that 30-minute interview window. But when you come to campus, the minute you show up to the time you leave, everybody's collecting feedback. Stephanie points out they do a 360. They want their student ambassadors to be involved. They want their faculty to be involved. Most of the time, their dean goes to meet the candidates and she writes the seating chart. She puts all the names down. And she would observe the behavior of students. There's always something that can come up as an opportunity. So she advocates for students to stay engaged. Find somebody at the school that you can chat with. Find a way to be personable. So when you're afforded an interview, take advantage of that 100% and tell people you love this school. This message gets over to the admissions committee.Moreover, this is just the logistics of the application. Stephanie explains there's a lot more to it after the interview has transpired or even what happens if you don't get the invite.

"People think they just have to pass that 30-minute interview but from the minute you show up to the time you leave, everybody's collecting feedback."

[30:47] For the Nontraditional Students

Stephanie says that the nontraditional students are becoming a standard these days. So she her advice is that if you really want this, never give up on your dream. Life is what makes who you are special. And the most interesting candidates that come to them are those that had a rich experience in life and been able to turn that around and become competitive.

There's also a lot of interesting things happening to academics where students in dual admissions programs or articulation programs that brought in the undergraduate world. 50% of their students are in the nontraditional category, about 26 years old on average.

Stephanie looks for the distinguishing story since every candidate has a story. Moreover, Stephanie stresses the importance of finding your story and see how you fit in that school. Look for schools. You may go to the AACOM website which shows all kinds of matriculant stats that you can look up on data reports. They show you the volume or trends. It's educated to be an educated consumer as Stephanie puts it.

"It's really important that as an individual and an applicant, you try to find your story and see how you fit in that school."

[32:35] How to Make Your Application Stand Out: Higher Sciences

With the sheer volume being translated who completed their application and checked all the requirements off, that limits the pool now down to 5,500. They know the numbers in order to yield the class size that they have. Usually, they have to interview about 3 candidates for every seat. That's somewhere around 700 applicants that they're looking to meet. And out of 10% of the first application pool, it's quite a challenge. So you have to put some minimum criterion. And if you're not meeting the criteria, you really need to find a way to stand out. Because even though their guidelines allows a dean to make a variance, it's also an accountability to their crediting body. They have to tell them and put on file that they've not followed their own policies. And so that might get everybody into trouble. So their criteria are mostly set at an achievable level. And candidates should at least try to maintain that.

If your GPA is 3.02 and just over the minimum criteria, you're really going to need some inside guidance. Find a way to connect with the school you're seriously interested in and go visit. Find the name of somebody who can set an appointment with you. Spend 30 minutes just talking about your file. Then do what they tell you to do.

As Stephanie has mentioned, she takes a personal approach to making it very transparent. She will open up somebody's file with them on the phone and discuss how they can strengthen it. Most of the time, it's going to be higher sciences. If you can show your academic rigor in microbiology or immunology and really come away with a good grade on that, that might lessen the impact. For instance, your let the sciences slip during your second undergraduate year because you were just having too much fun.

Stephanie adds that the biggest conversation she has that's most common is they know they've messed up but they really want to go to medical school. And they know they've got a bunch of things in their undergraduate career they've got to fix. If students started out of high school with 100% mindset on doing it, then they're going to miss out on all the fun of undergrad. So it's constant balancing and taking and giving of what life brings to the candidate.

"Try to judge, this is where you are, this what you have, now, what can you add that will distinguish you?"

[35:47] How to Make Your Application Stand Out: Volunteering, Scribing, and Scholarships

Besides higher sciences, find volunteer work or work with a physician. In their case, they love how you work with an osteopathic physician. They need to see you have the heart and translation of the whole philosophy osteopathic education. They're really looking to see that emulated in your application. And it comes out. So it's easy for them to spot.

Also, Stephanie mentions that scribing is a great way to get into the business of medical care. There is exponential growth in the candidate’s ability to relate, to grasp, to express themselves. Because all of this is part of what they're going to look at in an application. So they screen by GPA and by MCAT to have some minimums. And then they may have some stratification based on what the results are.

They also look at whether you're coming from an underserved, minority background. Maybe they just didn't have access to tutoring and skills. It may be an opportunity for someone to showcase a scholarship or even an agency they've been working for on a volunteer basis to help explain.

[37:11] Master's Degrees and Postgraduate Coursework

Stephanie goes further by saying that Master's degrees and postgraduate coursework are very good application enhancers. So if you didn't do so hard in the sciences and got a very moderate GPA. Again, science courses are only a big part of the application they review. They suggest going ahead and proceeding into a Master's program. It changes the students ability to really get into the track for medical school.

Stephanie explains that most of the time, people come to the table saying they're weak in the sciences, particularly those who would pursue their master's. But she has seen some really interesting master's and a variety of programs that show a whole different side of that. They happen to be a provider of an MPH program. So candidates interested in NSU, if they get involved in their MPH program, they've already demonstrated an affiliation and an interest in NSU. And they've gotten to know them. In fact, some of their faculty from the DO program teach in the MPH program and vice versa. So for them, an MPH program is a really good thing.

But the issue is it doesn't take care of the science problem, if that is really the problem. So you want the student to be also working on the coursework. Harvard Online has that as well as University of New England specializes in online prehealth prerequisites. She thinks it enhances somebody's academic resume.S o even though people have traditionally gone through a program and attended a university with the online program available, you can be doing a couple of things at the same time. Nevertheless, the C is a requirement for their individual science prerequisites. But if you really want to show that you now have got it together and you're a matured student. You figured out your learning style. You know your personality. You know how to balance. And you're working now and you're gaining this experience so you're able to apply what you're learning.

"Going back and repeating a course to augment that grade in the transcript is a good tactic. "

[40:30] AACOMAS Rules and More Tips to Improve Your Application

The one thing that's killing everybody this year is that AACOMAS went through a major change in how they're recording grades. Instead of grade replacement, they're using an averaging mechanism. So it makes it much harder to get people's GPA up with that kind of strategy. But they look at everything. So even though your prerequisite may be one degree and then  you have another A in replacement in the file, they will see it. They can see an academic coursework over four to six years. And they can see where the candidate has really been. This can become a part of the context during your interview. Any way you can demonstrate that is going to tell them that you're ready for medical school.

"Their ability to handle and recover and be resilient is really what we're looking for in the application."

Additionally, just continue to show in any kind of community service. Their school is big on community service. So they really like to see a variety and not just what happened in the undergrad. The want to see that you're intentionally deciding that you're an advocate for, say, abused women. And that you've been giving time at a free clinic for rape victims, for instance. There are lots of ways a personality can be expressed.

"We are looking for diversity. We are definitely looking for strength and this well-rounded candidate where the character can be seen."

Take your time with your application and ask people for some feedback. See if an objective person could see the same thing that a candidate from the inside is thinking they've put together in their application.

[43:01] Are You Worrying About the Merging of ACGME and AOA?

In the MD world, the postgraduate training is merging (ACGME and AOA). When a student is looking at applying to MD and DO schools and thinking about that postgrad training, Stephanie advises to think of it in terms of the medical school. Does one medical school rank higher over the other when it comes to residency?

Conversely, Stephanie has a different view on this whole scenario. She feels very optimistic that this is a great opportunity for medical schools to come together. They can look on a parallel basis of what is the best demonstrated practice and what might be things that can be left behind as old ways of doing business. She thinks the vision to create a universal postgraduate training experience is right where it needs to be. Her hunch is the standardization process at the medical school level. She thinks it just makes sense that if you're going to be producing candidates desirable to residency programs, that they come out with consistent competencies from those programs. It's a long time down the road though.

"You need to find a way to make yourself distinguishable and desirable."

With residency applications, they're looking for the same characteristics. Be distinguishable and engaged in your education process. Show leadership and that extra pieces of where you take initiative. Most of them now look for students that either have a graduate certificate or some type of master's degree, maybe in a subspecialization. Or what kinds of student club leadership and things you can do in medical school. So she really doesn't think this issue between osteopathic and allopathic is going to be too much of an issue in the long run of residency applications. They're all working on this universal guideline.

The biggest challenge she sees in osteopathic education is going more towards the ACGME guidelines are. So she thinks they're students in the osteopathic world have more to catch up on. But isn't any different than what they've been doing for years. Their students have always been competitive to both. They've been ahead of the curve on this. Stephanie adds that when you look at a school, look at their residency match. Because the schools have to report in what all the graduates are doing when they take the residency. What kinds of subspecializations are they going in? They make this available on their website, which is also a requirement for all schools. Make sure that when you get down with your process that you are highly competent and competitive physician. You want to be able to find where you want to match.

"Match rates are a really good indicator of where students are going."

For the most part, Stephanie thinks the schools are doing a good job in preparing competitive applicants. Her biggest concern is the locations of facilities so they have to get clever and creative about how much training spots they have. That's three years of intensive training that most students have to acquire. So the creative piece of it is still the same challenge we have today. We have to find good quality training places for residents to go and then still have physicians involved in training. They are licensed in a limited way. So they still have to have that residency director and other senior physicians overlooking what they're doing.

[49:32] More Pieces of Advice

The only thing that matters is your attitude going into it. Everything is predicated off of your effort and the work you put into it. Just because you go to Nova because they have great residency match rates, doesn't mean you're going to match at a great residency. You still have to put in the work and put in the effort.

Stephanie adds that you should focus on where you are and do the best with what you can and where you're at. Find a way to really know yourself and figure out how to leverage your strength. And that's where it's going to shine.

Even if you realize you hate the rotation, just embrace it and get the best you can from the scenario. It won't last forever. You've got to get through the process. Then eventually, you can go where you want to go. Be mindful of where you see yourself in the long run. Just find a way to really accentuate your strength.

"Use that fourth year when you have your elective rotation to test out some of these residencies."

[53:16] Why You Should Consider Going to KPCOM

Stephanie says she has worked in the community for almost 30 years and when she had a career change and opportunity, she tried to come to NSU COM only because she worked on the outside and they train their physician students. She could see the distinguishable difference in the candidates. The ability to see the caliber of their student body and faculty and their dedication to the process to her is no where else. Lastly, she says it's not for everybody. It has to be the right fit. But for those that decide to make it, it's just truly focused on students. They're focused on being innovative, and the care and compassion they emulate in their mission. It's not marketing talk and a different walk when you get there. That's why they encourage people to visit their campus to get a feel for it. Stephanie says it's only something you can experience when you're there. They're engaging their students throughout the whole process to make sure people can walk out with that impression.

Lastly, there are students in our Facebook Hangout Group who go to KPCOM. They're always open to answering questions about the school.

Links:

NSU Dr. Kiran C. Patel College of Osteopathic Medicine

Facebook Hangout Group

AACOM

AACOMAS

Pre-SOMA

OMED Conference

Harvard Online

University of New England

Nov 01, 2017
257: Author of Med School Uncensored Talks About his Journey
48:18

Session 257

Dr. Richard Beddingfield is a cardiothoracic anesthesiologist and author of Med School Uncensored: The Insider's Guide to Surviving Admissions, Exams, Residency, and Sleepless Nights in the Call Room. We talk about his journey and what he learned along the way.

Richard was a nontraditional premed student. He only found out later in the game that he wanted to be a physician. Right now, he's a practicing cardiothoracic anesthesiologist in Wisconsin.

I have five copies of Richard's book to give out. To get a chance to win, leave a comment in the comment box below, specifically about what you're most worried about surviving when it comes to medicine. Also check out our other podcasts on MedEd Media Network.

[02:38] His Desire to Become a Physician

Richard was studying business back in college, majoring in Computer Information Systems. And he just happened to notice an advertisement for an event called Mini Med School in Michigan. It was six or seven sessions where the event would have some speakers from the University of Michigan. They would speak about a variety of topics related to medicine, specifically about a systems-based approach.

Initially, he never really considered medicine and he wasn't sure if he was ready for that. So he was a senior when he went to the Mini Med School. He remembers being fascinated by learning about the human body and how it works, etc.

Meanwhile, he was enjoying his work in information technology. He was almost graduating at that time. He worked for another year or two. So the thought about medicine just got stuck in the back of his mind. To him, it was too hard for him to redo everything. And then he finally got the degree.

Then he started volunteering at a nearby hospital a couple times a week, few hours each time. He did outpatient surgery, pharmacy, and medicine wards. He was basically the same stuff volunteers do. But he took advantage of that opportunity by asking everyone he keeps in contact with - physicians, nurses, PAs, etc. He asked about their careers, what they're doing, likes and regrets, what they'd do differently.

"I was just trying to pick everyone's brain. I wanted to know if I wanted to do this, I want to really commit to it."

Then he started shadowing out of his volunteering experience where he met a couple of other physicians. He asked them if he could follow them around for a day.

And when he decided to so some prereq classes in the University of Minnesota. And he met someone who was in a similar boat. So they both bonded well and helped him with his research project on health literacy. He'd go to the county hospital a couple times a week to collect data from patients.

So the idea of medicine was born during his senior year of college year in 2001. By 2003, he decided it was something he wanted to do so he went back in the summer of 2003. And he started doing his prereqs.

Instead of doing a formal postbac program, he designed the courses to fit. He was able to do some part-time work at nights too so he's able to help pay the bills.  Then he took the MCAT afterwards by Spring of 2004.

[11:15] Transitioning Into Medical School: Struggles and Studying Techniques

Richard recalls it as a very intense studying period. He had been out only a year and he was glad it was not that long. He still remembered how to  do it. So it's not as hard as when you've been out for ten years. When done with premed work and he took the MCAT, it was the point he was done for the time being. So was only able to focus on writing his essays and secondary applications and interviewing.

He was working in an office at that point and found the job so he could continue to pay the bills while going to the medical school application process. And it took almost a year doing it. For him, this was nice respite from all the studying.

"Anytime you back into the full-time student mode, it takes a little adjustment."

Richard considers himself a good student having come out of college with a good GPA. Though there were times he also had to work hard. But he believes almost everybody who comes into medical student is a good student. They frequently didn't have to work extraordinarily hard to do that. You had to study and put in your time. But most people coming in never really had a point where they were just struggling to get by.

With his premed classes, he describes them to be very difficult because he was taking all the sciences classes all at the same time. And he was in classes with mostly freshmen and sophomores who are also still figuring it out.

Starting medical school, Richard says it was a different story. They started with an intense six-week straight anatomy course. And it was a different league. It almost consumes all your time. For him, that was the bigger transition point for him. But he was able to adapt to it by honing his study skills and managing his time well.

There's no point in sitting there with an anatomy book or a book in your lap if you've reached that point where you know you're just not acquiring anything more. It's easy in high school or college but it's different in medical school. Either you're focused and studying. But if you think you can’t continue anymore, enjoy your life a few minutes and go back to studying.

[17:50] Second Guessing His Decision and Finding Motivation

Richards admits having second guessed his decision at many points. And he things most physicians, if they're honest with themselves, will think about whether it's the best decision nor not.

"There were times where I questioned if I was going to be able to do it and do it well."

Like most people in medical school find it that through college, you're usually doing quite well. In med school, there were classes he was good at and in some, he wasn't or just average. It was those times that he had a little bit of self-doubt. This is not uncommon considering you're surrounded by so many talented and good students.

That said, it was just more of self-doubt rather than regretting doing it. Moreover, he describes pre-clinical years to be pretty challenging. You're just sitting there, attending lectures, and taking exams.

To keep his motivation during those times, he stayed involved. He encourages students that in some point during the medical training process, to do some research. He actually put his name on a list of students interested in doing research. He realized he enjoyed being in the operating room and doing more procedural work. At that point, he was already considering doing Emergency Medicine, Anesthesia, and Surgery.

So he put his name on the map list of students and he got paired up with a urologist who was doing research on kidney stone patients. He started doing it in the first summer between his first and second year. He spent a lot of time going to the operating room, collecting data and talking to patients. It means juggling with your medical school responsibilities, but with proper planning, being with patients helped keep him motivated.

[22:19] His Thought Process in Choosing His Specialty

Richard was a nontraditional student and didn't decide to get into medical school until years after graduating college. But it was more organic in medical school as he would describe it. He enjoyed internal medicine as well as all the rotations. He took some more than others.

He recommends premeds that every time you start with a new rotation, approach it with much of a blank slate as you could. Try to not come in with any sort of prejudice. Say you don't know much about it and see what this is. Who knows, maybe you'll love it.

"Every time you start with a new rotation, approach it with much of a blank slate as you could."

So Richard tried to more open-minded and as result, he enjoyed different aspects of different specialties. But at the end of the day, he personally found that he was more willing to stay late in situations where he was dealing with more hands-on specialty or rotation. Emergency medicine was one of the early ones he dealt with and surgery.

Depending on how you medical school set up is ranged, some students didn't have a lot of rotations until later in their second year. Unfortunately, you have to get involved in terms of choosing your specialty by starting at that point. As with University of Minnesota where Richard attended, they had a fairly flexible way of arranging their classes. He also knew from his volunteering and shadowing experiences as a premed that he enjoyed his time working with outpatient surgery and the like.

"You need to know that you absolutely love it and you're not going to be satisfied unless you're doing surgery."

So from there, it was just more of deciding on the individual details. Number one, whether he enjoyed the work of surgery enough to do a surgical residency. He believes this is a big decision considering how consuming the specialty can be.

Alternatively, if you don't feel surgery is something you want to do, then you have those other options like ER, anesthesia, and the like. So he just decided what practice setting he enjoyed the most which was working in the operating room. He enjoyed the medical side of it and just being in the operating room outside of the curtain for him, doing surgical work wasn't as exciting for him. So he chose anesthesia.

"It's a nice specialty if you like working in the operating room but don't necessarily love the day in and day out stuff of surgery."

[27:35] Dealing with Turf Wars

Richard has always been practical in analyzing things and having gone through private practice, he realized that the baits and questions about the turf wars are all over the place. They're broader than anesthesia and CRNAs, which is typical example. Other departments go through the similar issues as well. For example, ER departments don't have ER-trained people and they just have internal medicine or physician assistants manning ERs. Or you could have orthopedic foot and ankle specialists versus pediatrists. But at the end of the day, Richard was fascinated by anesthesia and the environment. So he started talking to more and more people.

Working with CRNA's and physician assistants, he has seen a lot of options. And all he knows that at their hospital, the acuity of patients has increased at most big hospitals. The same is true in remote hospitals in rural areas.

"Gone are the days where your average surgical patient is a 35-year-old with maybe some high blood pressure and that's it."

Richard explains that they're now routinely in the operating room working on people in their 70's, 80's and even 90's. They're doing heart surgeries on them or liver resections or lots of orthopedic care. These are sick patients. They require a lot of understanding of all the physiology going on with medicine. He adds that in general, there's a place for all the different providers of care. At their hospital, he feels like their hospital has a demand for anesthesiologists. And the same with other fields. Most specialties have "mid-level providers" but that's not reducing the demand for physicians. Because patients appreciate the education and experience physicians bring regardless of the specialty.

"The demand for physicians across all specialties is going up and is still very high."

That said, we don't really know what the future holds. But to bring this to full circle, Richard mentions this turf war has been talked about back in the 60's and 70's. In fact, one of the physicians during his mini med school experience who sort of became his mentor, he was a premed right when the Medicare Act was passed. And he was told not go into medicine since Medicare was going to ruin it.

"There's always going to be people towards the later stages of their career who don't like the changes."

Moreover, one of the interesting things is that it is changing so rapidly in terms of technology and treatment modalities. They are making some things possible now that weren't possible at all even ten or fifteen years ago. As a cardiothoracic anesthesia, he spends about third of his time at the hospital focused on cardiac surgery patients. And now, they're having an increasing number of trans capillary and valve replacements. They are cardiologists at their hospital in conjunction with cardiac surgeons. They're doing what used to be an open chest, open heart procedure, aortic valve replacement. They can do it now in an hour and a half couple of hours under deep sedation. They apply local numbing medication in the groin and use catheters to go up and deploy new aortic valves. He can't imagine that a cardiac surgeon 20 years ago.

This is completely changing and disrupting huge areas of cardiology and cardiac surgery just the way that stents did back in the 80s and 90s. That said, it's difficult to predict since medicine is changing so rapidly.

At the end of the day, you just have to decide what do you really enjoy? Talk to some of the people in the field. Go ahead and hang your hat to it. As with Richard, he thinks he can get a good career of it. Patients are getting sicker. Procedures are getting more complicated.

"I have not seen physicians in short demand. It seems like everyone wants more physicians and more highly trained people."

[35:40] About Med School Uncensored

Richard realized he wanted to do a book during his senior year in medical school. He volunteered to mentor some premeds at the University of Minnesota. Particularly, he met a young premed for coffee where he answered some questions the person had who was interested in getting into medical school. Then he asked him some questions about what they were expecting once they're in medical school. So he thought writing the book was a great way to help premeds with the details and the logistics of how to get in. He wanted to reassure them about the different steps along the way. He thought there was something missing that tells premeds and early medical students what medical school is like.

So in the book, he talks about the premed process and some of the basics. But he leaves a lot of the details to other folks. What he really wants to get at is the big picture. What he imagined is if someone had an older brother or sister six or seven years older. They're a premed and their older sibling just finished the process. And then you're sitting down over some coffee over beer. So he wanted an unvarnished reality of what's it's like in medical school and residency. Then he goes all the way through getting into fellowship and the pros and cons of it. And finally, the actual process of getting your first job - what you need to watch out for and what you can do through the process.

"I take you through all those steps starting from the premed experience all the way through medical school, residency, fellowship."

So it was that interview with that student back when he was a high school senior. He didn't have time in medical school to write a book but he found a little more time during fellowship. He started jotting down the Table of Contents or simply what to talk about. Then in between fellowship and getting his first job, he just set the ground running and wrote all his thoughts down. He wanted to get it while it's still fresh in his mind where he still had that trainee mindset. He then began reading books on how to publish a book and the rest is history.

[42:50] A Message to Premed Students

Richards finds that premeds have the motivation and the drive. And the thing to remember is to try not to get bogged down on things like the turf wars and the like. Since the details are going to change. The training process to become a physician is so long. If you're premed right now, you're probably not going to be practicing until around 2027, which is about a decade minimum, assuming you're doing a three-year residency.

When Richard started as a premed, nobody talked about the Affordable Care Act and so on. And people are going to talk about different things. Just remember why you want to do it and it's what's going to get you through. Of course, the desire to help people in the very intimate fashion. Those types of goals are what's going to get you through the day. You can't be distracted with what's happening now because it's changing.

"Whatever issue, details, the logistics and political things you're worried about aren't even going to be relevant in ten years."

He also remembers some students wanting to do medicine to find a cure to a certain disease. And he tells them it may be a little too specific. Because the time it's out there, that might not even be an issue anymore.So just focus on your broad goals and what drew you in. For him, it was simply the fascination with learning more about the human body, how it works, the disease process, physiology, etc. And he always enjoyed working with people and having a job where he gets to interact with different people.

So whatever is drawing you to medicine, just hold on to that. Don't get distracted with the political and economic stuff. You'll figure it out some way. There will always be an opportunity for you. It may not look exactly like what you're expecting right now but it will be there.

[47:11] Win a Copy of Richard’s Book!

Get a chance to win Richard's book by leaving a comment below about what you're most worried about "surviving" - whether that means the premed world, getting to medicine, getting to medical school, residency, etc. I have five (5) copies of his book to give out.

Links:

MedEd Media

Med School Uncensored: The Insider's Guide to Surviving Admissions, Exams, Residency, and Sleepless Nights in the Call Room

Oct 25, 2017
256: A Look at Carle Illinois College of Medicine with Dean Li
48:11

Carle Illinois is hoping to change the way medicine is taught, focusing on engineering and medicine together. This is our discussion with the dean, Dr. King Li

Oct 18, 2017
255: Q&A With Premed Students at a Small Liberal Arts School
40:19

In this Q&A we talk HPSP, shadowing, clinical experiences, mistakes I made on my journey and so much more. Want me to talk with your club? Let me know!

Oct 12, 2017
254: MD vs PA! Let's Talk About it with a PA to Help You Decide
57:57

Session 254

Savanna Perry is a PA who helps pre-PA students get into PA school? We chat to discuss the differences in the career field to help you decide. Savanna runs a podcast, The Pre-PA Club Podcast, and a website called The PA Platform. She's also going to post this conversation on her podcast this week.

We talk about some of the differences between being a PA and a physician as well as the differences between a PA student and a medical student, and finally, the differences between being a pre-PA and being a pre-med.

Maybe you're questioning yourself whether you want to be a physician or PA is enough for you. Or maybe you're a pre-PA right now and thinking if you should go on to be a physician. We're going to talk about the traits and characteristics you're going to need to be a successful PA or a physician.

[02:17] A Brief Background on Me and Savanna

We started our conversation with me giving a little description about my journey. I'm a physician by training and somehow stumbled into the premed advising world. I don't practice anymore as I am now a full-time podcaster. I currently have four podcasts with some more coming. I help premed students get into medical school. I help them with advising in terms of personal statements, interviewing, and more. I also teach a little bit at the local medical school here in Colorado.

Savanna is a physician assistant who practices full time in dermatology. She graduated from PA school three years ago. And just like me, she's gotten into the coaching world on the PA side of things. With The PA Platform, she helps students get into PA school, learn the ropes and figure out what's needed to reach their goals.

She's also married to an internal medicine resident on his second year. So they've seen both side of things as she was going through PA school while her husband was going through medical school.

[04:16] Should You Choose PA as a Plan B?

"PA is different than being a physician. It's still heath care. It's still patient care. But if you want to be a physician, be a physician."

If you've shadowed PAs and NPs and those other career fields and if you're happy with that, go ahead and do it. We obviously need PAs and NPs too.

Being married to a physician and having gone through the process together, Savanna chose the PA route over MD or DO. She and her husband started dating in high school. So they've been together through undergrad. They went to the same school, both Biology majors. Even though they're pursuing different tracks, they took exactly the same classes.

For her, freshman year was tough in the sense of trying to decide what she wanted to do with her future. She always been someone who's very focused on the future and wanted a plan in place. She basically thought about going different routes - PA school, med school, dental school, PT school.

After doing lots of research and much shadowing, following around some PAs and doctors, she tried to see the differences on a daily basis. She also considered the schooling differences, which was a huge part of her decision-making process. She couldn't see herself in school and making the commitment that medical school requires. She wanted to start her family and be able to get out there and start working and working with patients. She didn't know if she could commit to one specialty.

Savanna also mentions that lateral mobility is the biggest part of being a PA. And she thinks it's a bit overrated since most PAs can abstain in one specialty. But it just made sense for her. Not to mention, the teamwork aspect of it. She likes having someone to bounce ideas off as well as the relationships she was able to observe.

[07:30] Her Husband's Thought Process Behind Becoming a Physician

As for Savanna's husband, he felt it wasn't really a decision but he just had that feeling he needed to go to medical school. What he tells people is that if you know you want to be a doctor, go to medical school. If you're not sure about it, take some time to figure it out.

"Look at PA if you want to be involved in health care but you don't necessarily want to go through all that training."

It's tough being in medical school. As a second-year resident, he's on the tail-end of a month of nights where he works six days a week for twelve plus hours and gets one day off. That said, Savanna is completely happy with her decision at the end of the day.

The biggest thing she wished she had is that feeling of missing out on the residency training. Hearing her supervising physicians talking about cool cases they get to see in residency at an academic center is something that made her feel jealous. She wished she had that intense training. But she has a great supervising physician who teaches her everyday. So she does feel she gets that to some degree, just that she wasn't able to see those really cool cases as she describes it.

[09:21] Residencies for PA

Savanna cites how different residency for PA is compared to medical residency. PA school is so quick and general. If you want that extra training for certain specialties like general surgery, ICU, or emergency medicine, there are now options available. They're usually a year of intense residency-like training program in certain areas. No formal ones in dermatology yet. But a couple are popping up in specialties like urology and OB/GYN. She mentions it's quite controversial since it's how the PA profession was designed. A lot of times, you can get the same training on the job and make a higher salary coming out. Then you can be trained in the way your physician would prefer instead of going through the residency. That said, the benefits have yet to be determined.

[10:57] A Typical Day in the Life of Savanna

In her role in Dermatology, Savanna sees about 30 patients a day. On a typical day, her supervising physician might see one with her. The physician would pop in really quick to make sure they're on the same page. The she would discuss one other case with her. At this point, she is very autonomous. She also describes having a great relationship with her physician, with a lot of trust. She trusts her to make wise decisions and that are within her scope of practice. And if she feel uncomfortable or out of place, she's going to come and discuss it with her. On the other hand, the physician may also come to her to ask for her opinion since she's able to go to more conferences than she does. Sometimes, she's more aware of the newer things going on. She considers hey physician a friend.

Additionally, she doesn't feel limited in her role in any way. She doesn't do a ton of surgery right now but she could if she wanted to. But she finds it more lucrative to see patients

"Right now, I don't do a ton of surgery but I could if I wanted to. It's another trust thing."

[13:10] PA Autonomy and PAs Deciding to Get into Medical School

In terms of having autonomy relative to the state, what she found for the most part is making it more of a decision between the supervising physician and the PA, instead of the state medical licensing board. She would prefer if they had to move to go to a PA-friendly state where PAs are able to be more autonomous. However, it's difficult. In Georgia, where she's at, they've had a few issues with the FDA changing a drug schedule. Then the state legislation is not catching up yet. As a result, PAs who could once write for pain medications can no longer do it anymore. She sees this as a problem for surgical and emergency medicine PAs. It's a continuous battle and she hopes more awareness in more legislation will come into play. But it hasn't really affected her at this point.

In my job as a flight surgeon for five years and in my clinic, I never worked with any PAs. The Air Force has special independent duty medical technicians (IDMTs) that are like super-EMTs. He would see some of his own patients and act almost like a PA. This is an easy transition for them into PA school since that's the role they're used to in terms to how much freedom they have and how much supervision they have. But in the actual family practice clinic, the provider in charge was a PA. So I've worked side by side with PAs but just not in my clinic.

Interestingly, I talk to a lot of PAs who went to PA school. They liked their job for a couple of years and then realized they just don't know enough and would want to know more. You're not treating the most acute things and you're not treating the most difficult patients and diseases.

"It's this balance of what are you happy with knowing and what you're happy with treating."

For Savanna, she's very happy treating things like acne. She loves seeing those patients. But if a crazy rash comes in or something out of her league, she is perfectly happy passing that along to her supervising physician. She loves learning about it and be involved in those cases. But she's also okay with those being over her head.

She admits this may change as she gets further into her practice. In fact even now after three years, she feels there are things she's much more comfortable with now. She has also knows some PAs who decided to go back and try to get into medical school.

On the flip side, there's a lot of physicians who are unhappy with their career choice. However, unhappiness or being unfulfilled with their career-choice is not very physician-specific. It's the U.S. in general so it's a cultural thing. For some reason, everybody just isn't happy, which is unfortunate.

[17:45] Getting into PA School versus Medical School

PA schools have a rigorous application process and it's getting more and more competitive each year. Even though her husband was applying to medical school, Savanna had more requirements than he did. There are more class requirements like anatomy and physiology. You have to take these again as well as other courses. She thinks it's because PA school is so quick so they want you to have a lot of that under your belt before getting there. Since they're not going to go over it again. They did anatomy and physiology but it was more intense than an undergrad level course. It was actually the same course at their program that the medical students went through.

Additionally, you have to have health care experience. This is also a big difference between PA school and medical school. Savanna mentions that med schools want more research whereas it's not that important for PA school. They don't care if you have research. They want you to interact with patients and they want to know that you enjoy interacting with patients. Some of these programs require a 1000-2000 hours.

However, I want to clarify that the research side isn't as important as most people think for medical school. Clinical experience is. But true, it's a huge difference in that most PA programs I've seen require a lot of clinical hours. But it's the same for medicine where they want you to get clinical experience since they want to make sure you want to be around sick people.

[20:34] The Origin of the PA Profession

Savanna takes us back to the origin of the PA profession. It was originally developed as a second career. This was when people were coming back from army jobs where they were basically acting as a PA. In civilian life, they didn't have a place to go. At that point they didn't want to go to medical school. But they had all this knowledge and skills. The PA profession was developed as this secondary career. Whether they've been nurses or respiratory therapists or some type of strong background in healthcare. Then they're just ready for that next step where they want more knowledge and more responsibility but not ready to commit to medical school and becoming a physician.

"Some programs still really want those people who are coming into this as a second career."

[21:37] The Path to PA School versus Medical School

PA programs range from 24-36 months. This is another difference between PA school and medical school. As for Savanna's PA program, the first year is usually didactic. They're in class every single day from 8am to 5pm. Then they went to clinical rotations for a year. She was watching her husband go through medical school where he was only in classroom from 8am to 12pm and had the afternoons to study. They got their summers off while Savanna went straight through no breaks except for a week for Christmas and a week in between semesters.

Some medical schools though are already getting rid of that summer break. A big draw is early clinical exposure. So if they cut out that summer and just take classes then you get early clinical exposure. I like that summer though because that's the last time of free time you get.

For medical school, the standard is two years of nonclinical, classroom training. This prepares you for Step 1 or Level 1 of the boards, which you need to pass to continue on in your training. Then you need to do clinical rotations for two years before applying for residency.

For PA school, there's the Physician Assistant National Certifying Exam (PANCE) taken at the end. Savanna describes it as a very general test. Pass that and you're good to go. Savanna feels those different Step exams in medical school are what's intimidating.

[24:00] Competitiveness in PA School versus Premed School and Medical School

The whole motto with this podcast and with everything is collaboration, not competition. IN the premed world, it's super cutthroat. It's super competitive. Reason that's my big mission in life because I don't think it needs to be.

But once you're in medical school, there are those who are the "gunners" who are out trying to do as best as they can. And they cut you down in the process. I went to New York Medical College and the vast majority of students are there to help you. They're there to collaborate and build a community. Some of my best friends are med school classmates.

"I think the competitive nature while in medical school is nowhere near what it is in the premed world."

As for PA school, Savanna refers to them as a family. They all help each other. Having different backgrounds, they're able to learn a lot of things on each other like doing IVs and stuff. Three of her best friends are from PA school and they still talk almost everyday.

[25:30] Lateral Mobility in PA and Residency or Fellowship Training

From the standpoint of moving around in careers, Savanna earlier mentioned that although they have some lateral mobility in terms of specialty, most PAs still choose a specialty and stay there. Based on talking to PAs, it's usually within the first few years of graduation that people tend to move around just trying to figure out where they belong. They try to figure out what they're interested in.

Coming out of school, she knew she wanted to do either dermatology or surgery. She feels very fortunate to find an awesome job which has worked out wonderfully. She hopes she never has to give that up. But she also knows that if they had to move to for fellowship or for her husband's job, she could find a job. and because of her dermatology experience, it would make her a hot commodity for a family practice or an urgent care in areas they struggle with since she has that background.

"It's an interesting mobility to move around but most PAs, once they find somewhere they like and are happy, they do tend to stay there."

As for medicine, you need to apply for residencies but you can do internal medicine. Then you explore all of the internal medicine fields - endocrinology, pulmonology, cardiology, GI, rheumatology, and the list goes on. Or you could choose general surgery and figure out what you like in the surgical field before going on and specializing in a surgical specialty as well.

"That's a stereotype I'm trying to break as well - the whole I want to be a PA because of lateral mobility."

Savanna stresses that if you want to be a PA, you should want to do it for the everyday roles and responsibilities that you'll have in the career. That's where shadowing comes in again because it's going to look so different depending on what area you're in. A surgical PA is going to work much more closely with their supervising physician than she would as as a dermatology PA. You'll be in the operating room with that physician mostly, if not all the time. And you'll be collaborating on every single patient.

[29:02] Where Does the Relationship Go Wrong?

Savanna's supervising physician signs all of her notes, as required by the state of Georgia. So she sees whatever Savanna is doing and if there is any question, she'd bring it up. But part of her trust in her comes from the fact that she trained her. Typically, her supervisor would say the same thing she does to any patients coming in. In fact, one of the biggest compliments given to her by her physician is she's basically her.

But where does the relationship go wrong? Where the PA hates the physician or maybe in general, hates being supervised and wants to be more autonomous? Savanna says this as being a big issue on both sides. As a PA, you need to know what you're getting into.

"You need to be okay with someone looking over your shoulder and giving you their opinions. If you're not okay with that, you shouldn't be a PA." On the contrary, Savanna doesn't think medical students get a great exposure to PAs so she's not sure if they understand it. Her husband didn't know what she did until she graduated. They'd both be studying and he would have a cardiology question. He would just ask him how she knows that. Or she'd come and say she excised a cyst and he'd be surprised she did that. So it wasn't until he got into hospital rotations (which she has already graduated at that point) that he actually understood what PAs do on a daily basis. And that there really are some great PAs and nurse practitioners out there.

So she thinks some medical students who have never been exposed to PAs have a misunderstanding of what exactly the role is. That said, Savanna thinks it's important for medical students, who will become physicians and will get to work with PAs someday, to understand what the role looks like and what the capabilities of a PA are. Even in her practice, they had a couple of physicians coming to join their practice. And they have never worked with PAs. Then after a few months, one of them came to her and told her how impressed they were by what she does since they didn't know PAs did that. So this is where education really comes into play.

[33:05] The General Population

As a PA, as to how many times they face patients that question why they're not with a doctor, this happens less and less. For the most part of that, it's because she has her own patients that only see her now. But it still happens.

"If a patient sees a bad doctor, they'll find another doctor. If they see a PA, they'll never see a PA again."

Savanna thinks this saying is true and that she has actually ran into this situation a couple of times. It all comes down to earning your patient's trust and respect by bring a good provider no matter what your role is.

Make sure you're as knowledgeable as possible and that you're really providing that best care you can. Continue to learn and stay up to date on everything. Moreover, she gets asked a lot since they think she's not old enough to be a doctor. Then she explains she's a PA. She's also encounter some who would ask when she's going back to becoming a doctor. So she has to explain to them that she's already done with schooling and she's trained by her supervising physician. It's a good think she made sure she was introduced to many of her patients. And because they trust her and Savanna, they know. And if they ever want to see her, she would be fine with that and she won't get offended by that. They just have to let her know upfront when they're scheduling. But it takes to continue to educate people and slowly earn their trust.

[35:50] The Right PA Mentality and Personality

So again as a PA student, you have to be okay with having a physician looking over your shoulder or be okay that the patient may want to see the physician sometimes. If you're not okay with that then you need to move on to MD or something else.

This is something interviews for PA school are looking for. They don't want those students who are going to be "fake" doctor and go rogue and do whatever they want. They want people who understand this is a collaborative role. It's something your'e working as part of the team, technically under supervising physician. To some people, this could carry a negative connotation but for Savanna, it's a benefit she enjoys.

Savanna adds that you can't go into this if you feel like you can't be confident in your decisions. For her, it's about putting their heads together. She likes to get all the information she can being a chronic researcher that she is.

No matter what area of medicine you work in, you have the difficult patients with difficult diseases. She loves listening to her physician's experience. She refer to herself as just a lifelong resident because she feels like she constantly wants to be learning as much as she can. They simply both just want to continue to learn. That said, if you want to be good at anything in life, you have to be a lifelong learner. Keep learning.

"I refer to myself as just a lifelong resident because I feel like I constantly want to be learning as much as I can."

From a physician standpoint, I'd love to go to my colleagues and we'd bounce ideas off each other, which is common in medicine in general. Not only a specific PA interaction.

[40:37] Advice to People Trying to Decide Between MD and PA

Savanna recommends students to shadow a lot and do some soul searching to decide if they'd be happy in that collaborative role and not as the ultimate decision maker.

My personal recommendation would be 100% shadowing. You have to shadow. Go out and see that a PA does. Interact with the PA. Watch the PA interact with a physician. Listen to how the PA talks about being supervised by a physician. Try to find PAs in different specialties and see what those interactions are like.

Find out the rules are for PAs in the state that you're in or shadowing in. Find out how autonomous they can be. Because you may be living in a state that you're not going to end up practicing in. Then you go shadow a PA and they're very autonomous. They don't interact with a physician all day. So you go into a PA school thinking how awesome it is to be a PA. Then you end up moving to a state that's not PA-friendly. And now all of a sudden, it's not the life you thought it was.

Savanna cites one resource you could use if this something you need to look into. Go to the state medical board and look at their website. Also, just ask PAs who work in that state since they're going to be your best resource to finding out what it's really like. Just try to get that first-hand knowledge.

[43:50] The Decision to Become a Physician

Back in high school, I thought I was going to be a physical therapist. Then I dissected a cat and I wanted to be an orthopedic. I wanted to marry that sports-related PT stuff with cutting. So I joked around that I wanted to be a doctor because I wanted to cut people.

The PA world never crossed my mind. Maybe PA school wasn't just as popular back when I went to school. I applied to medical school back in 2001.

[44:55] Are PAs Encroaching on Doctor's Space?

There are just physicians that don't know how to play well with others. You're going to find those personalities everywhere in life.

"There would be physicians out there who don't know how to use a PA and don't know what a PA can add to their practice."

If you're a PA or pre-PA and you start working with a physician who just doesn't know how to play well with you, just go find another physician. There are good doctors and bad doctors as much as there are good PAs and bad PAs. So it's not that physicians don't like PAs but there are just some physicians out there who don't know how to work well with others.

[46:15] PAs Make Less Money than Physicians

Savanna adds that if you're considering being a PA, you also need to be okay with the fact that you're going to make less money than a doctor. And you're going to make money for them. For her, she's fine with that. She sees herself as her physician's assistant. It would have been otherwise if they didn't have a great working relationship.

She knows that she makes money for the practice. But she's also compensated very fairly for her time. And she doesn't have to deal with any of the administrative stuff. She comes to work, she sees patients, and she goes home.

As a PA, you have to know your worth to the practice and to the doctors and be okay to fight for that a little bit. But you also can't expect the same compensation a physician is getting.

As to why this is, there is the liability issue. The physician is more liable than you. From a practice standpoint, PAs have to be supervised in most states. So the physician is the one that owns the practice. In most instances, they spend all of the overhead money in marketing and everything else.

[48:07] What I Hated about Medical School and Thinking You're Not Smart Enough

I hated the preclinical years. I had taken three years off between undergrad and medical school. I didn't get in the first year. I took some time to fix my application and finally got in. So I basically forgot how to be student that I was miserable studying and learning, except for anatomy which was the only thing I like. I came in very close-minded saying I wanted to be an orthopedic surgeon so why did I need to know biochemistry. Hence, the misery.

Then once I got to the clinical rotations which was the second two years, I was just happy. I was interacting with patients. I was in the hospital. I was doing what I wanted to do. But it's a grinding, long process. This is another thing is you have to know yourself. Are you going to be able physically, emotionally, mentally - are you going to be able to survive medical school, residency, fellowship, before you actually become a "real" doctor out there working? Another thing I want to stress is how students go and think they're not smart enough to be a doctor so they'll be a PA. This is just silly. As Savanna mentioned earlier, they're learning the same stuff. They're learning a lot less of it for a shorter amount of time.

"You don't have to be a genius to do well in medical school. You just have to work hard."

Savanna thinks the same with PA school. With so much information, it's so easy to get overwhelmed. But the nice thing is that it's relevant information. This is why she enjoys the didactic year of PA school more. She feels she could have done medical school. Sure, the first year she'd have some doubts. But looking back and watching him struggle, she just think medical school is just too difficult. Part of that is those comprehensive exams which can be intimidating.

[51:24] People with Lower GPAs Switching to PA School

Savanna says her most asked question is they have a low GPA, can they get into PA school? And I get the same question with premed students. And that next level is this mindset that their GPA is not good enough to get into medical school, so they'll go to PA school. This is another silly thing.

PA schools shouldn't be Plan B for somebody who wants to be a physician unless you are okay with everything mentioned here. Being a PA as a Plan B right off the bat just is silly. It's two different careers first of all. Secondly, if you have a poor GPA, you can still get into medical school. It may not be as fast as you want. It make take a couple extra years. You may have to do a couple of extra things. But if you have a low GPA, there are ways to overcome it to show and prove to the admissions committee that you can handle medical school. That's what they want to know. They don't want to accept a student who's going to fail. It looks back on them and it's a waste of seat.

"GPA and MCAT are so important but they're not the end all be all when it comes to getting into medical school."

I often tell students that not all GPAs are created the same. If you have a strong upward trend with your GPA (ex. last undergrad years or postbac or science-heavy master's program), this will help you overcome a low GPA. This is the same advice she gives to pre-PA students is if they really want to do it, there are ways to get there. The backup they tend to go to is nurse practitioner. It's a different career. They are similar but the paths are different to get there. If you want to do PA and you're set on it, then that's what you need to keep working towards.

[55:33] Last Thoughts

Hopefully, this gave you insights into the difference being premed and pre-PA, differences in the schooling, and once you're in practice. If you have been walking this line but not sure what you want, and you've defaulted to the physician side, hopefully this podcast has helped you understand those differences. So when interviewing comes as well as writing personal statement or secondaries, you don't mistakenly leave the door open for an interview.

Please share this podcast to your friends, both PA friends and premed friends, as well as to your advisors.

Links:

The Pre-PA Club Podcast

The PA Platform

Oct 04, 2017
253: Almost Everything You Need to Know About Postbac Programs
44:54

Session 253

Dr. Glenn Cummings is the Associate Dean and Director of the Postbaccalaureate Premedical Program at Bryn Mawr College in Pennsylvania. We discuss mistakes students make and so much more about postbacs.

If you're a nontraditional student, you will certainly get a lot of information from this. And even as a traditional student, there will be plenty of information for you as well. Also, don’t forget to check out all our other podcasts on MedEd Media Network.

One quick thing which we didn't get to talk about in the interview is if you're thinking about applying to postbac programs, there is now a centralized application service for postbac programs. Not every postbac is participating in yet. As you're doing your research and looking at postbac programs, figure out if they're taking part in PostBacCAS. Or learn if you need to individually apply to that postbac program.

[02:21] From PhD in American Literature to the Premed World

From a PhD in American Literature, Glenn has been a pre-health advisor for seventeen years now. And he started for two reasons. First was he wasn't happy with the research he did in graduate school. He knew it just wasn't where he was headed. Second, he really wanted to do the advising piece.

Just as he was finishing his doctorate, he had a job at a small nursing college. Then it began to turn into a liberal arts college that was poorly funded. They didn't have any system for academic advising. He was teaching American literature to older students who have gone back to school after raising families and having careers. Some were working full time.

He was at the University of Virginia at that time and the premed advisor of 20 years left. Then he was asked to do it on a trial basis to see if he enjoyed it. It also included pre-law since he was the director of pre-professional advising at that point. Ultimately, he likes the pre-health students the best so he decided to stick to it by 2000.

Although science was not his background, he wanted to alleviate suffering and improving people's well being was something he shared with the students. And that's what has brought him to Bryn Mawr as their associate dean and director today which he has been with for three years.

[05:55] What is a Postbac Program?

Glenn defines postbac as the short term for postbaccalaureate. It's a program you do after you get your bachelor's degree. The premedical postbac programs fall into two types: The career-changer (which he sometimes calls it "start from scratch") program is where most students that have not had the premedical requirements. So they take this program for a year to take the basic sciences to be eligible to apply to medical school.

The other type is where the students have done most, if not all, of the courses in college but they didn't do as well as they wanted to. So they need to do additional science and enhance their record.

"Postbac means "post college" but not graduate school."

[07:00] Postbac Right After College: Is It Right or Wrong?

Many college students, say sophomore or junior, and they're planning on taking a postbac. Is it the wrong thinking?

Glenn has been at UVA for four years and at Princeton for eight years where he also ran the health professions advising program there. Glenn says that in his last couple of years before leaving Princeton, he saw there were students who were very well-informed. And that were so many opportunities offered to them that were exciting to them. These are things like studying abroad for a year or double-majoring. Or the institution has a senior thesis. And so sometimes they thought they just couldn't get those courses in.

"The number of applicants we get in our program that are college seniors has grown a little bit every year."

Whether it's wrong or right, Glenn admits that he doesn't know it. But what he sees is the advantage of time where they're able to think about whether it's the right decision. However, it's not in the spirit of what these programs were created for. At their institution, Glenn says they still consider students right after college but they'd interview them. They would carefully inquire about their interest in medicine.

Personally, my assumption is they've been told to be a perfect student with perfect numbers and extracurriculars. So they would take the safe road and delay all of that stuff until later. But Glenn thinks it's more of the students getting excited with so many activities in college. But in term of this being a better way to get better grades or to take the easy route, Glenn doesn't think this is the case.

[13:00] To Take a Postbac or to Pursue Continuing Education?

He further explains that students attracted to their program express their desire for a sense of community. He describes their program as having a very tightly knit community between 75 and 80 students. They are fairly small but large enough to be able to foster diversity. So they wanted that group with similar goals and similar values.

"They wanted a group of people going through the same thing they were going through, almost like a dress rehearsal for medical school."

Secondly, in some schools, students may not also have a structured advising system. At their institution, they're very involved in the student's academic success. They have one-on-one with students everyday, making sure their weaknesses are being addressed. They know what their strengths are. They're essentially guiding them towards academic success.

My usual advice to students if you need the structure then a formal postbac program will give that to you. And community is a very important aspect too. Glenn adds they facilitate cocurricular activities as well such as speaking and different events centered around healthcare. It's very important that you're able to show that you can be part of that community during interview.

[17:25] Shadowing and Clinical Experiences

Although not part of the curriculum, they do orient students about the need for having shadowing and clinical experience as part of their typical week. At Bryn Mawr, students arrive at the beginning of the summer. And over that summer, Glenn has a staff member who works with them to find a place in the community where they can get some clinical experience. This is done in a way that enhances what they've already done. Many of their students have already had these kinds of experiences under the belt while some have very little. There are others who might be doing clinical research or working in a clinical setting for a couple of years before they got there. So it basically depends on the individual. Nevertheless, the staff member works with them closely to help guide them towards a clinical experience they find valuable.

Moreover, they have a large database of what everyone has done in the past so they also have access to that. Although they don't have this but some colleges have a shadowing program at the local hospital that you could apply for.

[20:45] How They Evaluate Their Students

Glenn mentions two things: the academic ability and their familiarity with medicine and their passion for it. So he admits it's a challenge for them when looking at applicants.

"Almost all of the people that come to our program have something in their story that did familiarize them with medicine."

Glenn explains that almost all of the students that apply to them have had some familiarity with medicine in some ways. Either they're volunteering at a hospital or they've shadowed a doctor or they have dealt with illness in the family. Or they've lost someone in their family or they're patients themselves. In fact, some of the most interesting applicants they've got are the ones that have seen the doctors, they want to be like, treat them, as well as the doctors they never want to be like.

They can get wrong sometimes but occasionally, there may be students who didn't have clinical experience. Then they'd go to the local hospital and they won't enjoy it. They don't like being with sick people. And they didn't realize what they were getting themselves into. But this is rare.

Sometimes, Glenn also finds that personal connection. They show they've been in a setting where they've been around patients. And sometimes this is enough for them. Their program is only short. It's only one year. And before you know it, you're trying to apply to medical school. So what he looks for students is that short-term potential for them to be able to go for an interview and talk about their motivation.

[24:10] Judging Career-Changer Applicants

Glenn says that this is a surprise to applicants all the time but they look at high school transcripts.

"We look at high school transcripts. We look at their high school science grades. So we do go back pretty far."

It does make sense because they've been in college for a long time, the high school is even farther back. But they want to see the last time the applicant was in an environment where they did lab work and they had to do science. They also look at their SAT and ACT scores. This can also surprise people sometimes. But they find this very informative especially if they haven't had any science in college. So they need to go back and look at those things. This gives them some sense to be able to predict the challenges.

"The grades in college mean more than you might think even if it's in discipline completely far from science."

Looking at how many classes they took or the level of classes they took or the challenges they face in whatever discipline they chose you can get some sense to be able to predict how they're going to do in a rigorous science program.In addition, Glenn says the letters of recommendation help a lot too. Many skills are actually transferable to doing well in the sciences. MCAT is not required for career changers but only for academic enhancers.

[26:50] The Biggest Mistakes

Glenn says the biggest mistake he sees in applicants is applying late. As what he said, they're like a dress rehearsal for medical school.

"We're a mini, little version of a medical school in terms of our application process. Get it in early."

The only have a certain number of seats for their class. And they see some really amazing applicants at the very end of the cycle. It's very hard for them to turn them down or to put them on the waitlist. It can be frustrating for them trying to build the best class they can. They're applying late for some reason. Nevertheless, they shut down by the first of March. They start accepting applications in August. For someone to wait until February to apply, unfortunately, the train is leaving the station. February is their actual deadline for the applications but they're still making decisions after that.

Historically, students work off deadlines. The whole rolling admissions is brand new to students who are now career changers or those undergrad students applying directly to medical school. Personally, I wish medical schools get rid of the word "deadline" and Glenn agrees with me on this.

Another important thing during application process is interview. They can do it via Skype. But regardless of Skype or in-person, there needs to be some real thought put into what they want they communicate in 30 or 40 minutes. This is the second most common mistake they see is when they come in poorly prepared. They don't listen very well and they do all the talking. They don't stop to breathe. Or they give just one-word answers. This is an interpersonal skill which Glenn thinks is not a problem for most older career changers. And it's mostly the younger students that struggle with this.

[31:30] Common Mistake Among Career Changers

Glenn thinks career changers generally do well in the interview because of their maturity and comfort level talking about themselves. But one common mistake they make is they dominate too much. They're just strong on the conversation they wanted to go in.

"Leadership is nice but over-leading can be a real problem."

Especially when you think about how they're going to treat a patient someday or how they're going to interact with a patient or medical staff, you don't want someone to be overly assertive.

The biggest takeaway as you're preparing for an interview is that you're being judged based on how you're communicating in that clinical setting. Glenn has actually read my book, The Premed Playbook: Guide to the Medical School Interview. And what he likes is the emphasis on being positive during the interview. But career changers tend to go through the professions they've tried and explain why it wasn't right for them. They talk about the reasons they don't like that certain career. It's negative and it comes out in the end that medicine was just the default they arrive at.

[34:20] What Is Linkage to Medical Schools?

At Bryn Mawr, they have eighteen linkages. They've been around for a long time thus the number. They've basically developed relationships with these schools. The medical schools see graduates of the program come to them and they really do very well in their medical school. So they want more of those students.

In a medical school linkage, instead of finishing the program and taking a glide year while you're applying to medical school, you applied to medical school halfway through the program. This happens at the very end of the application cycle (winter). If you're conditionally accepted and you finished the program strong then that conditional acceptance turns into a real acceptance. Then you can start medical school that summer.

Some of them waive the MCAT.  They've got plenty of tests later on, your boards being the big one. So you're not getting out of standardized testing for the rest of your life."

"This is very attractive to people but this is not a reason to try delaying just to avoid the MCAT. "

The disadvantage, however, is that they would ask you to commit to one school in a very, very short period of time. You arrive in a program within months and you're choosing one school at the exclusion of all the other 140 medical schools in the country. So you're trying to convince yourself it's where you belong. It's a tall order for a lot of students.

Now, if you're a postbac in a program that didn't have linkages, Glenn wouldn't worry about it. If you do well academically in the program and have the transcript and extracurricular to show, you're going to be a great applicant.

Glenn says it's a tough decision to make without the complete picture. If you applied the normal way, applying to 15 schools and you traveled around the country. You look back to that years from now knowing that you really cast the wide net and explored all your options. It's hard for someone linked to ever know that.

"One of the disadvantages is the choice of school and how well you really know you belong in one place."

[37:45] Why Bryn Mawr for Postbac?

Glenn takes pride in the students they have at the school due to their diversity. Second is the collaborative learning environment they have. The basic sciences are taught in a way that they're broken into groups and working collaboratively as much as possible.

[39:28] Looking for a Career Changer Postbac?

Glenn's advice is to get out there and get that clinical experience. Some people come into the program with very little of that. But if you're maximizing the way you're doing it, create some time in your week. Prioritize just enough to get three hours of time every week to get into a hospital setting and do some clinical volunteering or shadowing. Do it as long as there is patient contact. This the best way you can start at least to figure out if that's the environment you want to be in.

And for those students who might have deferred their decision to apply one year after the next and say their job just gets in the way, you just need to do it. Make it happen.

Lastly, Glenn wishes to tell people out there sitting in a cubicle and worried about making that leap, is that it's never too late. And that's because of the postbac programs. So have faith in that.

"Just have faith that it's not too late."

Glenn adds that you can talk to other current postbac students who have also been career changers. Sometimes, they just have to see examples of people made the decision makes you realize that it can actually happen. While in some careers, it may be too late, but through their postbac programs, it's really not too late for those wanting to pursue medicine.

Links:

Bryn Mawr College - Postbac Program

MedEd Media Network

PostBacCAS

The Premed Playbook: Guide to the Medical School Interview

Sep 27, 2017
252: Navigating the Premed and Med School Path with ADHD
35:03

Session 252

The Premed Years Podcast is part of the MedEd Media Network, where you'll find all our other podcasts to help you on your medical school journey.

Please come out to the UC Davis Pre-Health Conference on October 14, 2017. I will be speaking there and have a table set up. I'll be giving away tons of stuff. The event is expected to have 4,500 students this year. This is the perfect avenue for you to network and meet a lot of the other premed students who believe in collaboration, not competition. I'll also hold a meetup in Davis, California so I can hang out and chat with students. I'm looking forward to meeting you there!

Back to the episode today, David is part of our Facebook Hangout Group. He's happy to share with us his struggles in getting into medical school.

David is a former member of the military and current med student. We discuss his journey with ADHD, PTSD and what made him successful getting into med school. He talks about what he did for his personal statement and what's he's doing now in medical school to make sure he's succeeding.

[02:20] His Interest in Becoming a Doctor

Although he already thought about it when he was younger, he really didn't take it seriously until college. He accounts his military experience for it that he wanted to do something different and something good.

His role in Baghdad was nothing medical. Then he saw their medical team helping Iraqi women whose kids have spina bifida get assessed and referred to clinics in the U.S. and Europe. And after seeing the reaction of the mothers getting help for the first time in there life, he knew he wanted to be a part of it.

Although he already had it growing up, it wasn't until he got into the U.S. Army that he got diagnosed for it. But he still thinks he was a horrible student. Then he got out of the army and went to college. He worked for the VA in mental health clinic. But he was doing support roles. So he decided to go back to school and get his postbac for the prereqs for medical school.

[06:30] His Learning Styles while Struggling with ADHD

He knew he was intelligent but it was hard for him to just put a book down and read. It was a struggle for him. Besides medication, the military helped him acquire the discipline he needed. But again, it wasn't until he went to college after the military that he realized how good he can do.

Procrastination is not an option for David. He found it so much easier to be very detail-oriented considering people with ADHD are not very organized to begin with.

Aside from medication, the other ways that he tries to handle ADHD while in college was talking to his wife or his dogs. Then he would teach them and explain to them the process how things are related. This makes it easier for him to remember things.

"If you teach it, you know it."

Whether you have ADHD or not, I can't stress enough the importance of teaching. This is actually why study groups are great. Especially when studying for the MCAT, building that network of students is important. One excel student may excel in one section while you struggle and you might excel in another section while another student struggles with it. So you just have everybody teaching each other.

Being a non trad and older than his peers because he's doing it as a postbac, he would have a random study group every now and then. But for the most part, he'd do it at home (with is dogs and wife). Teaching greatly helped him for subjects like Microbiology and stuff. But for psychology, he would just go on walks and listen to Khan Academy videos. He'd download videos onto his phone and listen to them over and over again.

Different learning styles work for different people. For David, it's a little bit of everything. For socio/psych, audio was great but not for most biochem stuff or orgo or gen chem. For biochem, he would just write everything down. So how learns depends on the topic. David says teaching is good for life. But there may be times when you may not have enough time .

"Try different techniques every other day and see if it works. If it clicks, keep on going."

[14:40] Should You Talk About ADHD in Your Personal Statement and Interviews?

Davide also got diagnosed for PTSD from his experience in Iraq. He thought it was a crucial part of his narrative. Otherwise it would have been weird to explain in his personal statement of how he ended up on this path. that said, he felt it he had to do it. He thought talking about ADHD and PTSD might be a risky endeavor. So he decided to not say he had PTSD verbatim.He just mentioned dealing with the loss of some of his comrades and how that affected him. But he definitely mentioned how he overcame his ADHD in his personal statement. However, PTSD is still unknown in terms of how it affects people. David has made a good decision here.

"ADHD is one of those more accepting than it used to be. So it's safer to talk about it. There's less of a stigma around it."

In terms of his interview, David describes being horrible at his interviews. His anxiety went through the roof. Although he prepared for it and did mock interviews, once interview day came, he did really bad. He was mumbling which was the feedback he got. David's advice is to do professional rehearsals especially if you have anxiety or talk to your healthcare provider if you have any issues. It wasn't until his interview that David realized there are some medication he could get on that would help in those kinds of social events.

Having gone through war and all the crazy stuff, David thought it was going to be okay. But the importance of the event hit him and he didn't expect him it would hit him hard. He didn't know how to prepare for it.

David admits having minimal experience with doctors. He had one shadowing experience and worked with a couple doctors at the mental health clinic. So he didn't really know too many doctors. It wasn't until later in the interview season that he started shadowing again. He started really feeling comfortable around that.

"Part of it too is unnatural anxiety being around doctors."

[19:47] the Thought Process Behind Which Medical Schools to Apply To

David actually got accepted the first time but not until later in the cycle. He didn't risk it so he started the re-application process. He started shadowing and volunteering more.

He went to school at University of Alabama at Birmingham. He is from Alabama and has lived there for a long time. In choosing schools to apply to, David says he didn't apply to as many schools as he probably should have. For instate applicants in Alabama, they had a pretty good chance if you're decent enough as opposed to other states that are more competitive.

David didn't apply to DO the first time around because for him, he didn't shadow DO's. But in hindsight, he considers this as a huge mistake. So when he started his reapplication process, he had already shadowed DO's and applied to about 16 programs.

Basically, he applied to certain MD programs based on his MCAT score and the instates. All in all, he applied to six programs total. The average is about fourteen or fifteen so six is definitely way below average.

[22:53] Huge Mistake: Applying Based Off Your MCAT Score

David actually got a score of 505 on the MCAT, which is pretty decent. And so I think David has made a mistake that a lot of students make is they look at that median number. And that median number doesn't tell you anything other than 50% of the students got higher than that score while the other 50% got lower than than score. That's the only thing that number tells you. It doesn't tell you whether or not you'd be competitive at that school.

"One of the biggest mistakes a lot of students make is they look at that median number."

[24:15] The Agony of Being on the Waitlist

When David got interviewed at South Alabama, he wasn't accepted until the end of June. During that interim, they put him on the hold status until the end of the interview season. And at the end of the interview season, he was put on the waitlist. So from March until the end of June, he was in limbo the whole time. And as soon as he was put on the waitlist, he tried to reach out to them. He was trying to get some feedback thinking he wasn't going to make it. For David, it was a very confusing time.

So during this interim, he already applied again. He got the Fee Assistance Program or MD and DO this time. He was basically already doing all the right things that he didn't do the first time around. The second time around, he just felt more confident that he would be getting in.

"I was doing all the right things that I didn't do the first time around. I felt so much more confident this time applying."

In fact, at the time he got accepted, he was so happy. And he found out he got accepted because he called them and asked to speak with the Dean. The school was going to start by end of July so he had to be prepared. He wanted to know if he had to make a move or not or to already start scouting. He was put in hold first and then he got accepted anyway.

"Make sure you have that right feeling that you checked all the boxes so you don't have to worry about not being a good applicant."

When he was on the waitlist, he'd check in with the school about once a month after the interview season ended. He was talking with the Dean at that point and he asked for feedback from him. He got told that he would have been in already had he not interviewed so poorly. This actually made him feel good because at that time, he was already enrolled to retake the MCAT. When he got accepted, it was a no-brainer for him to take that acceptance. And even if he wasn't accepted he, he thinks he would still be fine. He was just so confident the second time around that time.

[31:20] College vs. Medical School: How Different Is It for Someone with ADHD?

David describes the metaphor of the fire hydrant. A ton of information coming at you and take in as much information as you can process. And everyone in medical school feels like they have ADHD as they're not able to process everything. But for someone with ADHD, David says a lot of the tools he has used to focus still work although the specific studying techniques have to be adjusted. A lot of the tools that he has used to focus still work. It's just  that the specific studying techniques have to be adjusted.

"If it worked for you as an undergraduate with ADHD, it could work in med school. You just have to work a little harder than everyone else."

[32:43] David's Final Words of Wisdom

If you're struggling with ADHD or whatever it is that is making you doubt whether you're smart or good enough to get into medical school, David says it's just a diagnosis. And that success in any academic level is a function of your effort. If you want to do it and you put forth the effort, you can make it happen. Doctors are not perfect. Anyone could make it happen. You just have to put forth the effort.

"You can't let the diagnosis or what others tell you to get in the way of what you want to do."

David is one of those students that show you that whatever is in your path, you can overcome it as long as you figure out how to do it. Get the support behind you to do it. And first and foremost, believe in yourself.

Links:

MedEd Media

UC Davis Pre-Health Conference

Facebook Hangout Group

Khan Academy videos

Sep 20, 2017
251: How to Protect Your Relationships as a Premed and Med Student
46:31

Session 251

Today's podcast is special because this is not only for you as premeds, but also, for your significant other. Share this podcast with your loved one who is going through this process with you. This will help both of you.

Sarah Epstein is a Marriage and Family Therapist and her husband is a second-year emergency medicine resident. They started dating when he was starting to study for the MCAT.

Sarah is the author of Love in the Time of Medical School. We talk about how you can keep your relationships strong. In her book, she talks about helping keep relationships going through the stressful time of being a premed, being a medical student, and being a physician.

Get a chance to win one of five copies of Sarah's book. Win one of five copies of the book Love in the Time of Medical School. Simply go to www.facebook.com/sarahepsteininsights. Like the page. Then leave a comment on this page regarding what's your biggest concern about juggling medical school and your relationship. From these comments, we will be picking five winners at random.

If you're interested in grabbing a copy of the book, check it out on Amazon. Sarah marked it down to a special price at $4.99 just for this podcast.

[02:18] Going Through the Process as a Significant Other

Sarah explains that they as significant others of others have a lot of challenges that a couple faces together and that the significant other deals with on their own.

Giving you a little background, Sarah is finishing up her training as a Marriage and Family Therapist in Philly. She started writing the book three years ago when her husband was a third year medical student. He was on his surgery rotation which felt like the pinnacle of all the challenges.

He was working 15 hours a day and she didn't know what to expect. She thought there was so much she wished she had known going into this process - in terms of what she can expect, how to understand what medical school looks like, what kinds of relationship issues would come out each year. So she started putting all this together. She started writing her own experiences. She started conducting research about physician couples. And she started interviewing other significant others of medical students. She wanted to get a sense for what other people's experiences have been like.

[04:38] Becoming a Significant Other

Sarah started dating her husband Brian when he was a Senior. They went to the same university. A month later they started dating, he started studying for the MCAT. In hindsight, she thought it wasn't the smartest decision. But she got to see the whole journey - taking the MCAT and applying to medical school through now. Brian is currently a second year emergency medicine resident in Philadelphia.

"The MCAT was really my first taste of what it means to be dating someone who's dedicating themselves to a life in medicine."

Being supportive and asking a lot of questions and finding interesting ways to spend time together when he was studying a lot became the key for them. They had to find ways to even just be in the same room or where they could take study breaks. They started to think of it as something they could face together. It was that team mentality. He was doing all the work but she was cheering him on. Marking his progress in studying made her feel like this is something they were going at together.

[07:05] Good Communication and an Attitude of Postponement

Sarah and her husband talked a lot. And over the course of the medical school, that was one of the fundamental keys to making it through each step. Unlike other processes of training, every year is something different. There's a new schedule, new goals to reach. So they talked through what it means to him to do well on the MCAT. She also tells him her concerns about getting to spend time together. She wants to feel validated by him that it's still important that they get to spend time together. And having that dialogue and re-negotiating over the last seven years, over and over again what their relationship is going to look like.

"If you think it will just work on its own, it really isn't true. There too many variables and too many priorities to put in place."

Sometimes, it also meant, this is his priority for now and they can't wait to celebrate after the MCAT or after the applications or in, or whatever. But it has to be balanced with having an attitude of postponement. They want to balance having that sense of the big picture but not putting everything on hold.

[09:40] How Much Say Do You Have in the Decision-Making Process?

For Sarah, how much emphasis she has as the significant other be putting into the decision making process for the student is an important question. Depending on where your relationship is, it's going to impact what kind of say or input you have.

At the time Brian was applying to medical school, they decided that their relationship was not far enough that she would have a say in where he applied.  He basically made the decision based on his scores, grades, and where he's going to apply. So she played a supportive role. When he had his acceptances, she helped him what made the most sense for him, and infusing thoughts about what would make sense for them.

Sarah recommends to think about where is your relationship at the time that they apply. Also, have that conversation with your partner about whether you should have a say. If you're already married or in a very committed relationship, this could look different.

"Medicine dictates the timeline sometimes."

Whether your relationship is ready or not, you're going to have to make some big decisions around who gets to say which medical school. Who gets to say where they go and what they do? And if you've only been dating for a few months, that could feel out of sync with where your relationship is. And this is the first taste for the partners of people in medicine that medicine really does call the shots sometimes.

[12:20] How to Frame Your Conversation

Especially if you think you're not really a good communicator, Sarah suggests the tone and the way you frame the conversation is really important. Premed students are very protective over their ownership of the process. They've worked exceptionally hard to get to where they are. So they feel like they really own it. And that's acceptable and appropriate if the relationships is not at a certain point. So talk in terms of yourself and say something like "I feel like I need to prioritize what I need during this application process. But I would love your help to look at the options." or "Are you also feeling this nervousness around the application process? Let's sit down and talk about it."

So be gentle about it. Don't make it about you. Avoid talking in "I" statements and talking about how hard you've worked. Say you're excited and you want your partner to be involved in helping you research schools but maybe you want the ultimate decision over what that means. But then tell them you're so excited about their feedback about what seems like a good fit. In a way, try to include the person by asking them what their thoughts are.

"Include the person even if the decision is ultimately something you're going to do on your own."

[14:44] Making It Work While Being Long-Distance

For Sarah, this is one of the hardest parts especially for the significant other. Because medical school is rigid. You're going to be somewhere for four years. You can be very lucky to get in all and feel like you have options.

Sarah and Brian were actually long distance during his first year of medical school because Sarah was in Thailand. So they didn't only do long distance, they were twelve hours apart. And when she got back, Sarah moved to Miami knowing nobody. She didn't have a network there. They went to school in Boston and she's originally from Dallas. So she picked up and moved to a place where she knows nobody to see if they could make it work. And it was really hard for her, for a number of reasons. What does it mean for her that she's moving for her boyfriend's career? Does this mean she's prioritizing his career training over her own? So it was a had decision for her. A lot of things have to come into play. But they've done the long distance and that she moved for him.

"Not everyone can make the decision to move for their partner."

Everything was practically new for them. And one of the things that really helped them was before she moved to Thailand, she visited Miami and she saw his apartment. They walked around the medical school. So being able to picture it made her connect to his world. She was able to picture what he was doing and who he was spending time with. She admits it's going to feel a little alien to some extent, for someone who's not in medical school, to hear about the experience.

"One of the things that really helped me feel connected to his world was being able to picture it."

While first year med school was exceptionally busy, Sarah says it' fairly easy to understand and grasp what your partner is doing. The hardest part for them was Brian not being able to conceive what her life was like in Thailand. She was living in a fishing village and teaching Thai children their abc's. And being unable to come visit her to get a sense for her world was difficult.

They also had to grapple with the fact that before they were long distance, they could pick up and talk to each other whenever. It didn't require a lot of forethought. But then suddenly they can't talk between the hours of 12 and 7 because someone's asleep. And he's got this incredibly busy schedule and so did she. So consciously making times for them to Skype with each other was vital. They had to prioritize it even if they were both tired or it was first thing in the morning. He had to miss an event or something like that. They had to put enough face time. And things changed considerably. He came to Thailand over winter break and Sarah claims it saved their relationship.

[19:10] Making It Work Living Together

Sarah describes the first year of living in Miami was harder for her. At least they had set expectations when they were apart. They created routines to make sure they were talking to each other. But when she moved to Miami with a new job and in a new apartment, he had his friends, his routine, his support system. And he had an exceptionally busy schedule. Second year was difficult since you had to start studying for Step 1. Once again, they had to re-negotiate what their time together would look like. Whether it meant sitting in the same room while they're each doing their thing. And finding other ways to feel connected. They had to foster smaller ways to connect when they couldn't be together. Basically, Sarah ended up being the third wheel to medical school.

"I was the third wheel to medical school."

What Bryan did for his part to make things work were a few things which Sarah considered as really vital. Brian was good at keeping her aware of what his schedule would look like. He made her feel she knows where he's going to be and staying in touch when he had to study longer than he thought. Or he had to go to an extra lab.

Knowledge makes you feel a little bit more in control because at least if he couldn't see me, I could plan. Especially in Brian's third or fourth year when he was doing something different every month with a different schedule and different expectation, it was important for them.

Additionally small gestures became a lot more important like taking the time to take a study break and go out for coffee. Or they'd take on little tasks around the house. They'd take time to notice those breaks in the schedule. Sarah describes medical school as being very busy but there are points in the schedule that are less busy than other points. This could either be right after an exam when the new material hasn't piled up yet or before you start an intense study period. Or save up some time in bank. So when those difficult study periods come along or someone's working a 15-hour day on surgery, they'd start texting each other more. He would leave her post-it notes around the house telling her he missed her. Sarah says it was that knowledge that he was thinking of her and their relationship even when he couldn't invest in it at that moment.

"Couples dealing with medical school really have to be intentional about noticing the ebb and flow."

[23:08] Connecting with Other Significant Others and a Support System

Being in Miami, Sarah says she was able to hang out with groups and medical students and describes it as quite an experience in terms of feeling a sense of alienation. But sometimes at medical school, they'd have parties and then their partners would come.That would be how they'd meet. Then they'd call on each other when one of their partners was on a tough rotation or when they're both studying at the same time. She also had one friend from college who's a partner with someone in Brian's class. So during study weekends, they'd hit each other up and plan a girls' weekend.

"The ability to connect with other people who get it saved me a lot of sanity."

She recalls she was going to have wine with the partner of someone in Brian's class. She texted her and said her boyfriend was going to bed at eight. And she was setting his schedule to meet his so she asked if they could do wine at five. Sarah agreed of course because she gets it. Other people get that you're living this weird schedule and you're doing your best to match the medical school schedule so you get to to see them. So it makes a big difference to have other people who get that.

In terms of having a support system, Sarah says that anyone dating a medical student really needs to tap into an emotional support system. If you're a local and lucky enough to live in a place with a big network of friends, let your friends and family know this is the reality. And that you might need a night out when your partner is studying. Or you need to vent about this and what it's like to be dating someone in medical school. Find those specific people in your network. Not everyone is equally good to vent to.So have one or two people that you can all up and say you just need to talk for a few minutes. Find those people who get it. Moreover, Sarah is also a big fan of therapy as a support system.

[26:29] Hardest Times as a Couple

In terms of stud periods, Sarah considers Step 1 as by far the hardest. She recalls after Step 1 was over, she was just talking to him and broke down crying. Because there were so many thing she hadn't gotten to tell him. There were so many conversations they had to put on hold. And both people had to go into long-term thinking mode. You can't have those day-to-day times together.

Rotations are also difficult at the beginning in third year. First and second are difficult but predictable. But third year is incredibly unpredictable. Not only is your partner doing a different rotation every month, but they also have a different schedule. They have different attending physicians to make the experience easier or more difficult. They can't necessarily stick to schedule like if somebody needs to stay late or an emergency comes in.

"Adapting to that change in schedule over and over can be really difficult."

That said, it was important for them to have the schedule in advance or have Brian talk to classmates about what this rotation was like so they can prepare themselves. If he's working 15-hour days, then she's putting five social events for herself on the calendar. Then they're going to spend a bunch of time together before that starts. So this became a very important part of their preparation.

Obviously, surgery was really tough since he was working very long days. They had an unusually difficult time with his pediatrics rotation. All because they both expected it to be a very light rotation. But it turned out that it wasn't. So the feeling that they had prepared and then getting the rug pulled up from under them was difficult.

"That unpredictability is the biggest factor for couples when you're dealing with rotations."

[29: 57] Common Complaints Among Significant Others

When Sarah got to talk to other significant others while she was writing her book, there were themes that came up again and again. The lack of time together was one of the biggest ones.

Another one is that sense of waiting. Almost everyone talked about how they would avoid feeling like they were waiting for their partner. Whether it's waiting for them to come home or for them to finish with their exam or waiting for them to finish with medical school. There is this feeling of powerlessness in the face of all of that waiting.

"Waiting is passive. It's difficult to hold on to for long periods of time when it's not your career."

So you're kind of put into this passive role of just having to sit and watch your partner do these things that are taking up all this time. They also talk about the things they would do to make them feel like they weren't waiting. Like if their partner would finally be free, and if they had already made plans, they'd stick to those plans. Sarah explains you can't drop everything and relinquish your life to medical school.

Another theme that came up was that sense of loneliness. It could come up when you feel like your partner is just not available. And you feel like a medical school widow or orphan. One woman even described the feeling as being married to the shadow of the person. She felt she was married to the idea of this person because in reality, they were never there.

Also one of the other things that came up is navigating social circles that involved a ton of medical people. When a bunch of medical students or doctors or residents get in the same room,that becomes the topic of conversation. So dealing with the feelings around that was one of the things that all of them talked about.

Personally, even when I would get together with Allison, my wife, and her fellow neurology residents, they would niche down and talk about neurology stuff and I felt I was an outsider even though I was a physician myself.

[32:53] Dealing with Alienation from Talking Jargon and Lack of Awareness

Sarah stresses the importance of having your partner be aware that that's a reality. If you're sitting with a group of medical students, a few different things that come up. In their household, they have a "no yucky stuff" rule because Sarah would faint just hearing the gross stuff. Her husband being an emergency medicine doctor, there are so many things she never hears about because she can't handle it. But he knows there are twenty other people in his life who are happy to hear about. But she will hear about other things.

Sarah's dad is the oldest of four boys and her grandfather was an anesthesiologist. The joke in the family was that all the girlfriends who came over dinner had to pass the test of sitting through his surgery stories. Her mom told her of one particular dinner when she was dating her dad. Her grand dad was talking about intestines coming out of someone's body during a surgery and her grandma was serving spaghetti. So there's that lack of awareness that not everyone can handle that.

"Jargon comes up. A lot of medical students' partners I spoke with talked about feeling incredibly isolated."

Sarah adds that most of them don't speak medical. They felt dumb because they didn't know the words. They didn't know what it meant when someone talked about blood pressure numbers and whatever they were learning that day. So it can be an incredibly alienating experience.

Sarah says after the first time this happens, you'll know it coming. So talk to your partner in advance and set up signal so they become aware of it too. You're going into it as a team so make your partner feel like they're not alone in that moment. You and your partner are in this together and not that they’re the med student and you're not. If it comes from your partner who changes the subject then great. Also, sometimes look at changing the conversation to another aspect of the topic.

For example, Sarah finds certain things about the hospital that are interesting like the relationships between attending physicians and the medical students and residents. So she's happy to ask about that. But that can be a way to pivot the conversation away from the technical details.

And when it comes to the yucky stuff, you have to come straightforward or have that signal with your partner so they can step in and say it to them that you don't want to hear it.

[37:20] The Keys to Surviving and Thriving Relationships

Sarah says there are three keys that lead this kind of relationship to survive and thrive. First is communication. For a medical student couple, that means re-negotiating what the relationship is going to look like as medical school progresses. Communication around listening to each other's stress. Listen to it and validate that stress. Those may not be at the same degree. But having the other one validate it goes a really long way. Have those little gestures when things are tough. Re-negotiate the relationship. Validate each other's stress.

Second is intentionality. You can't just let it happen because it won't. Things will fall through the cracks. There's always more studying. There's always more to do at the hospital. So really be intentional and make sure you find time together.

The third key is flexibility, which Sarah admits as the hard one for her since she likes to have a plan and to know what's going on. So be able to relinquish a little bit of the control. Move plans around and find creative ways to spend time with each other.

"Being flexible about that was vital because without it, it will always drive you crazy because we just can't control it."

[39:50] Dealing with Discouragement from Other People

Sarah has had people telling her that all doctors cheat on their spouses. She has also been asked if she's going to raise kids alone one day. Or people tell her she'd never have to work (as if her decision to work only has to do with finances and not her own ambitions). And these are things that can be hard to deal with. Sometimes random acquaintances make these comments about their assumptions. A little bit of it is judging your relationship to that person. Sarah suggests you have to pick your battles because this will happen a lot. So she'd either brush it off or make a joke about it. It would be the best response to an acquaintance. But be more honest with people and how it feels to hear that with people close to you. Tell them what it means to support you. Tell them it's hard and tell them what kind of support you need. That you need them to be there to listen to you. And that you can't be hearing things like what you're doing because it's not helpful.

You want to surround yourself with people who are going to be encouraging and supportive. It's okay to tell people what you need from them even if it's not their first instinct.

[42:20] The First Steps to Being Intentional

Sarah recommends having a check-in. Wherever you are in your relationship, those check-in's are really going to be important to see where your partner is at so you can improve things. It's possible that your partner who's not a medical student may be feeling stressed about what medicine is going to mean for your collective future but they haven't felt entitled to talk about it because they're not the ones taking the exams. Or maybe the medical student is feeling overwhelmed or guilty that you had to move somewhere like what Brian felt.

So get some of those feelings out in the open about what you've been feeling about the process. Talk about how you can start supporting each other. What do you need? What do they need? How do you manage each step?

Also, cut yourself a little bit of slack as a couple as you're trying to figure out. You're working on it. And as long as you're working together on it as a team, you'll get there. You can get there.

Links:

MedEd Media

Love in the Time of Medical School by Sarah Epstein

Sep 13, 2017
250: The Extreme Burden of Being a Physician (It's worth it)
46:03

Session 250

With Houston still feeling the effects of Hurricane Harvey, and Hurricane Irma gunning towards Florida, how can we help and learn from those on the ground? In this episode, we have Dr. Jean Robey and today she talks about her writings and some insights into the extreme burden of being a physician. She talks about whether it’s worth it and whether this path is really something you want to get into.

Hurricane Harvey, a Category 4, hit Texas on August 25, 2017. Its devastation will continue for a long time. And all of the men and women on the ground, in and around Houston helping those in need, need your help. If you're listening to this and you're in a situation where you can get on the plane or get in a car and go help, then please do.

If you're part of the club like AMSA, Premed AMSA, or Pre-SOMA and there is a sister club at the University of Houston, reach out to that club. Find out what they need, what you can do, what you can send, who you can send, and help. And another hurricane is hitting Florida. Please help. The people on the ground need you.

[04:05] Why Jean Writes as a Physician

Jean admits, "I'm scared we will not be enough and help will run out." This is a piece Jean wrote about the recent Hurricane Harvey in Texas. For her, writing suddenly became so much a part of doctoring.

She recalls a time being so stressed out and she stopped writing. She didn't realize these were connected because she wasn't enjoying doctoring anymore. That's because she had nothing to write about. And this means not being able to get close to her patients. As soon as she aimed to have something to write about which meant getting close with patients, she just felt more fulfilled about her interactions, her life, and her career.

"I write actually because I have to and I long to have to write because that means I'm touching something deeper."

So the writing happens because it has to happen. But Jean says it's not just writing notes. She really writes them from start to finish otherwise it will evaporate and she will lose that very kernel that excites her. She also describes having that tingly feeling while writing things down. And usually this touches people. As much as possible, she writes and gets it when it comes hot off the press and she gets these moments when she's with patients.

[06:30] Dealing with Burnout and Elevating Humanity

I asked her whether this is her way of approaching burnout and Jean explains how she is a problem-solver.

"What burns people out is having a job and having something that must be done."

Then she adds what if you went to work, addicted to something deeper that you can only access because of the privileges and the privacy of being a doctor? It's not about exposing patients. But she has this idea that she doesn't know enough about life or herself. And if that's true, she's actually looking for them to tell her about life and herself. Because patients have other experiences and they have other perceptions. So Jean gets fascinated by this idea. She likes how she's building constantly on her thoughts. She relates this to doctoring where you mature as you practice.

"As much as experience, it's an intuition about how someone's going to do, what someone needs, why they need it."

Jean says you can almost immediately see it in a patient where they are in their personal evolution. And that's because you've seen it a thousand times in a thousand renditions, but it's not quite repetitive. There's some detail about it that adds to a little nuance and she's fascinated by this. Like a crazy raccoon, Jean is collecting little trinkets. Then whey they give her the chills, she just wants to share them. She wants other people to take the shortcut and have a piece of it.

Jeans mentions this controversy about getting someone's consent if you're going to expose them and talk about their privacy. But she does the stories in a very composite way or generic way. This way, she can evade the details. But some of the details matter. Nonetheless, she never writes a story that's going to push the human being down.

"I never write a story that's going to push a human being down. I want to elevate humanity and its understanding."

And in a lot of these times, even when horrible or tragic, Jean describes the stories have something in it that's really honorable and victorious. There is conflict but the resolution always airs on the side of being human. The stories are not made up. They are purely human. But Jean explains the need to lure people so they can access it. A lot of the stuff we feel actually can't be spoken very clearly.

[10:20] Rekindling that Passion for the Job

Jean believes doctoring is a calling. And in that calling, we hear society ask for leadership. And we hear society asking people to be thoughtful, intelligent, and compassionate. They ask them to lead when no one knows what to do or no one is brave enough to know what to do. Every time she goes to work, Jean is not saying she doesn't get tired or she would rather be doing fun things, but she aims to make a difference. She aims to save a life.

"I don't go in there thinking I'm going to be THE thing, but I am going to be a part of many things that can save a life."

Jean also shares her personal motto of "There is universal good. Evil doesn't dissipate. It gets pushed around." She adds that if we are people of valor, we will seek out that hard thing and try to iron it out. And try to start a solution an fix a problem. In medicine, what we really want to champion is people that don't mind fixing problems.. They want to fix problems and be in charge of fixing those problems. So if you seek out the thing that keeps you from burning out, you need to seek the idea of these two things, Jean says. Try to help. Just try to do what you can of what you got and just try to take care of the universal needs. Moreover, Jean shares this idea that if you're going to participate, make it worthy of you waking up and doing it.

[13:50] Dealing with Patient Entitlement

Jean thinks that if your intentions are noble, the math will add correctly over time. Jean also believes that the good guys win. Things can get difficult but you have to draw the lines, know your intentions, and stand firm for principles. It's not about servicing them. But make them understand how this is hard for them. Acknowledge what they're trying to do. But recognize their evolution. Begin to develop a relationship with them.

Jean tends to do some "canned" things whether or not the patient would cooperate. But in the end, the patient will usually change their mind. So when you engage patients and they're pushing back, that behooves us to try to understand why. Make them understand you care for them and that you dedicated your entire life to try to take care of them. And that you will always be there whether they show up or not.

[18:20] Putting Others First Before You

Jean personally believes this idea of doctoring being part of the priesthood. They need nothing. They want nothing. They own their souls and salvation to the church of medicine. She didn't initially understand how this was all possible. Humans as we are, we're going to have families. We're going to have diseases. We're going to have wants. So how do you marry the church of medicine?

She explains that the intention was that we would make ourselves whole. Engage the extreme task of taking on this responsibility, this obligation, this duty, and this calling. Then prepare our families where oftentimes, someone is in more need than they are.

"We just farm our families to understand that 90% of the time, someone else is in need far greater than what we must be dealing with."

While there is truth to this, when it becomes not true is when the balances have been tipped and it already becomes dysfunctional or unhealthy. For instance, if your child is sick or your husband is dead or you are suffering, then you need to back off from this role and responsibility. You are no longer able physically, mentally, and time-wise to carry the extreme burden. Jean further explains that when you're in this field, you're accepting a little bit of the unusual extremes. And when you look at quality of life for a physician and work-life balance, Jean believes we're pushing back against the idea that you were supposed to get everything. All the time. All the attention. All the love. All your duties. That said, you can't push all the way back. Physicians are never going to be nine to five. Even holidays. It never dawned on Jean that they could have a holiday hour. They don't get holidays. They get coverage and they trade. And that's just the way they're able to continue what human existence is. There's no break. It's not like death or disease decides it's Sunday or Saturday. So Jean thinks that when society is asking more of them, it's right to respond with "Yes, I'll give you more. But when I need something, I want you to be able to give that to me. And while I'm giving you so much, I need you to honor me. Because I am doing something that many won't do. I am giving of you and the family around me. Because when I come in and write checks, I write checks against my account and against my children and my husband and my marriage and my extended family. I ask them all, and they have been farmed this way."

"We're not only servants of society, we are leaders..we're going to be there. We're going to lead the entire show."

As doctors you show up. You're the leader of the show. You tell them what the problem is and how you're going to fix it. You tell them how they're going to help you help them fix this. As doctors, you are picked to walk into a room and just decide you're going to be go-to guy. From there, there's going to be plenty of other people at the table. But someone's going to have to calm everyone down, organize stuff, figure out what you need and where to get it. Sign the paper. And take responsibility. And a lot of times, Jean thinks we're not given enough credit as physicians because that is sort of a social contract.

[25:01] What You Can Learn from Disasters

What fascinates Jean about first responders is how they know how to act.They know how they use what they've been cultivating this whole time - their knowledge, connections, know-how to solve multifaceted problems. She has seen physicians who immediately organized a place, a time, and crew. They would immediately phone calls to pharmacy reps and companies and tell them what they need. And they've created a complete treatment plan for disaster. She saw them really try to hone in and deal with and prioritize what they're seeing. They were able to make long term plans. She describes this as being physician-like. You deal with the acute problem and then try to make up long-term problem for rehabilitating the tragedy.

As physicians are going to different tragedies, they may start to feel overwhelmed both emotionally and physically. They can't justify re-charging when there's so much suffering around. Also, because in this mindset of creating a treatment plan for all the people, Jean thinks that inside somewhere, something cracks.

"I think inside somewhere, something cracks because it's so much all at once and there's no end to it."

Jean says these physicians talk about dying inside a little bit as well as other nurses and other volunteers. They're dying because they just can't do enough. So with the idea that hope is going to run out, Jean says it's not going to stop coming. And even if you're not there, you can send money and try to do what you can do to help. But she says what we really need to do is feed that positive energy that lets that responder repsond. Feed that energy that validates that response. Give the responder validation and encouragement. This tells them that you see them and while you may not be able to directly help them or be there, you can feed into that energy somehow.

Another thing they want to hear is that the outreach is not going to end. And that people know that what's happening in Harvey, they still can't find people. And it's still wet. There are homes that are still four feet under. Just a few inches less than the maximum because the water didn't go anywhere. And even those homes that have dried up would mean six months of renovation. It's school year and it's a holiday coming up in four months.

"There's a million things that are going to happen in their future when their entire present was decimated."

And whatever they can garnish is not enough to make a day. So when we look at how we're going to react in Florida or continue to care for Harvey or any tragedy in America, we need to be able to do acute planning and long-term planning. The society around us also needs to feed into energizing and continuing to fund and help that long-term planning. Katrina was a great example of how that took years. A lot of people had to relocate. And that was difficult too. A lot of physicians on the ground right now feel it's already too much. And they were getting short on day 2. They knew because they knew how to take care of long-term problems that there was going to be a day 200 and a year two.

"How were they going to keep going if the rest of society was going to get bored with their tragedy?"

[30:45] Addressing Physician Suicide

As physicians, we also have our own little hurricanes in life and Jean sees physician suicide as a challenging topic. These are very driven and introspective people. For some reason, got seduced by the idea of getting into medicine and tackling that incredible mountain. Take that beast and put them in a crucible. Some of them tried three times in trying to get in. Or they tried once and thought this is what they wanted. They get there and realize it's not what they wanted. Then maybe what they were looking for is now gone because medicine is changing. And they don't know how to respond to that change. There are so many possible variables. But this beast that comes in and finds themselves not knowing how to weigh their value or measure up to expectation. And not knowing how to feel both worthy of being someone's doctor and being someone's doctor and colleague.

Jean explains that something happens in their mind and then suddenly they're not just good enough and they're not right. They're too deep. And now they're suffocating and they just want release. They just want to stop hurting. And the problem is we're not really good about being our colleagues drowning.

"We're too busy taking care of people we think are sick and we think we're healthy. We think somehow we're above it."

So it's the last place physicians look. You don't look at your colleagues that have gotten this far and done so well. So many times, Jean has read so many stories whey they didn't click. We think they're okay but they're not because we don't see that part of them. And as a culture in medicine, we need to tell our students and trainees that we're not looking for you to be perfect. We're not looking for you that there's not this ultimate doctor mold that you're supposed to fit in. There's room for all sorts of doctoring in doctoring.

"For the most part, your particular nuances can bring value to the human experience."

[34:50] As Doctors, We Are Evolving!

Jean adds that what is wanted from you is that you're genuine and your very specific personality. It's okay for you to not be doctor so and so or do it that way. There's no absolute kind of win or fail. And you're growing.  Years after and you're still an evolution. For Jean, part of engaging a patient grows her. She's becoming the very doctor that will retire every single day. She has worked all her life to get there but relatively speaking, it's only fifteen to thirty years that she will be doing this. Not that the identity changes but she's going to stop focusing on this at some point. She's in and she's out and in that period of time, she's going to evolve as a person, not just as a doctor. And as she evolves as a doctor, that means she didn't come in whole. And if she had thought at any moment that as she was supposed to be good enough as a novice, she would have quit too. But she didn't. She didn't assume she was going to be perfect.

Moreover, Jean stresses that it doesn't matter how smart you are or how prepared you are. The day they take the training wheels off and you are on your own is the biggest nerve-wracking day. And that day extends into the biggest one to five years of your life. There's no one else to check off to and there's no one else to validate your thought process and your decision-making. That first patient that you are attending for is like your first baby. Then you begin to realize you need to fly now. Then you come and fly.

"The day they take the training wheels off and you are on your own is the biggest nerve-wracking day."

Listen to colleagues and ask for advice. Then you keep your growth going. But Jean says that the first moment you own it all, the decision, the plan, the outcome and the responsibility and interaction, you own it all. There's no one to come in and rescue you. That moment is part of an evolution that takes the entire career. Jean admits she still gets nervous and she says you're supposed to get nervous. And she still second guesses a lot of the things. She'd still go to her colleagues and they'd still discuss cases until they agree om things. But you have to be humble and be around people who allow you to be humble that way. In the grand scheme of things, medicine in infantile. We're just scraping the surface.

"We think we're smart but in the grand scheme of the universe, we're making small dents here."

Jean thinks a lot of medicine needs to be flexible so we can adapt to more knowledge. Always mean well and always do well. And in the long run, when you look at why suicide happens, is we're in a culture where we continue to think doctors are somehow perfect. We think we have been perfect from the very beginning. But Jean says they're not looking for that. Instead, they're looking for potential when hiring doctors. If they're calling on their colleague, they're looking at growth in their potential. And if they retire, they're looking to see that they've fulfilled their potential.

So if you get into trouble, ask for help. If you feel pressure, maybe rethink. Although Jean thinks suicide is something deeper and it escapes logic. Jean has talked with those who have done it. She describes them as telling not of love anymore but more of how diseased they were.

[41:10] As Students, How Do You Keep on This Journey?

Jean some overachievers were susceptible to hearing that being a doctor was hard and they would go and climb that mountain. Maybe they weren't gifted or called that way but they just saw the mountain and wanted to achieve it.

Now, there's so much on the other side of that balance that makes it distasteful. Students aspiring to be doctors are looking for a calling, and doctors tell them it's a job. So Jean wants to inspire those noble people who have gifts. And by their nature and their drive, they can walk into a room and accept the challenge. They accept the extreme burden in exchange for the intense and indescribable intimacy of being gifted someone's vulnerability.

Patients come in and you get the privilege to ask them anything you want. It's meant to direct your treatment plan and understand their illness. They tell you the truth and they just open themselves up. If they resist, you can always turn the key and tell them you need the information. But people are looking for connection too. So they come back and they come back constantly to try to dig deeper into themselves and the problem.

So Jean says what we want to do is to encourage and attract that kind of applicant. People come to you asking for help and saying, "Now what?" You've got to have resources and answers. You need to plan on plans and plans and plans for months and years. And that's valuable to you because you suddenly get close to something indescribable. You suddenly get close to what she describes as the "ethos of medicine" - human connection, really honest, and really vulnerable. And that connection just tells you about you. Finally, it just takes that insanely exquisite moment and you're so glad you were of that position and profession. Because that's the only way that you would have had that moment.

[45:10] Go Help! They Need Your Support

If you're in a situation where you can pick up for a little while and go help whether it's a day or two or two weeks, go do it and help. Don't just do it for the application but do it to support a fellow human in need.

Links:

AMSA

AMSA Premeda

Pre-SOMA

Sep 06, 2017
249: This Physician Wants to Change The Narrative Around Death
45:50

Session 249

Dr. Shoshana Ungerleider is a Hospitalist turned evangelist for Palliative Care. Learn what you can be doing now to help patients in their most critical times no matter what field of medicine you're getting into.

If you're looking for full-length MCAT practice tests, check out Next Step Test Prep. They have ten full-length practice tests that simulate the real exam to help you get the best score possible. Use the promo code MSHQ to save 10% off your purchase.

Last week, I was at the Podcast Movement where I was nominated for the Academy of Podcasters Award for Best Science and Medicine podcast. And for the third year in a row, I came up short. Nevertheless, it was a blast!

Today, I have an amazing conversation with Shoshana who does her very best to change the conversation around dying. She funded Extremis, a short documentary about end of life decisions being made in an intensive care unit. It has been nominated for an Academy Award and others. Now, she's pointing her efforts towards End Well, a symposium to bring together all the best minds in the world, not only in healthcare, but also in the community and technology space - anybody that wants to help change the end of life decisions and care going on in this world. The event is taking place on December 7, 2017 in San Francisco.

[02:40] Her Interest in Becoming a Physician

Taking the nontraditional route, Shoshana realized she wanted to become a doctor way after college. Her undergrad studies ran the gamut from Fine Arts to Women Studies, Spanish, and Marine Conservation Biology. At the very end of college, she thought she would be pursuing a Doctorate in Marine Science. But she quickly realized it wasn't enough for her. She wanted to work with humans, not creatures who can't talk back at her. Not knowing what her next steps would be, she took a job all the way across the country in North Carolina. She had opportunity to work at a medical center. three months into the process of being an intern at the medical center, she realized she wanted to go to medical school.

At 23, she found herself back in college doing undergrad courses at UNC Chapel Hill. She completed the coursework the following year and took the MCAT. It wasn't until she was 25 that she thought she has done all the work, taken the exam, applied and somebody wanted her.

There were times she thought of doing something else. She felt she had many years to continue to think about the right professional course for her. She was lucky to have great mentors that had come before her who have also taken time off between college and medical school. It's changing now since most people take some time off or take the nontraditional route before starting medical education.

So it did cross her mind but her biggest focus is where she's going to be happy and fulfilled in life. Despite that it took her four years off, she thought this is the right path for her. Additionally, the best advice she got was that if there's anything else you could see yourself really being happy and fulfilled in doing, do that.

"If there's anything else you could see yourself really being happy and fulfilled in doing, do that."

Shoshana says that if you have a million interests and medicine is just one of the many and not the end all be all for you, don't go into medicine. Because there are so many factors that come along with it such as time commitment and financial proponent. It's hard especially for women since you're spending seven years minimum to complete the training. That's a lot of time of your life to give up. It's worth it but she thinks you really have to be sure this is something you want to do.

"People need to be as certain as possible that that's the right path for them before jumping all in."

For many people, having a family is something they see as a part of their future lives, if it isn't already. For women, especially, age 22-32 is prime time for people to be thinking about children and family, although it's not for everybody

[08:25] Finding a Mentor and Asking Specific Questions

Shoshana explains there are so many points in her life where mentors played a big role. She had family friends and random connections that turned out to be wonderful mentors for her. This was when she was looking at whether medical school was the right path as well as in terms of applying and where to go. Then where to go for residency. So she had people already built into her life who were there.

Now, she stresses the widespread use of social media and the acceptance of connecting with individuals via Twitter or LinkedIn. Just send them a thoughtful note on LinkedIn. Say you're a premed and you're interested in medicine. Say you'd love to get their thoughts about xyz. Or simply ask them a specific question hoping they'll see your message and write you back.

"There are so many people that you can connect with that you wouldn't otherwise have had access to."

As a practicing physician, Shoshana has been able to connect with people she saw as complete role models whom she never thought she could reach out to. She just put herself out there. She says that if there are specific people that you want to connect with or whom you think could be helpful, reach out to them.

I want to stress what Shoshana said about asking a specific question. You have to ask the right questions to the right people. Or ask the right questions in the right places. A lot of students are going through this process and they just ask very general questions. And physicians won't respond to that. Do some home work to ask good questions to potential mentors or people you're reaching out to.

Shoshana adds that doctors and other professionals are incredibly busy. If you're writing this note to someone, know that they probably have 20 seconds or less to be reading the subject line. They're going to read the first few sentences of the message. And they're going to decide if they even want to keep reading. So be as thoughtful as you can and be prepared as you can when reaching out to somebody. Make sure you've done your research and what their background is. Your question should be something they could just easily pop on their iPhone or their computer.

"Be as direct as possible with your question. Be as thoughtful as you can knowing these folks are incredibly busy."

[13:10] Challenges Being a Nontrad

The hardest part for Shoshana was getting through all those forms and writing those essays. This is not something unique to a nontraditional student as everybody probably dreads the secondaries. She says there's nothing about being a nontrad that she struggled with specifically there. But it was more of an asset for her. In her interviews, she has had some life experiences so she could talk about things she had worked on, research she had done after college. She could give a clear sense of the time and effort she'd put in to make sure medicine was the right path for her which she did after college.

"I've had some life experience. I can talk about things that I had worked on...It was a real benefit in the process."

Mostly, she didn't enjoy medical school. She admits not being a great test taker. Where she trained, they had major exams every two weeks. And she found it really hard. She studied all the waking hours of everyday worried about the exams. But one thing she did that really helped her was that she found herself so focused on grades. It was overwhelming. So she decided to stop checking her grades in medical school. Although she says this may not work for everyone but this did work for her. She realized she had already one by getting there. That was her ultimate goal to get into medical school. The fact she made it, she just had to study and work hard in taking tests but being less focused on the actual grades. She couldn't really do more than what she was already doing as she was working very, very hard. And that was already enough for her.

Moreover, in the clinical years in the third and fourth year for her, she loves being able to take care of patients. The second two years of training were much better for her. She found it well-suited her just being in the hospital and not so focused on the classroom.

"Medical school is hard. Anyone who tells you otherwise is either a complete genius or lying to you."

[17:00] Choosing Which Schools to Apply To

Shoshana thinks a lot of medical schools now are radically changing their curricula or the way information is taught to either fewer years in the class. Or their building in a research year potentially. They may also make the classroom material more case-based. So the context is built into what you're learning. And now with websites being readily available for all institutions, it would be much easier to research. And find out which schools are doing what kind of change around that.

For Shoshana, being a bad test taker as many students are too, she probably would have looked at places that had fewer months in the classroom. Or those that had more hands-on time either with research or getting a master's degree during medical school. Or where she can spend more time on the wards taking care of patients. That would have been a better fit for her.

That said, the institution where she trained has radically changed in the last five years in how they approach the undergraduate medical education, specifically the first two years in the classroom. Nevertheless, she believes there's a lot of variations still out there and it just takes some digging as to which schools have the right setup. It depends on what you're looking for.

[18:45] How Shoshana Would Have Created Medical Education

What Shoshana thinks should be changed in the current system is the inclusion of more case-based learning. It's helpful in the way that it helps students to remember material better because it's taught in an actual patient setting. She feels there is so much of medical school that she never used or have to think about. And looking back, she feels it was a waste of time. And she believes a lot of people feel this way too. She also feels very strongly that medical schools need to teach a little bit on healthcare economics. She finished training with very little understanding of the healthcare system. People talk about it everyday and how it's a big issue.

"Medical schools need to teach a little bit on healthcare economics."

And as a physician, Shoshana thinks you should be able to at least very high-level talk about it and think about it critically. Unless you've studied that in your undergrad years or are an avid reader of what's happening, it's pretty hard to fully understand that. We have such a convoluted, multi-faceted problem of healthcare. So it would have been very helpful to have some formal training and how to think about that.

Additionally, Shoshana says there are many opportunities outside of just a clinical physician taking care of patients for entrepreneurship in medicine. This is also something that is not taught. So she would probably add some components around healthcare economics and entrepreneurship. Make sure doctors are more involved in these conversations on a national level or policy level and industry. These are two areas she finds herself being very interested in now.

[21:50] Palliative Care: Does It Do Harm?

Shoshana defines palliative medicine as a fairly new medical subspecialty that focuses on quality of life for anyone facing serious illness. It can be used at any time during the course of that illness. It employs a team-based approach to caring for people.Palliative care is fantastic in that it employs a team-based approach to caring for people. Typical palliative care teams have a nurse, a social worker, maybe a chaplain, a physician, and sometimes, some other folks on the team. They work together in a much more interdisciplinary fashion than you might find in a healthcare setting. They talk about what matters most to patients who are facing life-limiting illness. And to make sure they're focused on the quality of life for as long as they have left. The field was born out of a need to bring humanity back to medicine.

"There is a place for us in medicine to take care for people when cure isn't always an option."

Many people see palliative care as going against the Hippocratic Oath, specifically about doing no harm. They think that palliative care is sort of giving up which does harm to patients. But in the last five or so years, palliative care has been much more widely accepted nationally. 90% of major hospitals in the country have palliative care available for patients. So things are changing but Shoshana says we have a long way to go. What she was thought is that death is a treatment failure. Nobody wants to talk about failure. A physician's job is to cure people of their disease and you've made it. But there are times when cure is not an option. As much as we would love to see everybody well, it's not always possible. So there are times when we need to transition our focus to a comfort-based approach if people are having trouble with pain and other symptoms. Or it's about shifting our focus to quality of life.

For some people, if they know treatment is no longer working, there are other ways to support patients and families through serious illness. That can be many things like spiritual care or treatment for depression related to their illness. Sometimes it can be pain control or other symptom management. That's not to say that palliative care is only for people for whom care is not an option. Shoshana clarifies that it's really for anybody who's been diagnosed with a serious illness. But they just tend to focus a lot on people with terminal diagnoses.

In the U.S. we are so technologically advanced and Shoshana thinks the healthcare system approaches every patient thinking that we should do everything for everyone. But she says that's not always the case. That's why she found herself in palliative care because she was taking care of so many those patients. She got distressed when she realized nothing she's doing for the person is actually going to help them.

So Shoshana believes that when we talk about "doing no harm" in the Hippocratic Oath, she felt she was harming people in their last few moments or days of life. When they could have been focusing on things that mattered to them. That could be being pain-free or being with family or eating and drinking instead of having a tube down the mouth. Again, she thinks things are changing around the acceptance of palliative care but it's still a long way to go.

[27:35] Palliative Care versus Hospice

Shoshana explains that hospice is a part of palliative care. Palliative care is a long continuum. When used at its best, it's a long continuum of time that begins from the diagnosis of a serious illness all the way through until the end of life - death and even up to grief and bereavement.

Palliative care can be used for years and years. Hospice is somewhat arbitrarily relegated to the last six months of life - medicare, reimbursement, designation where patients have to be "reasonably" within the last six months of their life in order to be eligible for hospice services.

[29:15] Palliative Care Resources

In order to learn more about palliative care, Shoshana mentions several great resources such as Get Palliative Care. It contains a lot of videos and it's geared towards the general audience. It talks about what palliative care is and how it can best support people.

They also have a lecture series on UngerleiderFund.org where they host experts in palliative care to come in on a quarterly basis as they talk about various components. Also, understand that palliative care works the best when patients get an early referral. For instance, the patient has been diagnosed with late stage cancer or advanced heart disease or liver failure. There's a team that can work alongside the primary medical team to offer an extra layer of support for patients and families.

To Shoshana, it's a no-brainer. Who wouldn't want an extra layer of support from a team which is what palliative care is all about. It's not about saying you're dying or things will be taken away from you.

"It's much more about making sure you are living well for as long as you have left on this earth."

[31:20] Talk About Cost and Insurance Coverage

Shoshana is not an expert on payer reimbursements. This is one area she loves to dive more deeply into. Often when patients are in the hospital and a palliative care team is called in to consult or see a patient and their family, that's covered by insurance. On the outpatient side like in the clinic and the patient is able to drive to the doctor, this will be a slightly different reimbursement setup. But most insurance companies recognize that palliative care offers a huge value for patients not only financially, but it's just good care. Shoshana also thinks things are changing around payers being much more willing to cover these services even alongside curative treatments. So people can be undergoing chemotherapy or other expensive treatments and still benefit from palliative care.

[33:15] About The End Well Symposium

One thing Shoshana noticed is it's always the same people when she goes to these gatherings. So she would like to invite new people to this conversation. She welcomes folks outside of the realm of palliative care like other specialties in medicine. Or more people from nursing or social work or even the spiritual care realm to get more involved in these high-level conversations.

Shoshana further shares that this is not a health care issue but a human issue. How we live and hopefully live well until the very end is something that applies to all of us. So she founded this first-of-its-kind gathering called End Well. It takes place on December 7, 2017 in San Francisco. She hopes to being together the worlds of design, technology, policy, media, law, patient advocacy - all with the goal of generating very inter-professional, human-centered innovation for the end of life experience. They're looking at how they can re-design systems and come up with new products, new services that transform the end of life experience into a much more human-centered experience.

So this is going to feel like a TED event. They will have 20 world-renowned thought leaders speaking. They will have a full day of engaging, short, highly-curated presentations. 400 attendees are expected to come from all over the world. They mirror the diversity of their speakers. It's open to the public. They'd love to have more medical students or people thinking of going to medicine. They're inviting anyone that cares about this issue as a human issue.

For more information, visit www.EndWellProject.org

[36:23] Painting a Picture of Palliative Care in the Curriculum

If Shoshana could design the perfect path for medical students and residents going through, she would recommend palliative care to be a part of the curriculum as early as the first few years in the classroom of medical school. She would have wanted a place for more pharmacology and better understanding of medications we use around palliative care. In the third and four years where she was spending time on the wards,

"A rotation with a palliative care physician would have completely changed my outlook on how I cared for all the patients that I was seeing."

It would have given her a much better foundation to think about how she can best take care of patients. For her, it wasn't until her first year of residency in internal medicine that she had any exposure to palliative care. That was her many months in the ICU taking care of very sick patients. They were not benefiting in any way from what they were doing in the ICU. Sadly, it's the default path for patients in this country. If you're sick and you need help no matter how old you are or sick you are, you will receive aggressive, invasive care even if it's not going to help you. So Shoshana felt this disconnect early on. It wasn't until she had a mentor in palliative care as a resident that she realized how amazing human-to-human conversations are with patients and families. She realized how powerful this is just as much as any procedure they do in medicine. It can be life-changing.

I think those interested in emergency medicine should listen to this whole interview a couple of times. I have a friend who won awards for helping people die. Her hospital is recognized that she helps patients with their care through palliative care medicine as an ER doctor. I think this is a huge point of entry for palliative medicine if we can get these doctors to start having this conversation.

Shoshana adds this is very true for ER doctors and primary care doctors included. It's very important to take care about issues such as advanced care planning. It gets back to these core questions of -  Who are you as a person? What are your goals and values for living your life? What is meaningful to you in your life? How do you share that with your family?

"We all have a part in this... anyone who takes care of patients. It's our job to be engaging in this kind of conversations."

[42:30] Shoshana's Final Words of Wisdom

What Shoshana wishes to tell students who may also be going through the path she went through is that it's going to get better. Just push through if you can. Once you're done with medical school, that's the biggest hurdle. That was the hardest thing for her. Residency is more time-consuming and more fun. If you want to take care of patients, that's where you get to do it and really learn. After residency, the world is wide open. There are so many paths.

And for people who don't yet know what to do, the right path will present itself. Shoshana was one of those people who wasn't sure what she really wanted. And after her eight or ten weeks of internal medicine on her third year, she was sold. She never thought that would have been her path. So just be open to those opportunities and experiences.

Lastly, clinical medicine is not for everybody. If you find yourself not so interested in taking care of patients but you're in the middle of medical school, there are a million other routes you can go with your medical degree. There are industries all over the place looking for physicians to consult including pharmaceutical industry, biotech, etc. There are a ton of entrepreneur physicians out there especially in Silicon Valley.

"There are many, many options so don't get discouraged if you feel like a career in clinical medicine isn't for you."

[44:26] Shoshana on the Specialty Stories

Listen to my interview with Shoshana on the Specialty Stories episode 7 where she talked about being a hospitalist

Lastly, check out Next Step Test Prep and use the promo code MSHQ on any of their products and services. But they're one of the best places to get MCAT full-length practice exams.

Links:

Next Step Test Prep (Use the promo code MSHQ to save 10% off your purchase.)

Extremis Documentary

End Well Symposium (December 7, 2017 in San Francisco)

Get Palliative Care

UngerleiderFund.org

Specialty Stories Podcast Episode 7: What is a Hospitalist? An Academic Doc Talks with Us

Aug 30, 2017
248: From Premed to Attending Physician - Showing You the Path
38:08

Session 248

Have you ever wondered what the whole path to becoming a doc looks like? I'm breaking down every step of the premed & med student journey to give you an idea!

We are celebrating five years of The Premed Years Podcast at the end of November. And I realized I haven't really covered this topic in depth and in totality on the podcast. It's that whole journey from starting off as a premed and finishing as an attending physician. So I'm walking you through that journey and fill in the gaps to give you a general overview of everything and what to expect along the way.

As humans, the biggest fear is the unknown. Hopefully, this episode sheds light on the whole process and it makes it easier for you to understand. Therefore, it would be a lot less scary. This is actually the first time that we've put all together in one. Also please check out all our other podcasts on the MedEd Media Network.

[03:15] Start of the Journey

You start off your journey as a premed. There's a lot of you that use premed for pre-PA or pre-NP or pre-Nursing. But the standard use of premed is if you're someone who decided to become a physician, whether a traditional premed or a nontrad. Whether you're in high school, in college, or after college, wherever you are on your journey, you're a premed as soon as you decide you want to be a physician. If you're in high school and deciding this, you have a leg up. You know what you want, hopefully. And just because you know it now as a high school student, it doesn't mean that's what you're going to want. Once you're in college and you're on that path, you may decide to change your mind. And that's okay.

[04:30] High School

As a high school student, you have a couple of options. You can go to a four-year undergrad university. Major in whatever you want as long as you take the prereqs for most schools. Those are usually English, Physics, Chemistry, Biology, Organic Chemistry. Some schools are adding in some Psychology, Sociology for the MCAT. Those are the general things you need to look at. You can major in theater. You can major in Spanish.

"You can major in whatever you want to become a medical student."

A lot of students mix up premeds with being the major. There are few, if any left, colleges that have a "premed" major." Most of them will have a premed track. Some will flag you as a premed in their system so the advisors can track you. So they know who you are and offer you advice along the way. As a high school student, you can go down that path. Even as a nontraditional student, you can go down that path.

You can also go to a two-year your university or a community college. There's a lot of myths around community colleges and some negative stigma around it. But the truth is, if you go to a community college, you're going to have to transfer to a four-year school. You have to do well throughout. And you're going to be fine. Most medical schools will accept community college credits. That is okay.

You can also apply for a BS/MD program so you can go straight into college knowing you're already accepted into medical school. Sometimes, they're six years or seven years. Sometimes they're full eight years. It all depends on the specific program you're applying to.

[06:38] Freshman Year

Once you've figured out where you're going to go, you start off in college. The biggest thing you need to do when starting in college is respect the transition to being a college student. A lot of students try to take on way too much stuff. They go on and read stories of students with 3,000 hours of shadowing and ten publications. They think they need to start right now or they won't get into medical school.

"Respect the transition to being a college student."

You don't have to start right now! Your job when you start college is to get A's or as close to A as you can get. Just be a college student where you are not told what you need to do everyday. You're given a syllabus. You're given dates of tests. And you're left on your own to figure it out. You can go to classes if you want. You don't have to go to classes if you don't want. Some colleges will have mandatory attendance. But you just need to get on to campus and figure out how to be a college student.

You need to start to get to know your premed advisors. They know the in's and out's. hopefully, of your college. They're going to know all of the classes that match up the best with medical school prereqs. They're going to know the best classes that match up with MCAT prep. They're going to be your champion, hopefully, along the way. They're going to push you and coach you and be there for you along the way. Don't show up at the very end of college and say you're a premed and you're asking a letter of recommendation from them. Again, first year of college and you're just dipping your toes in the water learning how to be a student. You're getting good grades and easing into that transition.

[08:55] Sophomore Year

Once your sophomore year hits, then you can start piling in some things in a step-wise fashion. You're learning how to take on more and more responsibilities, more organizational skills. You're going to be needed better study skills. You're going to be needed along the way. So you're just building up on each step of the way.

"Along the way, you will see that every year you're adding more and more to your plate."

Once your sophomore hits, now you can start looking into research if you want to. Research is not mandatory but I recommend you try it out to see if you like it. You'd be surprised. This is the time to start to get into clinical volunteering. This is the time to start to do some shadowing. Shadowing can also be done on your first year since it doesn't take a lot of resources. You're just there hanging out. You can do it once a month or once every couple of weeks for a couple of hours here and there. It's not going to take a lot of time. First year is to see and continue to prove to yourself to reinforce that you're on the right path and you still want to be a physician. So that's what shadowing is for.

Then start doing clinical volunteering on your second year. Start to get in front of patients and interact with patients. There are many ways to do this such as the hospice, as an EMT, a CNA, an ER volunteer. You can be any loads of different things. You can be a certified phlebotomist.

"You can do a lot of different things to get in front of patients."

Answer for yourself what counts as clinical experience. Were you close enough to smell the patient? That's the general saying in the admissions world. Being a scribe is a great experience Most scribe physicians will allow you to have some interaction with the patient. You're going to need to interact with them. They will fill out the chart. Make sure you have everything down properly. If you're interacting with the patient, even if it's not in a specific clinical environment, and you're like a home health aide, that counts as clinical experience. You need to do some non clinical volunteering as well. Just go out there and show you can spread your time out and you can handle the workload. Show that you can still go out and contribute to the community.

Leadership is very important as well. You need to be able to show you're a leader. You don't have to start three different clubs on campus or run for class president. But you need to have some leadership experience.

So as a sophomore, continue to be a great student and adding in these extracurriculars - research, clinical experience, nonclinical volunteering, leadership experience, shadowing. Additionally, you can start prepping for the MCAT too. You don't need to but a lot of students like to do it at this time. They buy MCAT books and take them to their classes. Then they look through the MCAT books and start to prep for the MCAT along the way.

[12:35] Junior Year

This is where things start to get exciting. Junior year, especially the end of junior year, is typically the time you're going to take the MCAT. Let's say 2020 is the year you want to apply to medical school. I recommend you take the MCAT in March or April 2019. So that's the tail end of your junior year. Along the same timeline, you're also prepping your application which starts around May and June of 2019 (again assuming you want to start medical school in 2020). So at the end of your junior year, things start to get even busier.

So basically you're adding more on top of all you've done during your sophomore year. As I've said, you're adding more every step of the way. And by the end of your junior year, add MCAT prep. Get down into the ditches of the MCAT world.

"You need to prepare for several months to do well on the MCAT. You need to take a lot of practice tests."

Check out Next Step Test Prep and use the promo code MSHQ and save 10% off their full-length practice test packs. It takes eight hours to sit there and take take a full-length practice test. That's how long the MCAT takes. So you need to do six or eight of them leading up to your exam. That's a lot of time you need to prepare for. And you can't just stop all of your clinical experience otherwise you will have this big gap.

As you're ramping up to your MCAT date, a lot of students think they've got all their hours in for clinical experience or for shadowing. So now they need to go prep for the MCAT. This is a big red flag for the admissions committee. They see that gap and they will question whether you're really interested in being a physicians. If you're really interested in being a physician then you would have continued to be around patients the whole time.

"It's very important not to just drop everything for MCAT prep and application."

Again, say, for a 2020 start date. Application happens in May or June of 2019. You need to start writing your personal statements around January. You need to start asking for letters of recommendation around March, April, or May. You need to start preparing for your interviews. You need to start asking for transcripts. You need to write all of your extracurriculars down.

[16:33] Keep a Journal

Let's rewind back to sophomore year when you're doing all of your curriculars. Make sure to keep a journal. So that when it comes to application time, you don't have to remember everything, it's all right there in front of you.

[17:00] Apply Early

At this time, let's hope you've already taken the MCAT otherwise you will also be prepping and doing your applications at the same time. And what usually happens is applications suffer and you'll apply later and later.

"Remember that the majority of medical schools out there accept students on a rolling admissions basis."

The earlier your application is in, the earlier that they will consider you as an applicant and the earlier that you will be invited for an interview. This means the earlier that you can get an acceptance. The later you apply, the less seats that are available. Then it becomes a giant game of musical chairs. Later in the game, there are more people with less seats. Your chances go down the later it takes for you to apply to medical school. So you need to apply early. Even if you don't have your MCAT score yet, you still have to submit your application. So you can go through the verification process. The application services are looking at your application and looking at all of the grades that you've entered. They will compare that one by one to the transcripts you have submitted. So it takes a long time since it's a human doing that. [18:21] Senior Year In your transition from junior to senior year, you submit in June. In July, there comes a lot of secondary applications. The medical school application is broken down into a primary application and then secondary applications. They are more essays. They take a lot of time to write. The suggestion is to submit your application early June. Start writing your secondary essays for as many schools as you can. And as soon as your application gets sent out, you will get a secondary and turn that around as soon as possible. There's this magical two-week window for submitting secondaries. Some schools will give you deadlines, some schools won't.

"There's this magical two-week window for submitting secondaries."

Again assuming you're applying early, August to April is interview season. It's a long interview season. So be prepared to get an interview at any point in there. When a school sends an invite, they'll send it through email or through their portal. You will be given a date or you log on and select the date. Again, the earlier the better because most schools have rolling admissions.

Depending on the school it's usually mid-October, at least for the MD schools. The AAMC has asked for MD schools not to release their acceptances until mid-October. The DO schools don't have the same rules so acceptance can go out earlier than that. So you have all the way up until March or April for interview and acceptances. Then if you're accepted, you're going to start medical school typically around August 2020 (for this example).

[20:42] First Year Medical School

So you're finally a medical student. You start off with your white coat ceremony Everybody is excited. Then reality hits and you realize that life is completely different now. There's that analogy of drinking out of a fire hose and it's so true. It's test after test after test. There are tons of material to learn. You just need to hit the ground running and go.

A lot of students ask how to prepare. What do you do in the summer before? What classes should be taken in undergrad? The answer is to just really enjoy your life up until medical school. Then start in medical school and just go.

"Don't really do anything to prepare to be a medical student other than being a good student."

So you start in August and in most schools, everything is nonclinical. It's all classes. Some schools will have some clinical-like experiences where you start to shadow and get around patients. You start to interview patients and learn those skills. They'll throw in some little bit of exam skills as well. First year of medical school is a lot of testing and a lot of fun.

Most schools still have a summer in between first and second year. You're free to go do some shadowing and some research. Take a break. Go do whatever you need to do during that summer. Some schools are dropping that summer and just going straight from first year to second and starting their clinical rotations even earlier. So you get more clinical rotations. You get more clinical experience. This is something to look at when you're evaluating medical schools. Ask whether they still have that summer. I personally recommend to still have that summer. I would not be a fan of not having that summer. Because it's a good break between all of the classes you're taking.

[22:55] Board Exams

Around the end of your second year, you're going to take the boards, Step 1 or Level 1 depending on whether you're an allopathic student or an osteopathic student. An osteopathic student is a DO student and allopathic student is an MD student. At the end of the day, you're a physician when you graduate. DO's have an extra skill of osteopathic manipulative treatment osteopathic manipulative medicine. The history is that DO students treat patients more holistically. I don't believe in that. There has to be more than that when you're looking at osteopathic schools.

So you take Step 1 and Level 1. Being an MD, I took Step 1. I didn't take Level 1 or COMLEx. If you're a DO student, you can take the COMLEX and USMLE. If you're an MD student, you can only take USMLE.

"Step 1/Level 1 is a lot of just basic science knowledge."

Step 1/Level 1 is a lot of just basic science knowledge. It's straightforward. It involves a lot of memorization, a lot of just knowing facts. I didn't do well in Step 1 because that's not how I'd like to be tested.

[24:27] Third Year and Fourth Year of Medical School

Once you finish Step 1 and pass it, you go into your clinical rotations during your third year and fourth year. A lot of it is just going to be whatever the mandatory clinical rotations are that your school has set up. A lot of DO students, especially, will have to travel a bunch to go to different sites to do their rotations. Fourth year, you start to do some more electives. You start narrowing down what you're interested in doing as a specialty or what you want to apply to for your residency. You set it up then you go for, say a month, and you spend your time there. You will hopefully do well so that when you apply, you'll match.

"Third year is mostly just a lot of standard rotations then on the fourth year, you start to work in the elective rotations."

Near the end of fourth year, you need to take Step 2, which is the second part of the boards. COMLEX Level 2 for DO and USMLE Step 2 for MD. I believe this test is more useful because it's testing you based on not just the knowledge or the memorization. It's actually giving you some more scenarios, more treatment-based things, a little bit more real life. So I had more fun on that test. Step 2 has CK or clinical knowledge which is the written test and the CS or clinical skills. For the CS, you have to go to a site and there's only a handful of sites in the U.S. It's a very expensive test. You have to fly there and stay for a night. You go to the testing center with standardized patients. You have to interact with the patients. Take history. Do a physical. Write a note. And you're tested on that.

All around the same time, you're also interviewing. You're applying to residencies. You're interviewing at residency programs. Then you submit your rank list for the match.

[26:58] The Match

The match is a very fancy algorithm. Its creators actually won the Nobel Prize for it. The algorithm takes your rank list where you rank from one to however many programs where you want to go to. On the other hand, the programs rank from one to however many students they want to accept into their program. Then the algorithm does its magic and you get to have Match Day in mid-March. That's when you open up an envelope and see where you match. You'll find out about it a week before whether you matched or not. And if you don't match, you go through what's called the SOAP process (Supplemental Offer and Acceptance Program). You will find out what programs aren't full and you call them up and ask them to take you. Match Day is a huge day in the medical student's life. It's something I won't ever forget. Most students graduate around May, sometimes later into early June; Then you start residency.

"Match Day is a huge day in the medical student's life."

[28:20] Residency

Once you finish medical school, you go into residency. A lot students get confused with internship and residency. Internship is just your first year of residency. For your internship, you have a prelim year or a categorical year. In my case, I did a prelim internship. I did a transitional year. It was a mix of medicine and surgery. You can do prelim internal medicine or prelim surgery.

"A prelim year is usually a year that you have to apply to separately from your main residency."

Some specialties don't have their internship built into the main program. They include dermatology, ophthalmology, neurology, and others. They're changing a lot all the time. So depending on the program, you may have to apply to a separate internship. Assuming you don't apply to a separate internship. You're just applying to internal medicine and you apply to your categorical three-year program and matched. When you are applying to residencies, there is a wide spectrum. Three years is the minimum like internal medicine, pediatrics, family medicine. Up to seven years for neurosurgery, plastic surgery, and other programs. You are doing your first year as an intern and residency for the rest of the time.

At this point, you are getting paid. It's about $47,000 the last time I checked but it may be more now. But it's the average across the whole country. It depends on where you live, cost of living, etc. But you don't want to calculate your hourly wage. If you look at the hours, you're going to be very sad because it's a lot of work. The last time I looked was 80 hours a week on average. 16 hours for first year residents, 24 hours for second and third year residents. Although this is constantly changing. There's a lot of stuff in the news recently with regard to work hour regulations in interns. It may go back to a 28-hour straight shift. So be prepared to work a lot as a resident. Moreover, realize that once you become an attending, there are no work hour regulations. So you can work a lot more than that. A hospitalist is working seven days on and seven days off. Those seven days they're on, they're on completely the whole time. They're sleeping but they're on call. Some hospitals now have nocturnists where they cover the nighttime hours to give the hospitalists some break at night.

Somewhere in your internship year, you're taking Step 3 or Level 3 of the boards. This is needed to get your license to practice independently. It's very important to finish that out strongly.

[32:44] Fellowship and Attending

Once you finish residency, you can go and practice and be a general pediatrician or a general internist, whatever you are. Or you can go do a fellowship depending on what you're doing. It can be one year or three years or maybe more than that. The three years is the maximum that I've seen but it could be more. If you want to learn more about this side of thing, go listen to Specialty Stories Podcast. I talk to specialists and listen to their path to medicine and what they're practicing. It''s very interesting to know all the different paths you can take once you get into fellowship and subspecialize in a lot of other things.

Finally, once you finish your fellowship, you are considered an attending. Whether you're in academic practice or community practice, you are an attending, Once you're out of training, you are an attending physician. Then you worry about your board exams so you can be board-certified in whatever you trained in. You also have to worry about continuing medical education to keep up your license and so much more. So it's never-ending once you become an attending. But don't let this scare you away because it's worth it once you get there. Not to mention you've been working a long time to get there.

[34:15] Final Thoughts

There are a lot of nuances along the way such as MD/PhD or some of the three year MD/DO programs out there. There are some deviations to what I talked about. But hopefully, this gives you a good long-term overview of what to expect. Let's assume four years of college, four years of medical school. That's eight years. Let's assume a three-year residency. That's now a total of eleven years. Plus one year of fellowship, now it's twelve years before you're an attending and making the big bucks. But along the way, you also have all your loans during your training. Most of those loans are accruing interest because you're not paying back a lot. They're deferred loans and a lot of other issues along the way. You have kids along the way. You married along the way. If you're still out there wondering if this is what you want, now you understand how this works. Hopefully, that will give you enough confidence to jump in with both feet.

"Whatever your situation is, it's a long journey. But it's a journey worth taking."

Check out the Hangout Group and go to our Facebook page. I go live almost everyday that I'm at home and in the office around 3 pm eastern time. I've been pre-arranging my schedule and the calls I have with students and other things I need to do throughout the day. I do a Facebook Live video and I will be putting them out as a new podcast called Ask Dr.Gray, Premed Q&A.

Links:

MedEd Media Network

Next Step Test Prep (Use the promo code MSHQ and save 10% off their full-length practice test packs.)

Specialty Stories Podcast

Hangout Group

Facebook page

Ask Dr.Gray, Premed Q&A

Aug 23, 2017
247: Do You Need an MD(DO)/PhD to do Research as a Physician?
49:42

Session 247

Dr. Maureen Leonard discusses her journey to medicine and her life as a physician scientist, working 70-80% of her time doing research with “just” an MD. Find out why she thinks you don't need to have a dual degree to do a lot of research as a physician.

First off, I will be in Tampa on November 4 and we'll be doing a meetup on the 3rd or 4th for the AMSA PremedFest. The event will be held on November 4-5 at the University of South Florida. Join hundreds of students as well as subject matter experts about what matters most on your journey to medical school. Get tips not only on how to get into medical school but also how to stay healthy once you're there. Explore the unique emerging specialties. Get practice in squinting and suturing. Register now and save some money using the promo code MSHQ17. Also check out all our other podcasts on MedEd Media Network.

Back to our episode today, Dr. Maureen Leonard talks about being "just" an MD and being a researcher. A lot of students question about the dual degree programs like MD/PhD or DO/PhD. And they think that because they want to do research, they need to get an MD/PhD or a DO/PhD. Maureen is "just" an MD and now has a Master's. Her job is about 70-80% research as "just" an MD. We talk about her journey into medicine and the advice she got when doing research as an undergrad with a PhD advisor. She also discuss the things she's been doing throughout her career as a premed, as a medical student, and now as a physician scientist. If you're thinking about doing that dual degree, listen to this episode and maybe you'll change your mind.

[05:45] Her Interest in Medicine and Her Premed Journey

Maureen knew she wanted to be a doctor when she was senior year in high school. Initially wanting to be a dancer, she thought it wasn't going to work out. But she realized she likes people and science so she decided to go down the medicine path. In figuring out it's what she really wanted to do, she did volunteer work at a neighboring hospital throughout high school. She also did part time job doing filing in Boston Children's Hospital.

The hardest part of being premed for Maureen is the ton load of work. She wanted to make sure she had a lot of experience so she can be ready to go to medical school. So she spent a fair amount of time doing research in her free time. Her major was psychobiology, which has been renamed as neuroscience. She did different research projects with rats throughout her time in college. Like many people, she got her EMT license. She was shadowing and volunteering.

"The hardest part was juggling so many things to try to make sure I was a well-rounded applicant."

She was basically the typical premed when she was in college. She got advice from her premed advisor. Although her psychology advisor thought research would be helpful, she was also interested in doing research. So she was encouraged to do both research and clinical experience.

[08:40] Research Experience Tickling Rats

Her major required them to do some research for the psychology degree and a thesis for the biology degree. They had a small class and her mentor at that time did a lot of research. So she got invited to do research with her and tried it out. She ended up really liking it. She likes the ability to ask questions and design how to answer that question and watch it all unfold.

"We were trying to identify what the vocalizations in rats meant."

The first research she did was identifying what the vocalization in rats meant. Maureen reveals that their research suggests that rats made a 55 kilohertz ultrasonic vocalization for laughter. You can elicit this vocalization if you tickle the rats. So she spent hours a day tickling rats to be able to elicit vocalization. They eventually did place preference studies to confirm that these vocalizations meant that they were happy. They didn't get the cute rats but the old, grumpy rats which they tickled morning, noon, and night. She obviously put this on her application and it did come up during her interviews.

[12:05] Her Thought Process for Not Choosing the MD/PhD Path

Her psychology advisor throughout her entire college experience was very adamant that she should do MD/PhD. Of the four people they worked with, two of them went to medical school and one did the MD/PhD. Maureen did not. She was told she should do the MD/PhD. She made it clear that she would be making a huge mistake if she didn't apply. Her advisor thought she could do more with the MD/PhD and since she was interested in research, it could open so many doors.

But Maureen decided not to go that route. She wanted to learn more about research being a new thing in college. She also felt she needed to go to medical school later than other people. She had to change her major when she got into college just so she could be premed. So she took a gap year before applying and did basic science research with mice.

She hoped research was going to be part of her life but at that time, she didn't know what she wanted to specialize in. She couldn't imagine agreeing to a seven or nine-year program when she didn't even know what her focus in medicine was going to be.

"I couldn't imagine applying to an MD/PhD program and not having this passion for what I was doing."

Part of her thought process was that in doing the PhD, you'd be delving into a specific question you have for three or four years. But she didn't have any question yet because she didn't know what she was going to specialize in. For her to be excited about spending so much time on a project, she knew she had to feel passionate about it. Until she knew what she wanted to specialize in medicine, she couldn't commit to something for that long without having any passion behind it.

[17:15] Taking a Gap Year and Global Health Trips

At the point she had spent doing a full year doing research and she wasn't sure. She thought research might be a part of it. But she spent the extra time they had in medical school not doing research. Instead, they were doing global health work. It was that one summer where they had time off between first year and second year. Instead of doing research electives, she did global health trips. She did this out of curiosity and not knowing what she wanted her life as a doctor to look like. It was something she wanted to experience. She wanted to spend her time in medical school examining whether it was something she was interested in the long term. She wanted to see what felt right to her.

During medical school, research stayed on the shelf. She went to internship and pediatric residency  at Tufts University in Boston. She still liked global health and research. At this point, she put both back into her mix. She felt so busy as a premed that in medical school, she decided to focus on the work and global health. She had to kick it in a notch again in internship in residency. She tried to do both to help her make an informed decision about how to spend her time as a doctor.

So she spent time on her rotations that did not require hundred hours a week. In her internship year in the first year of residency, she did retrospective chart review with pediatric gastroenterologist. She felt it was what she wanted to get into. Then on the second two years of residency, her program allowed her to spend a month each year in Haiti. She was doing global health work related to cholera and general pediatric medicine.

[21:44] Fellowship and Mentorship

As a pediatric gastroenterologist now, Maureen got involved in studying coeliac and all the gut microbiome involved with that. She got interested in studying autoimmune disease during medical school. She did a lot of reading about autoimmune disease. She read about how many people thought that the gut is a very important organ in the development of autoimmune disease.

Her reading during medical school and her experience in internship in residency was where her research interest was. Applying for fellowships, she looked into different programs that had either mucosal immunology or some sort of autoimmune group within their GI group. This is how she landed at Massachusetts General Hospital because they had a mucosal immunology and biology research center. Nevertheless, Maureen accounts luck for ending up being able to to do exactly what she wanted. Her mentor came six months after she started.

"I chose a place that had many opportunities in the area that I was interested in and my mentor was doing exactly what I wanted to do."

When she was applying for fellowship, Maureen was reading all of her mentor's research which she found very interesting. She didn't reach out to him until he moved to Massachusetts General Hospital. So he sort of became her virtual mentor at that time.

[25:10] She's "Just" an MD

Maureen says that 70% to 80% of her week is dedicated towards research which means three and a half to four days a week. So she's doing research and not doing patient interaction. She sees patients one day a week.

When she was focusing on research, she applied for a master's in clinical and translational investigation. She had some training in statistics and clinical trial design. But because in pediatric gastroenterology they had two years to focus on research, that's what she did. She had a lot of experience during those two years. She wrote papers. She has a mentor in line with the projects. He gives her a lot of opportunities which she takes. So she has been able to become a translational investigator.

"I realized there is this large lab that there are many PhD's that have skills that take years to perfect."

What she can do is really go to the clinic, see patients, identify clinical problems. She's able to obtain clinical samples from patients and then collaborate with the lab guys. She does some work on her own to and answers questions which she finds clinically interesting. She basically wanted to get down to this physiologic or pathophysiologic level.

Maureen didn't feel that having just her MD didn't hold her back. Because she did the specialty training where she had time to focus on research, she had an advantage. At this point, Maureen can see that she can continue down this academic physician scientist path. It was her plan in the first place and she loves doing it. She likes that she gets to see patients, do research, collaborate with so many people, and everyday is different. On the other hand, she has the opportunity that if she decides to make a change she can become a full time clinician. So she thinks the Master's degree has helped her as well. She can go to a pharmaceutical or a device-manufacturing industry and be a medical director. She can also become a translational scientist at a startup up company in Boston.

"I think I have a lot of different opportunities as a physician that has focused on research."

[29:10] What It Would Have Been If She Did MD/PhD

Maureen thinks that if she did the MD/PhD route, it would look similar and she would look a little bit older. When you do the MD/PhD route, there's a balance either way. It works for her because everything she does is based on Coeliac disease and gluten-related disorders. So she's able to see patients one day a week. The she gets to do the research. She adds that all the patients she sees could possibly be research subjects or inspire research questions. She's extremely focused which allows her to see patients and do research.

"If you do MD/PhD, you still have to decide where to focus the majority of your time."

Additionally, Maureen doesn't want to give up skills so she does an extra half day every other week doing procedures. She could do less clinic and do more research. But she doesn't want to give up seeing patients because she likes it and they help her with all of her research. So if you go the MD/PhD route, you still have to make choices on how much time do you want to spend being a clinician or being a scientist. Nevertheless, she doesn't think it would be any different because she couldn't see doing less clinical work than she's doing now.

Maureen has gotten to where she is now not because of the letters after her name. She made the decision based on her interests. She was also being very intentional with the life and the practice and the setting she wanted to create. She adds that you're going to have questions and you're going to need to answer them. You will find a way and the success will come. So she never regretted doing the MD/PhD route.

"If there is passion for a certain research project, it doesn't matter what letters are after your name."

[32:22] Research Grants and Awards

Maureen currently has an award from NIH and a grant from NIH. Because she does more than 50% research, she is eligible to apply for the NIH Loan Repayment Program. As long as you are doing more than 50% research and you have a research project in line with the NIH, you can write a grant and be awarded up to $35,000 a year for two years. That money goes straight to your loans. They also pay some federal taxes on that. Just this past week, Maureen received her third and fourth year of that award. This means over $140,000 straight to her loans. It's basically free money. Maureen stresses how helpful this is.

"By working at a major academic center, you are not making the same salary that one could make in another state doing more clinical work."

Another thing is that NIH is paying a fair amount of her salary through a mentored research grant called an NRSA for F (Individual Research Fellowships) grant. She didn't initially about all these grants. And as a physician scientist, there are different grants you can apply for. This is a mentored grant so she has this grant for three years. She has already completed the first year of the grant. She is trying to publish some papers and she's now beginning to apply for the next NIH grant. It's a K award, a five-year grant that pays 75% of your salary. Sometimes, you may even need to do a little bit less clinical work to really focus during that mentored career award.

In order to be awarded a mentored grant, you need a mentor who's going to oversee all of your work and supporting you with the rest of the salary the NIH isn't covering. So basically, she's not an independent researcher at this point in the NIH's eyes. But rather she's a mentored grantee. Then the K is you're developing your own independent projects and the R is an independent investigator award.

Maureen says she likes to stay in research. Although the funding environment is very difficult, she's been very lucky. But she has also worked hard. She has gotten several grants but applied to many more than she received. Say, out of fifteen, she only got three. So a lot of times is spent on writing and it's difficult. Maureen is realistic and she loves what she does. She wants to keep doing this. Her goal is to continue and she's writing another grant. She's always writing grants and she's going to continue to do that. And as long as she has funding, she's going to stay whether that be on the academic path through the pharmaceutical industry. She basically feels good about her options.

"I am happy that I really love being a clinician and that I can see myself staying in research."

[38:10] The Nuts and Bolts of Writing Grants

Maureen explains that writing grants varies. Some grants will ask for letters of intent. You can write a two or three-paged letter about what you want to do. Then they'll invite you to write a full grant. For others, no letter is needed and you just need to write a full grant. The grant means that you are writing your summary of what you're going to do.

"The grant means that you are writing your summary of what you're going to do."

Usually in a page, you're writing about your specific aim which is what you're exactly going to do. Then have another five to six pages containing support information about why you're going after those research aims and how you're going to do it. A lot more goes into it including your file sketch that contains about five pages of your background and your contributions to science. They want your publications and awards. You may provide bio sketches for anybody supporting you in this grant. It can be your mentor or anybody you're going to work with. Or it's anybody who's going to train you if you need to learn certain techniques to complete the grant. You also need to provide letters of recommendation from one person or they could require up to three or four people. You also have to give details of your budget. How much you're going to spend, where, and when. You need to provide a timeline for when you're going to do all of this. In general, Maureen does pilot funding. A pilot grant might be 20-30 pages in total. The NRSA grant was closer to 60 pages because a lot of documents need to be included. It includes what you're going to say to the IRB and how many people you plan on enrolling.

Writing a grant can take a long time. It can take months before someone can come back to give you feedback. But for the NIH grants, the loan repayment program award and the NSA grant took months. It took her a month to write it and then she got a lot of feedback. the more people you can send it to, the more feedback you can get. She usually gives herself a couple of months including the K award.

[41:42] Recommended Classes for Premed Students to Become a Better Researcher

Maureen recommends trying to take some basic statistics courses which can be very helpful. She doesn't do statistics frequently so she gets help with it. But taking those courses has helped her understand how to plan a study and what kind of analysis she can do. She thinks it's great to have a better understanding of how research works. Understanding clinical trial design is a good class to take as well. Ultimately, try to read research in the area you're interested in and get into what people are doing. For premed students interested in research, try to check out PubMed or Google Scholar. And just start searching keywords.

If you're trying to decide on whether a single degree or dual degree is right for you, Maureen says that you can really accomplish your goals with an MD. If you find that you needed the PhD for some reason, that's an option. You can do that after your MD. There are other degrees like a Master's that might help you if you need to have more training or you feel you want more training. She thinks it's certainly possible to have a career focused on research with just an MD. Her mentor has a very productive lab and he's just an MD. So it's definitely possible. Either way, you're going to have to determine how you're going to spend your time. There are only so many hours in a week.

"It's certainly possible to have a career focused on research with just an MD."

[44:55] Time Management

Maureen says it's hard to figure out how to manage your time when you're doing research and being a clinician. It's hard especially when you're so passionate about a project. There's always more grants to write. There's always papers to write or a chapter to write. So she had to really actively try to manage her time and take time off. She's still working on this. She's trying to determine which grants make the most sense to apply to and what papers must be written. She has been able to manage her time a little bit better now that she has grants. She can now take her time in writing other grants. But in research, you can always keep writing and reading so you have to draw some lines in the sand for yourself. "

In research, you can always keep writing and reading so you have to draw some lines in the sand for yourself."

Maureen wishes to tell premeds out there that it's so worth it. She gets to manage  her time the way she wants right now. The premed years where you're trying to reach your goals are the hardest years. But she loves her job and the balance she has. She loves doing procedures and seeing patients. She loves being able to answer questions she finds so interesting. So it's totally worth it. Keep it up.

[46:55] Final Thoughts

As Maureen has said, you don't need to have a dual degree to do a lot of research as a physician. If you want to do research as a physician, you can do research. You don't need the PhD to do it. Not having a PhD doesn't hold you back. Dr. Leonard is at one of the top academic medical and research institutions in the country. She has"just" and MD and her mentor has "just" an MD and they're out there doing amazing things. They're doing a ton of research and are successful at it. They were not being held back by not having a PhD. But if you're that student who loves research and can't see yourself doing anything else, go ahead and get that PhD if that's what you like. If not, now you know that you don't have to and that is okay.

Again, check out these final announcements:

October 14, 2017 - UC Davis Pre-Health Conference

November 4, 2017 -  AMSA PremedFest (Use the promo code MSHQ17.)

February 17, 2018 - UCF Medical School Admissions Symposium

I will be at those said events and I would love to see you there. More awesome things to come! Thanks for joining me.

Links:

NIH

NRSA

AMSA PremedFest

PubMed

Google Scholar

UC Davis Pre-Health Conference

UCF Medical School Admissions Symposium

Aug 16, 2017
246: Ask Dr. Gray, Premed Q&A - Lots of Great Questions Answered
41:16

Session 246

It's been three years in a row that our podcast has been nominated by the Academy of Podcasters at the Podcast Movement. The actual awards ceremony is on the 23rd of August. The Red Carpet Party happens at 6 pm and the Awards Show starts at 7:30 pm It's free to go to the awards ceremony so I would love to bring some of you there. If you're interested, shoot me an email at ryan@medicalschoolhq.net. I am also putting together a dinner meetup on August 21st. To find out more, join our Facebook Hangout Group.

Back to our episode today, I'm answering a ton of questions that came in through our voicemail feedback hotline. Feel free to drop in a question and call us at 617-410-6747. When you call in, don't leave an email address or phone number so I can just play the whole clip in the episode. We also had a lot of great questions come in through our Facebook Livestream. I'm basically doing a daily Q&A show on Facebook. If you'd like to come hang out and watch the livestreams, go join our Facebook page specifically for this. Click on the Like button and get notified when I go live.

Additionally, I'm turning those Facebook Livestreams into a new podcast called Ask Dr. Gray, Premed Q&A. It will be a brand new podcast separate from all our other podcasts at the MedEd Media Network. So check it out and if you like, subscribe to the show.

[05:55] Nursing Experience as Clinical Experience

Question from Josh: He is currently from the University of Central Florida going into his summer year as a nursing major. He is starting a process of trying to get all his extracurriculars down along with his MCAT application. He wants to apply next year.

His question: Does all my hours at the hospital of learning to be a nurse count as clinical hours? Should I put that on my application?

My thoughts:

This is a very common question for those coming from a nursing background whether you're still studying as a nurse or already working as a nurse. And yes, it does count as a clinical experience. In fact, it's a great clinical experience. You get to interact with patients. Obviously, you're not interacting with them as a doctor. But premeds students aren't interacting with patients as physicians either. So you're probably doing more than the majority of premed students out there. If you are interacting with patients in whatever way you are doing that with, close enough to smell the patients, that is great clinical experience. So absolutely use that for your application.

"Close enough to smell the patients, that is great clinical experience."

A second question that comes up a lot is whether or not you have to shadow a physician. No, that doesn't mean you don't have to shadow a physician. You should shadow a physician, period. Being a nurse or a nursing student doesn't mean you understand what being a physician means. It doesn't mean you understand what the life of a physician does. It doesn't mean you know what the physician does outside of that patient room and everything else that encompasses a physician's job. So you still need to shadow physicians to satisfy that kind of requirement for medical school.

[09:40] Solely Studying for the MCAT: Would It Hurt Your Application?

Question from Jacob: Calling from Pennsylvania, Jacob is a graduate. He graduated in 2016 with his bachelors in biochemistry. He took a year off to work at an emergency room to better understand a physician's lifestyle and to better understand if being a physician is really what he wanted to be. After that year, he realized it's what he wanted to do. And he's been studying for the MCAT. It's what he's all been doing while having a few undergrad courses to help him with the MCAT. Unfortunately, his scores aren't still exactly where they need to be as January approaches. So he plans to extend his MCAT to March. So what has been originally scheduled in January is now going to be in March. He thinks he still is not doing too much besides just studying for the MCAT. He's worried med schools are going to look at it and say it wasn't enough and he should have been doing other more extracurriculars. So Jacob is worried what he should be doing these next couple of months. Should he be solely focusing on the MCAT and go after that and make sure it's taken cared of before he starts adding things to his plate? Or would it be better to start doing a little bit of other things at this point? He's worried it will look bad if he's just strictly studying for the MCAT and just taking a few classes here and there for about six months.

My thoughts:

A student can get in big trouble here. I've talked to students who've gotten that feedback from admissions committees where there is a huge gap in extracurriculars. Jacob also mentioned about patting the application but that's not you're going to be doing. You're showing consistency throughout the application. You're showing consistency throughout your premed years. Number one, that you can handle doing some extracurriculars and doing well in your courses. And you're doing well on the MCAT. But it's also proving to the admissions committee that you truly are passionate about what you're saying you're passionate about.

If there's a huge gap in patient contact and let's say you get all of your extracurriculars in your first two years of undergrad and you don't have anything for two years. You hit that number by your sophomore year so you think you're good. But you're not. You go your junior and senior year without anything. And when you apply, your timeline for your activities shows a big gap in patient exposure. When the admissions committee members are going to see that, they're going to think you're really not that excited about patient care. They think you've been avoiding it now for a year or two.

"You need patient interaction."

I'm not saying you need ten to twenty hours a week. But if you can get a couple of hours every a couple of weeks shows some consistency. Maintain even just a little bit of time with a little bit of consistency. This way, you can still do well on the MCAT and still focus on the MCAT. But you can also get those hours you need to keep maintaining that experience. So that instead of ending it in 2015, you can say you're going to continue to do this up until your matriculation into medical school. Again, not a ton of hours every week.

"Just maintain that consistency so that you can put that in your application."

There's going to be ups and downs with how much you can do during each semester even during the months within that semester each year. There's going to be different things happening. So you can't maintain a consistent benchmark of hours all the time and that's okay. So again, just maintain that consistency.

[16:02] Taking Master's to Improve Your Grades

Question from Matt: He recently graduated from Columbia University in New York City and got a master's of science degree in Human Nutrition. His performance in grad school was not as good as it was in undergrad. In undergrad, he graduated with a 3.6 and had a load of different grade opportunities. He is curious about how medical schools view performance in grad school as opposed to undergrad.

My thoughts:

This is a very common question I get from students trying to improve their undergrad grades by taking graduate level courses. The answer really depends on what your graduate level courses are. He did say he is taking a master's in science in human nutrition. But Human Nutrition isn't known as one of the "hard sciences." So it's not very hard science heavy. There may be some other courses in there like biochemistry and others. But from what I know from nutrition courses, they're not very hard science-related. When a medical school sees that, they're going to be looking at that.

"You have to be very careful with Master's degree."

Master of Public Health is not a hard science. It's not going to be looked upon very favorably when an admissions committee is looking at your 2.9 science GPA from undergrad and your 4.0 science GPA in your master's of public health. They're not going to be convinced that you can handle the science now. The best place to go is a couple of things. Just do a normal postbac. If you're trying to improve your coursework and your grades, just do a normal postbac. The other place to look at if you want to do a master's is to get an SMP (Special Master's Program). It's a very specific program usually set up through the medical school. Or it's set up through the institution where the medical school is located. You're proving to the admissions committees that you can handle your stuff. In the first place, 3.6 is a good GPA so I'm not sure why this student is worried about his GPA.

Anyway, a lot of students will have a plan B. And a lot of students will use the master's as their plan B. They pick a master's based on their ability to find work if they don't get into medical school after applying. That's how they choose the master's instead of what is the best master's to get them into medical school. It's what the best master's to find them a job if they don't get into medical school. And that second line of thinking is harmful for your overall path into medical school.

"A lot of students will have a plan B...that second line of thinking is harmful for your overall path into medical school."

[20:10] Medical School or PA School

Question from David: Living in Portland, Oregon, David is 34 years old. With no prerequisites for anything, he basically has nothing underneath his belt. But it's something he is strongly considering. He has a BA from University of California Sta. Cruz in the Classics which he got five years ago. Currently, he is just hanging around and not doing much. He wants to go back to school and thinking about medical school or PA school. He wants to know my thoughts, how to get started, and some do's and don'ts being in a stage this late.

My thoughts:

The fact you're calling me and asking the question of whether you should do it or not, well, I can't answer that for anybody.

"Only you know if this is right for you."

The problem I had with this question is the student said he's sitting around not doing much. And just thinking about medicine and PA school, you should be out doing Go shadow a medical student. Go shadow a physician. Shadow a PA. Go and get involved in clinical volunteering. Be around the patient. Don't sit around and say you really like scrubs so you think you want to be a doctor. Your bachelor's didn't do enough for you since you're just sitting around doing nothing do so maybe a doctor is what you want to do. You cannot think theoretically about this stuff. Go do it and make sure you enjoy being around patients. If you have done both and you are looking at both and you're still unsure, shadow a physician and a PA. Ask them what they like about their job. Ask the PA why they didn't go to medical school. Ask them why they chose to go the PA school route.

"Make sure you enjoy the sciences behind being a physician or being a PA."

PA's will give you different reasons for going this route while physicians will also give you different reasons for why they chose it. But you have to go and explore it yourself. Don't sit around and think what it looks like being a doctor. You need to go out and experience it for yourself.

There's this other student that asked about taking a gap year and just now exploring medicine. He is shadowing and doing some research. He's trying to figure out what he likes. It's definitely the perfect example of what to do to show your interest or to learn if you're interested in becoming a physician or a PA or NP.

[24:53] The Plan B Mindset

If you have a question, call 617-410-6747. We will do more of these Q&A shows where you can call in. We also had a couple questions coming through the Facebook Live. Again, make sure you're a part of our Facebook community.

Question from Sammy: He's wondering what his next step should be. He has secondaries going in. He's still doing volunteer work but feels like he should be doing something more. He's asking for suggestions on what to do in the event he doesn't receive any offers for interviews or acceptances. Should he be working towards some research postbac in biodmedical science? What should he do? Sammy is currently working full-time to save up funds for school.

My thoughts:

This is an example of the Plan B thinking. What if you don't get any interviews? You have to kind of think that way at this stage of the game. But it's still too early though. If you're applying to medical school, go all out. Get all of your secondaries in. Don't let anything else distract you from that. That's your main priority. If you haven't yet, get your primary in. Take the MCAT. Get everything in as soon as possible. Then you sit and wait. It's a waiting game. Now without knowing the specifics on why you didn't get an interview, it would be hard to offer suggestions here.

"The best answer is to talk to your advisor and find out where the weakness in your application is."

If it's your GPA, do some postbac work. If it's your MCAT score, go retake the MCAT. If it's lack of clinical experience, get some. It's a very easy way to look at your application. What's missing here? What didn't the admissions committee like about your application to not get any interviews?

The same goes if you do get interviews but don't get any acceptances. What is it about the application? Sometimes, it's not the application. Sometimes, it's your interviews. Natalie was here on the podcast back in Session 241. She applied to the school three times. In the last application cycle she did, she had interviews. She didn't the first time and second time, she got six to seven interviews. She got waitlisted and one of them, she got rejected from the rest. She applied again and didn't do much to tweak her application. But she applied again and worked with me for mock interview prep. Then she got five or six acceptances. She just had a white coat ceremony at the University of Michigan. So there's a lot of pieces to the puzzle of why you didn't get in the first time or why you didn't get any interviews.

[28:47] Shadowing Hours

Question from Ryan: How many hours of shadowing do med schools look for?

My thoughts:

There is no great answer for that. I typically recommend students to have at least 40. It's a random number I came up with. There's no hard science behind any of it. There is really no right answer to that. You need to have enough to know that you want to do it. But you don't need hundreds of hours.

[29:12] Types of Postbacs

Question from Emily: Can you do a normal postbac if you already have the prerequisites for medical school? What is a normal postbac?

My thoughts:

There are two types of postbacs. Academic enhancer postbacs are for students who had their prereqs already. They've taken the sciences but didn't do too well on them and you need to retake them. There are also career changer postbacs for students who don't have the science prereqs. They need to take all the science prereqs so they go and do a career changer prereq. Go to AAMC's postbac page where they have the database of all the postbac programs out there. You can sort and filter by state and by type of program, etc

[30:19] When to Take Biochem for the MCAT

Question from Bruff: Should I try to take biochem a semester before I take the MCAT? So that I can review it over winter break. Or take it in the Spring semester so it will be more recent?

My thoughts:

It's up to you. It depends on how good you are at remembering stuff and being prepared. It depends on where the MCAT falls into that. I don't know if I'd recommend taking it while you're trying to prep for the MCAT. I would try to take it earlier as possible so that it doesn't interfere with your prep.

[31:00] Shadowing Hours

Question from Adam: He's asking whether he should focus more on shadowing time if he has a great amount of non medical volunteering with some military stuff. He only has time for one option right now.

My thoughts:

"Shadowing is not the end all be all. You need some shadowing but the clinical experience is much more valuable."

If you have enough shadowing, dump it and just continue the clinical experience.

[31:37] Premed Advisors

Question from MJ: What if your advisor is useless? What about advisors who don't do anything until long after you need their assistance? Like granting committee letters after you graduated. You pushed ahead on the MCAT and have gotten shadowing in.

My thoughts:

There are good advisors out there as much as there are bad advisors. It's just like there are great doctors and bad doctors and great everything and bad everything. If you're having problems with your advisor, understand that you don't have to have that committee letter from them. It's not required to apply to medical school. If you feel getting a committee letter from your committee is not going to help you and it's going to hurt you then skip it.

"If you feel getting a committee letter from your committee is not going to help you and it's going to hurt you then skip it."

Cut them out of the equation. Have the letter sent to AMCAS directly or to Interfolio or to AACOMAS. Have the letter just sent directly and just cut the committee out of the process completely Don't let the committee hurt your chances of getting into medical school.

[32:58] Best Qualities of a Med School Applicant

Question from Xavier: What are some of the best qualities that you've seen from successful students who were admitted to medical school? How important is research and publications?

My thoughts:

First of all, you need to be determined and be hard working. You have to be smart enough to get good enough grades in your classes and a good score on the MCAT. But what it really comes down to is being certain that this is what you want to do. You have to be able to reflect on everything you've done leading up to the point of your applications. Be able to reflect on that journey and through that personal statement, you're able to show that reflection.

"Show why you're doing this, not just that you did do it."

Most of the students have done it. Now is just a matter of reflecting and explaining that reflection to the admissions committee members through your personal statement.

In terms of research and publications, it's not that important. It's important to go and explore it. Go and see if it's something you like. Do it if there's some research you think you will enjoy. Getting a publication is just an extra line you can put in your application. But it's not that important to get published.

"Get some research experience. There are lots of different kinds of research."

Clinical research allows you to interact with patients and physicians. Bench research involves interacting with lap people, a PhD specifically, who's the PI doing all of the research. Go experience it and see if you like it. If you do, keep going. If you don't, go find something else.

[35:04] High School Extracurriculars

Question from Ryan: Do extracurriculars participated during dual enrollment at a college in high school relevant for the medical school application? What do medical schools think of high school AA students? Does it help in the application?

My thoughts:

Everything that happens in high school stays in high school. But transcript-wise, if you're taking dual enrollment courses, those grades are going to pull into your application for medical school.

"It's an unwritten rule among advisors is whatever happens in high school extracurricular-wise, stays in high school."

However, if you do an extracurricular in high school and continue that for a good chunk of your college career, mention it. Put the start date in high school. Other than that, getting an AA while in high school doesn't really matter.

[36:35] Showing Positive Trends

Question from Mason: He has about 60 credits from three different schools from eight years in the military. He got a 3.6. He just started his first full-time semester at the university he will be graduating from. He got a C in Physics I and II. He bit off way more than he could chew. Even though it's not his first actual semester of college, he's wondering if a positive trend from hereon and out be considered?

My thoughts:

Any positive trend anywhere is great. As long as your grades are going up then of course it's good.

"Medical schools have the ability to sort and filter based on whatever or however they want."

At least for Texas, they upload all the data points you've entered. They get transmitted to the schools. They have their own software to manipulate that data and use it however they want to. I've talked to admissions committee members where they look at the last 20 hours of sciences. So they have that ability to filter. They can tell the computer program to show them the last 20 hours of sciences for this student. And if there's a solid GPA there then great. They go to the next step, look at the personal statement, etc. So you always want that positive trend.

[38:40]  Final Thoughts:

Drop in your questions at our voicemail hotline at 617-410-6747. Again, don't leave your number or any contact info in those voicemails. Check out our Facebook page so you can watch and be notified when we go live on Facebook. Look for Ask Dr. Gray, Premed Q&A.

If you're in the southern California area and looking to hang out with me. I will be having a dinner meetup on August 21. Then on August 23 is the Academy of Podcasters Awards Ceremony. I'd love for you to come hang out with me.

November 4-5, 2017  - AMSA PremedFest in Tampa, Florida ( I will be speaking at the event and have my table set up.) Use the promo code MSHQ17 until October 25, 2017 to save some money off your registration.

Links:

PMY 241: Third Application Cycle was a Charm for This Premed!

AAMC Postbac Page

AMSA PremedFest

Interfolio

MedEd Media Network

Academy of Podcasters

Podcast Movement

Facebook Hangout Group

ryan@medicalschoolhq.net

www.medicalschoolhq.net/facebook

Aug 09, 2017
245: Why Does Texas Have It's Own App and More TMDSAS Questions
44:47

Session 245

In this week's episode, we have two guests coming on the show. Dr. Scott Wright is the executive director of the TMDSAS (Texas Medical and Dental Schools Application Service. He talks about the Texas medical school application. Our second guest is Enrique, the man behind the TMDSAS podcast. It offers a valuable resource to students thinking of applying to medical school, nontrads included.

But before that, listen to this week's episode of the Specialty Stories podcast (Session 34) where we interviewed a gastroenterologist who specializes in interventional endoscopy. Also check out the other podcasts we have on the MedEd Media Network.

If you're thinking about going to medical school, check out AMSA PremedFest which will be on November 4-5, 2017 at the University of South Florida in Tampa. Gain insights into how you can best present yourself as a medical school candidate, how to succeed in the toughest classes you'll ever take, and how to emerge from the experience as a healthy, happy physician which a lot of people aren't doing right now. Explore topics like cornea transplantation, genetics, and narrative medicine. Also get a chance to suture and splint and much more. I will also be there and talk about the interview process. Save some money off the registration fee and use the discount code MSHQ17 until October 25, 2017.

Back to our episode today, let’s go behind the scenes in the TMDSAS process. If you're hoping to apply to medical schools in Texas, and even if you're not applying in Texas, go check out this episode.

[03:30] Why TMDSAS Stands Alone

Representing the 50th year of the TMDSAS in 2018, Dr. Wright explains that the precursor to TMDSAS known as the Medical and Dental Application Center began in 1968. This is five years prior to when AMCAS started. Alongside this, Texas began the idea of centralized application service for the school in Texas. So Texas basically pre-dated the AMCAS.

The state legislature of Texas limits the number of non-residents that can go to a medical school in Texas to 10%.

"Only 10% non-residents can enter or be in the classes for the Texas medical schools."

This behooves the Texas schools to have a rich pool of applicants from inside the state. This is good for schools for them to be able to say that they're getting largely Texas residents applying. This does not suffice to say that non-residents can't apply. But because of the limitations the legislature puts on the medical schools, it benefits all of them to have a centralized application service just for the Texas schools.

Moreover, they work diligently to keep the cost low. They have a flat fee. So to apply to all medical schools in Texas, there is a flat fee of $150. To apply to an equivalent number of schools to AMCAS would be $500-$600. Since they're only serving Texas schools, they're able to keep the cost low.

"We are Texas. We have to do things differently."

[06:44] TMDSAS Exceptions and New Texas Residents

At this point, all Texas schools are state-supported except for two private schools, Baylor University and University of Incarnate Word Osteopathic Medical School. The legislation only affects the publicly supported schools. So both of these schools do not participate in the TMDSAS.

TMDSAS doesn't get any funding from the State of Texas but they are funded strictly through application fees from the students.

"We try to keep the cost low to encourage applications from anyone who's interested."

They're able to keep the cost low by a small staff and not having a lot of overhead costs which AMCAS does. While AMCAS has a fee assistance program, they don't but they try to keep the cost low for everyone. They want students to feel comfortable applying in $150 as a plausible amount to commit to applying to a total of ten medical schools in Texas.

As far as new residents are concerned, Dr. Wright says that as long as you meet the residency requirements, TMDSAS doesn't flag the application of new Texas residents.

[10:05] How to Prepare for TMDSAS versus AMCAS and AACOMAS

Dr. Wright encourages students to view the questions of all three applications  in the beginning of the process. Generally, all three are similar in terms of the information they're trying to obtain although they may be asked in a different way. Largely, if an applicant works diligently to develop a strong and extensive resume, they're going to be able to answer those questions regardless of the application service.

In the case of Texas with ten schools cooperating together, they have the ability to really work very carefully, extensively, and directly with their institutions. They meet twice a year with the deans and directors to go over changes that need to be made. As compared to AMCAS that has about 125 schools to deal with. So it's not possible for them to craft questions into ways that reach the very core of what institutions want.

[13:05] Biggest Mistakes Student Make in the Application

"Many of the mistakes that are made is because the students rush through it."

TMDSAS open their application every year on or about May 1st. They literally have people who submit their applications on that same day. So they're taking less than 24 hours to complete one of the most important documents they've ever completed. So they end up messing stuff up. They rush through it.

Dr. Wright explains that each section of the application has to have something in it that they're able to save before students can submit it. Students that tush through things make mistakes, miss words and have grammatical issues. They leave stuff off and then realize they've made a mistake. Sadly, they can no longer make changes. Once they push the submit button, it's done. They can longer open it back up for anybody. And the medical school is going to see whatever it is you submitted. Dr. Wright advises students to slow down. Take time to proof-read everything.

Additionally, course entry is probably one of the biggest parts of the application. This is where they require the student to enter a variety of data points for very college course they've ever taken. This can be very labor-intensive. So they often try to get around that by only entering one class per semester or get things mixed up. So you need to enter these courses correctly. The GPA calculation depends on the entry of those courses. TMDSAS has to of course-verify that what was answered is what's on the transcript. As soon as a student sends their transcript to TMDSAS, a physical person looks at their transcript and goes through it line by line. So you have to make sure you're entering your data correctly.

[17:10] What If You Messed Up Your Transcripts?

Dr. Wright explains that if you happen to mess up your course entry, it depends on the extent of error or how this plays out. For instance, they have students who have entered every semester they were in school but they only entered one class per semester so the application will let them save. In this case, TMDSAS will bump this right back to them or they're going to process their application as is. They send it to medical schools then the schools are going to say the students were not following instructions.

The application service is part of the continuum of this process and they take their role very seriously. They have encountered students that lie and they've determined it was intentional falsification. They've had students who were trying to hide some classes they didn't want in their GPA. They've had students who tried to submit letters of recommendation from false people. When this happens, the medical schools

"We take it very seriously, our role, TMDSAS, we take it very seriously."

When this happens, medical schools are told there are flags in the application. TMDSAS also sends a letter directly to AMCAS and AACOMAS. So they would know who the applicant is and what the infraction was. Dr. Wright reiterates how serious this stuff is and how they take these things very seriously so students should take this seriously. They're seeking to enter a profession that has ethics and has moral standards. The society expects them to uphold this so they have to do this right from the get go.

There is a national registry database for classes and this comes up on a subsequent school's transcript. They get a transcript for a certain school and it shows they transferred from another school. The other way this comes up later in the process is under the financial aid. And if they only found out about this up to this level and it goes that far into the process, the student is out. They will be dismissed before they even start.

[22:30] The Role of TMDSAS

TMDSAS transmits every data point they have to all the Texas medical schools. It is then the medical school's responsibility to load whatever they want to upload into their given admissions system. This varies from school to school. TMDSAS is communicating to medical schools so they get everything TMDSAS has.

The individual medical school uploads into their system and looks at it in a variety of different ways. But they're potentially going to see everything. They're going to see GPA's in a lot of different ways as well as MCAT scores, answers to the questions, personal statement, etc. They see potentially everything that TMDSAS has access to and they just filter and sort however they want.

[24:23] GPA Calculation

TMDSAS goes through a processing effort where they have verified that the student has entered the information correctly. This is so particularly with the course entry since this produces the GPA calculations.

Dr. Wright points out that TMDSAS differs from the other application services in the way that they don't calculate pluses and minuses. So it's strictly an A, B, C, D, E, F generation on the GPA calculation.

In addition, every course attempt is calculated into the GPA. So if they took Organic Chemistry I and made a C and retook it a semester later and made an A, both of those grades are going to be calculated in the GPA. It's not the latter one or the better one.

[25:35] The Application Cycle Time Frame

Once the student pushes the submit button, this goes into a queue. They look through the application. They will review a variety of points in the application. They review the way students have coded the classes. Then the application goes to another queue to be transmitted to the schools. Depending on the time of year will dictate how long that process between when they push the submit button and when it gets transmitted to the school.

"In height of the application cycle, that can take up to four weeks."

The cycle typically takes up to four weeks but they have examples where they tell students upfront what date they're working on it. This way, students will have an idea how long it's going to take until the medical school gets their stuff.

Dr. Wright says they used to get tons of applications in September. Their typical deadline is October 1 although for 2017, it's September 29. So they used to get tons of application in the last week. of the cycle. For example, they might get 2,000 applications in the last week. He finds this totally crazy for students to wait this long. But they have seen a shift in the trend.

"I think the students are getting the message that they need to apply early."

Students are now more and more starting to apply early. Dr. Wright says the biggest height of the application cycle is probably late June or late July. It's interesting how Dr. Wright says this has happened in the last three or four years. This podcast happens to be out for about four and a half years now.

[29:25] Understanding the Rolling Admissions Process

I asked him about changing the term "deadline" so that the students understand that this is a rolling admissions process. Medical schools really want the applicants to apply early because this gives them more time with the applications in a holistic environment. They want students to submit as early as possible.

A discussion that they've made with medical schools is a graduated application fee. For example, if a student applied before September 1st, the fee is $150. And if they applied after September 1st, they could raise it to $250. This encourages the students to apply earlier which essentially benefits them. It not only saves them money, but also, the school can get their stuff a lot earlier.

[31:21] Competencies of a Successful Applicant

Dr. Wright emphasizes that's important for students to recognize that everything they do from the minute they step on their college campus is going to affect their application. This includes the organizations they get involved in or the amount of time they study. This includes the efforts they make in class to engage and concentrate. It involves the friendships they make in and out of the classroom and the connections they make with professors. Everything they do is going to build in their application.

"The second you step on the campus, the second you go to class, you're filling out your application."

Dr. Wright recommends students to envision it this way otherwise it could badly impact their success. Moreover, they emphasize the idea of holistic admissions. But he firmly believes that society expects of its physicians. What medical school want out of students that come into their institutions are ones that have strong personal qualities. They're ethical, honest, and with a strong degree of integrity. They know how to communicate with each other. They're empathetic. They have a broader picture of what it is they're doing.

At TMDSAS, they will soon be doing a podcast on personal competencies. Dr. Wright recommends listening to their podcast. They emphasize the importance of interpersonal skills. The see a lot of students who fail on these issues. Maybe they have a great MCAT score or GPA but they can't carry out a conversation and that's going to be problematic.

"They need to envision when they go to the doctor, what do they want to see? And that's what everybody else wants to see."

Dr. Wright recalls taking his daughter to the doctor when she broke her arm. And as they walked to the orthopedic surgeon's examination room, he didn't look to either one of them in the eyes. Never once did he make any personal connection with them. And he was just flabbergasted. So they found someone else who can treat his daughter as a patient.

[36:27] The TMDSAS Podcast

While Dr. Wright is the god of the admissions universe, Enrique is the god of the TMDSAS podcast. It basically started when Enrique ran into Dr. Wright's office and introduced the idea of starting a podcast which he approved of.

"The whole idea of the podcast is to leverage the level of collaboration that all of the TMDSAS participating institutions have."

The podcast seeks to connect the different admissions officers and different advisors throughout the state. Enrique has been able to come in contact with them in his eight years of medical admissions in Texas. So he tries to get them to offer some advice to applicants who may not necessarily know what kind of questions to ask. So the whole concept of the podcast was to acclimate the potential and current applicants to the world of medical, dental, and veterinary admissions. So they get to understand what the schools are looking for and how they can develop different qualities the schools are looking for.

[37:38] Resources and Help for Nontrads

They had just finished their first series where they're meeting all of the deans of admissions of all the schools. They also started a series for nontraditional applicants. They're going back to some of the deans that offered to help some of the advisors. They want to tailor certain topics to nontraditional applicants. These could be persons looking into a second career in medicine, dentistry, or veterinary medicine. They can be somebody who took a gap year or a reapplicant. They all come from different backgrounds.

But the ideas that come from them and the drive they have to get into these schools is negated by the fact that they don't always have access to somebody who can help.

"We're using the podcast in creative ways to help connect all of our applicants."

Many times too, new advisors throughout the state figure out what to do in order to prepare students for the school application. Another cool thing they're currently developing is a community for nontraditional applicants. On their Facebook page, they've built out a group for nontraditional applicants. They encourage everyone to join so they won't feel they're alone. They hope to build this community as part of the series. They will be having some webinars hosted with different advisors and different admissions officers that relate to the questions coming out of the group.

Go check out their resources on the TMDSAS website and you will also find there the resource page for nontraditional applicants. Also check out the TMDSAS podcast to listen to their great episodes.

[41:03] How to Strengthen Your Application

Dr. Wright recommends students to apply early and to be very careful in submitting their application. For nontraditional students, he talks about making good choices.

"We are looking for strong students but we're even, more so, looking for strong people, solid character."

So he advises nontrads to make good choices which produce good results. Finally, he quotes Albus Dumbledore from the movie Harry Potter that says,

"Who you are is a product of your choices, not your abilities."

You have choices to make so you have to make wise choices. This is going to affect in multiple ways how successful you are in the medical school admissions process.

[43:43] Final Thoughts

Go listen to The TMDSAS Podcast and go share it to your colleagues and advisors. Give a rating and review. Your advisors would definitely love to hear an official podcast from an official application service for the great state of Texas.

Links:

The TMDSAS Podcast

TMDSAS website

TMDSAS resource page for nontraditional applicants

TMDSAS Facebook group

SS 34: Community-Based Interventional Gastroenterologist

AMSA PremedFest Baylor University

University of Incarnate Word Osteopathic Medical School

ten medical schools in Texas

Aug 02, 2017
244: Entrepreneurial Premed Stands Out For the Ivys
37:23

Session 244

Prerak is a premed student who is about to start medical school at Yale after a successful undergrad at Berkeley. Listen to his story and check out his YouTube.

AMSA PremedFest returns to Florida on November 4-5, 2017 at the University of South Florida. Join hundreds of students like yourself and hear from physicians, med students, and subject matter experts about what matters on the road to medical school. You'll get tips not only how to get in to medical school, but also, how to stay healthy once you're there. Explore unique emerging specialties and get practice in splinting and suturing. Register now at amsapremedfest.org and receive up to $30 off the regular registration free using the promo code MSHQ17 until October 25, 2017. I will be there on November 4 and I will have a session on the medical school interview as well as a table set up there so I can meet you! Come join me and everybody else at the AMSA PremedFest.

Back to our episode today, Prerak Juthani has a great YouTube channel and is doing something very similar to this podcast. He started free tutoring company, a club at his undergraduate institution. He has been very entrepreneurial on his journey, finding problems, and finding solutions to those problems making him a great applicant to medical school. Now he's about to start at Yale Medical School soon.

[03:15] His Interest in Medicine

An Indian-American, Prerak never knew he wanted to be a doctor but he always had the option open. He claims to be lucky having parents who never forced him on becoming a doctor which is stereotypical for most Indian-American families.

Prerak is passionate about three things - teaching, learning, and interacting with others- and it was after he started undergrad when he realized that medicine is the intersection of these three. The ultimate turning point for him was the fact that his dad was having major heart problems who had a triple bypass during his third year in college. He was amazed by how revolutionary being a doctor was to have that kind of impact on someone's life.

As an undergrad, Prerak was studying Molecular Biology and Public Health. He was passionate about research so he knew he was going to do school for a while whether it be in PhD, Master's or even Health Care Administration. All he knew was that it was going to be in the healthcare realm. But he didn't know it was going to be medicine in particular until halfway through his second year of college.

"The interest in health care came from the amount of power this particular occupation has to impact lives on a direct basis."

No one in Prerak's family was actually involved in medicine. Having been teaching for so long, he describes the feeling of seeing your students' eyes open when they get something. He says this is probably the same feeling you get as a doctor when you're interacting with patients. More importantly, what really appealed to him is having that direct impact. He can make that connection, see where someone's problems lies, and try to make a positive change.

[06:27] Teaching in Premed and Preparing for Medical School

Prerak initially took a lot of undergrad premed courses and he ended up being a tutor for certain classes. He then worked his way up to being the study group leader where he led his own study group alongside the undergrad class to keep them up to date. So he became a study group leader for molecular biology. At that point, he was able to show students and make them understand the intricacies and magnificence of the human body. Basically, Prerak simply finds the human body to be mind-blowing and he's fascinated by it.

"To see them partake in that passion and see that passion grow in them is something I personally enjoyed."

In terms of finding the information he needed to prepare for medical school, Prerak admits the lack of knowledge he had. He didn't even know the application cycle would take a year until he was only two months away from graduating. It was this lack of education and the need for improved general transparency across premed culture that actually drove him to start his premed organization and YouTube channel. So he was apparently learning on the job, a lot of it actually. He did all the work of sending a hundred to two hundred emails just to find a doctor to shadow. He wished he had found this podcast earlier since he never had any mentor.

Doing his undergrad in Berkeley, Prerak explains that the resources are present but the problem is that some students may not even know about it because the student population size is just so huge (35,000 for example). Because it's a large public university, no one's going to spoon-feed you to get advising or bring information to you. So you have to take initiative and figure stuff out on your own.This is the part, Prerak says, where there could be a lot more catalysts to make it easier for students to have access.

"In any public institution, there's resources there but the problem is they get diluted down by the number of people there are."

[11:33] The Biggest Shockers During Application

First, Prerak took the pre-2015 MCAT and was rushing for it because he wanted to take the three-hour test than the eight hours. Second, he realized getting those secondaries don't take mercy on you at all. He was getting six to seven secondaries a day that wanted them back in like two weeks. So this was a huge realization for him. He admits being a slow writer and trying to meet those deadlines were just impossible for him. He sent some of those secondaries a month to six weeks late because he just couldn't. And that was a huge shock for him.

Prerak admits he just had to learn on the go in getting through those secondaries. He learned afterwards that there were certain secondaries that you should prioritize because these schools were heavily rolling. He didn't know this on the spot. The Ivy's at least don't work on a rolling basis. But what he should have known was to prioritize those that had rolling admissions. But he was just so overwhelmed that he was just literally going through his inbox and picked one randomly. He had no strategy involved which in hindsight, he could have strategized more.

"There were certain secondaries that you should prioritize because these schools were heavily rolling."

So what he did when he got any secondary was to make himself feel better by writing all the questions down in an Excel template. He'd write down the deadlines and take all their prerequisite information down before he even started working on it. It was like staging it all with little tiny victories.

"Every victory in the med school application process is a big victory. You've got to take it for what it's worth."

[14:40] Fighting Competition Through Cooperation

One thing that Prerak says was different about his application that made him stand out was the level of entrepreneurship that he showed. Berkeley did a good job in teaching him that if there's a problem out there, you're never too small to take it on. Back when he was a first and second year at Berkeley, he would consider himself to be in a very dark place. He felt so incompetent. Then on this third year, he realized a lot of people felt the same way. So he created an organization to fight this and their motto was fighting competition through cooperation. They did this by providing free one-on-one tutoring and advising to any incoming students. Prerak stresses the importance of learning from your experiences and going out there to fix it.

"If there's a problem out there, don't just live with it. Just because you dealt with it doesn't mean other people have to."

So Prerak took from success of this organization and built on it. During his gap year, he did a similar thing where he started a YouTube Channel. He even created an organic chemistry board game called React!

Both of these were intended to bridge the big problems he saw- the first one, being organic chemistry. Second, his YouTube channel was intended to increase educational accessibility for the lack of transparent premed culture. Prarek describes how medical schools respect this. They don't look for success all the time but it's seeing that you saw a problem and you're willing to address it. This was something he talked a lot in his interviews which he thinks was the big reason he got in.

[17:11] Ethnic Disadvantage and Diversity Question

Prerak doesn't think he felt any explicit disadvantage but he did notice there were a lot of questions that hinted at diversity factor. That diversity factor question was always so hard for him to answer because he can't rely on just saying his Indian-American because they have a lot of those. So he thinks it was an implicit disadvantage in that he can't answer this question as well as someone who might be an underrepresented minority could have. Personally, I don't recommend talking about race, ethnicity, and stuff in diversity questions.

So when Prerak was writing his secondaries, he answered this question in the sense that he was diverse because of his immigrant experiences. He says this is probably not the best answer considering there are a lot of successful immigrants. So it's not diverse.

It only hit me later that it didn't have to be restricted to those black and white norms we're brought up with. Go to any school's Office of Diversity and Affairs and it's always about race or sexuality or your immigrants. This is the primary reason it was so hard for him to think outside that. But once he started interviewing, he started to realize that diversity is more about experiences.

"Diversity is more about your experiences. What are you passionate about? How have you brought those passions to life?

He caught the eye of his interviewers whenever he mentioned the board game he created. This was pretty much different from what interviewers normally hear from most students who would do research stuff. He then realized his diversity factor was enacting change to big problems he might not have even known he was doing. Now he thinks that should have been his answer and the board game was an excellent example.

Understand that the interviewers get bored with students saying the same answer over and over again. And they just want something different. They just want to have a conversation with you. Prerak says the interview trail is a lot of learning and troubleshooting on your own and you start realizing what people care about.

[21:25] The Interview Process and the Magic Sauce

Prerak says he prepared for his interview like any applicant would but it was too scripted in a sense. He remembers interviewing at UC Davis and he brought up the office of social welfare and they didn't even know they had one of those. So he felt it shows you did way too much research and you were not giving genuine answers to the question. Then you start learning from your experiences. You start seeing people's reactions and what people want to talk about. It got to a point he realized having scripted answers in terms of knowing how you're going to answer the question is good.

"It's also phenomenal to go off-script... to really just speak from your heart."

He thinks that his interview with Yale was where he felt that he literally did not stick to any of the answers he had written down. For example, there was already something on his mind when he was asked why he wanted to go there. But his answer was that all the students there looked so happy. It's something he has never seen at any other med school. And today, all the third years he saw were smiling and helping answer the questions. He had already known they were going to ask him why Yale and he already had an answer for that. But that was not the answer he ended up saying. His answer was based on experience and this came out as more genuine. Then they had a much longer conversation after that.

[23:20] Checking Off the Boxes

One question Prerak gets asked a lot is what med schools are looking for. He explains that med schools are not looking for any one type of person. They want people that are passionate about what they do and how they do it. The problem that he sees with many students today is that they think you need to ABCDE to get to med school. Med schools can see when someone has done something because they need to versus they've done something because they want to and they're passionate about it.

In terms of what he did in his application because he thought he had to do it, Prerak mentions the research as pivotal. But during his first research experience, he had no idea what was going on. He was doing things for the sake of doing it and he regretted it. He went into research because he thought it was something he had to do to get to med school. So for the first two years, he was just literally taking instructions, never asking questions and never understanding what he was doing. He just thought he had to do it because he needed it on his application.

His wake up call was when his research mentor thought he was only doing it for the application. He was told that if he wasn't asking thought-provoking questions, there was no reason for him to be around.

"I just can't be doing things because I need to be doing them. I need to be engaged or not do them at all."

After this, he took a much more active stance in research. He got involved in molecular research. By the end, he was able to write a thesis and was able to substantiate exactly why he was doing things. This would never had happened when he was doing it for the sake of doing it, which he did for the first two years. And he's glad he made that shift.

[26:40] Dealing with Self-Doubt

Prerak jokingly says second-guessing yourself is a prerequisite to be a premed. This is a normal thing for premeds because the path is so long and so brutal. If you can stand through that, it shows your resilience. You have the determination to stick through ten more years of schooling.

"You have to have these moments because at the end of the day, they make you stronger."

This is not as bad as it's going to get. Med school gets difficult. Residency gets difficult. You're going to have those times where you're going to question yourself. But at the end of the day, if you know you've stuck through it and you have the passion to remain committed to it and you've stayed to it. It speaks to your character and it speaks to your drive to succeed in med school. Prerak also mentions a Chinese proverb where you all down seven times, stand up eight. So resilience is a big barometer to be a doctor.

[28:05] Choosing Which School to Go To

Basically, it went down to choosing between Yale and UCLA. It was mostly financial. He was offered a better financial incentive. First of all, he has been in California his whole life so he saw it as a chance to go four years out and expand his comfort zone and the challenges he's going to encounter. Another thing he liked about Yale was it's being forward-thinking in terms of the lack of competition. It was one of the first med schools that implemented the pass/fail system. They have tests but they're not intended to intimidate you. All of those these are intended to provoke you to learn as much as you can. Their Yale system is all geared toward making sure every student feels comfortable and can make the most out of their education. Prerak describes this sense of students being able to do what they want at Yale. It provides them with a larger degree of freedom and the amount of autonomy they give to students.

[29:50] The Impetus for His YouTube Channel

Prerak read the book When Breath Becomes Air as well as the books of Atul Gawande and realized they were very good about documenting their experiences. It documented the big change in their career and how they're governed by interactions they have with patients and people in the medical field. So he wondered how they're able to keep track of all the encounters with an enormous amount of detail. He figured they were writing these things down. He was just fascinated by their level of self-reflection. But then again, he knew he wasn't a writer but he loves to talk. So he created this forum where he could go to med school and reflect on the things happening to him. He documented his growth as a doctor.

He started the channel in January 2017 and as he progresses, he wants to use the channel as an outlet for pretty much anything and everything that impacts him meaningfully. It's his way of documenting his journey and reflecting on things. He will continue to use the channel as an outlet for anything that he thinks is important that he didn't know before and other people should know.

For all premeds out there, Prerak recommends you watch his video on how you can go about approaching the MCAT. His episode is called All You Need to Do to Kill the MCAT.

Another video he recommends that you get down right way is How to Answer the "Diversity" Question.

"The meaning of diversity does not just strictly confine you to those things we've been taught growing up."

Again, Prerak stresses how diversity is so much broader than just sexuality or race. And his video addresses this diversity question. It's not only applicable to med school application but also in college applications and even if you're applying for a volunteer position. This question can show up a lot and getting that holistic perspective on diversity is important because almost every med school secondary asks that question. Hence, you need to get this down early and see how you're going to foster diversity. Your diversity factor is super-beneficial.

[34:00] Prerak's Final Words of Wisdom

Prerak leaves students with some pieces of advice. Take it one step at a time. The premed journey is a never-ending slope upward. Everyday you will have new challenges. Everyday you will have a new question of self-doubt. At the end of the day, you want to have that level of dedication to know that you're just going to get back up if there's something that knocks you down. Take it one day at a time. You don't know where life is going to take you but it's going to be for the better.

"Don't worry about connecting the dots now."

A quote from Steve Jobs that he loves is "You can only connect the dots looking backwards. You cannot connect them looking forward." If you take it one day at a time, you'll see why they happen the way they happen.

[36:20] Special Stories Podcast

Go check out the Special Stories podcast. Today's episode features the story of a pediatric neurologist who specializes in headache medicine.

Links:

AMSA PremedFest

Prerak Juthani’s YouTube Channel

React! When Breath Becomes Air by Paul Kalanithi

Prerak's videos on All You Need to Do to Kill the MCAT

How to Answer the "Diversity" Question Specialty Stories Podcast Episode 33: An Academic Pediatric Neurologist - A Headache Doc

Jul 26, 2017
243: A Burnout Story and What You Can Do to Avoid It
21:31

Session 243

Today, we're talking about burnout which is something very personal but very important in the grand scheme of the medical world and the premed world. Allison joins us to talk about her experience with burnout during residency and we talk about how you can hopefully cope during a stressful time.

I've talked to a burnout expert before back on Episode 47 and we went through some free dance exercises and some other things. But I wanted to talk about burnout from a personal standpoint so I have Allison on the show to talk about her experience, what we experienced together going through that, and then how we can transition this and help the student though whatever they may be going through.

[02:02] A Personal Experience: Allison's Residency

Allison was going through a neurology residency which wasn't very easy at Massachusetts General Hospital, a big academic medical center. Even when we were married, at that time we were living apart. She was working 80 hours a week and had to do her one-year internship and the following year was her first year of neurosurgery residency and was on call every fourth night for about 32 hours. She describes it as a crazy and very intense experience with very sick people.

Days off would be spent on sleeping and eating and not much "me time" which is apparently important. She realized something wasn't right once she noticed she had trouble concentrating. It was very disturbing for her since she always had to rely on her brain and she felt like she couldn't and this bothered her. For example, she would be at work and she'd have trouble getting her work done. It wasn't bad enough that it was apparent to everybody else, but to her who used to be very efficient and was used to getting things done quickly, she felt like she was moving like a tortoise. Fortunately, she wasn't on a busy rotation at that point and it was further into the year.

"I just didn't feel like myself. I felt like I couldn't recognize myself in the mirror. And I was really down, super down, depressed."

This happened during her first year of neurology residency and second year of residency as a whole. Again, first year was the prelim internship year. But Allison says her first year of neurology was 100 times busier. Month 7 and she just felt like it was starting to eat at her. She was just tired. She was living in cold Boston and she was practically working all the time. She had no work-life balance. She was back living with her parents after she recently got married and she found it very hard. I was back in the Air Force and busy and was doing my own stuff too.

[07:05] No Outlet and Losing Focus on Your Health

Allison and I would get on the phone and Allison would just say she was fine because she also didn't want to burden me. Her friends in residency were all going through the same thing and her friends outside medicine couldn't actually relate to what she was going through so she felt there were not any people she could talk to about it. They would sit around together but they really didn't talk about burnout. The residency program talked about it but it was also a well-known fact that first year was brutal and there was a light at the end of the tunnel and you just had to get there because the second and third years were much more manageable.

Allison didn't know what was happening except that she felt bad. She didn't have time to sit around and feel sorry for herself. She was dealing with trying to take care of really sick people and didn't have time to focus on herself.

"You're very focused on taking care of other people and sometimes to the detriment of your own health."

[10:02] Premed Burnout and How to Avoid It

As a premed, you may not be taking care of patients, but you're studying organic chemistry and physics and biology, chemistry, organic chem, and MCAT prep and biochem. It's kind of the same as you're trying to power through that. You're sacrificing sleep, exercise, and eating right. So students go through this as well and not just physicians. There's also that possibility of rejection and that's very stressful for many people.

Allison recommends decreasing the dose is an important thing which means decreasing the amount of work. Although you can't necessarily do this but you structure your breaks so that you don't hit a wall and feel like you have to push through that wall and then hit another wall. So it's like breaking the cycle. Exercise is another important thing. Allison wasn't doing it other than running around the hospital. Sleep is also huge. People can get nervous, stressed, and burned out and they don't sleep well and that's terrible for your brain. it won't help you in terms of studying or learning and it makes you feel more depressed.

"Depression feeds on itself so it's hard to convince yourself that things can be okay when you're feeling really depressed."

Allison also cites the importance of talking to somebody and sometimes that may not be your friends or family but a professional who can help you though that with different strategies.

[13:14] Breaking the Stigma

Acknowledgment is the first thing. Burnout, as rampant as it is, is almost stigmatized too because nobody really wants to have a medical student or a physician hanging around a resident who's burned out since you have to be able to do your function and do your job. So as much as we say it's common but if you start advertising that you're really burned out, Allison thinks it's not a welcomed discussion for a lot of people. So going outside of where you are to get help is important too. But I disagree with Allison here because I think we need to break this stigma and going outside is just continuing it. But if you feel you can't get the help you need or you're embarrassed, don't let that get in the way of you getting help.

[14:20] The Constant Need for Doing More

As a premed, there's this constant need for doing more and getting great grades, doing the extra curriculars, clinical experience, shadowing, and whatever else you need to do to get into medical school.

In residency, there was always a lot to do and that you're also expected to be reading and you won't have time to do that when you're working 80 plus hours a week. Allison didn't have the bandwidth to this when she had time off because she only wanted to sleep.

The important piece here is that you're really going through burnout, take a couple days off. If you're a premed, give yourself some respite. Take a two to three-day off or one week if that's possible for you. Give yourself a breath of fresh air.

[16:05] Decreasing the Dose

As a premed too, you can decrease your dose by dropping your classes or taking a semester off or a year off. This is okay. I would rather a premed on the verge of going through burnout and going through these issues and see a semester off than see a a full semester with classes that have C's and D's because they were burnt out and couldn't handle it. If you're in that spot, take the time off. Volunteer somewhere and go work with a hospice or get a scribe job. Do something out of academics for a little bit for you to recuperate and fix yourself.

Also, as a premed, getting that time with patients reminds you of why you're doing this in the first place. this can help you feel refreshed. If you're feeling burned out, you're not alone. It's a huge problem for physicians and if you're dealing with it as a premed, it's still there. So it's something to practice learning to prevent yourself from falling down the rabbit hole. Learn the skills very early on so that when get to be a physician, you're able to better manage it. Neurology has one of the highest rates of burnout and biggest job dissatisfaction. As a physician, Allison had a recent burst of burnout and she had to do all these things - decrease the dose, get help, talk to me, lean on friends and family.

"My goals now is how to prevent this from happening in the future because it's a potential cyclical thing."

The demands in medicine just grow more and more all the time and that's not going to change. So you need to figure out how you can withstand all that.

[19:45] Final Thoughts

If you are feeling signs and symptoms of burnout, if you're not happy with what you're doing, it's okay to take a break. Make sure you're eating right. Make sure you're exercising. Exercise has been shown over and over again to be a cure for everything. Eat well. Exercise. Get sleep. And go talk to somebody if you need to. Stress can lead to autoimmune problems so protect your physical health and take care of your mental and emotional health.

Links:

MSHQ Episode 047: Avoiding Burnout as a Premed, Med Student, and Beyond

MedEd Media Network

Jul 19, 2017
242: Secondary Essay Common Mistakes and How to Avoid Them
15:16

Session 242

Once you submit your primary application, the work isn't over, secondary essays are still a huge part of your medical school application.

On this podcast, I've covered a lot of different topics related to the application process including personal statements, application in general, interview prep, etc., but I've never actually talked specifically about writing your secondaries and so I want to touch on this topic today, specifically, the most common mistakes students make when it comes to secondary essays.

[01:22] First Biggest Mistake: Not Writing Them Sooner

One of the biggest mistakes students make is waiting for them to come before they start working on it. If you're in the middle of the application season and you've submitted your primary application and if you're not writing your secondary essays, you're behind.

"You need to pre-write your secondary essays so that when schools send them to you, you are prepared to send them right back."

Some schools will monitor how long it takes you to send a secondary back and they will use this as a gauge on your interest to get into their school when probably it took you three weeks to respond while their average response time is a week and a half so, chances are, you could be put lower down the list. Remember that the medical school admissions process is a rolling admissions process, which means that as soon as applications open, the clock is ticking. This is different than applying to college which is a deadline-driven process. As long as your application is in by the deadline, you're just as good as everybody else that applied. This is not the same with medical schools. So the earlier you turn in your primary application and the sooner you're done with your secondary essays, the sooner your MCAT score is in, the sooner your letters of recommendation are in, the sooner your application is complete, then the schools will look at your application and determine whether or not they want to give you an interview.

"You need to get your secondary in as soon as possible so that your application is complete before other people."

If you're asking how to pre-write your essays if the schools haven't sent them to you yet, the good news is most schools don't change their essays from year to year, with a few exceptions, but most schools don't. You can go to Student Doctor Network as well as some other websites out there that have a list of secondary essays.

You will find that writing secondary essays gets easier and easier over time because a lot of them are around the same theme.

[05:22] Second Biggest Mistake: Letting Them Sit or Unopened

The second biggest mistake students make with secondaries is letting them sit on your desk or unopened in the mailbox. Let's say you scheduled a vacation in the middle of application season for some reason and your secondaries are just sitting there for a couple of weeks while you're traveling. You can't do this.

"Time is important when it comes to secondary essays, the application in general as a whole. You need to get all of that as soon as possible."

[06:18] A Deep Dive into the Essays

You will find out that a lot of the questions are very similar from school to school. A lot of them are going to ask about diversity questions or why a DO school so you need to be prepared to answer those. Some students will try to answer types of questions, like a diversity questions or "what will I bring to class" type of questions. Don't try to answer question batches. Just answer a school and finish the secondary for that school and then move on to the next school. Don't try to work outside of a school framework.

[07:25] Third Biggest Mistake: Not Answering the Question

One common feedback I give to students I work with is that they're not answering the question. They told a beautiful narrative about this patient they saved but they didn't answer the question the school was looking for. You have to answer the questions.

"Secondary essays are so much easier to write than your personal statement because it's asking you a specific question."

Most of the questions are asking you something very specific so keep that in mind and make sure you're answering the question. I recommend you get feedback from somebody and ask whether you're answering the question here.

[08:49] Fourth Biggest Mistake: Too Generic

A common question that comes in from a school on the secondary is what is it about their school that makes you want to go there. A lot of students can get so generic here that I can just copy and paste it from secondary to secondary for every school that asks the same question. You need to say something specific about the school. You need to draw up and do some research and come up with a list of programs at each of the medical schools or student organizations at each of the medical schools. If you want to join a specific program in that school because it can help make a big difference, talk about that. Mention the program by name. Mention very specific types of things or types of research. Mention the mission statement or the vision statement. Do your research. A lot of them may look alike after a while, but do your research and see if there's anything specific that you can draw out of those things to help you write your secondaries.

[11:02] Fifth Biggest Mistake: Repeating the Same Story

Students tend to repeat the same stories from their primary application on their secondary. Don't tell the same story. Even if, say they're asking for your most meaningful clinical experience, you can talk about the same experience, but don't tell the same story. Don't repeat it.

"Talk about the same experience. Don't tell the same story."

Some essays will also specifically tell you not to repeat anything that's in your primary application and if that's the case then you can't even talk about the same experience. You have to figure something else out. It can be frustrating when schools do that especially when they ask about your most meaningful clinical experience when it's what you put in your primary application too.

Additionally, some schools will ask for a list of extracurricular activities. Just copy and paste from whatever list you created for your primary application. You don't need to re-work everything and re-frame things and tell new stories. Just copy and paste it. Some schools just want it in their secondary form and not in the primary application.

[13:03] Sixth Biggest Mistake: Copying and Pasting Without Editing

Do not get caught copying and pasting without editing. You don't want to be that student who sends a secondary essay to NYU that says you would love to be part of Columbia Medical School next year. Be sure to edit it and have somebody look over your stuff. Copy and past all you want. Put it aside for the day then go back and check the next day. Make sure all of the names have been changed and everything is up for you to send off.

Links:

MedEd Media Network

Student Doctor Network

Jul 12, 2017
241: Third Application Cycle was a Charm for this Premed!
51:08

Session 241

Many students would have given up, but Natalie didn't. She had to apply to medical school three times. The first time around, she ignored her premed advisor who told her not to apply yet. Her second time around, she applied and did very well. She got tons of interviews but didn't get in. Then on her third time, she took each obstacle and learned from it, ultimately gaining acceptance to six medical schools.

Hear her journey, how she became successful, what she learned along the way, and her advice to you so you don't make the same mistakes.

[01:25] Interest in Medicine and Growing Up in a Stressful Environment

Natalie recalls wanting to be a doctor back when she was five years old in kindergarten. Obviously, she always had that interest since she was a child. Part of it too was having an aunt who is a doctor and that she likes people and the idea of helping people.

Fast-forward to college when she was shadowing physicians, she started volunteering in the emergency rooms near her home and the idea appealed to her even more having been able to actually connect with people and having to learn more about the pathology, she got more involved. So the combination of science and service appealed to her.

"I had an interest since I was a child but then I realized why I want to become a physician because of my experiences during college and after college."

Natalie describes her family as having done their best to provide a great environment for her and her two siblings who were very different. One didn't graduate from high school while one is currently in community college. She didn't have much academic guidance from her parents in terms of asking them questions about school since her mother didn't graduate high school and her father being in a different area of expertise. So whenever she had issues on something, she would just do her research and she sought out mentors and asked questions.

Additionally, Natalie had to learn to work in a very stressful environment. When Natalie was in high school, her cousin who lived with her was also in high and he got into trouble that led to some people threatening them. Despite everything that was happening, Natalie knew she had to do well in school and just learn to work under stress.

"With persistence and then with my faith, knowing how to handle difficult times with a positive attitude, that really helped me."

[05:40] Her Source of Motivation

What made her stay down the path is the certainty that this was what she wanted to do and that she was willing to work really hard to get to it, not to mention that didn't see herself doing anything else. In her case, she had to try three times and her motivation came from the idea that it's going to take a lot of work but she eventually be a physician if she did her absolute best and if she sought the resources she needs. She needed to do this so she sought the mentors she needed.

"I would always ask myself, what was missing here, what didn't you do right the first time?"

For her, it was about being willing to put in the work and knowing she was picking the appropriate steps, not just guessing. Moreover, being a person of faith she believes that knowing this was something she was meant to do, she felt confident that it was just a matter of time. So she thought not getting into medical school was not just her time and she was going to learn something very important in the two years she wasn't in medical school. True enough, she learned a lot about her as a person and she was able to support other people going through other issues she gone through before and this gave her motivation too in knowing that her time out of medical school had some purpose to it as well and she thought she'd become a better doctor because of it.

The second time she didn't get in and she was waitlisted at six schools, she thought about what she could learn in the interim. So she worked as a college instructor for adults with learning disabilities. Had she not had that experience, she would not know how to communicate well with patients that had disabilities. As a result, she knows how to speak with them better or why not to look at individuals with autism in the eye. She basically became more aware of different things. Natalie considers this as a success and being one of her best experiences especially having learned so much from it.

"Knowing who I was, knowing that this was what I wanted to do, and looking at each time I didn't get in as something that had purpose to it, something I could do in the interim time that I could take to learn, that motivated me."

[10:05] On Finding Mentors

Natalie kept in touch with her pre-health advisor when she was an undergrad at Johns Hopkins so she had someone to go to every time she had a question and her advisor gave her any contact she needed to assist her. She basically did the same thing during her postbac, developing great relationships with the people that wrote her letters and any time she had questions, they would also give her advice. Moreover, she applied to different internships and different jobs from where she also got to find mentors. So she tried every possible outlet. She tried whenever she saw interesting research at a nearby hospital or urban institution and she also looked online for reasons that students get into medical school. She would look at who wrote the article, where they come from, and whether this person could answer possible questions. She basically tried the obvious routes and in other cases, she would take the risk and try to get in touch with the person.

[11:55] Choosing a Postbac

Taking a close look at her first application, Natalie thought it wasn't realistically the most competitive GPA with about 3.14 in her sciences. The rest was good but there were a couple of dents on her GPA because she took on too much. Being a Type A personality, Natalie admits of making the mistakes of trying to take too many credits at once, trying to balance really difficult classes with extracurriculars, and trying to study for the MCAT when she was taking a very difficult class.

"Do not put too much on your plate... Know thyself and know how much you're able to balance."

Seeing the mistakes she made and the dent she had made, she had to show to medical schools that she'd be able to handle a large academic course load of challenging classes that's why she did the postbac which was also upon the advice of her other mentor.

Taking the postbac did help her where she got seven interviews. In doing research on which postbacs to go to, she searched online as well as checking the AAMC List of Postbaccalaureate Programs which were categorized according to career changers and academic enhancers where she had to do the latter. She had to show schools that she was able to get A's and some upper level Biology courses relevant for medical school. Natalie found UPenn on the AAMC website and applied to several but thinking it was the one that fit her best, she went to UPenn once she got accepted.

"Rather than reinvent the wheel and apply with no changes, I thought the postbac was the best option."

In the first semester, Natalie was taking three classes and dropped one when she felt she didn't do well on the first midterm and she knew she had to focus on the other two where she got A's on both which were very tough classes, Immunobiology and Neurodegenerative Diseases. By the second semester, she took four classes and did very well in all of them. What basically helped her was not putting too much on her plate. Knowing those four classes were very dense in information and required a lot of work, she knew she shouldn't get involved in too many extracurriculars. So assessing very early on which classes were going to be a problem for her and what she should be doing outside of school, and balancing them helped her.

[16:35] Knowing Your Learning Modalities

Another thing that helped her that she learned her learning modalities. Knowing she was heavily visual, she was very tactile and she had to ask a lot of questions. So knowing she wasn't going to pick up very much during lecture but instead pick up more from images, it helped her study a lot better.

In figuring out the best way for her to study, she was just observing herself. She realized what calls her attention a lot are pictures. The way she remembers things are through pictures and once she made that connection and realized she would be more efficient with her time if she applied it to the way she studies and focus less on reading too much text.

She also noticed what people said about her. For example, what drives Natalie's mother crazy is that if she repeats the same thing five times, it won't stick. but if she writes it on a note, she will remember it because she sees the note. She can be attentive when listening to a story but when it comes to instruction, it was different and she had to connect what one was saying to a picture.

[19:15] Overcoming Self-Doubt

The third time Natalie applied and after she interviewed, she prayed and said she was a little scared because she didn't get in the first two times and it was really difficult for her to see the white coat. So took a lot of comfort in praying and meditating. She wrote things down in journals and she had a ton of spiritual experiences. She felt more certainty whenever she addressed her doubts that way. Lastly, knowing herself and not seeing any sign or having any feeling that she was meant to do something else brought her a lot of comfort and more certainty. Nevertheless, there were times that she had to ask herself if it was really a closed door. But there were other situations that made her feel certain that this was what she was meant to do which were more spiritual in nature rather than academic. There were little things along way that were positive reinforcements or signs saying that this is her thing and it's just going to happen in the time you need it to.

[21:35] MCAT Mistakes

When Natalie took the MCAT the first time, she was taking Biochemistry while studying for the MCAT and she was taking time to commute by bus. She was trying to balance a summer condensed biochem course with a condensed MCAT course. That said, she was putting too much on her plate and she was very exhausted to the point she didn't realize her exam was moved to a day earlier. The information was sent to a different email so she only found out about it through word-of-mouth the night before the exam. Then she still had commute.

"Had I not been putting too much on my plate, I think I could have avoided that problem. I could have done much better."

Not only on the MCAT, doing too much at the same time also put a dent on her GPA because she was getting A's on her midterms but she didn't do well on the exam for biochem and she ended up with a C- in the course when she could have gotten an A had she not had to study for the MCAT and commute. She realized she should have done one thing at a time. That was her first mistake of doing too much all at once and not giving herself enough time to rest.

[23:33] Taking a Gap Year and Dealing with Family Pressure

Moreover, her pre-health advisor had advised her not to apply to medical school right away and to wait another year to study for the MCAT and then apply. Succumbing to family pressure who wanted her to apply right away, she did and it backfired. She also met others who were hesitant to take a year off for certain concerns like pressure from family or fear of not recalling what they learned in school. These are reasons that prevent students from taking the time off they need and they cram as well as some financial reasons.

Natalie worked during the time off she had and saved for her applications as well as for mock interviews and for the first months she started school. She points out that although she's starting later, she's starting more comfortably because of it. Plus the fact that she is more prepared and she has more experience relating to patients and more knowledge about herself to help her study better.

"It's tough but try not to worry about it. Look at it this way, it's going to be harder if you don't get in and you don't prepare the best because you're going to have to do it all over again."

Natalie adds that you have to be aware and try to look at full possibilities, what is best for you and what is more likely to happen. To add to that, don't necessarily listen to what other people are telling you especially if they have never been on this path. Natalie's father actually discouraged her from the major she was pursuing when to her it was the one of the best things she ever did. But her father didn't understand that. She was a Writing Seminars major which involved writing screenplays, poetry, fiction and nonfiction. She actually figured learning other skills that she can have that's going to help her in the long run and that would make her stand out and so she thought of becoming a writer. Her father told her it wasn't going to get her much out of college and she told him her ultimate goal was medical school anyway so she can major in anything. Her father told her she had to get straight A's and be a science major and she disagreed with this. Natalie would describe her school as a premed factory being surrounded by physicians all the time as well as science professors and premed students so she knew what she was talking about.

"It doesn't mean you love your parents any less. It just means that they don't always have the answer so do what's best for you."

[29:20] The Second Application: What Went Wrong?

Natalie got in touch with three admissions committees that interviewed her. One reasons it was easy for her to connect with them is because she sent them thank you notes (some emails, some handwritten). As a result, they were grateful and welcomed her to ask more questions. So she asked for some feedback from them and a couple of them told her that bringing her MCAT score of 29 up to a few more points, she had a much better shot at getting in. They told her she had a strong application but that was the weak spot.

After consulting her mentor, she was advised to do mock interviews. She also noticed some postbac programs provided mock interviews while others didn't.

"I saw that the students that had mock interviews had a much higher success rate."

Natalie says she had the idea what to say during the interview but not having anyone to practice with, she didn't have anyone giving her feedback. This was what she actually noticed was missing. She had the numbers, The MCAT was borderline and she knew people who got in who had 29 and below so she figured the mock interview was the major difference. She worked with adults with learning disabilities so she had that additional experience under her belt and she was volunteering at a hospital so she knew the mock interview was the thing that was missing.

For Natalie, the most difficult part in the interview was getting started and the infamous "Tell me about yourself" question where she had a rough start with it. So she did know walking out of the interview that the first part of it was horrible. She adds that some interviewers have a way of making you feel more comfortable but it doesn't guarantee that they're going to write you a positive review.

"The first minute, even the first fifteen seconds, really determines how the rest of the interview will go."

[33:20] The Benefits of Mock Interviews

I actually worked with Natalie in doing the mock interviews and she says that knowing that a professional helped her who is someone who's a doctor and who had gone to medical school and had experience interviewing, she thought that if she can go through interviews with me, she can go through interviews with anyone else who's going to interview her. So she knew she was going to be more prepared and she had thought of every possible question she could think of and she had rehearsed it with an experienced professional so that gave her a lot of comfort.

Additionally, Natalie was practicing four different types of interviews so this made her comfortable too. She had gone through multiple interviews before. At one point, she interviewed at one school that did two one-to-one interviews and an MMI. She thought she has done this before so she took each question as a challenge if she needed to pause and thought about it and she told the interviewer she needed to think about it. These are things she learned from the mock interview, which are little things that prepared her and made her more calm and composed.

Natalie didn't feel as stressed though because she already felt much more articulate because she practiced and having carried with her amazing tips. Walking into her first interview, she was nervous yet calm. Prior to mock interviews, she was nervous at every interview.

"There is that little bit of anxiety because it's your first interview and you want to get into medical school but you're also confident."

Natalie actually received some very difficult questions particularly during some of the MMI's. She explains that what really helped her was this one piece of advice I gave on my book, The Premed Playbook: Guide to the Medical School Interview, which was to read a lot of healthcare magazines. One of the questions asked was about euthanasia and she read an article about that so she was able to give them a very good answer. It was because she followed this advice and she was reading such topics that she was able to get a very-informed answer and give the interviewer her stance on it and sticking to her beliefs about it. There were also other parts where she had trouble answering but she asked for a moment to think instead of just staring blankly. This gave her time to collect her thoughts. Lastly, whenever she didn't know something, she would tell the interviewer she's not sure but she would tell them what she thinks. Knowing that you're not always going to have the answers helped a lot too.

[39:00] Tally of Acceptances on Her Third Application Cycle

Out of fifteen interview officers, she only went to ten. She had six acceptances and the rest were waitlists. Natalie says that aside from her postbac and her work experience, what made the difference this time was the fact that she had done four mock interviews. She reviewed them each time and she was also staying very well-informed and this helped her give some very articulate and applicable answers to relevant issues. During her third application, she went into the interview more prepared, more articulate, and more knowledgeable.

In narrowing down six acceptances to ultimately decide where to go, Natalie wrote down a very detailed description of what she really liked about each school and what she disliked. She ranked the schools and gave it a score. She was down to three schools which scored 9.1 out of 10. She also looked into financial aid which helped her a lot. She basically kept note of everything. When it came down to her final decision, financial aid played a role but also, she tried to put herself in a hypothetical position.

"If I had gone to this school, will I be thinking what if I had gone to the other one?"

Ultimately, she looked for what's going to make her happy, where she wants to match for residency geography-wise, match lists, and her own ranking of the schools with details of what she liked and disliked. Natalie is going to the University of Michigan - Ann Arbor.

[43:05] Future Aspirations and Final Words of Wisdom

Natalie hopes to work with underserved populations and she's considering getting a Master's in Public Health but she's keeping an open mind knowing she's going to find other things she would like. As to what specialty to get into, she's a curious person so she might make her decision on the third year. She likes working with her hands and she scrubbed into surgeries. She remembers coming out of each one elated. She's also starting school early since Michigan has a program for students interested in health equity so she's doing that and getting a jumpstart in Anatomy and Histology and get connected with mentors.

Finally, Natalie's advice to those battling with self-doubt and had to reapply, is to take the time to prepare the way you need to even if you have to wait a year or two to get your finances in check or academics in check. A year or two years will not put a big dent at all when you look at the grand scheme of things. Look at the available resources out there. Look at AAMC and look at postbacs. They can be expensive but you can take loans and scholarships. Try to see it as an investment.

Natalie adds that there is always room for improvement so don't feel so hopeless. Be real with yourself and ask yourself, what could happen better. Be honest with yourself and be humble as well. In her case, she had to pay a little more for mock interviews but she believes it's a very great investment.

"It's very easy to assume that you did your absolute best and you made no mistakes. Chances are, you made a mistake. Humble yourself, be honest, and address that issue."

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