Pre-Medicine E-Book

Joel Thomas

• Herausgeber: Thieme Medical Publishers
• Kategorie: Fachliteratur
• Sprache: Englisch

Veröffentlichungsjahr: 2022

Beschreibung

The one-stop, comprehensive resource for students considering a career in medicine

In recent years, applying to and getting accepted to medical schools in the U.S. has become increasingly difficult. In 2020–2021, only 38% of the 53,370 students who applied to U.S. medical schools were accepted. For the most prestigious medical schools, the acceptance rate was just 1.4–2%. Pre-Medicine: The Complete Guide for Aspiring Doctors by Joel Thomas, Phillip Wagner, Ray Funahashi, and Nitin Agarwal is a comprehensive roadmap that guides aspiring physicians through the rigorous process of preparing for and getting into medical school in the U.S. By bringing together multiple authors with different life experiences and perspectives, this unique book has broad appeal to students from diverse backgrounds.

The text is organized by five sections: The Pre-Med Primer, Succeeding as a Pre-Medical Student, Applying to Medical School, Medical School and Career Insights, and an Appendix. This invaluable resource tackles challenging topics and addresses uncomfortable questions that necessitate engagement with multiple opposing viewpoints and careful data analysis. The first and foremost goal of this book is to provide essential information to individuals that need it to succeed in their pre-med and medical school journey.

Key Features

•  Authors graduated from the U.S. News Top 20 medical schools and/or trained at a Doximity Top 20 residency program
•  Demystifies the lengthy and confusing medical school application process, providing practical advice and evidence-based strategies for successfully tackling each step, starting in high school
• Provides readers with a realistic and honest picture of the daily challenges and rewards that aspiring physicians face—from pre-med to residency

This is a must-have resource for anyone who is considering a career in medicine. The no-holds-barred insights shared in this book will greatly optimize the chance of medical school applicants gaining admission to their top choice.

Leseprobe

Pre-Medicine

The Complete Guide for Aspiring Doctors

Joel Thomas, MDDiagnostic Radiology ResidentWashington University School of MedicineSt. Louis, Missouri, USA

Phillip Wagner, MDInternal Medicine FacultyThe Johns Hopkins HospitalBaltimore, Maryland, USA

Ray Funahashi, MDCEO and Co-Founder of The Labkind ProjectPeter H. Diamandis A360 FellowHead of Clinical Affairs at Gesund.aiBoston, Massachusetts, USA

Nitin Agarwal, MD

Assistant Professor of Neurological Surgery and Orthopedic SurgeryDirector of NeurotraumaDepartment of Neurological SurgeryWashington University School of MedicineSt. Louis, Missouri, USA

42 Illustrations

ThiemeNew York • Stuttgart • Delhi • Rio de Janeiro

Library of Congress Cataloging-in-Publication Data is available with the publisher.

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.

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New York, NY 10001, USA www.thieme.com

[phone], [email protected]

Cover design: © Thieme

Cover image source: © Thieme

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Printed in USA by King Printing Company, Inc.

5 4 3 2 1

ISBN: 9781684205097

Also available as an e-book:

eISBN (PDF): 978-1-68420-508-0

eISBN (epub): 978-1-68420-509-7

Important note: Medicine is an ever-changing science undergoing continual development. Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at the time of production of the book.

Nevertheless, this does not involve, imply, or express any guarantee or responsibility on the part of the publishers in respect to any dosage instructions and forms of applications stated in the book. Every user is requested to examine carefully the manufacturers’ leaflets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Every dosage schedule or every form of application used is entirely at the user’s own risk and responsibility. The authors and publishers request every user to report to the publishers any discrepancies or inaccuracies noticed. If errors in this work are found after publication, errata will be posted at www.thieme.com on the product description page.

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Contents

Preface

How to Read This Book

Acknowledgments

Contributors

Section I: The Pre-Med Primer

1.The 30,000-Foot View

Ray Funahashi and Joel Thomas

1.1Step 1. Get a Bachelor’s Degree

1.1.1Complete Required Classes

1.1.2Engage in “Recommended” (Essentially Required) Activities

1.2Step 2. Take the Medical College Admissions Test (MCAT)

1.3Step 3. Complete Online Applications to Medical Schools, Attend Interviews, and Get Accepted

1.3.1The Primary Application

1.3.2The Secondary Application (Secondaries)

1.3.3Admissions Interviews

1.3.4Acceptance

1.4Step 4. Attend Medical School

1.4.1First and Second Years

1.4.2Take the USMLE Step 1 (or COMLEX-USA Level 1) Exam

1.4.3Pass/Fail USMLE Step 1: A Deeper Dive

1.4.4Complete Core Clerkships, aka Get a Taste of the Different Specialties

1.4.5Electives

1.4.6Take the USMLE Step 2 Exam (CK and CS)

1.4.7Complete an Acting Internship (AI), aka Pretending to Be a First-Year Resident

1.4.8Complete Away Rotations (Optional)

1.5Step 5. Apply to Residency

1.5.1Match Day

1.6Step 6. Complete Residency

1.6.1But Wait.Why Do I Have to Attend Residency? Isn't Medical School Where You Learn Medicine and Become a Doctor?

1.7Step 7. Complete Fellowships (Optional)

1.8Step 8. Become an Attending Physician

1.9Summary

2.What Medical Schools Look For

Joel Thomas

2.1What Are the Goals of Medical Schools?

2.2How Many Students Approach the Pre-Medical Years

2.3How YOU Will Approach the Pre-Medical Years

2.4The 6 Pillars

2.4.1Pillar 1: Academic Excellence (aka Good Grades and Test Scores)

2.4.2Pillar 2: Commitment to Serving Others

2.4.3Pillar 3: Clinical Experience

2.4.4Pillar 4: Social and Emotional Intelligence

2.4.5Pillar 5: Non-Academic Excellence–Passion and Deep Achievement

2.4.6Pillar 6: Integrity

2.5For Lovers of Hard Data

2.6Summary

3.The Pre-Med Principles

Ray Funahashi and Joel Thomas

3.1Protect Your GPA and Integrity

3.1.1YourWell-Being > GPA

3.2Do Not Take the MCAT Until You Are at least Averaging Your Target Score on Official Practice Tests

3.3Be an Interesting Person with a Cohesive Narrative Evidenced by Breadth and Depth of Experience

3.4Build Your Relationships and Mentorships

3.5Keep an Open Mind and Remain Introspective

3.6There Are No Guarantees

3.6.1Student Perspective: Mindfulness Meditation

3.7Summary

4.The Types of Pre-Medical Students and Paths to Medical School

Ray Funahashi and Joel Thomas

4.1There Are Different Pathways to Medical School

4.2The High School Student, Guaranteed Admissions Pathway

4.3The High School Student, Traditional Pathway

4.4The College Student, Early Assurance

4.5The College Student (Sophomore)

4.6The Re-Applicant

4.7Post-Undergraduate or Career Changing Applicant (31-Year-Old)

4.8Your Pre-Med Journey

4.9If You Are a High School Student

4.9.1Step 1: Get Involved in Clinical Experience, Shadowing, and Research Opportunities

4.9.2Step 2a: Consider Applying to a Guaranteed Admissions Program

4.9.3Step 2b: Get into a Reputable College and Maintain a High GPA

4.10If You Are a College Student

4.10.1Step 1: Evaluate your Institution and Course of Study

4.10.2Step 2: Get into a Pre-Medical Program (If Your School Has One)

4.10.3Step 3: Choose a Major. Yes, Any Major!

4.11As You Near Undergraduate Graduation

4.11.1DecideWhich Type of Medical School Applicant You Will Be

4.12If You Are a Non-Traditional Applicant

4.13Summary

5.Building Your Narrative

Chistian Morrill and Joel Thomas

5.1What Is a Narrative?

5.1.1Who Are You?

5.1.2Why Medicine?

5.1.3Why Now?

5.2Summary

6.Common Pre-Med Diseases and How to Treat Them

Joel Thomas

6.1Pre-Medical Neurosis

6.1.1Overview

6.1.2Risk Factors

6.1.3Differential Diagnosis

6.1.4Treatment

6.2Gunnerrhea

6.2.1Overview

6.2.2Risk Factors

6.2.3Differential Diagnosis

6.2.4Treatment

6.3Syndrome of Inappropriate Enthusiasm (SIE)

6.3.1Overview

6.3.2Risk Factors

6.3.3Differential Diagnosis

6.3.4Treatment

6.4Pre-Medical Denial Syndrome

6.4.1Overview

6.4.2Risk Factors

6.4.3Differential Diagnosis

6.4.4Treatment

6.5Senioritis

6.5.1Overview

6.5.2Risk Factors

6.5.3Differential Diagnosis

6.5.4Treatment

6.6Summary

Section II: Succeeding as a Pre-Medical Student

7.Guaranteed Admission Programs and Early Assurance Programs

Samyuktha Melachuri, Chinweoke Osigwe, Eva Roy, and Joel Thomas

7.1Combined Bachelors/Doctorate Programs

7.1.1What Are Bachelors/Doctorate Programs?

7.1.2The Good and the Bad

7.2If GAP Programs Are for You

7.2.1What to Do in High School?

7.2.2How Do GAP AdmissionsWork?

7.2.3What Is Undergrad Like as a Combined Bachelors/Doctorate Student?

7.2.4Length of Program

7.2.5The Fun Stuff: Unique GAP Student Opportunities

7.2.6Final Thoughts

7.3Early Assurance Programs

7.4Summary

8.Schools, Majors, and More

Christian Morrill and Joel Thomas

8.1Choosing an Undergraduate School or Pre-Med Program

8.2High-Yield Advice

8.2.1Excellence Breeds Excellence

8.2.2Student Perspectives on Undergraduate Prestige

8.2.3Medical Alumni

8.2.4Prehealth Advisors

8.2.5Prehealth Clubs

8.2.6Opportunities for Exposure

8.3What Major Should I Choose?

8.3.1By the Numbers

8.3.2Pros of “Traditional” Majors

8.3.3Pros of “Non-Traditional Majors”

8.4Guiding Principles for Mapping Out Your Curriculum

8.4.1What Are Your Passions Outside of Medicine?

8.4.2WhatWill Prepare You the Most?

8.4.3Challenge Yourself (Within Reason!)

8.4.4Skill Development

8.4.5College Faculty

8.4.6Don’t Burn Yourself Out

8.5Summary

9.Timing, Class Structure, and Personal Schedules

Phillip Wagner and Joel Thomas

9.1Prerequisite Classes

9.2Interview and Admissions Process

9.3Class Structure: Common Pitfalls in Scheduling

9.3.1Overloading Your Scheduling

9.3.2Too Many Science Classes with Labs

9.3.3Trying to Schedule for Maximum Quality of Life

9.3.4Scheduling Class Times You Know Will not Work for You

9.2Interview and Admissions Process

9.3Class Structure: Common Pitfalls in Scheduling

9.3.1Overloading Your Scheduling

9.3.2Too Many Science Classes with Labs

9.3.3Trying to Schedule for Maximum Quality of Life

9.3.4Scheduling Class Times You Know Will not Work for You

9.4What Happens if I Do Poorly in a Course?

9.5What Do I Do with My Vacations? (e.g., Summer Break)

9.6Personal Schedule—Why You Need One, and Why You’ll Probably Enjoy It

9.7Summary

10.Obtaining a Solid GPA

Eva Roy and Joel Thomas

10.1Tips for Succeeding in Your Classes

10.1.1Don’t Cram

10.1.2Prioritize Active, Undistracted Studying

10.1.3Master Both Understanding and Memorizing

10.1.4Manage Your Time with Technology

10.1.5Understand Your Optimal Study Space(s)

10.1.6Reach Out for Help as Early as You Think You Need It

10.1.7Don’t Schedule Too Many Difficult Classes Together

10.1.8Consider Third-Party Materials

10.1.9Take a Break!

10.2So What if I Have a Low GPA?

10.3Summary

11.Extracurriculars

Eva Roy and Joel Thomas

11.1So What Can You Do?

11.1.1Medically Related Clubs

11.1.2Non-Medically Related Clubs

11.1.3Sports

11.1.4Sororities, Fraternities, and Professional Societies

11.1.5Explore Your Passions

11.1.6Other Leadership Opportunities

11.1.7Non-Traditional Extracurriculars

11.2What Are Medical Schools Looking For?

11.3Summary

12.Clinical Experiences

Phillip Wagner and Joel Thomas

12.1Summary

13.Shadowing

Phillip Wagner

13.1What Is Shadowing?

13.2Why Is It Important?

13.3How Are These Shadowing ExperiencesWeighed by Admissions Committees?

13.4Nuts and Bolts of Shadowing

13.4.1First Contact

13.4.2Meeting the Doctor

13.4.3The Quest for The One

13.5Shadowing Basics

13.6How Does Shadowing Develop Your Narrative?

13.7Summary

14.Volunteering

Phillip Wagner and Landon Cluts

14.1Non-Medical Volunteering

14.2Medical Volunteering

14.3Which Type to Engage in?

14.4Some Important Points

14.5Do You Need to Do Volunteering to Get into Medical School?

14.6So, Do You Really Need to Volunteer for the Application Process?

14.7How to Record Your Volunteering

14.8Summary

15.Research

Jorna Sojati and Joel Thomas

15.1Research: Does It Spark Joy in You?

15.1.1Does Curiosity, the Ability to Ask Novel Questions and Seek Answers to Them, Drive Your Motivation for Medicine?

15.1.2Is There a Subject You Are Passionate about and Hope to Contribute to?

15.1.3Do You Have the Time to Commit to Research?

15.1.4Are You Willing to Put in the Effort Toward Becoming a Student Researcher?

15.1.5Ideally, You Should Pursue Research that Sparks Your Interest and Contributes to Your Narrative

15.1.6Are You Considering an MD/PhD Program (or Other Research Dual Degree, e.g., MD/MS)?

15.2Navigating Medical School Applications Without Research Experience

15.2.1Devote More Time to Your Other Pre-Medical Endeavors

15.2.2Enter the Application Cycle with a Strong GPA and MCAT Score

15.2.3Find the Right School for You, but also Recognize that not Having Research Generally Hurts Your Application

15.2.4Consider Postgraduate Research Opportunities

15.3Finding Opportunities for Research

15.3.1Reflect

15.3.2Review

15.3.3Reach Out

15.3.4Realistic Expectations

15.4Mentorship

15.4.1The Principal Investigator (PI)

15.4.2Everyone Else

15.4.3You

15.5Types of Research and Publications

15.5.1Basic Research

15.5.2Clinical Research

15.5.3Translational Research

15.5.4Social Research

15.6Summary

15.6.1Short-term Research Opportunities

15.6.2Longer-term Research Opportunities

15.6.3International Research Opportunities

16.Gap Years, Employment, Graduate Degrees, and Post-Baccalaureate Fellowships

Phillip Wagner and Joel Thomas

16.1If You JustWant to Take a Breather

16.2If You Need to Strengthen Your Application

16.2.1More School

16.2.2Employment

16.2.3Research

16.2.4Miscellaneous

16.3Summary

17.Crushing the MCAT

Landon Cluts and Joel Thomas

17.1The Test

17.2The Logistics

17.3Student Perspective: Exam Day

17.4The Results

17.5The Classes to Take Before You Take the MCAT

17.6So What’s the Best Way to Prepare?

17.7Timeframe

17.8Resources

17.9Kaplan versus The Princeton Review

17.10Classes

17.11Other Options

17.12Practice Exams

17.13Practice Questions

17.14Critical Analysis and Reasoning

17.15Other Sections in General

17.16Biochemical Foundations

17.17Chemical and Physical Foundations of Biological Systems

17.18Test-Taking Strategies

17.19Retake or Not to Retake?

17.20Final Thoughts

17.21Summary

18.Self-Care and Wellness

Joel Thomas and Eva Roy

18.1Why Care Now?

18.2So How Do I Get Started and Keep the Ball Rolling?

18.3Physical Components ofWellness

18.3.1High-Quality Sleep

18.3.2Exercise

18.3.3Healthy Diet

18.3.4Avoiding Unhealthy Substance Use

18.4Mental Components ofWellness

18.4.1What IsMindfulnessMeditation?

18.4.2When Should I Talk to a Professional?

18.4.3What Is Burnout, andWhy Should I Care about It Now?

18.5Summary

19.Finding Mentors

Christian Morrill

19.1What Are Mentors and Why Should I Care about Them?

19.2What Attributes Should I Look for in Mentors?

19.2.1Desirable Success

19.2.2Nurturer

19.2.3Network of Resources

19.2.4Strategic Coach

19.2.5Cheerleader

19.2.6Honest Critiques

19.3Five Mentors to Start With

19.3.1The Physician

19.3.2The Upperclassman

19.3.3The Researcher

19.3.4The Role Model

19.3.5The Classmate

19.4The Key to a Successful Mentor Relationship

19.5My Mentor Relationship Isn’t Working!

19.6Letter of Recommendation and Your Mentor

19.7Summary

Section III: Applying to Medical School

20.The Big Picture

Joel Thomas

20.1All Right, I Get It—This Might be Painful. So How Do I Apply to Medical School?

20.2Two Years Before Intended Matriculation

20.3One Year Before Intended Matriculation

20.4Intended Matriculation Year

20.5Early Decision Application

20.6How Much Will This Cost?

20.7How Can I Keep Track of the Admissions Cycle for My Individual Schools?

20.8Student Perspective on Student Doctor Network School-Specific Threads

20.9What Are Update/Intent Letters, and When Do I Send Them?

20.10Additional Resources

20.11Summary

21.Before You Begin: Application Strength Analysis

Joel Thomas

21.1Check Your Readiness to Apply to Medical School

21.2Are You an Underrepresented Minority (URM) Applicant?

21.3Medical School Admissions Consultants

21.4Summary

22.Before You Begin: Application Cycle Prophylaxis

Phillip Wagner and Ray Funahashi

22.1Personal Social Media Cleanup: Assess the Damage

22.2Email Preparation: This Email System Setup Will Keep You Sane Throughout the Application Cycle

22.3Store All of Your Application Files and Notes on the Cloud in a Single Space

22.4Look into Travel Credit Cards and Loyalty Programs 5 to 6 Months before Interviews Begin

22.5Be Ready to Manage Your Stress

22.6Summary

23.Letters of Recommendation

Phillip Wagner

23.1How to Maximize Your Odds of Getting a Strong, Positive Letter of Recommendation

23.2So How Many Letters Should You Have, and of Which Type?

23.3Committee Letters

23.4“I Have a Lot of Options. Who ShouldWrite My Letters?”

23.4.1Academic

23.4.2Nonacademic

23.5When Do I Ask for the Letter?

23.6How to Actually Ask

23.7How to Follow-up

23.8What If Someone Asks You to Write a Letter for Yourself?

23.9Summary

24.DO, MD, and International Schools

Joel Thomas

24.1Doctor of Osteopathic Medicine (DO)

24.1.1History of the DO Degree

24.1.2How to Apply to DO Programs

24.2International/Caribbean Medical Schools

24.3Summary

25.Dual-Degree Programs: MD/PhD, MPH, MBA, JD, and Others

Jorna Sojati and Ray Funahashi

25.1Why Are Schools Offering More MD Dual Degrees?

25.1.1Students Obtain Cross-Disciplinary Education, Training, and Networking with a Second Degree

25.1.2Master’s Dual Degrees Are Accelerated So They Can be Earned Together with the MD in 5 Combined Years

25.1.3Medical Students May Get Admissions Benefits

25.2What Kinds of Dual Degrees Are Medical Schools Currently Offering?

25.3How Do Dual DegreesWork?

25.3.1Students Generally Complete Their Additional Degree after Their Core Clerkship Year

25.3.2MD Dual Degrees Vary Widely Partnership Level, Curriculum Integration, and Accommodation . . . 181

25.4The Physician-Scientist (MD/PhD)

25.4.1Why Do an MD/PhD Program?

25.4.2How Are MSTPs Different from MD/PhD programs?

25.4.3What Is the Timeline for MD/PhD Programs?

25.4.4How Does Financial Aid for MD/PhD ProgramsWork?

25.4.5How Does the MD/PhD Application ProcessWork?

25.4.6Are GPA and MCAT Requirements Different for MD/PhD Programs?

25.4.7What Type of Research Can You Do as an MD/PhD Student?

25.4.8What Careers Do MD/PhD Graduates Have?

25.5Other Dual-Degree Programs

25.5.1Should You Consider Non-MD/PhD Dual Degrees?

25.6Public Health

25.6.1MD/MPH

25.7Business

25.7.1MD/MBA

25.8Law

25.8.1MD/JD

25.9Public Policy

25.9.1MD/MPP

25.10Biomedical or Clinical Informatics

25.10.1MD/MSc

25.11Bioengineering

25.11.1MD/MSc

25.12Clinical Education

25.12.1MD/MSc

26.Medical School Rankings

Phillip Wagner

26.1Ranking Overview

26.1.1Who Does the Ranking?

26.1.2Who Ranks the Rankers? A Historical Perspective

26.2The Methodology: What Goes into Ranking a Medical School?

26.2.1The Rankings Algorithm: Research versus Primary Care

26.3Contextualizing These Quality Proxies: What Are They?

26.3.1Quality Assessment

26.3.2Research Activity

26.3.3Primary Care Production Rate

26.3.4In Defense of This Ranking Criteria

26.4On the Other Hand

26.4.1Student Selectivity

26.4.2Faculty Resources

26.5Overall Limitations and Criticism

26.6Summary

27.Making Your List: What Schools Do I Apply To?

Joel Thomas

27.1Should I Apply Early Decision?

27.2Medical Schools with Unique Features

27.3Summary

28.Primary Application: AMCAS, AACOMAS, and TMDSAS

Joel Thomas

28.1AMCAS

28.2AACOMAS

28.3TMDSAS

28.4Summary .

29.Transcript Review

Joel Thomas

29.1AMCAS

29.1.1AMCAS Transcript Entry Synopsis

29.1.2AMCAS Course Entry Special Cases

29.1.3AMCAS Concluding Thoughts

29.2AACOMAS

29.2.1Transcript Requests to Yourself

29.2.2Transcript Requests to AACOMAS.

29.2.3AACOMAS Transcript Entry Synopsis

29.2.4AACOMAS Course Entry Special Cases

29.2.5AACOMAS Concluding Thoughts

29.3TMDSAS

29.3.1Transcript Requests to Yourself

29.3.2Transcript Requests to TMDSAS

29.3.3TMDSAS Transcript Entry Synopsis

29.3.4TMDSAS Course Entry Special Cases

29.3.5TMDSAS Concluding Thoughts

29.4Summary

30.Activities and Meaningful Experiences

Joel Thomas

30.1AMCAS

30.2AACOMAS

30.3TMDSAS

30.4Summary

31.Personal Statement

Landon Cluts and Joel Thomas

31.1Timeline

31.2Everyone’s a Critic

31.3Pitfalls

31.4How toWrite the Personal Statement

31.5Example Personal Statement

31.6Summary

32.Altus Suite: CASPer, Snapshot, and Duet

Joel Thomas

32.1Which Schools Require It?

32.1.1AMCAS

32.1.2AACOMAS

32.1.3TMDSAS

32.2When Should I Take It?

32.3How Do I Prepare?

32.3.1Ethical Knowledge

32.3.2Identifying Multiple—Potentially Unspoken—Perspectives in an Interpersonal Conflict

32.3.3Articulating Your Values and Responsibilities

32.3.4Choosing a Side and Justifying It.

32.4Is There Any Practice Material?

32.5Summary

33.Secondary Application

Joel Thomas

33.1The Prompts

33.1.1Diversity

33.1.2Breadth of Perspectives

33.1.3Why Us?

33.1.4Explain Yourself

33.1.5Challenge

33.1.6Most Rewarding Experience

33.1.7Academic Interests

33.1.8Back-up

33.1.9Alternate Universe

33.1.10Continuity

33.1.11What Else?

33.1.12Looking Ahead

33.1.13Values

33.1.14Looking Ahead

33.1.15Narrative

33.1.16Community

33.1.17Ethics

33.1.18Regional Ties

33.1.19Miscellaneous

33.2Summary

34.Interviews

Joel Thomas

34.1How Important Are Interviews?.

34.2So How Do I Maximize My Face Time with Current Medical Students?

34.3Interview Day Preparation

34.3.1Know Your Answers to the Following Questions Cold

34.4Multiple Mini-Interview (MMI)

34.5Summary

35.Interview Trail Travel and Attire

Joel Thomas

35.1Interview Trail Travel

35.2Interview Day Attire

35.3Summary

36.Wait-List and Update Letters

Phillip Wagner and Joel Thomas

36.1Update Letter

36.2Letter of Intent

36.3Summary

37.Financial Aid Phillip Wagner and Joel Thomas

37.1A Snapshot of Current Debt, Income, and Wealth

37.2Financial Aid Doesn’t Matter Early in the Process

37.3Financial Aid: When You Are Applying

37.4Financial Aid: After You Have Applied (Submitted Your Primary and Secondary Applications) .

37.5Financial Aid: After Acceptance

37.6Understanding Your Personalized Award Letter; What Types of Aid Are Available?

37.6.1Government-Backed Loans

37.6.2Institution-Based Loans

37.6.3Need-Based Aid

37.6.4Merit-Based Institution Scholarships

37.6.5Outside Scholarships

37.6.6Private Loans

37.6.7Special Service Contracts

37.6.8MD/PhD, and Other Combined Degree Programs

37.7So What Does the Debt Data Tell Us?

37.8Financial Aid: After You Are Accepted

37.8.1I Was Accepted,Where Are My Financial Aid Packages?

37.8.2We Are Quickly Approaching the Aprilth Deadline, and I Haven’t Received All My Award Letters Yet. What Should I Do?

37.8.3The School I Want to Attend Gave Me Much Less Aid than Another School. Is There Any Way to Appeal My Aid Award?

37.8.4The School IMostWant to Attend Gave Me Much Less Aid than Another School andWill Not Negotiate with Me.What Should I Do?

37.8.5How Much Should the Cost of Medical School Matter?

37.9Summary

38.Acceptance and Decisions: What Really Matters When Choosing the One School

Phillip Wagner and Joel Thomas

38.1Cost

38.2Rank/Prestige

38.3Culture

38.4Research

38.5Match Success

38.6Personal

38.7Location

38.8Work-Life Integration

38.9Resources and Support

38.10Curriculum

38.11Summary

39.Before and After Matriculation Ray Funahashi

39.1Relax and Enjoy

39.2Finding a Place to Live

39.2.1Close to School

39.2.2Cheaper Location

39.2.3Fun Location

39.3Should I Live with a Roommate or Alone?

39.3.1Living with Roommates

39.3.2Classmates as Roomies

39.3.3Strangers as Roomies

39.3.4Living Alone

39.4Preparing Your Study Space

39.5Orientation and Start to the Semester

39.5.1Socialize Now

39.5.2Explore the Area

39.5.3Seek Mentors and Tutors . . .

39.5.4Get Involved in Projects

39.6Summary

40.Plan B and Reapplication Phillip Wagner and Joel Thomas

40.1First Find OutWhatWentWrong

40.2Execute Your Plan B . .

40.3Reapply

40.4Summary

Section IV: Medical School and Career Insights

41.Real Talk on a Medical Career

Joel Thomas

41.1“Becoming a Physician Allows Me to be a Lifelong Learner and Appeals to My Desire for Constant Intellectual Stimulation” (aka “I Like Science”).

41.2“Becoming a Physician Would Allow Me to Regularly Make a Deep, Personal, Positive Impact in People’s Lives”

41.3“I Want to Become a Physician to Do the Best, Evidence-Based Medicine for My Patients. I Want the Most Breadth and Depth of Knowledge, and This Is Why I’m Not Content with Becoming a Physician Assistant or Nurse Practitioner—Even Though I Understand that These Providers Make Crucial Contributions to the Healthcare Team”

41.4“Physicians Have a Doctoral-Level Understanding of Their Craft. I Want to Both Excel at Patient Care at the Bedside and Revolutionize Treatment as a Whole through Research. Along the Way, I’d Like to Find and Establish a Niche for Myself in an Area of Medicine that Truly Inspires Me”

41.5“Becoming a Physician Is a Fairly Straightforward and Reliable Way to a Comfortable Income that’s Recession-Proof”

41.6Ok, I Get It. Residency Is Hard. But How Bad Can It Really Be?

42.Real Talk on the Medical School Experience

Ray Funahashi and Joel Thomas

42.1Medical School in a Nutshell

42.2Medical School Hot Takes

42.2.1Memorization Is King but not Enough

42.2.2School Material Alone Is often Inadequate to Succeed

42.2.3Extracurriculars—Aside from Research—Don’t Really Matter as much in Medical School

42.2.4You Might Run into Some Hypercompetitive “Gunners,” but Overall the Environment Tends to be Collaborative

42.2.5Grading Can Be Hit-or-Miss at Times

42.2.6Altruism, Passion, and Empathy Aren’t Enough toWard against Burnout

42.2.7Self-Care Is Harder but Still Non-negotiable

42.2.8The Social Scene Is Very Unique

42.2.9You May Experience (Covert) Harassment, and It Is not Ok or “Just Part of the Process”

42.3Medical School: A Class-by-Class Breakdown

42.3.1Year: Basic Sciences

42.3.2Year: Organ Blocks

42.3.3Year: Core Clerkships

42.3.4Year

42.3.5Miscellaneous Years

42.4Summary

43.Real Talk on Succeeding in Medical School

Joel Thomas

43.1You Still Need a Schedule—Now More than Ever

43.2You Still Need to Maintain Wellness—Now More than Ever

43.3Exhaust All Active Learning Resources before Even Trying Passive Learning (If at All)

43.3.1Preclinical Years

43.3.2Clinical Years

43.3.3Shelf Exams

43.3.4Dedicated Study Periods

43.4Proactively Search for Your Passion

43.5Summary

44.A Peek at the Residency Application Process

Joel Thomas and Neal K. Ramchandani

44.1Residency Application Cycle: The Big Picture

44.2Couples Match

44.3How Do Residency InterviewsWork?

44.4What Do I Do When I’m Done with Interviews?

44.5Final Thoughts

45.A Day in the Life in Medicine

Joel Thomas, Phillip Wagner, Ray Funahashi, Nitin Agarwal, and Vamsi Reddy

45.1Vamsi Reddy—Fourth-Year Medical Student (MS4) at Medical College of Georgia

45.1.1Preclinical

45.1.2Clinical (Depends on Rotation)

45.2PhillipWagner, MD—Third-Year Resident (PGY3) in Internal Medicine at University of Pittsburgh Medical Center (UPMC)

45.3Nitin Agarwal, MD—Seventh-Year Chief Resident (PGY7) in Neurosurgery at University of Pittsburgh Medical Center (UPMC)

45.4Joel Thomas, MD—Transitional Year Resident (PGY1) at Indiana University Methodist

45.5Summary

46.Nonclinical Careers Ray Funahashi

46.1Yes, Some People Don’t Pursue a Clinical Career after Medical School

46.2Why Do People Choose Nonclinical Careers?

46.2.1Original Plan

46.2.2Skillset/Interest Mismatch or Pull in a Different Direction

46.2.3Burnout/Lifestyle

46.2.4Failed Residency/Admission

46.3Pivot Points: When Do People Switch to Nonclinical Careers?

46.3.1Before Residency aka During or After Medical School

46.3.2During Residency

46.3.3After Residency

46.4What Are the Typical Nonclinical Jobs?

46.4.1Consulting (Business Strategy and Management)

46.4.2Biotechnology (Bio-Tech/Med-Tech)

46.4.3Pharmaceutics (Pharma)

46.4.4Research (Academia, Pharmaceutical Industry, or Government)

46.4.5Data Science (Biomedical/Clinical Informatics)

46.4.6Health Insurance/Chart Reviewing

46.4.7Hospital Management

46.4.8Healthcare Policy

46.4.9Graduate and Medical School Admissions Consulting

46.4.10MedicalWriting/Medical Education Content Producer

46.4.11Investing/Venture Capital

46.4.12Entrepreneur/Start-up

46.4.13Limited Practice

46.5Summary

47.Stories of Inspiration

47.1Joel Thomas—“Fake Pneumonia”

47.2PhillipWagner—“The Bigger Picture”

47.3Nitin Agarwal—“The Axon to Neurological Surgery”

Section V: Appendix

Appendix A: Resources

A.1Student Doctor Network (SDN) Forum

A.2Reddit

A.3MD Applicants

A.4AMCAS, AAMC, AACOM, TMDSAS

A.5MSAR

A.6Med School Insiders

A.7Khan Academy

A.8Organic Chemistry as a Second Language

A.9Resources during Medical School

Appendix B: Medical Specialties and Subspecialties

Index

Preface

So you want to get into medical school?

Great! Welcome to the years leading up to it: the pre-med (pre-medical) years of your life.

We know there can be much uncertainty during this time about how to prepare, when to take the MCAT, how to do well in your science classes—it can all be overwhelming. The journey will be challenging, but we did our best to pass down the pearls of wisdom we learned from our own journeys, as well as from pre-meds who came before you and succeeded—even after having failed at first.1

Within this book, we lay out strategies which we believe to be most advantageous for pre-medical success. We’re fully aware that not every recommendation will apply in the same way for every pre-med. Therefore, we encourage you to weigh our recommendations against your personal circumstances, the most up-to-date scientific evidence, and the judgment of your mentors. Additionally, there is no single best way for each pre-med to get into medical school. As such, we encourage you to track your progress, to remain open-minded about opportunities for improvement, and to experiment with our suggestions when you can safely do so.2 Making informed decisions is crucial because—unfortunately—there are no guarantees to the process of getting into medical school, and it is dangerously easy to inadvertently destroy your chances.

So why choose this book out of the sea of available pre-med resources?

●We address the hard, uncomfortable questions: Should you major in something easier to get a higher GPA? Does going to a more prestigious college matter for medical school admissions? Why do doctors have the highest rate of suicide among any profession even though matriculating medical students have similar—if not better—mental health than the general population? Why do so many medical students ignore their schools’ lectures (for which they’re paying around $60,000 yearly) to study at home from outside resources? Is it even financially worth it to become a physician nowadays?

–These topics cannot be answered with a quick Google search. They require engagement with multiple opposing viewpoints and careful data analysis. We do much of this legwork for you, but we also provide you with resources for further research on your own.

–Many other books about medical school simply gloss over these issues, even though they’re some of the most important considerations for anyone seriously considering a life in medicine.

–We bring together multiple authors with different life experiences and perspectives. As such, we feel that our conclusions on these issues are broadly applicable to students from different backgrounds.

●We have a proven track record of success using our own methods. We all went to a US News Top 20 medical school and/or trained at a Doximity Top 20 residency program.

●We are deeply committed to evidence-based recommendations. You will find a source for virtually every claim in this book. We are also careful to avoid several discouraging trends in nonfiction: cherry-picking data to fit claims as well as citing sources that vaguely support the claim made (if at all). Rest assured, we have scrupulously read every primary source cited in this book, and we also took the time to perform multiple reviews of early drafts to remove claims and sources that were not sufficiently supported by the authors’ consensus. We also qualify the strength of our “surviving” recommendations, as well as the level of confidence we have in the sources themselves. Additionally, for every claim that we make, we made a good-faith effort to explore alternative recommendations to avoid cherry-picking information that naively supports our intuitions. We also took care to use open-ended search strategies (e.g., “What are the pros and cons of spaced repetition?” vs. “spaced repetition benefits”) when researching to assess the broad body of evidence surrounding the topics—rather than just the data supporting our intuitions and preferences. Nonetheless, we still invite you to be skeptical and scientifically rigorous when reading through our recommendations. If you find any claim in this book that seems off-base or unsupported by science, we encourage you to contact us to discuss.

●We don’t care about making money. We encourage anyone who cannot afford to pay for this book to reach out to the authors for help in finding an affordable option from the Publisher. Our first and foremost goal is getting this information out to whoever my need it.

●We are committed to updating this book as a living, breathing document that evolves with the medical landscape. We know that many of the recommendations in this book will become outdated shortly because medicine constantly changes. The authors have resolved to regularly update the book’s recommendations throughout their careers, and this book will update in real-time with its companion website: premedicine.info

Congratulate yourself on taking a serious step toward a career in medicine. Whether you read this book cover-to-cover or jump ahead to the sections that interest you, we sincerely wish you the best of luck in your future endeavors. Hopefully we’ll see you in the doctors’ lounge someday.

Disclaimer

The opinions expressed in this text do not reflect those of the institutions at which we trained or worked, and are ours alone.

Each of the authors’ viewpoints were subject to editorial feedback and criticism, but they are ultimately their own. We know that despite how much we tried to be respectful, considerate, and accurate, that some of these opinions will not necessarily address the uniqueness of every reader’s experience or situation. We know that this book would not have been created—or be anywhere as helpful as we think it can be—without input from a variety of voices and perspectives. We also see no reason why that input should stop. If you are concerned that one of the opinions or recommendations put forth in this text is inaccurate, malicious, incomplete, or hurtful, please reach out and discuss it with us.

Thank you for reading!

Joel Thomas, MD

Phillip Wagner, MD

Ray Funahashi, MD

Nitin Agarwal, MD

__________

1One of the co-authors poignantly attests to this. Ray Funahashi’s major motivation for writing this book was to minimize the mistakes made by future applicants, as he personally did not get into a single medical school during his first application cycle. In retrospect, he realized that he simply lacked clear, cohesive guidance on the overall application process and spent a painstaking amount of time integrating material from various blogs and forums to ultimately gain admission in the next cycle. He hopes that no one else will fail to get into medical school for the same reasons he originally faced.

2For example, trying a new study strategy several weeks before a low-stakes quiz, NOT the weekend before the final exam.

How to Read This Book

This book contains a lot of information. It is meant to be a comprehensive tome that covers every major aspect of the path to becoming a physician, from exploring your initial interest in medicine, succeeding as a pre-medical student, maximizing time between college and medical school (if relevant), applying to medical school, picking a medical school, succeeding in medical school, applying for residency, picking a medical specialty, and finding professional satisfaction in medicine as the field constantly evolves. As such, there are a number of different ways you3 can read this book:

If you’re already committed to becoming a physician, then we recommend reading the book cover-to-cover. You will likely not retain everything, but you will catch important glimpses of concepts and perspectives you may not have been aware of. You can always return to those sections for additional detail when you’re ready.

If you’re already committed to becoming a physician and in a high school, then start with Chapter 7, Guaranteed Admission Programs and Early Assurance Programs to read about ways to get admitted to a medical school as a high school student. Many readers might be unaware that these programs even exist.

If you’re already committed to becoming a physician and early in undergrad, then you should also start with Chapter 7, Guaranteed Admission Programs and Early Assurance Programs to read about early assurance programs (i.e., conditional acceptance to medical school early in college). Many readers might be unaware that these programs even exist. You will also benefit from the other chapters in Section II: Succeeding as a Pre-Medical Student that meticulously discuss each major aspect of building a competitive application (e.g., volunteering, research, MCAT, personal wellness, mentorship).

If you’re already committed to becoming a physician and approaching graduation, then you should read Section III: Applying to Medical School in detail to get a perspective on every major aspect of the application process, as well as potential plans (B, C, D, etc.) if you don’t get accepted. Alternatively, if you don’t plan to apply to medical school at the end of college, then you should read Chapter 16, Gap Years, Employment, Graduate Degrees, and Post-Baccalaureate Fellowships to explore the best options for the time between graduation and medical school.

If you’re struggling with personal wellness, self-doubt, anxiety, or depression, then we recommend starting with Chapter 5, Building Your Narrative; Chapter 6, Common Pre-Med Diseases and How to Treat Them; and Chapter 18, Self-Care and Wellness for avenues to explore on your own. That said, this book is no substitute for professional medical and psychological counsel.

If you’re still simply exploring medicine as a potential career, then we recommend reading Section I: The Pre-Med Primer to get a birds-eye view of the process of becoming a physician. We also recommend skimming through Section II: Succeeding as a Pre-Medical Student to get a better perspective of the various commitments you will have to juggle for several years. We also recommend reading Chapter 41, Real Talk on a Medical Career; Chapter 42, Real Talk on the Medical School Experience; Chapter 43, Real Talk on Succeeding in Medical School; Chapter 45, A Day in the Life in Medicine; and Chapter 47, Stories of Inspiration for rich, detailed accounts of the day-to-day life in medicine, ranging from the mundane to the extraordinary. We also recommend Chapter 46, Nonclinical Careers and Appendix B: Medical Specialties and Subspecialties for a comprehensive (but by no means exhaustive) list of the tremendous variety of options available for practicing medicine.

If you’re already in medical training (e.g., medical student, resident, or even attending physician), then we recommend reading Section IV: Medical School and Career Insights and even Appendix B: Medical Specialties and Subspecialties for perspective and discussion on evolving issues in medicine and professional fulfillment.

Acknowledgments

We are deeply grateful to the following reviewers who provided insightful comments and critiques on earlier drafts of this work.

●Carolyn Ayers, MD: Internal Medicine/Pediatrics resident, Indiana University

●Reetwan Bandyopadhyay: Pre-med Undergraduate, University of Pittsburgh

●Elizabeth Cook, MD: Transitional Year Resident, Indiana University; Dermatology Resident, MedicalCollege of Wisconsin

●Abigail Gerig: Software Engineer

●Anna Grobengieser: High school student interested in medical school

●Brandon J. Kiley, MD: Psychiatry Resident, Washington University School of Medicine

●Philip King, PharmD: Clinical Pharmacist, Indiana University; Assistant Professor, Pharmacy PracticeCollege of Pharmacy and Health Sciences, Butler University

●Amaan Rahman: BS/MD Student, University of Pittsburgh

●Neal K. Ramchandani, MD: General Surgery Resident, Vascular Surgery Fellow, Indiana University

●Kenneth Shiao, MD: Transitional Year Resident, Indiana University; Diagnostic Radiology Resident,Emory University

Contributors

Nitin Agarwal, MD

Assistant Professor of Neurological Surgery and Orthopedic Surgery

Director of Neurotrauma

Department of Neurological Surgery

Washington University School of Medicine

St. Louis, Missouri, USA

Landon Cluts, MD

Research Coordinator

Department of Orthopaedic Surgery

University of Pittsburgh School of Medicine

Pittsburgh, Pennsylvania, USA

Ray Funahashi, MD

CEO and Co-Founder of The Labkind Project

Peter H. Diamandis A360 Fellow

Head of Clinical Affairs at Gesund.ai

Boston, Massachusetts, USA

Samyuktha Melachuri, MD

Resident

Department of Ophthalmology

University of Pittsburgh School of Medicine

Pittsburgh, Pennsylvania, USA

Christian Morrill, MD

Research Fellow

Department of Pediatric Urology

Brady Urological Institute at Johns Hopkins University

Baltimore, Maryland, USA

Chinweoke Osigwe, BA

Medical Student

University of Pittsburgh School of Medicine

Pittsburgh, Pennsylvania, USA

Neal K. Ramchandani, MD

Vascular Surgery Fellow

Department of Vascular and General Surgery

Indiana University

Indianapolis, Indiana, USA

Vamsi Reddy, MD

Consultant

McKinsey & Company

New York, New York, USA

Eva Roy, MD

Resident

Division of Plastic and Reconstructive Surgery

Brigham & Woman’s Hospital

Harvard University

Boston, Massachusetts, USA

Jorna Sojati, BS, MS

Medical Student

Department of Medicine

University of Pittsburgh School of Medicine

Pittsburgh, Pennsylvania, USA

Joel Thomas, MD

Diagnostic Radiology Resident

Washington University School of Medicine

St. Louis, Missouri, USA

Phillip Wagner, MD

Internal Medicine Faculty

The Johns Hopkins Hospital

Baltimore, Maryland, USA

Section I

The Pre-Med Primer

1The 30,000-Foot View

2What Medical Schools Look For

3The Pre-Med Principles

4The Types of Pre-Medical Students and Paths to Medical School

5Building Your Narrative

6Common Pre-Med Diseases and How to Treat Them

1 The 30,000-Foot View

Ray Funahashi and Joel Thomas

Whether you’re already committed to or still contemplating a career in medicine, understanding the birds-eye view to becoming a physician is paramount.

You might be surprised to learn that applying to medical school requires years of preparatory work from required courses and grades to volunteering, shadowing, and extracurricular activities. There are also many unwritten rules, like working with the “pre-medical committee/advisors/office” at your college and carefully timing your application.

Feeling overwhelmed? Don’t worry! We’ll explain all of these things step-by-step so that you will feel well-prepared and poised for success. Below, we outline the basic pathways to medical school and becoming a physician. We will describe each step in more detail in the subsequent chapters, so focus on understanding the big picture for now. You’ve got this.

How do you become a physician in the United States? Let’s get started!

1.1 Step 1. Get a Bachelor’s Degree

All medical schools in the United States require you to have a bachelor’s degree (B.S. or B.A.) from an accredited college or university (they require you complete 90 credits before you apply, and that you will complete your bachelor’s before enrollment). The degree can be in any major. Yes, whether you are a biology major or a philosophy major, it doesn’t directly affect your chances of getting into medical school.

Additionally, some applicants take additional time to pursue another degree, work, or do research after finishing their bachelor’s to become more competitive applicants. More on this later.

On the other hand, if you're in high school and committed to becoming a physician (and have thoroughly explored that commitment), then you can apply to Guaranteed Admissions Programs to secure a spot in medical school at the time you enter college. More on this in Chapter 7, Guaranteed Admission Programs and Early Assurance Programs.

1.1.1 Complete Required Classes

In addition to receiving a bachelor’s degree, completing certain classes in the sciences, humanities, and mathematics is a prerequisite to applying to medical school. These classes can be—and often are—done while working toward a bachelor’s degree. The usual length of time for this step is 1.5 to 2 years if doing this in the context of an ongoing bachelor’s degree, and 1 year if completing a post-baccalaureate pre-medical program. In general, it takes most people 4 years if they need to complete a bachelor’s degree, although students in some Guaranteed Admission Programs can save up to 2 years off the process and complete their undergraduate studies in 2 years instead of the usual 4.

Common Prerequisite Classes for Applying to Medical School

●One year of Biology with laboratory.

●One year of General Chemistry with laboratory.

●One semester to one year of Organic Chemistry with laboratory.

●One year of Physics with laboratory.

●One year of English.

●One semester of Biochemistry.

One year = 2 semesters, or 6–8 credits, depending on the course and your school’s academic credit system.

Some schools require additional classes such as Statistics, Calculus, Genetics, Sociology, and Psychology.

Some schools will accept Advanced Placement (AP) credit and some won’t. Some schools require one year of organic chemistry, whereas others will accept one semester of organic chemistry + one semester of biochemistry.

Since these requirements are a moving target (i.e., liable to change over time), we recommend discussing with your pre-med advisor and/or checking the admission requirements on individual schools’ websites before creating your academic schedule.

You might be surprised to note that you’re not required to complete any “medical” courses as an undergraduate, (e.g., anatomy, physiology, microbiology, and immunology). This is because all medical students will cover these subjects in the first 2 years of medical school, but in extreme detail and focus on clinical applications. The undergraduate years are instead designed to develop your general scientific thinking to develop a scaffold for clinical decision-making and application of science in medicine.

If you didn’t complete these required classes, you have options to complete them by taking them through a pre-medical post-baccalaureate (post-bac) program (see Chapter 16, Gap Years, Employment, Graduate Degrees, and Post-Baccalaureate Fellowships).

You should have a good — ideally great (close to 4.0) — GPA, especially in your science classes (more in Chapter 10, Obtaining a Solid GPA).

1.1.2 Engage in “Recommended” (Essentially Required) Activities

Most medical schools want to see that applicants have the following:

Clinical Exposure

How do you know if you want to become a physician if you have never been exposed to medicine from a career perspective? Medical schools expect applicants to have either (ideally both) shadowed a physician in person or worked/volunteered in a setting where they worked with patients and/or physicians. In case you were wondering, being a patient yourself doesn’t fulfill this expectation.

Volunteering and Service

Medicine is a field where you are caring for others. Accordingly, medical schools expect applicants to demonstrate this through volunteering over a significant period of time. Volunteering should be longitudinal and personally meaningful.

For example, an applicant who volunteers for several years at his/her local food shelter and communicates personal meaning from the experience demonstrates a more compelling commitment to service than an applicant who volunteers to clean the local park for a week and can’t articulate any transformative insight after doing so. Medicine is a 24/7 vocation, and showing you can commit to something matters.

Research Experience

The practice of clinical medicine actively evolves through scientific discovery, and many medical schools are also academic research institutions. Most—if not all—value students who have demonstrated critical thinking using the scientific method. In addition, as a doctor you will be a lifelong learner. This means that you will have to be able to consistently appraise and critique the latest research when making day-to-day clinical decisions. The research you get involved in doesn’t have to be medical—it can be in any academic field from philosophy to theoretical mathematics.

Schools don’t necessarily expect you to become a researcher or conduct research once you are in medical school, but they still value those who at least have had the experience.1

1.2 Step 2. Take the Medical College Admissions Test (MCAT)

MCAT stands for Medical College Admissions Test, and it is a standardized computer-based exam that tests critical thinking and comprehension across physical sciences (physics and chemistry), biological sciences (biology and organic chemistry), psychology and sociology, and verbal reasoning. This is the “big test” that you may have heard other pre-meds talk about. Taking this test is a prerequisite to applying to medical school, and doing well is essentially a requirement for acceptance into medical schools.

Your MCAT score is one of the most important factors in your application’s competitiveness besides your GPA because medical schools will have a soft (and sometimes hard) cutoff on reviewing applications based on the MCAT score. That means some schools will have automatic cutoff scores that will preclude certain applicants from having their applications even be seen by reviewers.

Generally, this test requires you to have a strong grasp on the scientific concepts central to the required coursework we have discussed. Your college classes should cover the majority of what you need to know, but you will most likely need to buy a MCAT review book or review materials to make sure you can focus efficiently on the right content. Some people choose to enroll in preparation classes, which are generally very expensive.

Basically, the MCAT questions give you information or evidence in a written passage or graph/table form. Sometimes this information will be baffling on purpose. You will need to understand how to identify the relationship between the new information given and scientific concepts you already know.

When you take this exam is up to you, but most people finish their science classes first and then dedicate weeks to months of study time to prepare to take the exam prior to June of the year before starting medical school. For traditional applicants, this would be around the end of their junior year of their undergraduate degree.

The timing of when to take this exam will vary based on your situation, especially if you are not applying to medical school straight out of college. Those applicants that have already graduated—or plan on taking time off but have not taken the test—will have to find a time that makes sense for them and when they want to apply.

The exam is graded with a numerical score that will permanently remain on your record. Generally, most medical schools will accept MCAT scores from the last 2 to 3 years. However, some schools may accept older scores. Schools also vary on how they determine the time cutoffs. Some schools count the time backward from the date of expected matriculation, while others count the time backward from time of application.

If you score poorly on this exam, you can retake the exam, but taking this exam more than twice is not encouraged. In addition, each MCAT score will likely appear on the exam transcript sent to schools; thus, schools will likely see a poor initial attempt followed by an improved score. It’s ultimately up to individual schools’ discretion what they do with multiple scores; the Association of American Medical Colleges (AAMC, i.e., the collective organization of US MD schools) has no hard requirements for Admissions Committees (ADCOMs).

How do you study for and score high on this exam? Don’t worry, we’ll tell you all about how to study for and score well on this exam in Chapter 17, Crushing the MCAT.

1.3 Step 3. Complete Online Applications to Medical Schools, Attend Interviews, and Get Accepted

Because the process from application to acceptance takes an entire year (see Chapter 20, The Big Picture), proper planning and timing is essential.

Ideally, you send your application to medical schools in June (one year prior to the fall of the year you want to matriculate), interview at schools in the subsequent fall or winter, and decide where to attend in April/May.

There are two parts to the application: Primary Application and Secondary Application.

1.3.1 The Primary Application

Also see Chapter 28, Primary Application: AMCAS, AACOMAS, and TMDSAS). This is what you prepare first and it includes the following:

●School transcript(s).

●MCAT test score.

●Manually categorizing the classes you have taken.

●Recommendation letters.

●Personal statement essay.

●Listing out your activities, short essays describing them, and listing hours involved in each.

●A list of medical schools you are applying to.

Quick Note about Letters of Recommendation

You will need to have Letters of Recommendation sent on your behalf as part of your application. The majority of these letters are typically from professors you’ve worked with at your school.

One recommendation letter, however, should come from your school’s “pre-medical committee,” if there is one. This is a group of advisors at your school, typically formed by several professors. They are like gatekeepers that prescreen pre-med students at your school. Read more in Chapter 23, Letters of Recommendation.

Quick Note about MD and DO

Did you know medical schools come in two flavors? Allopathic (MD: Doctor of Medicine) and Osteopathic (DO: Doctor of Osteopathy). All you need to know right now is that you can be a physician with either degree.

Both curriculums overlap, and most patients don’t know the difference between an MD doctor and DO doctor. You can apply to either or both MD and DO schools. Read more in Chapter 24, DO, MD, and International Schools.

1.3.2 The Secondary Application (Secondaries)

This is explained further in Chapter 33, Secondary Application. It is an online application that becomes available to you once your Primary Application is received, and it is specific to the schools to which you applied. Most of your schools will send you a link to complete a secondary application unless you were screened out (e.g., your stats weren’t good enough).

The secondary application generally includes the following:

●More questions about you and your background.

●Additional essays for you to write about, for example: why do you want to come to XYZ medical school?

Because you will be receiving these essays to complete from most of your schools around the same time and you have to complete them quickly, it can get a little overwhelming. And yes, most secondaries will have a fee.

But there’s good news! The essay prompts do not change much from year to year, and you can usually find the prompts on the Internet. This means you can prepare your essays ahead of time before you receive the actual secondary. In addition, many schools tend to have similar questions/prompts, so you can have somewhat of a workable template for yourself.

1.3.3 Admissions Interviews

Yes! The schools have reviewed both your primary and secondary application, and they liked you on paper. Now they want to interview you to see if you are the real deal. You will receive these invitations via email or through an online portal where you submitted your secondary.

Interview season runs from about late September through early February. Schools may differ slightly.

This chapter was originally written prior to the COVID-19 pandemic, when interviews were exclusively in-person and associated with extensive costs from travel and lodging. Since the COVID-19 pandemic, the logistics of medical school interviews have been evolving, with multiple admissions cycles switching to 100% online interviews. The future for medical school interviews is still uncertain, but many of the basic facts of the interview experience still persist. It’s a nerve-wracking time of constant email and forum-checking, and every ping from your phone kicks up your blood pressure. Luckily we have tips on maintaining your sanity through the application cycle. Read more about logistical tips for the application and interview trail in Chapter 22, Before You Begin: Application Cycle Prophylaxis and Chapter 35, Interview Trail Travel and Attire.

Interviews can be with faculty and/or medical students. They come in a few different flavors like Traditional (e.g., “What brought you to this point?” “Why do you want to become a doctor?” “Come to our school,” etc.) or Multiple Mini-Interviews (MMI), which offer a large number of mini-interviews at multiple stations in succession. These shorter interviews may include problem solving and eliciting your take on ethical dilemmas. Read more about acing your interviews in Chapter 34, Interviews.

1.3.4 Acceptance

Finally, the application process is coming to a close! Schools have notified you of acceptance offers and you have chosen THE ONE (as per Chapter 38, Acceptance and Decisions: What Really Matters When Choosing the One School). Maybe you had waited diligently on several waiting lists and employed the strategies in Chapter 36, Wait-List and Update Letters in the meantime. Nonetheless, you’re going to be a medical student! In the coming months, you will make arrangements to relocate and apply for financial aid (Chapter 37, Financial Aid and Chapter 39, Before and After Matriculation).

Many students will take on loans to finance the large cost of tuition and living expenses. You will fill out a FAFSA form for financial aid and work with your medical school’s financial aid office to arrange your loans and potential grants/scholarships.

1.4 Step 4. Attend Medical School

1.4.1 First and Second Years

After a brief orientation period getting to know your new school and classmates, you will hit the ground running with the books… or online videos and flashcard apps. Strap yourself in for long study hours!

Curricula slightly vary among schools, but generally, in your first and second year you will study basic biomedical sciences with classroom lectures, anatomy cadaver lab, and online learning. You also will learn the basic physical examination and some patient interviewing skills. Of note, medical education is rapidly advancing, and many schools are experimenting with progressive, more interactive learning methods. Read more in Chapter 42, Real Talk on the Medical School Experience and Chapter 43, Real Talk on Succeeding in Medical School.

What Are Basic Sciences?

As a pre-med, we refer to basic science as chemistry, biology, physics, and the subsubjects that are included under those subjects (e.g., microbiology).

As a medical student, we refer to basic science as the subjects covered (to the extent) on the Step 1 USMLE exam. These include anatomy, microbiology, cell and molecular biology, pathology, physiology, behavioral sciences, pharmacology, biochemistry, genetics, immunology, nutrition, epidemiology, and biostatistics.

MS = Medical Student

You might hear med students referred to as MS1 or M1. The M or MS stand for Medical Student, and the number refers to what year of medical school they are currently in. So an MS1 or M1 is a first-year student, MS2 or M2 a second-year student, and so on.

MS1 → First-year medical student.

MS2 → Second-year medical student.

MS3 → Third-year medical student.

MS4 → Fourth-year medical student.

Likewise, residents are referred to as PGY1, PGY2, etc., for “postgraduate year 1,” “postgraduate year 2,” etc.

1.4.2 Take the USMLE Step 1 (or COMLEX-USA Level 1) Exam

To progress through medical school and residency, you have to pass the medical licensing exams. Of note, there are two major pathways by which this is done: the U.S. Medical Licensing Exams (USMLE) for MD students, and the COMLEX-USA exams for DO students. There are four USMLE exams in total: Step 1, Step 2 Clinical Knowledge (CK), Step 2 Clinical Skills (CS), and Step 3. The COMLEX-USA exams are analogous but also cover osteopathic medicine; however, many DO students choose to also take the USMLE to make themselves more competitive for ACGME (i.e., MD) residency programs (more in Chapter 44, A Peek at the Residency Application Process).

In medical school, you take Step 1, Step 2 CK, and Step 2 CS. In residency, you take Step 3. These exams not only give you a numerical score but also have a pass/fail threshold. They also have a “score once” policy, meaning that if you fail the exam you can retake them, but if you pass, even if you pass with the slimmest of margins, you may never retake it.

Traditionally, between the end of your second and into your third year of medical school, you will take the Step 1 exam. However, some schools have their students take it after the first year, and other schools have pushed it to the end of third year. Step 1 is a basic science-focused exam. This 8-hour exam had been considered the “biggest exam” of medical school, as it had traditionally been one of the most—if not the most—important variable for placement into competitive residency programs (analogous to the MCAT for medical school admissions). However, the National Board of Medical Examiners (NBME) decided to transition Step 1 to a pass/fail scoring system. The implications of this for residency program placement (as well as its impact on the relative weights of other aspects of evaluating applicants, e.g., clerkship scores, medical school rank, research productivity) are speculative at the time of writing, unfortunately. 2,3,4,

1.4.3 Pass/Fail USMLE Step 1: A Deeper Dive

Step 1 was essentially the MCAT of medical school: the single most important standardized marker of your academic aptitude that could make or break your application to competitive residency programs. Students spent countless hours studying for this exam—often at the expense of their in-house exam material—to make themselves maximally competitive. The NBME, however, concluded that this disproportionate emphasis on a single exam—that may not even reliably predict one’s aptitude as a physician—majorly contributed to stress and poor mental health among medical students. As a result, the exam was made pass/fail.

So what are the implications? Again, it’s not completely clear yet, but many speculate that Step 2 CK—taken at the end of third year or the beginning of fourth year—will take the place of Step 1 as the standardized measure of academic aptitude. This could prove disastrous for someone who spent 3 years preparing for a highly competitive specialty (e.g., orthopaedic surgery) only to receive a score that would essentially remove them from the running, arguably invalidating 3 years of grueling work. Medical school prestige could also be weighed much more, making the MCAT significantly more important for eventual residency placement (as more prestigious schools tend to have higher average MCAT scores). Number of publications, abstracts, and presentations may also become more important for competitive residency, incentivizing applicants in these fields to pursue research years to build their CVs even further. Ultimately, we urge readers to stay up-to-date on the developing downfield effects of this change, as it may impact your decisions on which medical schools to ultimately attend, especially if you’re thinking about a competitive specialty.

Indeed, the preliminary available data appears consistent with our predictions, as a survey of residency program directors in 20205 revealed that medical school prestige and Step 2 CK scores will become more important, given the lack of objective Step 1 scores to distinguish among applicants.

1.4.4 Complete Core Clerkships, aka Get a Taste of the Different Specialties

For your third and fourth years, you will complete clerkships in the major various hospital medical specialties (internal medicine/general adult medicine, pediatrics, obstetrics and gynecology, surgery, psychiatry, family medicine). A clerkship, also referred to as a “rotation,” is a period of a few weeks (typically 4–8 wk), where you spend time being a team member in a particular specialty. You will be supervised while seeing patients, examining them, and coming up with diagnoses and treatments with the team. During your clerkship years, your schedule will entirely consist of rotations. This means every few weeks, you will be moving on to a new rotation.

Clerkships are considered one of the most stressful aspects of medical school; at the same time, what one does on a clerkship is incredibly nebulous and hard to truly understand until one is actively participating in one.6