Monday, July 30, 2007

Top 10 List: Pieces of advice for pre-med students

Overheard during the interviewer lunch break at my med school's interview weekend: one old doctor to another - "The very first student we interviewed blew us away. She'd summited Mt. Kilimanjaro, competed in the Olympics, and was an honours student with incredible research experience and publications. You know, if applying to medical school was like this back when I applied, I don't think I'd be admitted."

Getting in to medical school is tough. In Canada, less than 30% of students who apply each year are admitted to a school, and on an individual basis Canadian schools accept as little as 3% of the people who apply (that's more competitive than some Ivy League schools in the USA!) (source). That's not counting the thousands of students who wanted to be doctors when they started their undergrad degree, and had to face the realization that thanks to things like the MCAT and the competitiveness of the pre-med world, and perhaps the odd slack semester or difficult year, they would never even make it to the point of applying for medical school.

Here's some advice I would give to any pre-med student applying to medical school, though non-pre-meds might find it interesting as well as it might give you a unique perspective into the mind of a pre-med student. I wrote this list assuming you know all the basic info - what the MCAT stands for, what an application involves, and the like, though keeners at any level of their training - high school, college, or university - might find this useful as well. Given that, what I've written below something I hope every pre-med could have the chance to read before they apply to med school.

10. Have a backup plan...
This is one of the hardest thing for pre-meds to do: plan what you'll do with your life should you not 'get in' this year (or ever). Why's it so hard? It just sucks to think about the fact that you might not be accepted. But, you can't put your eggs all in one basket... you need to be realistic and know that even some applicants with the highest marks aren't accepted anywhere. Nothing is for certain. So, have a backup plan if you don't get in this year... and also consider what you could do with your life should you not get in at all. This might even mean considering taking a 'pre-med' degreee other than biology, since you don't need a biology degree to apply; if the only job you'd be interested in doing that you can get with a biology degree is medicine, you might want to do something else.

9. ...but don't give up if you don't get in your first time.
It's turning out more and more now that getting into medical school is more about learning how to "play the game;" because it's such a crap shoot, anybody who doesn't get in their first time applying would be stupid to throw in the towel right away. Even if you didn't get an interview, go to an advising session if any of the schools you applied to offer one, and give it another go.

8. If you do get in, don't do anything the summer before you start classes.

Seriously - don't work. Travel, but only for part of your summer, since travelling around can be stressful and you want to have time to veg. Give yourself at least a few weeks to sit around like a bum and do nothing, maybe see some friends that you won't be able to hang out with when things get busy. Let me put it this way: you now only have a couple of summers left (unless you chose to apply to a 3-year program!).

7. Know what doctors do before you decide you want to be one.
It would be devestating sacrifice so much energy, effort and free time just to keep up in the pre-med rat race and realize later on that medicine isn't for you, so learn what a doctor does - not just daily, but learn what the lifestyle is like, the stress level, the impact on family life. How? A few ways: you can read books and biographies about physicians, you can shadow physicians where you live, or you can go to a developing nation and volunteer your services at a medical clinic or hospital. The third one shows commitment and could have much better opportunity for clinical exposure, thanks to different policies on liability; though if you do that, please make sure you're going to a place where you can actually contribute and not just be watching or being a pain, and remember that some med schools actually use the length of time you spend away as a 'filter' for resume padding; a former dean of admissions in Canada, as quoted in a newspaper article: "only the affluent can spend six months in Africa volunteering at an AIDS clinic. ... it's become sexy to put stuff like that on an application.... but they're not necessarily going to get extra points for it."

6. Know what other health care professionals do before you decide on medicine.

What does a perfusionist do? What's within a Respiratory Therapist's scope of patient care? Did you know that there are nurse anesthetists? How do you know that you want to be a doctor, not a nurse? As well, getting to know other health professions will help you respect other health care professionals once you start working with them. Finally, it will add depth to your understanding of your own motivations if you can be positive that you want to be a doctor, and not some other type of health care provider. Following #4 (below) can play a huge role in satisfying this, but make sure you still get the chance to see what these people do in real life as well. From my experience, anyone in these professions is more than happy to tell a future doctor what their job involves, if they're approached with interest and respect.

5. Don't kid yourself: Training to become a doctor is one of the most difficult things you can do.
Even though it may appear easy at first, when finals come around (even in first year) you will realize that you've never done anything more difficult, more demanding mentally, intellectually, and emotionally. It will take over every minute of your free time and you will have to set aside time usually devoted to family, friends, and yourself; literally my entire days the month before finals was wake/study/sleep, even though in undergrad I never had to study very much for most courses. The only people who don't feel this way around finals are the ones who have spent their entire semester studying, literally every day and weekend, or are exceptionally brilliant - and there will only be 1 person of the latter kind in your class so chances are it won't be you. And that's just first year. For third year, add all that stress to being on call, having to deal with patients, nurses and doctors daily, having a pager go off while you're sleeping, and having to study for finals in the midst of all that. In all honesty, I've always said that the only thing I can think of that is more demanding and draining than becoming a doctor is boot camp, and boot camp only lasts 12 weeks. However, that was until I read about a U.S. Marine turned doctor, who discusses "How Residency is Different from the Marines" (scroll down to find it). Even though he says the Marines was harder, training to be a doctor must be pretty hard in order to even deserve the comparison.

4. There is much value in reading the online medical blogosphere.
See my post titled 'why pre-meds should read medical blogs,' then for a place to start, check out my 'guide to medical blogs for beginners' . Here, though, I'll just list a couple of the several reasons. You'll see from jaded residents and medical students just how hard med school can be (try reading the Don't Become a Doctor series on iFindings' blog, as an example). You'll learn what being pimped means and how med students react to it and the subtle, unspoken rules involved. You'll hear about the most exciting moments in the OR, what it's like to be sued and sued again, learn from the mistakes of medical students and read what residents wish they had done differently. As well, you'll learn more about different health care professions if you take the time to read their blogs, fulfilling piece of advice #6. Beyond that, medblogs can give you a perspective on how these different professions work together in the same problem - see, for example, the story Perspectives, written in three parts: part I by a cop, II by a paramedic, and III by a nurse. And, you'll get involved with the profession in a unique way - by engaging in discussion, leaving comments and e-mailing blogging doctors, you can get 'face time' and advice from physicians that you might not get elsewhere.

3. Make sure that going into medicine is your own decision.

Are you doing this because an expectation has been imposed on you by your friends or family? Is this a dream you once had that has now faded, but it's just too hard to tell everyone that you are switching career plans? If you do go into medicine just to satisfy someone else's plan for your life, you are going to hate yourself, and you'll have nothing to keep you going when you have to give up everything for medicine.

2. Marks come first. You can always add volunteer activities after you graduate; you can't go back and increase your undergraduate GPA.
You don't want to look back on a year or a degree and say, "Those marks don't reflect my true potential...I wish I would have worked harder." My dad has told me over and over again of a man he knows who wanted to get into medicine, but when it came down to applying, his GPA was too low because he'd had more fun than study time in his first year of university. More than a few times I've been having conversations with people who say "My brother / cousin / friend tried to get into medical school, but couldn't..." and often it ends up being a GPA issue.
Some people end up having to take a master's degree just so that their undergrad marks aren't considered... they have to work extra hard to make up a first semester where they played more billiards and pranks than studied, or a year when they didn't figure out that they understand organic chemistry until the last week.

1. Be 1000% sure that medicine is what you want to do.
...and make sure that you've completed #7 so that you are making an informed decision. Please do not go into this profession if you aren't completely and utterly sure that this is what you want to do. You'll only end up hating yourself for it, and if you stay in the profession, everyone around you will hate you, too.


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Sid Schwab said...

I think it's a good list. I know a book I'd recommend, but that'd be crass. The only other thing -- and maybe it only applies to the US -- is to try to get a sense of the present and future possibilites of where it's going and where it will end. Lots of doctors my age are depressed and disappointed and frustrated. The reasons are worth knowing. On the other hand, people just entering the field will have the advantage -- and I'm not being facetious here -- of not having known the good/bad old days. Be sure your expectations are likely to match reality.

Anonymous said...

Good advice, Vitum. Do I sense a little angst or regret in there? That sounds like the kind of advice I started to give a few years in, when you realize that it's not quite honest to wholeheartedly encourage young people to get into this field.

I want to say something encouraging, but it's hard to know what. Try me again in a year. They tell me it gets better. :)

Anonymous said...

Appreciate your great list, and the link (wink!) Thinking about healthcare the way it is today, I would advise anyone considering a pre-med degree to also consider a double major in business, as business and management savvy is really being demanded of so many practices in today's confused healthcare world.

In our hospital, a large number of the physicians have been sent, courtesy of our institution, to business classes at a local university!

Beach Bum said...


I agree with you on getting into Canadian schools. That's why I, and many of my classmates, ended up in the Caribbean. There are Canadians studying medicine all over the world, because it is next to impossible to get into a Canadian medical school.

I was one of those who had outside interests in undergrad, and don't regret letting my gpa slide to pursue them. I have always thought that the profession needs doctors who are accustomed to living a full life, not just well-acquainted with the four walls of the library. And in case you were wondering, I graduated with distinction for both my undergrad degrees, and got a 32 on my MCAT. It's just that for med school, it wasn't enough.

And yes, I was too stubborn to want to play the games. That may have been a failing on my part, but I don't regret it, or the journey I've been on trying to get into medical school. In some respects, it feels as if I maintained and developed a firm sense of who I am, and didn't try and make myself into what the admissions committee wanted me to become (I think there's a blog post there somewhere).

Having said that, I wouldn't want to sit on the admissions committee for a Canadian med school. Having to sort through all those applications, most of which were from well-qualified applicants, would be a huge challenge.

I agree with you that med school is very challenging, and demands a huge amount of concentration. However, the there are so many options once one's training is completed, that a student needn't fear they are signing their lives away. Many of the doctors I know, while busy, lead relatively normal and balanced lives. It's possible, once residency is over to actually enjoy life.

Heck, it's possible to enjoy life in med school.

I would caution students who are thinking about a backup plan to think about playing the game. My backup plan was working as a professional musician (which I did). But I think that admissions comittees were confused by my obvious love of music, my obvious professional skills (fairly high-profile gigs with regional orchestras), my starving artist resume (full of part-time jobs and moving around), and my application to med school. It didn't seem to matter that I explained that I loved them both, the fact that I wasn't doing something obviously medically related seemed to be confusing.

Research is good. I had the good fortune to have several relatives who are doctors, so I did (and do) know what I was getting myself into.

Thanks for a thought-provoking post.

aidan said...

Thanks for posting this, it's given me quite a bit to think about. I've already somewhat failed #2 -- a single bad semester pushed by GPA below last year's cutoff for my home university. Fortunately, I'm pretty well set for the rest of the points, especially #4.

Keep up the good writing!

Anonymous said...

I know this is an old blog, but I happened to come across it. Thanks for posting this. I understand that it takes a lot of time and effort to pour your thoughts onto the web in an engaging manner.

Anonymous said...

Many doctors do need a lift.
The problem at hand is the hemophilia community especially in Illinois. The hemophilia doctors, nurses, and social workers in many Illinois healthcare treatement centers are very abusive, harsh, cold, criminal-minded, uncaring, neglectful and too hard on patients. Patients depend on these doctors because because they want their medicine and to live and there aren't too many doctors available. Doctors are making the hemophilia patients have too many Emergency Room Visits and hospital and clinic visits when they can treat it at home most of the time. Doctors are trying to greedly make extra money off the patients and make them get extra ER visits and, unnecessary surgeries and other test that they do not need. Docotrs are prying on a few patients who they think are stupid and over billing them and making them come to the doctors a lot and not servicing a large variety of patients. The hemophilia doctors and nurses in Illinois need to be audited. They are out of date with their care, the doctors are tool old and do not study and their treatment is really too primitive and overblown and out of proportion to be dealing with needles, syringes and other intricate supplies. They need a new staff of more younger and experiences doctors and nurses. The doctors are grumpy and do not want you to page them or call them. The nurses are irritable and grumpy and do not want to be bothered and make the patients care difficult and uncomfortable because they do not want to work in the first place. They yell at the patients and cause them stress and emotional damage. They cause abuse in the patients families and the doctors and nurses also appear to be too overstressed with hemophilia and have a sickness theirself.
These treatment centers for adults and children are mainly the problem: Children's Memorial Hospital, Northwestern Memorial Hospital, University of Illinois Hospital, Michael Reese Hospital, Cook County Stroger Hospital, Rush Presbyterian St. Luke Hospital, and Illinois Masonic Hospital- all in Illinois, seem to be the main problem Hemophilia Treatment Centers that need correction and improvement. The patients just cry all the time and then they make them go to a lot of clinic appointment and the doctors threaten them to look like they are perfect to make their reports look good and successful. They don't give them all the medicine they need. They experience many bleeds because the doctors won't give them their Factor to use at home. They try to get them in the Emergency Room then hospital so they can make more money of of them. Hemophilia medicine is very expensive and doctors get greedy off patients. They make them do extra strenuous activites so they will need more Factor from the doctors and the doctors can make more money. The are viewed as specimens and not human beings. The pressure is really bad on children and adults to be perfect and not get bleeds-to look perfect. No one is perfect-not even those who don't have hemophilia. The doctors and nurses are harsh and mean to patients when they get a bleed. It is just sad that they try so hard to live a normal life and these greedy doctors try to make them look bad to make a buck. They should have a heart for Hemophilia! The patients suffer from doctor's abuse. This is definately true in Chicago and Illinois treatment Centers.

Anonymous said...

Hi My son is the first year med school tsudent. He called me to say that he wants to quit the school. I am torn apart. On one side he is making his choice which is his right. On the other side I am wondering if hs is making this choice for the right reasons. Is it harder then he thought? Would he adjust if he stays in school a bit longer? Should he complete at least the first semester and take time off so that he has an option of coming back?