"I have never understood why medical schools have twenty year olds learning medicine."

While my age has been posted on this blog ever since it began over a year and a half ago, only recently have some commenters drawn attention to my age:

"Blogger, one question for you. How on earth did u get in to med school at 21? What was your life style like from high school through undergrad? " - anonymous

"I have never understood why medical schools have twenty year olds learning medicine. They have gone from high school to undergraduate to medical school and have absolutely no life experience. Of primary importance are the marks of the applicants; all else is secondary." - fossildoc

Before I begin I'd like to thank the many, many people who brighten my day every time they post a comment on this blog. Even if you don't agree with me (or my medical school's decision to accept me, perhaps, in an indirect sort of way?)...no offense taken. Keep 'em coming!!

It's interesting hearing this perspective when, first of all, I am by no means the youngest person in my class. Most medical schools publish statistics of their admissions class, which show that the average age is usually in the mid-twenties but the youngest person is often 20 years old on admission (and sometimes younger).

This is by no means the extreme, however. In some schools in Quebec, students are admitted to a five-year med program after only being out of high school for two years. And in the United Kingdom, students are admitted to a six-year med program straight out of high school.

Secondly, I sincerely agree with the fact that life experience is important. Personally, I took a year off and worked in a completely unrelated field and travelled between my undergrad degree and the start of medical school. I gained so much perspective in this year.

And not only is this my personal opinion, but many med school admissions committees would agree. If a spot comes down to two applicants who are equal on paper in terms of their academic qualifications, the applicant with more life experience will always be the one finding the thick envelope in their mailbox.

While fossildoc may have been right twenty years ago, and many schools retain a minimum mark cut-off, today it's no longer true that med schools admit students based primarily on their marks.

And as a result, the amount of life experience in my class alone means the people in my class are all fascinating and there are so many whom I admire for various incredible reasons.

In addition to life experience though, medical adcoms look for something even more important: maturity. Maturity is an important factor in medical students and indeed physicians and you'd be hard pressed to find a school that admits someone whose immaturity compromises their professionalism.

Given all that, however, I can empathize with these readers who question how young medical school applicants are. I submitted a forum post a while ago after being frustrated at the immaturity of some of my classmates:

"Most of the 3rd years in my class have demonstrated immaturity at one point or another, more so than the people who got in after 4 years or took some time off after graduating. By immaturity I mean anything from showing disrespect by talking loudly in lecture to uncontrollable giggling and crude comments during the genitalia examination clinical skills video. ... If it were up to me, based on what I have seen, I wouldn't allow 3rd years to get into medical school at all."

Needless to say I pissed off a lot of third-year applicants with that last statement, and in retrospect it was a bit extreme, but a) ruffling feathers on the interweb is fun and b) the number of mature young students compared to the number of immature young students - from my impression - is miniscule.

But while the ratio is low, the presence of a distinction demonstrates a point: the maturity of an individual cannot be inferred from their age. In other words, just because a student is young, doesn't mean they're immature. There are some students in my class who have stunned me when they revealed their age, because based on their maturity level, I would have guessed they were five years older than they actually are.

And that's the point I'm trying to make. Unfortunately I couldn't have said it as well as worriedandwaiting, who summed this topic up really nicely in a statement on that pre-med forum, and with whose comment I'll close:

Are you a better doctor because you're 25 or because you're 35? That question has no correct answer. Age is not the factor. Who you are as a person is what matters. It is your life experiences that define you as a person, so try to maximize this opportunity to grow as an individual. As we all know, some 21 year olds already have a lifetime of experience, while some 30 year olds still think like teenagers. It all depends on the person.

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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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Question for Vitum: Should I take a MCAT course?

Despite the narrow topic of this post, hopefully it will be entertaining for those of my readers not even considering medicine, due to my random attempts at humourous comments throughout. Those who have taken the MCAT, well, post a comment with your experience.

Every so often I get a question from pre-med students, and here's another one. I've gotten it a few times, so in a combination of laziness (I don't want to have to repeat myself 100 times) and desperation for attention (by directing the asker here instead of e-mailing him back, this will get my blog 1 more hit) I figured I'd post my standard answer here, with aforementioned random attempts at humourous comments throughout.

Q: Should I take an MCAT review course?
- Scotty, my very capable pre-med buddy. I'm rooting for ya.

Ohhhhh the dreaded M-word. I hated the MCAT and am exceedingly glad that it is behind me. In the spirit of the cliché that putting together a medical school application is like a several-year process of 'jumping through the hoops' (GPA, reference letters, application, interview, extracurriculars, volunteering, additional items to make the application well-rounded)... the MCAT is one of the higher, slightly more intensely flaming hoops. I would much rather take a five-second polar bear swim in dilute hydrochloric acid and succumb to a quantity of international scorn and jeers such as Bush goes through in a day, then repeat that ordeal of studying, preparing, writing, waiting and waiting for results, and going through dehydration from my three-week-long cry session when my marks did arrive. (I didn't do that bad, actually, so I only had to take it once. Praise Allah.)

A bit of background, first. For those who aren't aware, companies such as Princeton Review and Kaplan have a business plan stemming from the incredibly brilliant idea that someone had one day: "I bet people pursuing their life dreams and ambitions would pay money for help." In that spirit of taking advantage of the vulnerable, they charge exorbiant amounts of money to help people who will do virtually anything to 'get in.'
(For those who really aren't aware, the MCAT stands for the 'Medical College Admissions Test' and is an 8-hour ordeal, usually preceeded by months of studying, testing your knowledge in general biology, chemistry, physics, organic chemistry, essay writing skills, and reading comprehension.)

Actually, test prep companies are not as bad as I just made them sound. Their courses are based on years of experience, they can indeed prepare you well, and in fact, on their websites they also have a lot of really good, free resources for admisison to many professions, which might give you an idea of what the application process is like or if it's right for you. For example, thanks to them, just now I was able to learn in 30 seconds that unlike the MCAT for med schools, for many law schools, an applicant's LSAT score accounts for over 50% of the admissions decision. There you go: something I didn't know before, but will be useful should I come to a career crisis in 2 or 20 years (unlikely. I'm happy where I am). The more you know.

So, my answer? Well, here's the short answer: In general, I'd recommend it and I'm glad I took one. But, it is expensive, so it depends.

That ambiguous response is unfortunately the best I can offer. Everything here on in will be basically serve to reiterate that. Sorry, but unlike scientific questions, there is no absolute, universal answer... okay, that was a little joke for people who are quite aware of the fact that there seem to be rarely any absolutes in scientific research (a hasty example: MedPage tells us that Aspirin is great for your heart by reducing heart attacks; a year later, the same source tells us it's bad for your heart by upping hypertension).

Back to MCAT courses: While I took the course and am glad that I did, whether or not you should take one depends on your personality type. Some people will benefit more than others. Let me explain: here are the reasons you might choose to take one.

Study motivation. Personally, I did take a Kaplan course before studying for the MCAT and felt it benefited me greatly. The general concensus of people in my class - which I agree with - is that a class is very helpful if you have trouble motivating yourself to study regularly. I do best with pressure to meet my study goals, so this aspect really helped for me. As well, if you can choose a course that starts several months before the actual MCAT, and then you'll be getting quality studying done well in advance.

Mock test experience. Second to that, the most valuable part of the course for me was the experience of writing several mock full-length MCATs in a large-group environment, in a huge classroom with a hundred or two other people, just like the real thing was going to be. Because it was full-length it got me in the groove of getting good rest the night before, packing a lunch, getting up early, and getting the timing down complete with breaks and the like. However, this might not be as big an advantage for you because the test is now going to be all online, rather than pen-and-paper like when I took it, so here I'm already dating myself. You might make fun of me for being that old, but hey, at least all my questions matched my passages (an error I've heard actually occured on a computer-based MCAT).

Resources. The question banks that these companies include with their courses are an asset in themselves. You get access to a huge amount of mock questions of varying difficulty just like you'll find on the actual test, which they write themselves based on the AAMC mock questions. In fact, you can imagine how far my jaw dropped when I opened my actual MCAT booklet and saw that the first question was on a topic that I'd seen a few times in the practice tests, with IDENTICAL diagrams (the questions were slightly different, though one or two were identical as well). A moment likes that makes you feel like all that money handed to the test prep company was worth it.

Lectures. As well, if you're someone who learns a lot from lectures, then this will help you out a lot, because they have some decent (and some not-so-decent) lecturers on the major topics. I don't fall into this category, so instead, for me lectures were a good chance to review on my own and distract the serious learners while I chit-chatted with other pre-med applicants and looked up NHL playoff game scores on my cell phone. However, for being someone who doesn't do well in lectures, there were still some outstanding lecturers that I learned a lot from, and in fact, I still refer to the notes I took in those MCAT course lectures.

People. If you're a social butterfly, and aren't sick to death yet by being surrounded by other keener pre-med types, then that in itself might be another reason for you to take a course; you'll meet lots of people with similar goals and aspirations, always good for sharing stories / advice / seeking out a potential life partner. I still keep in touch with or randomly bump into people I met in my MCAT class; two of them are in the year ahead of me in my med school, and I saw another one who was applying for admission at my school this coming year. Then again, the people might be just the reason you choose not to take an MCAT course. See my friend's quotes below.

Aside from my lengthy answer, you might be thinking, what do other med students think? Look how helpful I am: just for you, I actually asked a few people in my class who happened to be on MSN right now. They all had different answers:

• "I didn't take the course but I didn't do well on the MCAT. It probably would have helped but I saved myself a thousand bucks or so."
  - My friend the wink.
  
  
• "I did take the course, and it helped because I am not adept at standardized tests."
  - My friend the little med student with a big heart (and mouth). (She chose that name herself).
  
  
• "I took one, and it definitely helped. They actually teach you what you need to know, have homework and a schedule that you strive to keep up with, and it just pushes you. The people in the class are intense pre-med keeners, though. They thought I was dumb and such a slacker, especially since i went travelling during the course too."
  - Kitty, my slacker friend.
  
  
• "I didn't take a course and I did fine. I didn't want to do the course thing because pre-med type people are too stressy for me. I studied from some Kaplan books I got from a friend. I just wish I studied harder for verbal reasoning."
  - Annie, my friend who was too unoriginal to choose a nickname. Actually, maybe I shouldn't mock people who are helping me. Sorry Annie.
  

So, if by now you think the course is right for you, then this inevitable question will be brewing somewhere in your cranium:

Which course should I take, Kaplan or Princeton Review?

Easy. All the people I know who took Kaplan say that Kaplan is the best (myself included), as opposed to the people who took Princeton Review. They say that Princeton Review is the best. I'll leave it at that.

For you? They both cost roughly the same. If they don't, find one which suits your budget the best. But obviously, most importantly, choose the one that fits your schedule best.

Final advice: Choose a course that starts well before your MCAT date. Despite the fact that you might want to get it over with quick like ripping off a bandaid, you'll probably find that more info sticks / you get to know how the test makers think better when you've been going over it for a few months as opposed to a few weeks.

Hope that helps. This was a hefty post, but I know that pre-meds usually don't complain about too much help. I also hope you didn't get lost in my answer full of random ADHD diversions. All the best as you tackle the MCAT giant for yourself, and remember, it's not that bad. Hopefully you come out alive.

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Premedasaurus extinctus

When I started my undergrad, I wanted to become a doctor, so I simply signed up for the "pre-med" major at my university. I didn't realize that I was jumping on to the last glimmers of a dying wave.

Musings of a Dinosaur is hosting Grand Rounds v3.23, and in an attempt to fit with the theme and thus get listed, I'm writing about the one thing that, this early in my medical career, I know about which has gone the way of the dinosaur: the "pre-med" degree.

Most "pre-med" students are aware that "pre-med" degrees don't actually exist anymore. My degree program wasn't even technically that; it was a B.Sc. in Biology, Pre-Med stream, or simply a collection of courses in and extraneous to the Biology degree requirements which happened to be common prerequisites for medical school. As a matter of fact, it was discontinued in my second year or so, leaving me slightly embarrassed and feeling without compass or sense of direc.... no, actually, I didn't really even notice.

That didn't keep me from shamelessly using "I'm in Pre-Med" to try and pick up members of the female gender. Surprisingly, this was so unsuccessful that I abandoned it in favour of pursuing getting struck by lighting while holding a winning lottery ticket and getting mugged by Chuck Norris at the same time. I figured my chances were better for the latter, and hey, who needs a girlfriend when they can say they were mugged by Chuck Norris, anyways?

In actual fact, I soon lost all enjoyment in introducing myself as a "pre-med." I found that common responses to this declaration were:

• "Oh, so you're going to be a doctor?"
• "You must be smart!"
• [pointing and shouting] "Hey, look, Mom, a nerd!"

These were combined with that which anybody in pre-med has had to deal with... the one thing that dominates every action you as a pre-med do: the thought of "getting in." Almost every pre-med wonders about everything they do, "Will this help me get in?" (ie. regarding a summer job) or worse, "Oh no, will I still be able to get in now?" (ie. regarding getting busted for what you thought was a harmless prank and then finding out that your high school's administration has less of a sense of humour than you first expected... uh, fictional situation, of course). It ends up being in the back of your mind all the time and soon gets pretty annoying.

Take that and add a bit of humility (ok, fine, insecurity), a bit more not wanting to let down people who thought you were smart, and a a lot of realistic awareness regarding the admissions process and the brutal odds that are involved, and you soon find that you'd much rather not tell people that you're 'pre-med.' By my second year of undergrad I told everyone that I was taking a Biology major. I hadn't even realized that by this time my university had pretty much phased out the 'Pre-Med' stream.

Clearly, though, Vitum avoiding the term 'Pre-Med' didn't drive it into extinction. So why isn't it offered any more, and what's the alternative now? Well, I'll take this opportunity to answer a question from Carrot Juice, who took the time to get in touch with me via e-mail and ask for advice about applying for medicine. I'll start here and continue to address this question in a few other posts.

Med schools are more and more in favour of diversity these days. People with diverse backgrounds make a better medical school class, so the story goes. This, in fact, is the driving factor behind allowing 43-year-olds to begin medical school, something which a lot of people are a little confused about because after all, there's a good chance they won't have many years to practice after they graduate. So now you can have a math major who becomes a surgeon, or a economist who becomes a general practitioner. Our class has engineers, a nurse, a paramedic, a school teacher, an Olympic athlete, an entrepreneur, a city councillor; we've also got PhDs alongside students who didn't even finish undergrad. In fact, the first semester of our curriculum is in a sense a compressed physiology undergrad degree, to catch up everyone to the same science level despite their diverse backgrounds.

Thus, no longer can you get through with your basic 'pre-med' combo of biology, biochem, organic chem and expect to be an A-1 applicant. Nowadays it's all about standing out. What else would you expect, though? With Canadian med school acceptance odds of something like 1 in 11, that's what has to be your focus; making your admissions essay, your interview, your application stand out from the other 1000-3000 applicants (depending on where you apply).

It's all about diversity; being one more 'pre-med' in a pile of 3000 'pre-meds' doesn't cut it anymore. And so, as can be expected, the 'pre-med' degree ended up where most of those bland, un-unique applications end up: in the 'gone forever' pile.

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My faculty's Admissons Committee has great taste

Other than a few exceptions, I'm really encouraged by the exceptionally good taste that my Faculty of Medicine has displayed in choosing our class. (And by exceptions, I'm not referring to myself. I'm one of the good-taste choices. Obviously.)

There are some incredibly fascinating people in my program. Students who have competed in the Olympics, played various sports at a high level, been politicians, media pundits, entrepreneurs and businessmen, matriculated from the world's top universities, or defended our country as soldiers or fighter helicopter pilots... there are so many people in my class whom I admire that I had to write a whole other post about it.

Beyond the incredible accomplishments of individual students, it's neat getting a group of medical students together and taking a look at them all. While there are differences between us, we're all so similar in many ways. A lot of us are really motivated, driven, and clearly know what we want to do with our lives (and in some cases that has come after trying several different things). We all care a lot for other people, and we are generally quite outgoing and love to chat (though this results in our class sometimes being overly chatty and not shutting up when it's time for class to start).

The thing that has fascinated me the most, however, is this: while everyone in my class brings a huge skill set to the table and our class is generally very intelligent, there are hardly any nerds; most people are really well-rounded and involved in a lot of different things. It's really interesting meeting people who are really outgoing and seem like your average cool guy or girl, but then you see them in a small group or talking about something we're covering in class and you suddenly see a brilliant side of them you haven't really seen before, watching them talk about the voltage-gated potassium transmembrane ion channels that play a role in the regulation of the insulin release from beta cells of the pancreatic islet, or something like that.

We've got a class full of really quality people, and it's been a blast getting to know everyone. I'll be proud to refer my patients to almost any one of my classmates someday, and I'd be willing to put my life in their hands.

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