When Do I “give up” on medical school?

Introduction

I was speaking with a group of undergraduate pre-med students who asked me when I thought someone should “give up” on seeking admission into medical school. My first inclination was to say that if medical school and medicine is your “dream” you should never “give up”. I thought a bit about what might be behind the question and I thought it might make a good essay topic for my blogs.

“Should”

I have never been a person who dealt in “shoulds” in terms of what might be the best situation for anyone’s life and life pursuit. If you want something and if really desire something, then pursue that “something” and make sure that you are in the best possible situation to achieve your goal. Any realistic (and the emphasis here is on realistic) goal is achievable in taking small steps daily toward it. Certainly, you cannot possibly reach anything if your are not moving “toward” it.

Long-term

The pursuit of admission to medical school and medicine is a bit like having more than 100 pounds to lose. You have to be consistent with your work on a daily basis or you are not going to see results. This means that everything “counts” and you can’t afford to “slack” or you won’t reach your goals. Your undergraduate work is an opportunity to set yourself up with solid and disciplined study skills that can take you into medical school and beyond. It is also an opportunity to learn how to learn and master coursework. Just as daily exercise and diet modification will lead you closer to losing that 100 pounds (ounces at a time), daily preparation/study and mastery of your coursework will lead you closer to your goal (one semester at a time). As you have probably heard, this is not a “sprint” but a “marathon” and like a marathon, you can’t just lace up your running shoes and expect to finish a 26.2 – mile race without some daily training and preparation. If you are not comfortable with long-term goal achievement, then use your undergraduate to obtain the characteristics that will make you comfortable with long-term goal achievement.

Overcoming difficulties

There are plenty of physicians out there who didn’t start off strong as an undergraduate. Perhaps they had some maturity problems or perhaps they just didn’t have the academic skills for the pre-med coursework but the important thing is that they kept their goals in mind. If something is not working for you in terms of getting your coursework mastered, then change it. You can decide at this very minute -even if you are on the verge of dismissal- that you are going to turn your academics around “by any means necessary”. The process of doing this “turn-around” can be a huge asset in terms of making you competitive for medical school but you have to be successful. Just thinking about getting your academics together (like dreaming about losing 100 pounds) won’t make it happen but taking some active steps toward changing your methods will get results.

Many students have gone from extremely low undergraduate performances to getting themselves competitive but the process is not easy or short. Again, it’s back to the daily and consistent work with constant checkpoints to make sure that you are keeping on track. Enlist the assistance of any study skills courses at your school; enlist the help of peer tutors; enlist the help of a good academic adviser. In short, get help from any resources that you can find. Often, your school’s counseling service can help you identify resources at your school that can help you. You have to take the first steps and be willing to make some changes. Why not make the changes because what you are doing is either successful or it’s not?

Just remember,  undergraduate “GPA damage control” is a long and expensive process. If you know this going in, then you can prepare yourself for the long haul. Again, medicine is not a sprint, it’s a long-term goal.

“Deal-breakers”

There are some things that are very, very difficult to overcome. I place things like academic dishonesty, felony convictions and substance abuse problems. Most medical schools, even if you are sitting there with a uGPA of 4.0 and an MCAT of 45, are not going to be very interested in you with these things in your background. If you have a substance abuse problem, get it taken care of long before you anticipate entry into medical school. There are excellent substance abuse programs out there and you can’t hide from your problems forever. Medical school on any pharmaceutical substance (other than pharmaceuticals prescribed by a physician within the guidelines of established medical practice) is expensive and heading for a crash either physically or legally. Neither of these are things that a  prospective medical school would like to deal with. In short, take care of what you need to take care of and educate yourself so that you can handle life without drugs of any kind. If you “think” you have a problem with tobacco, alcohol, uppers, downers and any other illicit substances, then you have a “problem”. Get your “problems” solved as soon as they are identified.

Living in the “Real “World

You are going to read (and hear) stories out there about John or Jane X who got into Medical School A or B with a GPA of 2.5 and an MCAT or 20. Those John and Jane X’s are very, very unlikely to be real people. The  average uGPA for medical school matriculants in 2007 was around 3.65 and the average MCAT was around 31. This means that the further from those average on the low side that you are, the lower your chances of admission. Admission to medical school with a uGPA of 2.5 is not impossible but it is improbable since the uGPA averages have been increasing every year. Get your uGPA as high as you can period. Get the highest MCAT score that you can period.

There are also folks out there who would believe that if you are an URM (Underrepresented Minority) in medicine, that you can get into medical school with drastically lower GPAs/MCAT. This is simply not the case because you have to have something in your application that shows you are capable of mastery of a challenging medical curriculum. If you are a URM and far below the uGPA/MCAT averages, then you likely don’t have a competitive application. Do what you have to do, to make yourself competitive and be prepared to take some years to get this done. I don’t care what your ethnicity/race is, you still have to be able to get through medical school if admitted. Admission is no guarantee that you will complete medical school. If you uGPA/MCAT is low, get yourself competitive by whatever means you have at your disposal.

But when do I “give up”?

You must answer this question for yourself. Preparation, application and matriculation in medical school is a very expensive process. How much time and money do you have? If you are a re-applicant, what you have you done to significantly improve your chances of admission? Just reapplying to medical school to “show them that you really, really want this” is not enough. You have to make some improvements on your application before you spend that money to reapply. Again, take a realistic look at what might have kept you out and get it improved.

If your application didn’t work this year, rework everything that you can rework before you submit for a future year. If you are reapplying to the same schools, you especially need to change and improve everything about your application that can be changed. Get fresh letters of recommendation, rewrite your personal statement (I don’t care how wonderful you believe it is, it didn’t work) and take more coursework if your uGPA is very low. Retake the MCAT if that is holding you back. (Beware though, retaking the MCAT and scoring lower can be a death blow). What ever you do, be sure to make it an improvement and not a change for the worse.

Looking at other career options

Some people believe that if they explore other career options such as physician assistant, nursing or physical therapy, that they are somehow giving up their dream. Nothing could be further from the truth. Explore other careers and have a realistic appraisal of how competitive you are for those careers. You may find that one of those careers better suits you in the first place from the standpoint of time of schooling to what your actual interests/motivation for medicine might be.

I am not advocating for anyone to seek to be a physician assistant, nurse or physical therapist because they “couldn’t get into medical school” but I am advocating that you should have a career back-up that you can love and pursue. You may not be competitive for physician assistant, nursing or physical therapist or you may not be interested in these great careers but you can’t make an honest decision without career exploration first. You may find again, that these careers are a great option for you and a better option than medicine.

Parting thoughts

Finally, be willing to let any of your advisers take a long and hard look at your competitiveness for medical school. If you don’t get in, get input from any and every excellent resource that you can find. Your goal is success on reapplication and you want to do everything that is within your grasp to ensure your success. Only you can tell when it’s time to move on to another career option and it’s YOUR life to live as you wish. Enlist any and all help that you can to get what you both need and want out of life.

The pursuit of becoming an excellent physician is a long goal. There will be people along the way who will tell you what you “can” and “cannot” accomplish. If you know yourself, and have faith in yourself, you know that you can accomplish anything that you want. You have to be willing to “run your own race” and take care of your own “needs”. There are as many routes into medical school as their are medical students.

If you should decide that you don’t want to pursue medicine, then that’s the best decision for you. Don’t let your life’s dream be anyone’s other than your own. It takes a fair about of courage to stand back, take a realistic appraisal of where you are and make the decision to move on to something else.

The other thing to consider is that getting into medical school does not have an age limit. Just because you decide not to continue with the pursuit next year does not mean that you can’t do something else and revisit medical school application three, four or even ten years down the line. As long as you have the desire, the stamina and are willing to earn competitive credentials, then give yourself a couple of years to decompress before you dive back into this process.  If something doesn’t “click” for you in 2006, it might “click” in 2009 because you are a different person with a different perspective.

Shadowing Me

Some people have asked what may be expected of a pre-med student who is shadowing a physician. I thought that I would write a bit about what I provide and expect on this shadowing experience. The expectations of the physician and the experience of the shadower definitely vary but I hope that this description provides those who have not shadowed with some things that might make the experience better.

Legal Matters

I have a confidentiality sheet that all pre-medical and medical students must sign before shadowing me. It outlines the confidentiality rules such as you may not disclose the name, condition or any other identifying information of any of the patients that you encounter during the shadowing experience. It also outlines that your may not write on any patient document while in the hospital and it outlines that you will observe all rules and regulations as you are directed by the staff of the hospital. These rules are for protection of the privacy of my patients and are pretty clearly outlined before you come to the hospital.

Dress

I ask that shadowers dress in business attire for the experience. This includes suits for males and suit or dress and jacket for females. I don’t ask for white coat because I seldom wear one. I have a badge that identifies you as a Student Observer that you will wear on your jacket along with a name tag.  My patients expect that you will be professionally dressed and they are made aware of your presence. If I am going to be doing any procedures that you will be observing, I obtain their permission before you are allowed to observe anything. The staff is quite aware that I have shadowers from time to time and are very helpful in terms of making you feel comfortable. They understand the process and are happy to help me make sure that you have a good experience.

What I expect you to do

I expect you to have some expectations of what you want to achieve in participating in this experience. You should write down a few objectives and have these ready for me to go over with you. Are you there to learn about my specialty? Are you there to learn about the practice of medicine in 2008? Are you there to discuss your chances of admission into medical school? Are you there because you need an additional letter of recommendation for medical school? In short, jot down a few objectives for your visit and have them handy.

I expect you to bring a copy of your Curriculum Vitae (resume). If you have a photo attached, so much the better but I take a digital photo of you and place it with my copy of the signed Confidentiality sheet. If I am writing a letter of recommendation, I like to look at the photo and make sure that I remember the person correctly. Sometimes people will ask for a letter several weeks after their shadowing experience and I like to make sure that I remember the person.

I also like for you to bring a copy of your Personal Statement (PS) and the medical schools that interest you. I usually read your PS before we begin the day and I often offer tips for making the document stronger. I also can provide some information about specific schools that might be helpful to you. I can also suggest particular schools that might be a good fit for you too. Again, I add your PS and schools list to the folder that contains the documents that I have mentioned above.

The Day

I usually have people shadow on a day that I am in the hospital ,clinic and teaching. While it’s a long day, it usually gives the shadower a good experience. I usually have folks come on the day when I am not on call and have a lighter procedure day. I want to you see some cases but I also want you to have plenty of time to ask questions and understand as much about my practice as possible. I also will send you a list of the cases that I have scheduled and a brief description should you want to do some research before you observe.

Over lunch, which I provide, we usually discuss your career plans and I answer any questions that you might have. Again, I usually have taken a look at your CV, PS and schools list. If you are yet to take the Medical College Admissions Test (MCAT), I usually offer some tips about preparation for this very important exam. Since you will likely sit in on one of may classes, I usually give you a copy of my lecture notes so that you can follow along. The class is a great time for you to meet some of my pre-clinical medical students or some of the third-years that are on my service. They usually have loads of hints and suggestions about application to medical school.

When the day is done, usually about 5 pm (just before evening rounds), I usually go over any questions that you might have and any expectations that you have of me that we haven’t gone over during lunch. If you need a letter of recommendation, I ask that you provide a deadline for me so that I can make sure that you letter is out in a timely fashion.

Most shadowers get a chance to participate in morning rounds, a few cases, in my clinic and sit in on a class or lecture. I think that while the day is pretty full for you, it gives you a fairly realistic idea of what this profession involves. After all, this is your shadowing experience and you have a short period of time to make the most of your experience. I also feel that you need to have exposure to the daily routine of what I do so that you can compare your shadowing experience with me to others that you might have. Again, this gives you a more realistic experience.

Finally, I do have people who come back for a second day sometimes. These folks usually have shadowed me early in their undergraduate career and now want to spend a little more time working on buffing their application before they submit it. I certainly do not ever have a problem with this. I definitely recommend that people shadow at several stages in their undergraduate career as sometimes the shadowing experience can hone your desire to pursue medicine if you were unsure the first time around.

Good sources of names of physicians who will allow you to shadow are the local medical societies in your locale. Most local medical societies will have lists of physicians who will work with you. I know that in many large metropolitan areas the city medical society will make all of the arrangements for you. This was how I was able to shadow several physicians before I entered medical school.

Another source of physicians who will allow you to shadow would be any medical schools that are nearby. You might contact the individual clinical departments of the medical schools which may be able to match you with the name of a physician or two that would allow you to shadow. Other resources are your family or personal physician who may provide this service or know a colleague or two that might allow you to shadow.

The important things to do are:

• Have a list of objectives that you want to accomplish on this visit.
• Find out what the dress code will be, what time you are expected to finish and what the daily agenda will be.
• Have a copy of your CV, personal statement and list of schools if possible (attach a small passport-sized photo) to your CV.
• If you need a Letter of Recommendation, be sure to provide a deadline, an address as to where the letter should be sent and if the letter is going to an individual or a committee.

The last thing is to enjoy your experience being mindful of the person who is allowing you to shadow them. This means being mindful of the confidentiality of their patients and send a letter of thanks when you are done.

Going Premed…

(The above photo is me in front of a poster as a graduate student)

At some point in your life, you have made a conscious decision to pursue medicine as a career. For me, that decision came after spending a couple of years doing research with and attending grand rounds with a very high-output cardiologist. At the time, I was far older than many of the professors in most medical schools yet alone the students but I was intrigued by the science and craft of medicine. My cardiologist mentor encouraged me to apply to medical school (after a bachelors degree in chemistry&biology + graduate study in biochemistry) as I definitely had more than mastered the pre-med coursework and had a strong interest in the direct application of my then research (ischemia/reperfusion effects on cell-cell communication).

For most medical students, the decision to pursue medical school comes in high school (or early undergraduate). They sign up for the pre-med classes: one year of general biology with lab; one year of general chemistry with lab; one year of organic chemistry with lab and one year of general physics with lab. In addition, most universities require humanities in addition to science in order to receive a degree. Biology is by far, the most popular major for most pre-med students but definitely not a necessity. Any major (from music to American studies) is a good major for pre-med as long as you are interested in the subject matter and as long as you thoroughly master the pre-med sciences.

For most pre-medical students, freshman year is occupied with General Biology, General Chemistry, English, History, math and a foreign language. Sophomore year is occupied with Organic Chemistry, General Physics and other general education requirements. Sometime during the sophomore year, a major is declared and so forth. The important things to consider are getting your general education requirements out of the way and doing exceptionally well in your coursework.

I was very fortunate to have attended a very strong secondary school. When I entered university, I had already taken Differential and Integral Calculus. My math course freshman year was Differential Equations. I had decided to pursue a double major in Biology with Math as a minor since I was interested in the subject matter. My interests in Biology were along the lines of organismal biology (comparative anatomy, parasitology, histology, cell physiology, biochemistry) and my math interests were very strong. I ended up taking Differential Equations, Applied Differential Equations, Advanced Calculus and Higher Algebra in addition to seminar. The bottom line was that I was passionately interested in this coursework because I was interested in being an excellent scientist and researcher.

At the time, I had no interest in medical school but a huge interest in the subject matter of science. This interest coupled with my study skills, enabled me to thoroughly master the subject matter of my coursework. I cared less about my grades and more about making sure that I knew everything that had been presented in these classes. It was during my freshman and sophomore years that I began to hone my study methods that would later serve me well in both graduate and medical school.

In organic chemistry, my performance in this class was not about getting an “A” but about making sure that I learned the theory and craft of organic chemistry. I made sure that I knew as much about the chemistry of carbon-containing compounds as possible in addition to the basics that I needed to devise synthetic themes. Organic chemistry started with an overview of types of bonding that carbon would participate in along with the introduction of families of compounds. Each family had their own synthetic reactions which intertwined to give more and more synthetic possibilities. My favorite means of devising a synthetic scheme was to take the final compound and work backward to the starting material. I was especially adept at anything that contained an alcohol (-OH) group.

In terms of organic chemistry and other coursework, I did not learn in isolation. All of my coursework was interrelated and contained valuable tools for my future work as a researcher. I never considered any course in isolation. General Chemistry contained principles that were useful in Organic. My math courses were quite useful in Physics for understanding how these principles were studied and developed. For some reason, I always saw the big picture.

Later on, as I moved from pre-clinical to clinical medical student, I could see how my ability to apply the principals of Organic Chemistry to the development of synthetic themes was just practice for applying the principles of my pre-clinical sciences to clinical problems. If I am treating a patient with Peripheral Arterial Occlusive Disease, I have to understand the science of how atherosclerosis is a complex disease process that involves inflammation (chronic) and epidemiology (risk factors). Nothing in medicine is studied in isolation. The nature of the pathological changes that I see in the arterial wall directly affect the physiology of the vessel and the progression of the disease. Organic Chemistry was my launch pad in the sense that it was a course that honed my ability to apply the concepts that I was learning to problem solving from many angles.

When I obtained my second bachelors in Analytic Chemistry (I was passionately interested in this subject matter), I found the ultimate outlet for my interest in problem-solving. My coursework for this degree consisted of Quantitative Analysis, Qualitative Analysis, Advanced Inorganic Chemistry (graduate course), Advanced Analytical Chemistry (grad course in electro-chemistry and mass spectrometry), Advanced Organic Chemistry and Synthesis, Instrumentation, Advanced Spectroscopy (grad course) and one year of Physical Chemistry. In addition, I took an undergraduate research course, Atomic Physics, Nuclear Physics and Analytical Biochemistry. When I began my chemistry degree, I had already taken the freshman and sophomore coursework (transferred in from my first university). I was in heaven in the chemistry lab and in class with graduate students.

Armed with a second bachelor’s degree, I applied for graduate school in Biochemistry and was accepted with full departmental funding. I was assigned to a research lab and began the work that would lead to my graduate degree in Biochemistry and Molecular Biology. My mentor was a cardiologist whose research interests were ischemia/reperfusion and low magnesium states. He was the ultimate mentor in that he was a fierce collaborator and Renaissance man. He had two research labs that contained a powerful group of basic scientists with broad research interests. I was fortunate to become associated with this principle investigator who encouraged me to master and study everything that was of interest to me. These broad interests later led to my application to medical school.

Your premed coursework is not torture (shouldn’t be anyway) but an opportunity for you to lean and master some fascinating studies. It is also where you set your groundwork for medical school. Your pre-med coursework is where you hone your study skills that will enable you to master large amounts of material in a short period of time. Undergraduate pre-med coursework moves at a very slow pace compared to medical school and thus you have an opportunity to build a solid knowledge base that you can apply (especially on the MCAT).

The whole study of medicine involves development of a solid knowledge base and application of that knowledge base to the treatment of your patients. There are few shortcuts to mastery of the materials that you will need for your day to day practice. If you think of your mastery of your pre-med coursework as the training ground for mastery of the study skills that will enable you to obtain your knowledge base, you will be well on you way to becoming an excellent physician. Medicine is the ultimate problem-solving profession which, makes medicine ultimately quite interesting.