The Coat Check

A Frank Conversation with a Medical School Admissions Insider

White Coat Checklist recently had the unique opportunity to turn the tables on a faculty interviewer for an MD program in the Greater Boston area. This off-the-cuff, off-the-record conversation was eye-opening in many ways: in some cases confirming widely held beliefs and in other cases offering new insights into the medical school admissions process, the search for residency slots, and more:

WCC: In your experience, what is the number one hurdle that trips up applicants during the medical school interview process?

I have perhaps 20 one-on-one interviews over the course of any given application cycle because of my physician and administrative duties. On average, 15% to 20% of each group will fail to respond appropriately to the ethical dilemma prompt, usually by missing the implications of their decisions. In many cases, candidates disregard the constraints of the physician role, given a doctor’s need to obtain informed consent for any course of action to the extent reasonably possible. Another challenging item for candidates has been to demonstrate convincingly that prior problems (poor academic performance, disciplinary issues, etc.) will not occur again in the future in a manner that will interfere with their ability to complete a medical school program. Denying such a possibility is not impressive – acknowledging the likelihood of challenges and detailing a specific plan of action accordingly is a different story.

WCC: Many applicants contacting White Coat Checklist have spent significant time preparing for peer interviews with current medical students. To what extent does peer feedback impact the admissions process?

Peer interviewers are a valuable resource for an admissions committee, up to a point. We value ‘fit’ with our program and if a peer interviewer has doubts that a potential candidate would acculturate easily we certainly take such feedback into consideration. That being said, a thumb’s up from a peer interviewer carries no weight with the committee whatsoever in terms of winnowing down the list of candidates. Peer interviews can only hurt you, if you come off as distant, uncertain, or otherwise poorly prepared.

WCC: There are many paths into medicine, from combined programs which begin at the undergraduate level all the way through non-traditional candidates coming into the profession in later years. What is your perspective of this range of options?

I truly respect non-traditional candidates – they often come across as more mature, more reliable, and more invested in the experience than younger people studying medicine in their 20s. To some degree, older students need to be at the top of their game to make the most of the experience in the more limited time that they will have to practice medicine thereafter. That being said, non-traditional candidates have been an incredible asset and support to their younger colleagues, particularly given their years of professional experience and outside perspectives which represent an added value to our program overall. In my personal opinion, combined 6- and 7-year BS/MD programs such as those offered in the Boston area provide a mixed value proposition. Perhaps 10% of such students clearly excel, but I would describe many other such students as below-average. Not to generalize, but repeated experience seems to show that many people who made such a momentous decision at such a young age may have done so for the wrong reasons, such as outside expectations, and may not be prepared to make the sacrifices required to get the most out of the MD experience. This pathway into medical school is not going anywhere, but it’s hardly the best option given the alternative of waiting to develop real-world experience and hone clinical/research skills after completing a four-year degree.

WCC: Given that the health care landscape is rapidly changing, many aspiring physicians are making the decision to pursue dual degree programs, just as more than a few current practitioners are going back to school to earn new degrees. What’s your perspective on this trend?

Personally, I see a Masters of Public Health or PhD track candidate as someone committed to making a difference as a working clinician in an increasingly multidisciplinary field. If applicants have specific motivations to pursue such endeavors and can point to relevant prior experience, they should absolutely undertake either path. The MD-MBA track can be somewhat more problematic. I know several such students who have gone straight into business, without ever applying to residency. MD programs were not intended to create business executives, and candidates need to understand the longer-term benefits for both the profession and themselves by focusing on the residency process and mastering clinical knowledge to fully prove themselves as medical experts. Daily practice can be very different from medical school because health care is changing so rapidly. If a physician is open to administrative leadership roles or eventually leaving practice for opportunities in biopharma or medical device fields, then planning to pursue a future MBA is probably a good idea. Remember, don’t assume you have the same credibility in the business sector as a physician graduate that you would as a retired physician. Thousands of working doctors will be retiring over the next decade, and many of them will bring that working clinical background into non-clinical contexts which MD graduates will never be able to match. It’s likely best for all concerned if medical school candidates focus on honing clinical and communication skills in the short-term, and re-consider MBA and related transitional opportunities down the road.

WCC: You mentioned residency programs as a primary focus for medical students. What is your perspective on the current state of medical residency?

Currently, I would estimate that U.S. medical schools graduate 17,000 MDs every year for about 25,000 residency slots, some of which are awarded to candidates from overseas. Within the next few years, expect this bottleneck to increase given efforts by multiple MD programs to boost enrollment. In perhaps three to four years, there will not be enough residency slots even if just counting MD graduates and excluding DOs. Aspiring physicians open to studying abroad are no longer well served by applying to non-U.S. medical schools in the Caribbean or elsewhere. Also, many candidates think that being offered an interview is a key step toward a residency offer when in reality many of those interviewed are winnowed out of the selection process, just as we were talking earlier about failure to respond appropriately during a medical school face-to-face evaluation. Residency candidates eliminated from consideration on an interview basis are not informed of that decision.

WCC: What advice would you give to medical school candidates in terms of extracurricular activities such as clinical research, physician shadowing, volunteering, particularly as they concern letters of recommendation?

The specific criteria for each of these supporting background items varies, but I can sum up the admissions committee point of view in a single word: ‘meaningful.’ Don’t assume that because you shadowed a physician for two days or volunteered on a hospital ward for a month that you thereby automatically qualify as a well-rounded applicant. Extended clinical exposure, and most importantly, refining insights and outcomes, are key for demonstrating that an experience has had an impact. Also, quantifying deliverables is a relatively minor aspect of this conversation. Don’t count blankets and bedpans – share stories regarding specific patients and how those narratives have informed your future ability and ambition to practice medicine. If you can’t do that, then you’re wasting everyone’s time. When undergraduates who have worked under me request a letter of recommendation, I require them to explain what they did and why it was significant. If they can’t, or won’t, then I tell them they should seek a letter from someone else. The White Coat Checklist letter of recommendation how-to guide parallels my perspective of a constructive, collaborative letter of recommendation drafting process. 

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