Applying to Medical School: Skillful Interviewing

For those of you applying to medical school, we're nearing the point where the first interviews will begin. Typically, the first invites go out in late July/August, and the first interviews are in September. Each school is different, particularly depending on when the secondary application goes out. Anyways, the interview is probably the most important part of the admissions process. Why? If a school gives you an interview, they're already pretty interested in you. Remember, only 10-20% of applicants to a school are interviewed. You already beat out a large portion of people. Now you have to land the deal.

In terms of helping or hurting you, the interview can do both, but to different levels. My opinion is that, a good interview will help you a little, but a bad interview will hurt you a lot. Think of it this way: You are like a cake. When you go to interview, the admissions committee is looking to confirm that you are what they want. They are checking to see if the cake is ready and looks good. Your individual talents/personality is the frosting or sprinkles or design that sets the cake apart from others. However, if they find your cake lacking in substance or taste, no matter how much frosting you put on it, no one will want to eat it.

So, how do you make sure you present your best, most tastiest cake? First and foremost, acknowledge that there is a great degree of luck involved. For example, on one interview, my interviewer and I had a lot in common. As a result, the interview flowed nicely from topic to topic, and we both had fun (at least I did). That was the luck factor; so much is dependent on who your interviewer is and how he/she is feeling that day, among other things. Don't despair though! You can still nail the interview by doing a few simple things.

1. Look nice. Make sure you are dressed nicely (suit is highly recommended) and well groomed. Medicine is fairly conservative (at least the interview part), so don't go overboard on make-up or fashion.
2. Be comfortable and relaxed. Okay, realistically you'll be pretty anxious; I was too. Just try not to let it show too much. Do some deep breathing exercises if you find yourself getting too worked up. And don't be afraid to take a second or two to think about a question before you respond. You want your sentences to be of substance; talking more doesn't necessarily mean better. Also, I recommend you wear your suit a couple times before your interview day. You can tell who is wearing a suit for the first time because they tend to look uncomfortable. So dress up to class or work a couple times to get used to the feel.
3. Be polite and positive. This goes without saying. Be polite to everyone, especially the staff and other interviewees. You never know when you are being observed...
4. Be passionate, be genuine, and know your application material. This is crucial. You will probably be asked about your application (some interviews are different, like the MMI). Make sure you can spend at least a few minutes talking about anything you mentioned. Most importantly, make sure you speak enthusiastically. Now, you don't want to go used-car-salesman on your interviewer, but make sure you convey a degree of excitement about the things you mentioned in your application. Look, everyone knows there is a great deal of scut work you have to do to get into med school. Just don't present that way. If you did research, talk about it. If you had a powerful experience volunteering or on a trip, explain how it impacted you so heavily. It's not the smartest, most accomplished people who get into medical school. It's the ones who show that they want it most, that they're willing to put in the effort to succeed. Make damn sure you get that point across.
5. Send a thank you note. For the love of all things good, write down the name of your interviewer(s) so you can send a thank you note. Often times you'll send it to the admissions office, and they can forward it to the person. Very important you do this. It doesn't have to be long (mine was a couple sentences saying thank you and mentioning a specific thing we talked about to make it seem less generic), but it's important you do this follow up.

You can find interview tips just by doing a simple Google search, so I encourage you to look up those general pointers. Honestly, the medical school interview is a lot of fun. It's the closest you'll be to getting into med school. You'll get to talk to students, find out about the curriculum, maybe even sit in on a lecture (if you get the option to stay with a student host, do it. It's way better than staying in a hotel. Just trust me on this one). The interview is the final hurdle you have to get over. There is essentially nothing left to do afterwards except wait for a decision. You can send update letters or interest letters to the school, but make sure you actually have something substantial to say. Avoid calling the office to see if a decision is made; you'll find out in due time. Most importantly, relax a bit. You got through it all! If all goes well, you'll get that beautiful, wonderful acceptance letter (and often phone call) in no time.

So remember, have fun. It's a long, tedious, stressful process, but if you stay positive and make the most of it, it'll reflect in your application, and good things will happen.

We All Spend Time As A Shadow

I leave my apartment and hop in the car, already feeling a little drowsy. It's 10:30 pm, and I'm heading to work. In order to satisfy a requirement for an internship, I scheduled two ED shadowing shifts back to back, starting at 11pm and going till 7am. I took two shifts previously from 6pm to 2am, but this was different. Going to work in the middle of the night feels unnatural, though the commute is pretty good. I arrive at the hospital, carrying my coffee-filled thermos (essential), ready for the night shift.

So, you want to be a doctor. Fantastic (although if I had a nickel for every time I heard that, I wouldn't be taking out so many loans for med school). What does a doctor do? If you answered "Helps people" you are probably a freshman with good intentions but much naïveté. If you chose "Paperwork" or "Sitting at a computer" you probably have a little more experience. If you said "Inflict pain and interrupt frequently" you are probably a patient. Most people have a general idea of what physicians do, but they lack the important day-to-day details. Medicine is fairly romanticized thanks in large part to shows like ER, House, or Grey's Anatomy, and the many that came before it. Watching people put in orders, review charts, wait for labs, or conduct rounds does not make for very interesting TV (to the general public at least). Thus we arrive at our stereotypical freshman pre-med, gunning for med school without any conception of what physicians actually do. This is where shadowing comes in.

The ED is arranged like a giant horseshoe, the interior being the nurses' and physician's stations and the exterior being the patient rooms. I set my coffee down and put my snack in the mini-fridge (god help you if you fail to bring snacks). I greet Dr. S. and we begin the night. Dr. S. is very mild mannered and speaks calmly (ER docs tend to come from both ends of the spectrum, calm and manic). It is a typical night at the ER; abdominal pain is coming at us from every direction and shows no sign of letting up. Not too far into the shift, an elderly woman arrives by EMS. She was unconscious and had some dried blood on her head, suspicious for a fall. She was weakly responsive to pain, but no spontaneous movement or sounds. She got the usual 'ER Special' consisting of IVs, blood tests, and cardiac monitoring. She would almost certainly be admitted. Neurology would be consulted as soon as possible. Several hours later, her daughter came running out of the room, shouting for help; the patient was having a seizure. After a tense minute or two of not being able to locate any nurses or Dr. S. (he is the only physician on at this point), we stream into the room to assess the situation. The patient has stopped seizing at the moment, but is now not breathing. Her heart rate plummets. Quickly, a nurse starts to bag her, and Dr. S. makes the decision to intubate. Respiratory is paged, and a nurse prepares anti-convulsants. Finally, she's stabilized, and we all go back to work. No rest for the weary.


Shadowing is exactly as it sounds: the student follows the physician like a shadow, in order to observe. However, unlike a shadow, you will constantly be in the way, and you can/might be allowed to ask questions. Medical students are expected to ask questions, even if they end up being forced to answer their very own questions and ultimately being chastised for not knowing the answer (doesn't seem fair does it). It is extremely useful though, because you gain firsthand knowledge of how a typical day/shift goes. For example, I was shadowing an ER doc, and for the first 2-3 hours, we didn't see one patient. Labs were backed up and beds were full, so we just sat on our asses until it cleared out a bit. You do get to see procedures and patients (especially in surgery), but the little things are actually the most important. Adcoms want to see that you know what you're in for; the fairy-tale can be your motivation, but you better be prepared for the reality.

Around 5am or so, Dr. S. are seeing a patient about back pain when the intercom clicks on. "All help to triage stat!" the nurse shouts (first time I heard stat used in a serious context). Dr. S. is not phased, and continues to interview the patient. Seconds later, "Physician to triage!" Dr. S. sighs, apologizing to the patient, and we head down the hall to the waiting room (slowly I might add). Before we get there, two beds complete with patients come flying around the corner, pushed by a couple personnel. Both patients were stabbed at a party and had just walked in the front door. Minutes later, a third patient comes in and is wheeled back to an empty bed. The ED goes into lock-down, police are called, vitals and IVs are started, and ambulances are called to transfer the patients (the hospital is not a trauma facility). Shortly after our three stab victims arrive, a code blue goes out over the intercom. The physician covering the wards, Dr. P., is currently in the ED, and Dr. S. is not sure if she's even ACLS certified. Dr. S. and his scribe take off after her with the code box, and I am tasked with getting vitals from the patients. They all appear to be in discomfort, but one looks very pale and is shaking (effects of epinephrine). Dr. S. and his now disheveled looking scribe (CPR will do that to you) return, and the patients are transferred.


So, shadowing is important, an unwritten requirement of medical school. But how do you go about it? I was lucky; I got an internship through the university that handled the initial contact. For those less fortunate, I would suggest asking around the hospital if you volunteer at one. Academic medical centers are probably the best choice because they will be used to having medical students around. Ask your friends too. I came from a completely non-medical family, so I was at a bit of a disadvantage. Many of my friends had physician parents or grandparents, so they became a great source of knowledge. There are lots of guides pertaining to shadowing though, so just search SDN or Google for more in depth advice. You don't have to rack up hours and hours of shadowing, but spend one or two full shifts per specialty. It helps to get some variety as well, but even one experience is better than none. Don't forget to have fun, but make sure you reflect on your experiences too. If you really can't see yourself living that life, it might be time to switch paths. That's what shadowing is for. It wipes away some of the glamour, exposing the realism of clinical practice. It disenchants, leaving only the most dedicated behind to finish the journey to medical school.

Of Schools and Secondaries

Welcome back! This is the second installment of "Liam's Somewhat Handy Guide to Applying to Medical School," and it's going to be a good one. In the first installment, we covered the Primary Application, introduced a couple tips, and tried to keep stress to a reasonable level. In this post, I'll be covering a short bit about how to decide to which schools to apply, and what the secondary applications entail (spoiler warning: money, essays, and waiting). So, let's get started.

Now, some of you might be thinking, "Liam, why did you choose to mention the schools here instead of in your post on the primary application?" A very valid question, and one I will politely choose to ignore. With that out of the way, let's talk about schools. There are 137 accredited U.S. medical schools and 17 Canadian medical schools recognized by the AAMC. The number of schools you can apply to through AMCAS differs slightly, because most Texas schools use a separate application service (TMDSAS) and some schools have multiple campuses (the University of Arizona has two campuses currently, although they're working on separate accreditation). In any case, you have about 125 choices if you plan to stay in the 50 states, and I would plan on choosing around 15-20. Why? Because of our arch nemesis, probability. Medical schools tend to follow the rule of 10%, where 10% of applicants receive an interview, and 10% of interviewees receive an acceptance (in reality, the probability of being selected after an interview is a little higher, around 15-20%, but the Rule of 10% sounds nicer). What this means is that around 1-2% of applicants to any given school actually matriculate in the fall. Now, before you reach for that bottle of whiskey, Tip #5 says "Don't Panic!" and you should strongly consider this one. Sure, the odds aren't great (still more likely than winning the lottery though). But that's why you're here looking up tips for how to improve those odds. Applying to several schools will help your chances, but you also need to make each choice count. 100 crappy applications won't beat 1 good one. Even if you're Johnny Awesomesauce, the Super Applicant.

So, now that you're completely discouraged, let's focus on how to choose specific schools. The first step is to find a copy of the MSAR®. This is your application bible. It has information on each school, including stats like average GPA and MCAT, and it can help you quickly eliminate schools that don't fit your profile. If you're as neurotic as I am, you might even enter this information into a spreadsheet to compare schools faster. I even computed Z scores for GPA and MCAT, and then averaged those to figure out how schools compared to my stats (borderline unhealthy behavior in retrospect). In any case, it'll help you eliminate schools that don't take very many OOS (out-of-state) applicants or ones where you are outside the range they usually accept. That way you don't waste time on money on an application that is doomed from the start.

The actual distribution of the 15-20 depends on you. For the love of all things holy, apply to your state school. It's almost always less expensive, and sometimes you will get some favoritism. Even if you don't intend to go there, include it. The rest of your schools should include some safety and reach choices, but make sure all your choices are places you can see yourself going to. Also, as a little note, there is a small area bias for residency locations (allegedly). What I mean is that applicants to residencies in the northeast may fare slightly better if they went to the school in the northeast. I suspect this is mostly due to familiarity and connections you develop within your area, so don't stress about this too much.

Now, this may come as a surprise to you, but medical school is basically the same everywhere. Each school has its own take on the curriculum and clinical sites, and some schools may be more focused into areas like primary care or research than others, but for the most part, they're all pretty equal. After all, an MD is an MD (it's your residency that really matters, but that comes later). My point is, don't think you have to go to a Harvard or Yale just because it's a good school. Go somewhere where you can enjoy yourself, develop new experiences, and make the most of your education. You're going to be stuck there for at least 4 years, so you damn well better choose a place where you can be happy. And, since we haven't introduced a new tip in a while, here's one now:

Tip #7: Be passionate.


Really, this should extend in to all aspects of your life. If you don't find yourself passionate or excited about the school, it's probably not the one for you (hint, you can substitute person for school to apply this to relationships too). People generally do better work when they are happy and motivated (or at least they don't mind the work as much), so it makes sense to maximize your chances of being in a positive frame of mind.

Secondaries
I've just gone on and on and on about choosing a school, and I've only barely mentioned the secondary application. There's a reason for this (Spoiler alert!). The secondary is really just a couple more essays, on average, I would guess about three, with a ludicrous fee. One essay is usually a "Why do you want to go here?" type, which is fairly self-explanatory. Look up information about the school, and talk about how it matches your experiences and goals. Check, one down. Another essay I encountered frequently asked, "How would you contribute to the diversity of the student body?" (ie what makes you unique?). This one can be tricky. It is really up to you to decide what aspect of your personality and history you focus on. If you're really struggling like I was, ask your friends and family for help. Sometimes you can overlook an event or behavior that's worth talking about. Those two are the ones that appear frequently. Keep in mind secondaries are pretty heterogeneous. Some had no essays (awesome, except for the money part) and a couple had 7+ essays (rarely, thank god). SDN has school-specific threads for the current cycle and previous one, so you can often check past threads to see how many and what type of questions the last group had.

Otherwise, there's not much to it. This is where the long waits come in. Most schools send secondaries to everyone, so the earliest you receive yours is usually based on when they received your primary. When you do get it, try to fill it out in a reasonable amount of time. That way, if you're filling out multiple secondaries, you don't get too bogged down. I would also recommend having all secondaries submitted and complete (LORs received) by the end of August. Interviews start around September, and you want to give yourself as much time as possible to be selected. After you submit your secondary, try not to obsess over it. The wait will be long and stressful, but if you keep checking SDN to see who is getting interviews, it will be that much longer and more stressful. But that's it. And not only that, most of the hard work is done! You still have the interview, but your chances greatly improve if you can get that invitation. So, put away the Tums for now and go enjoy your summer. If you have to wait, may as well make the most of it!

Applying to Medical School, the Primary

May is here again, which heralds the beginning of the 2013 admissions application cycle. Thousands of pre-medical students will begin filling out their AMCAS applications (the primary application), inputting a long list of information that seems slightly redundant. However, this should not discourage a pre-med, because by this time, hoop-jumping and tedious activities should be well practiced. Assuming you are a pre-med, let's go over some of the stuff you will need for the primary. (Note: These are my recommendations and experiences with the application. Your experience will differ. Take my advice with a healthy degree of skepticism and maybe an antacid).

Also note: This is a longer post. Use the search function to find what you're looking for, although I'd love it if you read the entire thing. I wrote all this stuff for a reason you know...

We start at the AMCAS application page. AMCAS is an acronym that is entirely unimportant; just think of it as the primary application, where grades, letters of recommendation, your relevant experiences, and the personal statement go. Eventually you will associate it with frustration, anxiety, and a vague sense of abdominal discomfort, but that comes later. Currently on the front page is a 20 minute video about the application. I suggest you watch it. Better yet, read the manual too. (A stretch I know, but suck it up. You're in for a lot of reading in medical school anyways). In fact, let's do that right now. Grab a snack, close out of Facebook, and give the video a go.



... Finished? Fantastic! That was a lot of material, and you may feel that mild abdominal discomfort developing already. Congratulations, you're ahead of the game! But like Douglas Adams said, "Don't panic." As with any large project, if you tackle it systematically, everything will turn out okay.

Coursework
As part of the application, you will have to input your coursework. This includes every class you've ever taken at a college, including community college and college credits you may have earned during high school. You will also need transcripts from each school you've attended. When you enter in your courses, you want to match the transcript as closely as possible, down to the course name and code. The manual has a couple special cases for certain classes, like combined lecture/lab classes. It is also okay to specify which semester a class is if it isn't explicit in the name (for example, if the name of organic chemistry is the same for both semesters, you can add a I and II or 1 and 2 to indicate first and second semester). Double and triple check that you entered everything correctly before you submit, as inconsistencies may hold up your application.

The rest of the application is not very complicated; there just happens to be a lot to fill out. That being said, here are the first two tips:

Tip #1: Use common sense. If you are completely unsure, ask for help.
Tip #2 : Be honest. Be yourself.

These tips extend through the entire application process really. The application is not trying to trick you. In fact, this application will be the predominant way the Adcoms (and possibly the interviewer) will get to know you. On one interview, I actually sat down with my interviewer as she went through my primary application bit by bit. So be reasonable. Answer questions as you would answer to a friend. Be completely honest, because you may end up being asked questions about your essays or personal statement.

Work/Activities
The work/activities part is where you enter information about the things you've done during college. This section and the personal statement are really the only ways the Adcoms will be able to get to know you as an individual, so do not skimp. That being said, you don't have much room, so you'll have to be concise as well. This leads into my next tip:

Tip #3: Don't sell yourself short!

You are applying to medical school. Just think about that for a second. That's pretty awesome. You've worked your ass off throughout undergraduate just to get to this moment. Sure, there's someone who set up clinics in Africa while rescuing infants from a burning building and scoring a 52Y on the MCAT. There's someone who somehow cured AIDS, cancer, and eczema with a single discovery. Don't focus on that. They're probably really boring anyways. Adcoms want people who are enthusiastic and genuine. Don't try to be something you aren't, but be proud of the things you've accomplished and what you think is important. Plus, you'll write better about things you naturally find interesting.

Personal Statement
The personal statement is similar in that regard, except it is longer and more like a story. Do not simply restate your activities. You want to demonstrate how your experiences and personality make you an excellent candidate. I took a couple of experiences I found most profound, and used them to tell a story about how they shaped my perception of medicine and the kind of doctor I wanted to be. My theme was fun; medicine is serious business but there's no reason why it can't be fun as well. So try to enjoy writing your personal statement. Imagine that J.K. Rowling wanted to write a book using you as the main character. Be memorable (in a good way. Spelling and grammar mistakes or completely inappropriate material may be 'memorable', but will probably hurt your chances). I suggest you have several people look it over too. Find an English major (better yet, creative writing) and ask him/her to make suggestions. They will be flattered that you need their skills.

Letters, schools, and miscellaneous stuff
We'll start with a tip:

Tip #4: Read everything thoroughly.


Make sure you read the instructions, questions, responses, everything completely. I'm serious. You can't change most of the application after you submit it. You'll kick yourself if you missed the "not" in a question, or used one school's essay for another one and forgot to change the names (not me thank god, but I heard stories). Minor mistakes can usually be clarified with individual schools (I messed up a course code so it looked like I listed the same course twice). For LoRs, make sure you check each school's requirements. Some cap how many they'll accept (min and max), and most specify from whom the letters should come.

Tip #5: Don't panic!


I'm saying this twice for a reason. Applying to medical school has a way of giving people ulcers (and emptying their wallets). You've spent years getting to this point. You've shadowed, volunteered, studied, tested, and worked far more hours than you've slept. Now you have to summarize those years in just a couple paragraphs, pay an absurd amount of money, and wait. Then, secondaries will come back, meaning more writing and more money. This is followed by a lot more waiting. You'll go interview, where everyone else seems to be more qualified and experienced. Then you wait some more. Eventually, mail will start arriving. Waiting and lists, two hallmarks of the application process, will be combined into one nebulous and depressing package. Rejections will test your resolve and patience. But, stay with me here, But, you'll check your email and see "Congratulations" in the heading, and promptly spend the remainder of the day getting absolutely smashed. And at no point should you panic. Mistakes can be fixed with a polite email. Your friends and other applicants can commiserate together. Even in a worst case scenario, there will be another application cycle coming around. There are many paths to medical school, and no one is best. So, don't panic. In the end, the people who get into medical school are not necessarily the ones with the highest grades or longest resume. The people who are accepted are the ones who are the most persistent and confident that they would make great doctors.