Working and attending college...

Potential lethal combination?
Many students find themselves in the unenviable position of HAVING to work and attend college at the same time. This a a potentially lethal combination in many ways. First of all, when something starts to suffer, it generally isn’t the job and second, burnout is a strong possibility. Both of these problems can be potentially avoided if you cut back on your coursework if you find that you must work full-time. If you are a full-time employee at most jobs, you have minimal time to study in between and thus, you can’t take on a full-time course load that includes pre-med lab courses. Decide that you are going to take your time and do well in your courses while leaving yourself plenty of time to rest from both coursework and employment. No medical school admissions committee is going to give you “brownie points” for trying to do a full-time course load along with full-time employment especially if your uGPA (or postbacc) work has suffered.

Recharging your batteries
You need time to digest and assimilate the material that you are learning in your pre-med coursework. Rushing through these classes with last minute “cramming” is not going to leave you with enough time to get the material in your long-term memory so that you can apply it on the Medical College Admissions Test. You need to be able to see the subtleties of what you are studying in addition to having some time to let your brain just rest. Again, rushing through your coursework makes MCAT review on the other end a total chore instead of a progressive process that will lead to success. Take your time, recharge your brain (even take a semester off if necessary) and then come back refreshed and ready to work at very high level.

Damage control
If you are retaking courses or attempting to take additional postbacc work to enhance your application, you need to do well without exception. You can’t keep posting mediocre grades and retaking courses with the expectation that eventually you will get that A and get into medical school. If you have significant prior poor coursework to overcome, take your time and remediate one course at at time. Pair a more demanding course like Physics with something less demanding like English/Psychology. Again, if you have prior poor coursework, you can’t afford to either do poorly in your recent coursework or drop courses because you have overloaded yourself. Slow, steady excellence will bring the success that you seek.

Keeping some perspective
If you have a family to support and take care of, be sure that you allow plenty of time for them. Working, attending class and then diving for a nap on the sofa or heading for bed is not going to do much for your relationship with your loved ones. They need your undivided attention and you need to interact with them for your sanity too. Let your loved ones be your much-needed and much-desired break from your schedule. They generally don’t expect your to be on your best behavior but only want you in your basic form. Allow them to see you, hang out with you and take you away from the grind of work/study on a regular basis. You grades will be better, you will be happier and you can keep yourself reminded of why you seek your goals in the first place.

Setting goals and achieving them
The whole key to finding success in the medical school application process is keeping your eye firmly on your long-term goals. I have stated in other posts that the process is like having 100 pounds of weight to lose. It isn’t going to happen overnight and you must take small steps on a daily basis to stay on track. It’s easy to get off track by the demands of work but you can’t achieve your goals by letting this happen. This means total organization and total commitment to the task at hand, be it work your studies. If you are at work, you give your work your full attention. When you attend class, you give your classwork the attention that it demands. It’s neat to be able to multi-task but most people are not able to work at a high level and achieve those A grades that you need for medical school admission at the same time. Again, if you work full-time, don’t expect to attend school full-time. If you attend school full-time, don’t expect to work full-time. The end result is that you wind up doing both things at a mediocre level which won’t allow you to achieve your goals.

Finally…
There are no “points” for getting this process “almost” right. The level of academic achievement that is demanded of a potential medical student is getting higher every year. The MCAT is getting more competitive as many students are taking prep courses and spending more time preparing for this exam. You can’t expect to be competitive next year with this year’s work because the bar will move higher. If you are attempting to upgrade your credentials, then you need to do a complete overhaul and put up some good academics (even one course is better than nothing). Don’t expect to be the exception to any of the rules in this process. You are not generally in a position to be objective about yourself and your abilities. Make sure that you get some honest and objective advice. Trying to self-evaluate is like asking your Mum if you are a great kid. Of course, she’s going to answer in the affirmative but it’s far better to get someone who doesn’t know you, to look over your things (like a good academic adviser who knows the pre-med climate). Allow plenty of time for getting your work done at a high level and you will see movement toward your goals without sacrificing your employment records, your sanity or your soul.

Selecting Medical School Applicants for Interview

Many medical schools are in the “thick” of the process of screening applicants and selecting those applicants that they wish to invite for interview. This process generally falls along the lines of first, making sure that the applicant meets the minimum requirements for said medical school in terms of undergraduate grade point average (undergraduate GPA) and scores on the Medical College Admissions Test (MCAT). While most medical schools will review the entire application, in terms of figuring out how to get 8,000 -10,000 applications pared down to a workable number for closer scrutiny, we screen by undergraduate GPA and MCAT scores. There just is not a better way to make the preliminary cut than these two factors.

In the case of those who do not make the preliminary cut, we generally send these applications for a secondary screen by administrative staff who are looking for criteria that we have flagged so that many of those cut by the undergraduate GPA /MCAT screen might make it back into the secondary screen if our administrative staff keys in on something in the personal statement, coursework or letters of recommendation that we should discuss in the admissions committee.

Those applications who DO make the preliminary screen are divided among the admissions committee members who read every work on the application and decide if we want to invite the applicant for interview. In short, do we want to meet this applicant? Would they be a good fit for our medical school? Do they show promise of being able to get through our very demanding curriculum? Do we want to know more about this applicant? In short, we invite applicants that we strongly feel will make good physicians based on the material that is present in their AMCAS applications.

That being said, as applicants are filling out those AMCAS applications, they need to be sure that the information in the AMCAS is as accurate as possible and as clear as possible. Many people have been rejected for interview based on a poorly written personal statement. These rejected applicant may have had the GPA/MCAT score but neglecting to write a strong personal statement is like heading out on a long automobile trip and draining the oil out of your engine. You are just not going to get very far even if your engine appeared to be in great shape. You need to have a well-written and coherent personal statement.

On the other hand, a great personal statement/letters of recommendation will not make up for very poor academics. If your academics are poor, take the time to get them as high as possible keeping in mind that the average undergraduate GPA for medical school matriculants is 3.6/4 and the average MCAT score is 30 with no single score less than 8. Some schools may have considerable variation around their means but my medical school does not.

Are schools “forgiving” of a poor undergraduate start but a very strong finish? To a certain extent this is true but there are academic “holes” that can be too deep to climb out of without years of “damage control”. In short, if medicine is your goal, work diligently and consistently at a high level. Don’t count of anything being “forgiven” and keep in mind that no allopathic medical school in this country is searching for applicants. We have far more applications than we need.

We try to make sure that every application is screened at least twice before sending out that dreaded rejection letter. This is a monumental task that seems to take longer and longer each year. Again, keep in mind that one of my medical schools received more than 10,000 applications for 110 spots in the entering freshman class last year. This year, we have already broken last years numbers. There are just too many good applicants out there.

As I read through the applications, I always look at how many hours of coursework an applicant has taken in any given year as well as the grades earned. In addition, I look at the content of those hours. If a student took three laboratory courses in one year and managed to earn a 4.0 GPA versus a student who took one lab course along with general education requirements and barely managed a 3.0, I tend to look more favorably on the first student. We also make allowances for things like full-time employment versus full-time student.

We look at the age of academic work. A student may have earned high grades 10 years ago but without recent academic work or a recent MCAT score, we generally will not offer admission. Many things change over the course of ten years including the ability to jump into a very demanding academic challenge. In most cases, we ask for some recent coursework in addition to MCAT scores not more than three years old.

In terms of multiple MCAT attempts, we tend not to accept students who have more than three attempts. If a student retakes, we expect the score to go up. If not, that is usually a signal that the student wasn’t prepared on any of the attempts. To keep taking that exam and scoring mediocre scores is generally a very bad idea. If your first score is not what you wanted, do a thorough analysis of your performance and correct your deficiencies. To just keep taking that test without doing additional preparation or changing your method of preparation, is not using sound judgment no matter what your undergraduate GPA.

Graduate school GPA does not overcome a poor undergraduate GPA. As a graduate student, you are expected to maintain a minimum GPA and you are expected to do well. While earning a graduate degree can enhance your application, there are huge differences between graduate school and medical school. In the case of special masters programs that are specifically designed for pre-medical students who need application enhancement, you need to do very well in these programs. Just taking the coursework will not work, you have to take the coursework and make yourself “stand out” from the rest of your classmates in these programs. It goes without saying that we scrutinize the performance of special masters students very carefully and take into consideration strongly, your letters of recommendation from your SM professors.

I have written the above so that those folks who are in the process of contemplating application to medical school might definitely understand how important it is to have a complete and strong entire application. You are considered within the context of how competitive you are with the rest of our applicant pool and how competitive you are with the national applicant pool. We are given AMCAS data as it becomes available and we adjust our standards according to the data that we receive. For the past five years, undergraduate GPAs and MCAT scores have been increasing. We don’t expect that this trend will reverse.

The number of applicants had increased slightly this year. We don’t’ know if this is a national trend or just a trend for our school. In general, many people look at medicine as a very lucrative career and seek out admission to medical school for this reason especially when the national economy is not as strong as in previous years.

Keeping up with your undergraduate coursework

If you have "taken the plunge" and decided that you want to pursue medical school, no doubt, you are taking or have taken some science courses. Most pre-medical students will start with General Biology or General Chemistry as General Chemistry is a prerequisite for Organic Chemistry. General Biology is one of the ultimate "survey" courses. A good General Biology course should contain a thorough introduction to the upper-division courses in the major while providing enough depth to cover the subject matter on the Medical College Admissions Test (MCAT). The bottom line is that General Biology can introduce hundreds of terms and concepts that are the basis for your major (if you decide on Biology).

Your General Biology course should have a very strong laboratory component. These labs should be designed to demonstrate and emphasize the terms and concepts that you studied in the lecture portion of your course. In general, these labs should occupy about 3 hours one time per week in order for you to make the most of your experiences here. My General Biology course was my only study of botany and I totally enjoyed the afternoon field trips that we were able to take. One of our instructors walked us around campus and explained just about every tree, shrub and flower in the springtime. It was a wonderful experience.

My method of mastering General Biology lecture was to scan the syllabus and figure out how much reading I needed to accomplish before each lecture. I would make a list of terms that needed to be remembered and put this list next to my notes. I would also take notes on one half of a notebook sheet leaving the other half of the paper for summary or notes from my text. By the time I had finished my text reading before a lecture, I would have a sheet of paper with a list of topics and terms that I would listen for during the lecture.

As I said before, I would take notes on the right half of a piece of 8 X 10 inch narrow-ruled looseleaf notebook paper. The left half would be for summary so that I could cover the right half and quiz myself on the concepts. I might also jot down a note or two from the text if there was something that was particularly helpful to the understanding of the lecture.

I would study my lecture as soon as I could. Usually this would be the afternoon after morning lecture. I would study a week's worth of lecture material every weekend paying close attention to how one lecture was related to the next lecture. In terms of the laboratory, I never went to lab unprepared. I would preview the lab; have a list of the procedures that we would be doing and then look at the questions that needed to be answered for the write-up. Since every lab required a written report, I was able to do half of my report before I actually performed the lab experiments or dissection.

I tackled General Chemistry in much the same manner as General Biology except for solving problems. I always made sure that I completely understood the concept that each problem involved. I kept a running list of formulas that needed to be mastered or memorized. When I had a spare moment, I could pull out my index card of formulas and do some memorization. Again, I would keep at least one lecture ahead of the rest of my class.

An ability to use algebra as a tool is essential for General Chemistry. If your math is weak, definitely shore up your deficiencies before you tackle General Chemistry. There are several short books around with titles like "Math for General Science" or "Math For General Chemistry". Check out these books and do some math practice if your skills are rusty. If you were required to take College Algebra, make sure that you complete it before you take General Chemistry. You can substitute some General educational requirements and take your Chemistry after you have completed your College Algebra course. General Chemistry can be quite "unforgiving" if you math is rusty or not up to level. The same is true of General Physics.

Your grades in your premedical courses are vitally important for entrance into medical school. Make sure that you thoroughly master this coursework (for the MCAT) and that you keep the highest GPA possible. Doing GPA "damage-control" is very difficult. If you get off to a slow start, figure out your problems and get your grades up as soon as possible. One low grade will not "tank" your application but repeated courses with multiple "Cs" will.

Keep up! Shore up! and Stay Up!

Working on your application to...

I am in the "thick" of application to fellowship and I thought I would write a few notes on the process. The application process is quite similiar be it for medical school, residency, fellowship or whatever else. Though I am done with the actual applications and interviews, I will reflect on the process.

Once you have decided that you are going to apply for something, you need to take a look at the criteria that will be used for evaluation of your application. For medical school, this means your undergraduate grade point average, your score on all sections of the Medical College Admissions Test, your extra curricular activities, your letters of recommendation and your personal statement. For residency, the players change to your grades in medical school and your scores on USMLE/COMLEX exams (Steps 1 & 2) and for fellowship, your evaluations during residency and scores on in-training exams.

You need to look carefully at what you bring to the application process. You cannot change your grades so if you are an undergraduate and reading this, you need to get the highest grades that you can possibly achieve. Do whatever it takes and make thorough mastery of your undergraduate subject matter (along with your pre-med coursework) your major priority. Contrary to popular belief, great letters of recommendation or wonderful extracurricular activities will not erase a poor undergraduate performance (nor will obtaining a graduate degree). You have one shot with your coursework so make the most of every opportunity to show your excellence.

As I have written elsewhere, you need to thoroughly prepare for and take the Medical College Admissions Test. This test should be taken after complete knowledge and preparation using the same manner of questioning as on the actual exam. Do not believe that you can take this exam once for practice and then once for "real". Nothing sounds an application "death-blow" like more than one mediocre MCAT attempts (or several attempts unreported). This is not an exam for "practice" but a measure of your suitablity for medical school. Whether you believe this test is valid or not, it's a stepping stone that is quite important.

Once you reach your sophomore year, you should have a good idea of where you stand in terms of preparation for medical school. If you have taken the pre-medical courses in sequence, you should be done at this point. You should start writing your personal statement too. The reason for this is that when you request a letter of recommendation from your pre-med science professors, you should include a copy of both your CV (curriculum vitae) and personal statement. These two documents allow your letter writer to get an idea of you and your outside of class achievements. You should also include a deadline and waiver of inspection of the letter. For most undergraduates, these letters should be sent to your pre-medical advisory committee/office where they will be stored in your folder. (If you have not made contact with this office, you need to do so as soon as you know that you want to attend medical school).

During your junior year, you should be solidifying your knowledge in your undergraduate major and preparing for completing your AMCAS/ACOMAS application. This usually involves obtaining unofficial transcripts from every institution that you have taken courses at since secondary school without exception. Even if you took a typing course at a local community college, you need to request and obtain a transcript because that course needs to be listed on your application.

Choose your medical schools in early fall of your junior year and make sure that you have taken 0r are scheduled to take the required coursework to make application. Some schools require courses like genetics, biochemistry or calculus in addition to the traditional pre-med courses. A consult of the MSAR (Medical School Admissions Requirements) should keep you informed on these additional requirements.

In terms of a choice of what major is best for you, choose the undergraduate major that interests you most. It is a huge chore to attempt "engineering" because you "heard" that it was more impressive to members of a medical school admissions committee. Nothing is more unimpressive than a mediocre undergraduate performance in a major that doesn't interest you. I often say to myself, if I had it to do over, and I knew that I would be going straight to medical school, I would have majored in American Studies, minored in Spanish and took my pre-med courses.

These thoughts are only fleeting because I attended college with the notion of preparing myself for a career in scientific research (not medicine). My undergraduate majors of Analytical Chemistry and Biology with minors in Physics and Math were my preparation for graduate school. I also loved and was quite passionate about those subjects. I enjoyed hours of working on problems in applied differential equations class and higher algebra/advanced calculus. If these courses are not for you, head into something that DOES excite you. After all, you are spending thousands in tuition dollars so you might as well get your money's worth.

I also cannot emphasize the importance of exploring the nature of your fellow human beings. College is a great time to gain exposure to a diversity of ethnicities and ideas. Immerse yourself in another culture by spending a semester or two abroad or studying the art, language and music of another culture. These experiences are easy to find on the campuses of universities and are a great source of stress-relief. There are literally millions of ideas out there to explore and enjoy even if the experience makes you a bit uncomfortable. Your life will be richer for the experience.

Application for residency closely parallels application for medical school except the deadlines are more unforgiving. In the allopathic system, the ERAS (electronic residency application service) deadlines have to be exceeded or you miss out on interview opportunities. You have to be thinking about your choice of residency shortly after you complete first year.

The reason why I give the end of first year as a deadline, is that you can use your summer between your first and second year as a means of exploring some of the specialties. Do not choose a specialty because you believe it will be prestigous or pay loads of money. Dermatology is often sought after as a prestigous and highly paying specialty but I would be a miserable dermatologist. I enjoy my colleagues who pursued this specialty but it was not for me. (See my posts on why I chose surgery).

Don't choose a specialty because you believe it will be in demand. Demand in terms of specialty comes in cycles and by the time you are applying for residency, the demand could be poor. I remember when I started medical school, the demand for anesthesiologists and anesthesia residency was pretty poor. Now, this specialty is fairly sought-after and in a couple of years, the field will be saturated. (Anesthesia is not a rapid turn-over specialty).

Choose a specialty because you love it and you can't imagine doing anything else. Sounds just like the reasons that you choose to apply to and attend medical school.

"Bottom-ranked" medical schools in the USA

Well, the time finally comes around for you to apply to medical school. How do you choose a medical school to apply to? What factors should be considered? What about those US News & World Report rankings? What about pass rates for USMLE Step I? What about Match Lists?

You may want to consider location as your first priority. Medical school can be a very expensive undertaking but add in the cost of a few cross-country airline flights each year (you do want to come home for Christmas don't you?) and you can add significantly to your costs of attending. You may also want to look at the cost of living in some of the cities that have medical schools. Cities like Washington, DC, New York and San Francisco can be quite expensive to live in while other cities like Cleveland may have substantially cheaper housing.

Your first step in choosing a medical school is to look at your competitiveness as an applicant. The 2005 (last year that we have numbers) averge GPA and MCAT for medical school matriculants was 3.65 and 29. You can simply look at your numbers and figure if you are above average, average or below average in terms of matriculants across the country. You can also consult the MSAR (Medical School Application Requirements) and look at the averages for individual schools. Again, are you above their average, at their average or below their average.

The next thing to look at is curriculum types. Most schools have some variation of an integrated (systems-based) or classical curriculum. Some schools also have problem-based learning (PBL) integrated with a systems-based curriculum or classical curriculum. The classical curriculum requires a fair amount of self-integration of the material for USMLE (all steps intergrated). The intergrated and system-based curriculi require less self-integration but may pose problems if you are a slow starter and find that you missed key portions of an important system.

Depending on your learning style, you may find that PBL is not going to be a good "fit" for you. PBL demands strong individual initiative and proactivity in terms of getting the information that you need. If you are not a natural leader or work poorly in group situations, PBL is going to prove problematic. PBL is also fairly dependent on good faculty who thoroughly understand its concepts and implementation of those concepts. In short, some people become lost in the PBL process and find recovery difficult.

How about "ranking" of your medical schools? It is not so much the rank of your school but how well you perform there. The high performers at any medical school are going to go further than the low performers at a high ranked school. If you are uncomfortable or stressed (money, housing, study space) in the environment of your "high ranked" school, you are not going to perform well and thus, the ranking of your medical school is not going to help you very much in terms of your performance.

Your medical school environment should provide adequate access to study rooms and materials, adequate lectures and access to the faculty that presented those lectures, adequate access to the information that you need for doing well in your coursework and a safe environment for you to come, go and stay late for study. If your faculty are not available during office hours or there are no study rooms available either in the library or in the school itself, you are going to have a difficult time mastering the material that you need to become a good physician. Again, this has little to do with the "prestige" of your medical school and more to do with the quality and ethics of your faculty. Strong medical schools may not be highly ranked by US News & World Report and the best medical school for you as an individual may not be ranked #1 by the rest of the country. In the end, your individual performance will determine how well you do on licensure boards, in your coursework and how much control you have over your choice of residency.

Choosing a Medical School

After I received my first acceptance, I knew that I was going to medical school but the question remained as to where I would be attending school. At that point, I had interviewed at three of my six schools and was holding one acceptance. It was late in December and I had interview invitations from three more schools. These interviews had been scheduled, two in January and one in early February. I had taken the August MCAT (MCAT was only offered in April and August in 1997) with my first interview invitation coming at the end of October. My interview season would run from early November to early February.

By my second medical school interview, I was well seasoned in the order of the day. There was always a meeting where someone from admissions/administration would speak with the group (8 to 20 people), then Financial Aid, then the scheduled interviews with lunch and a tour. Every school followed some version of this plan. Sometimes the tours would be after lunch and sometimes the tour would be first and interviews after lunch. In any event, there was a tour. (Even at the medical school where I taught, I elected to particpate in the tour much to the delight of my student tour guide).

By my third interview, I found that I was easily annoyed by the boastful pre-med. Every interview group has one or more persons who will brag about their publications, undergraduate GPA or MCAT score i.e. their general superiority. These folks will usually "scope out" one of the quieter folks in the group and proceed to attempt to "explain the ropes" to the quieter student. I observed one fellow brag about his undergraduate school and how everyone of his friends had been accepted to multiple medical schools and how his acceptances were likely in the mail. He also bragged about how he was going into Cardiothoracic Surgery and that the particular school that we were interviewing at was not particularly good for Cardiothoracic Surgery so he hoped that he didn't get in there. I often think of this guy today because I never encountered him later. I guess his hopes that he was not accepted at my medical school came to fruition. I wonder if he every got into medical school with his abrasive personality traits and booming voice.

By my last interview, I had five schools to choose from. My first criterion was location. All of the schools that I had applied to were located on the east coast (South Atlantic Region). I didn't want to attend medical school more than 200 miles from where I had grown up. The city, where I lived, had six medical schools within a 40-mile radius and eight medical schools within two hours drive. It was not difficult for me to apply to a variety of schools and still stay fairly close to home. Location was high on my list of priorties in choosing a medical school.

My next criterion was the "vibe" that I experienced during my interview day. I wanted to attend a medical school where I knew that I could be happy on a day-to-day basis. I was looking for a medical school that had a diverse student body (ages and ethnicities) because I thought that it would be fun to interact with many different people. i was also more intested in a medical school where the atmosphere was more cooperative than competitive. I also wanted a patient population that was fairly diverse too. Three out of my six medical schools met that criterion very nicely. The other three were acceptable. Generally, an urban medical school was going to suit me better than a medical school that was located in a rural area.

I didn't care so much about curriculum or USMLE pass rates. The one thing that graduate study taught me well was the my performance on any exam was based on my preparation and not on materials presented in lectures. If one person from a particular school had passed USMLE Step I, then the school was fine. USMLE Step I was not a significant factor in my choice of school nor was the match list as the matching process is self-selecting. As long as at least one person from any of my prospective schools had matched into the specialty of their choice, I knew I would be fine.

I did listen to my uncle's and father's friends when it came to medical school selection. At my top choices, I definitely knew that these schools provided an atmosphere that was condusive to an adult learning style. I also picked the brains of a couple of my cousins who had attended medical school. I wanted to know why they chose the schools that they chose and what was great about those schools. I was also fortunate to be a resident of a state that had three excellent medical schools that were reasonably priced.

By the time it came for me to make a selection, my number one and number two schools had offered me scholarship money. This money was based on my incoming GPA and MCAT scores. I carefully weighed my choices and was heavily leaning in the direction of my top choice when my number two school offered me a full-ride scholarship. Well, my choice was made and I was very happy to accept their offer. I am happy to admit that I could be bought by a good school offering a full-ride tuition scholarship. The conditions of my scholarship were that I would have to keep a high GPA in medical school which meant that I had to start strong and stay strong.

In the end, I chose well. I attended a medical school with an excellent faculty, cooperative student body and was exposed to some of the finest medical practice in the country. I am now quite happy to be an alum. When I started my intern year, I never appreciated my medical school more because I was a definite self-starter. I knew how to take very good care of patients and how to get things done. It was not much of a step to go from fourth year medical student to intern for me.

Things that I have realized now that I have been out of school. It is not the prestige of your medical school but your performance at said school. In the end, paying $250,000 for a medical education has to be worth every penny for you and you have to make the most of your education. I am happy not to have attended a school that cost $250,000 because that kind of debt would not be worth those enormous interest payments on loans. I am happiest with my total debt of $40,000 for four years.

Any medical school in this country, provided you do well, can prepare you for any career that you want. People who do not perform well in medical school can knock themselves out of competitive specialties and the prestige of their medical school will not overcome a poor performance.

Osteopathic versus allopathic medical school is a non-issue in today's world of medicine. Either type of school can provide the teaching that will enable you to become a physician. It is a myth that graduates of osteopathic medical school must go into primary care. I have worked with every type of specialist that were osteopaths from orthopedic surgeons to ENT surgeons to neurosurgeons. If you perform well in any medical school in this country, you can enter the specialty of your choice.

In the end, choose a medical school where you know that you can excell.

Why I went to medical school at a later age.

Back in 1995 when I was a busy graduate student, I was happily contemplating my future career as a college professor. Even as a child, I knew that I wanted to be a research scientist. I had excelled in math and science in the English school that my Mum had so carefully chosen for my education. My Mum was very pro-active when it came to the education and enrichment of her children. She was my first and best teacher. She had taught me the value of an education and the value of observation. While directing the growth of her children on a self-sustaining farm, she made our 90-acre horse farm, a living laboratory for our education. Armed with this background, we were expected to excell at all things academic. The "buzz" around our evening meal was not about sports but about Einstein's Theory of Relativity and higher mathmatics in addition to the fine reasoning of Immanel Kant.

Later, after I graduated from secondary school and entered university, I realized that I could trust my own observations and conclusions under the conditions of study. I approached every class with the vigor and demand for knowledge that my Mum had instilled in me (fostered with a healthy dose of curiosity on my part). I loved every second of my General Biology course and challenged myself to master every factoid that my professor presented. I never attended lab without careful preparation and continued with careful evaluation of every thing that I had observed. I was also very organized when it came to my coursework.

The first semester of my undergraduate freshman year, I took General Biology, General Chemistry and Differential Equations in addition to an English class on Critical Writing and review. I also played on the tennis team which required a fairly high demand on my time. Thus, I had to carefully set a study schedule and keep to my study schedule. When I started college, I knew that I was going to major in chemistry with an emphasis in the chemistry of the living.

I sailed through General Biology and General Chemistry with gleeful passion. I also loved my Differential Equations class as I explored the theories of solving these mathmatical equations. In addition, I honed my heavy flat serve and backhand volley that usually intimidated my opponents into submission. I had learned to play serve and volley with the boys so I generally dominated females who never came into the net. Most of the tennis games that I won were won on my fast, flat first service.

During my sophomore year, I took University Physics, Organic Chemistry and Histology. Again, my humanities courses consisted of a course on Early Puritain writers and History of American Thought. I had tested out of both classical and modern foreign languages haven taken classical Greek, Latin and Modern French while in secondary school. I also took a course in Applied Differential Equations (with the engineers). Physics became my favorite class and I loved Histology too. Histology provided a nice contrast from figuring out physics problems and mastering concepts.

During my junior year, I studied Analytical Chemistry, Advanced Inorganic Chemistry, Physical Chemistry, Advanced Analytical Chemistry (graduate-level mass spectromety and electro chemistry), Nuclear Physics and Atomic Physics. I spent most of my days in the laboratory and loved the precision of my coursework. I also began working on my honors project as an undergraduate researcher in the laboratory of one of the analytical chemists. Working in his lab honed my love of developing hypotheses and design of experiments. Most of all, I started to see the dawn of the use of mass spectrometry in the analysis of large biomolecules.

My senior year brought decision-making for me. I was torn between the graduate study of Analytical Chemistry and Biochemistry/Molecular Biology. My senior honors thesis had been on determining the detection limits and analysis of Snake Venoms by Matrix Assisted Laser Desorption Time of Flight Mass Spectrometry. By doing this project, I had learned much about biomolecules and the analysis of large biomolecules (proteins).

I decided to apply for graduate school in Biochemistry/Molecular Biology. I was accepted and received departmental funding to teach both undergraduates and perform my laboratory experiments. I was placed in the lab of a cardiologist who was working on oxidation-perfusion and low magnesium states. This lab was multi-disciplinary with immunologists, biochemists, biophysicists and chemists present. I thrived in this atmosphere. Here, I found a constant exchange of ideas and constant challenge to ask questions and research to find the answers to those questions.

My principal investigator requred his graduate students and reseach scientists to attend Cardiology grand rounds. It was during these sessions that my interest in the clinical applications of my research came to the forefront. I read as much as I could on cardiology, physiology and pharmacology. My PI loved my questions and one day suggested that I apply to medical school. "The worst thing that can happen is that you don't get in", he said. " If that happens, you continue your work here". He presented this as a "no-loss" proposition. This seemed reasonable to me at this point in my career. I could already see where the knowledge to be obtained in medical school would be useful for my research.

I took my comprehensive exams for my Ph.D in June, filled out my AMCAS and promptly took the MCAT that August. My MCAT study strategy was to study for my comprehensives (read, I didn't have much of a strategy). On MCAT day, I hopped on my bike and rode the six miles to my test site. I got in line for check in and listened to Aerosmith and Toni Braxton on my Walkman. I was seated in a room next to a window where I could look up and see a lovely blooming cherry tree with loads of fluffy pink blossoms.

The first exam section was Verbal Reasoning. I scanned all of the passages and chose to do the ones that didn't interest me first. I had little interest in psychology, history and sociology but loved science fiction and science. I scanned the questions and then read the passages underlining the key points that I needed for each question. I finished this section with time to spare so I just looked out of the window and enjoyed the view. I could totally let my mind wander far from this exam room and relax completely.

My next section was the Physical Sciences section. It was long but I had always worked these types of problems by using order of magnitude. I enjoyed the challenge of figuring out the hook for each question and supplying the answer. I found that I didn't need to do very many calculations as I could clearly figure what was being asked by underlying key words and working the problems using order of magnitude. This section was my favorite and I worked each problem as they came. About ten minutes into this section, three young men got up, turned in their test materials and left the room. My next question was, "Am I missing something here?" "This is really not THAT bad". Again, it was nice to be able to look outside for a mental break from the work.

The next phase was lunch time. I checked my bike and headed over to a small cafe where I knew the owners. After a light lunch of soup and tomato sandwich washed down with my favorite Diet Coke, I settled in the hallway ourside of the testing room with my Walkman and some Moody Blues. There is nothing like "A Question of Balance" to keep your head clear. I had chosen my music very carefully and made the right choices.

The afternoon session consisted of the Writing samples and Biological Sciences. I finished the tests, hopped on my bike and headed back home for a nap. Later that evening, I went to a disco with a couple of my mates and lost myself in the pounding music and Guiness stout. It had been a long day but it was over. No matter what, I was locked into whatever score I received and my application would be complete that October 15th.

My first interview invitation came on October 20th and my first interview was the last week in October. My last interview was in February. By my final interview, I was holding three acceptances and went on to acquire six out of six acceptances. To my astonishment, I had been hugely successful in application to medical school.

I don't know why I was accepted and two of my friends did not make it in that year. One of my friends was the president of the Pre-med honor society (I wasn't even a member) and the other had more publications that I and what I considered a better application. Both were also much younger that I. The only thing that I had beaten them in was MCAT score. Of the three of us, I had the highest MCAT score by far. My undergraduate GPA was strong (it had to be for graduate school) and I had held some interesting jobs (TV news producer, political campaign manager, environmental speech writer) in addition to my scientific work. I was also a pediatric, perinatal respiratory therapist (something that was hugely interesting to me at the time and easily obtained).

With that first acceptance letter, it hit me that my life was going to take a turn that I had not planned. I was going to add research physician-scientist to my career. I would teach, perform my clinical duties and research. To the delight of my uncle, I would follow in his footsteps.

I was never a "Pre-Med" student as an undergraduate. I certainly remember my classmates anguishing over receiving "Bs" in their science classes and grumbling about my performance since I really didn't care that much about the letter grade. I was in the class for the information. It was funny how my focus on mastery of course material (because I had to KNOW this material to be a good scientist) made getting the grade more easily than calculating what my score had to be to get an "A". My tests were my challenge to do better and better. If I destroyed a few curves along the way, it didn't matter much to me.

In the end, I carried a large body of knowledge and a solid background into medical school where I could build upon that background. Little did I know, until the second week of lectures, that I would be baraged with more information and a short time to assimulate it. My absolute curiosity about all things human would be satisfied many times over and continues to be satisfied to this day. For me, medical school was the ultimate mental exercise with a limitless supply of interesting experiencs and facts. I had the time of my life and learned to love the craft of medicine, not to mention, that I have met some of the most interesting people along the way.