Top 10 List: Pieces of advice for pre-med students

Overheard during the interviewer lunch break at my med school's interview weekend: one old doctor to another - "The very first student we interviewed blew us away. She'd summited Mt. Kilimanjaro, competed in the Olympics, and was an honours student with incredible research experience and publications. You know, if applying to medical school was like this back when I applied, I don't think I'd be admitted."

Getting in to medical school is tough. In Canada, less than 30% of students who apply each year are admitted to a school, and on an individual basis Canadian schools accept as little as 3% of the people who apply (that's more competitive than some Ivy League schools in the USA!) (source). That's not counting the thousands of students who wanted to be doctors when they started their undergrad degree, and had to face the realization that thanks to things like the MCAT and the competitiveness of the pre-med world, and perhaps the odd slack semester or difficult year, they would never even make it to the point of applying for medical school.

Here's some advice I would give to any pre-med student applying to medical school, though non-pre-meds might find it interesting as well as it might give you a unique perspective into the mind of a pre-med student. I wrote this list assuming you know all the basic info - what the MCAT stands for, what an application involves, and the like, though keeners at any level of their training - high school, college, or university - might find this useful as well. Given that, what I've written below something I hope every pre-med could have the chance to read before they apply to med school.

10. Have a backup plan...
This is one of the hardest thing for pre-meds to do: plan what you'll do with your life should you not 'get in' this year (or ever). Why's it so hard? It just sucks to think about the fact that you might not be accepted. But, you can't put your eggs all in one basket... you need to be realistic and know that even some applicants with the highest marks aren't accepted anywhere. Nothing is for certain. So, have a backup plan if you don't get in this year... and also consider what you could do with your life should you not get in at all. This might even mean considering taking a 'pre-med' degreee other than biology, since you don't need a biology degree to apply; if the only job you'd be interested in doing that you can get with a biology degree is medicine, you might want to do something else.


9. ...but don't give up if you don't get in your first time.
It's turning out more and more now that getting into medical school is more about learning how to "play the game;" because it's such a crap shoot, anybody who doesn't get in their first time applying would be stupid to throw in the towel right away. Even if you didn't get an interview, go to an advising session if any of the schools you applied to offer one, and give it another go.


8. If you do get in, don't do anything the summer before you start classes.
Seriously - don't work. Travel, but only for part of your summer, since travelling around can be stressful and you want to have time to veg. Give yourself at least a few weeks to sit around like a bum and do nothing, maybe see some friends that you won't be able to hang out with when things get busy. Let me put it this way: you now only have a couple of summers left (unless you chose to apply to a 3-year program!).


7. Know what doctors do before you decide you want to be one.
It would be devestating sacrifice so much energy, effort and free time just to keep up in the pre-med rat race and realize later on that medicine isn't for you, so learn what a doctor does - not just daily, but learn what the lifestyle is like, the stress level, the impact on family life. How? A few ways: you can read books and biographies about physicians, you can shadow physicians where you live, or you can go to a developing nation and volunteer your services at a medical clinic or hospital. The third one shows commitment and could have much better opportunity for clinical exposure, thanks to different policies on liability; though if you do that, please make sure you're going to a place where you can actually contribute and not just be watching or being a pain, and remember that some med schools actually use the length of time you spend away as a 'filter' for resume padding; a former dean of admissions in Canada, as quoted in a newspaper article: "only the affluent can spend six months in Africa volunteering at an AIDS clinic. ... it's become sexy to put stuff like that on an application.... but they're not necessarily going to get extra points for it."


6. Know what other health care professionals do before you decide on medicine.
What does a perfusionist do? What's within a Respiratory Therapist's scope of patient care? Did you know that there are nurse anesthetists? How do you know that you want to be a doctor, not a nurse? As well, getting to know other health professions will help you respect other health care professionals once you start working with them. Finally, it will add depth to your understanding of your own motivations if you can be positive that you want to be a doctor, and not some other type of health care provider. Following #4 (below) can play a huge role in satisfying this, but make sure you still get the chance to see what these people do in real life as well. From my experience, anyone in these professions is more than happy to tell a future doctor what their job involves, if they're approached with interest and respect.


5. Don't kid yourself: Training to become a doctor is one of the most difficult things you can do.
Even though it may appear easy at first, when finals come around (even in first year) you will realize that you've never done anything more difficult, more demanding mentally, intellectually, and emotionally. It will take over every minute of your free time and you will have to set aside time usually devoted to family, friends, and yourself; literally my entire days the month before finals was wake/study/sleep, even though in undergrad I never had to study very much for most courses. The only people who don't feel this way around finals are the ones who have spent their entire semester studying, literally every day and weekend, or are exceptionally brilliant - and there will only be 1 person of the latter kind in your class so chances are it won't be you. And that's just first year. For third year, add all that stress to being on call, having to deal with patients, nurses and doctors daily, having a pager go off while you're sleeping, and having to study for finals in the midst of all that. In all honesty, I've always said that the only thing I can think of that is more demanding and draining than becoming a doctor is boot camp, and boot camp only lasts 12 weeks. However, that was until I read about a U.S. Marine turned doctor, who discusses "How Residency is Different from the Marines" (scroll down to find it). Even though he says the Marines was harder, training to be a doctor must be pretty hard in order to even deserve the comparison.


4. There is much value in reading the online medical blogosphere.
See my post titled 'why pre-meds should read medical blogs,' then for a place to start, check out my 'guide to medical blogs for beginners' . Here, though, I'll just list a couple of the several reasons. You'll see from jaded residents and medical students just how hard med school can be (try reading the Don't Become a Doctor series on iFindings' blog, as an example). You'll learn what being pimped means and how med students react to it and the subtle, unspoken rules involved. You'll hear about the most exciting moments in the OR, what it's like to be sued and sued again, learn from the mistakes of medical students and read what residents wish they had done differently. As well, you'll learn more about different health care professions if you take the time to read their blogs, fulfilling piece of advice #6. Beyond that, medblogs can give you a perspective on how these different professions work together in the same problem - see, for example, the story Perspectives, written in three parts: part I by a cop, II by a paramedic, and III by a nurse. And, you'll get involved with the profession in a unique way - by engaging in discussion, leaving comments and e-mailing blogging doctors, you can get 'face time' and advice from physicians that you might not get elsewhere.


3. Make sure that going into medicine is your own decision.
Are you doing this because an expectation has been imposed on you by your friends or family? Is this a dream you once had that has now faded, but it's just too hard to tell everyone that you are switching career plans? If you do go into medicine just to satisfy someone else's plan for your life, you are going to hate yourself, and you'll have nothing to keep you going when you have to give up everything for medicine.


2. Marks come first. You can always add volunteer activities after you graduate; you can't go back and increase your undergraduate GPA.
You don't want to look back on a year or a degree and say, "Those marks don't reflect my true potential...I wish I would have worked harder." My dad has told me over and over again of a man he knows who wanted to get into medicine, but when it came down to applying, his GPA was too low because he'd had more fun than study time in his first year of university. More than a few times I've been having conversations with people who say "My brother / cousin / friend tried to get into medical school, but couldn't..." and often it ends up being a GPA issue. Some people end up having to take a master's degree just so that their undergrad marks aren't considered... they have to work extra hard to make up a first semester where they played more billiards and pranks than studied, or a year when they didn't figure out that they understand organic chemistry until the last week.

1. Be 1000% sure that medicine is what you want to do.
...and make sure that you've completed #7 so that you are making an informed decision. Please do not go into this profession if you aren't completely and utterly sure that this is what you want to do. You'll only end up hating yourself for it, and if you stay in the profession, everyone around you will hate you, too.

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Question for Vitum: Should I take a MCAT course?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Which course should I take, Kaplan or Princeton Review?

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

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

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

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

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