Preparing for Medical School

You should realize at the outset of your college career that every medical school admissions committee will initially screen your application by viewing your grades as a whole. This is expressed by your grade point average (GPA), which simply represents the total of your average for each academic year divided by the number of years you have attended college (usually three at the time you apply, plus any summer school work completed). Then your science course average, your achievement in your major and in the more challenging premedical requirements (such as organic chemistry and physics), and honors work or independent study are all scrutinized. This means that it is imperative that you apply all your talents (and remedy any deficiencies) at the time you begin college studies. It is risky to wait until you are faced with serious academic problems to decide to buckle down to the demands of your courses. It is difficult, although certainly not impossible, to rectify the results of one unimpressive semester, let alone an entire year. Thus, for example, a B or 3.0 for your first freshman semester will give you a maximum B+ or 3.5 average for the year only if your second semester is straight A or 4.0. Similarly, a 3.0 for the entire freshman year would demand a perfect sophomore year to bring you up to a B+ level. In addition, a mediocre semester or a mediocre year can seriously undermine your self-confidence and raise doubts about the wisdom of your career decision. This type of situation is undoubtedly one of the underlying factors in the significantly high incidents of changes in majors among freshman premeds.

Your Major

Historically, premedicine has changed to keep pace with advancements in medical education. In colonial America, premedical education as such was nonexistent. However, as medical education became more sophisticated, so by necessity did premedical education come into existence. During this century there have been varying trends in premedical programming. The older school of thought was that a specialized preprofessional program was mandatory. As a result, a formal “premedical major” with a prescribed program of study was established. A strong movement away from this approach began in the mid-1950s. Students were encouraged to select any major that was of interest, but if it was in one of the sciences (as was frequently the case) they were also urged to obtain broad exposure to the humanities and social sciences as well. Currently the pressure, due to diminished time allotted to the basic sciences in medical school, has given impetus to encouraging students to complete more science courses in college, so that the pendulum has swung somewhat in the direction of a science major. While completing ascience major, students automatically take the required premedical courses.

The specific choice of which science to major in is yours alone. You should, before making a decision, evaluate your school's science departments in terms of their requirements, quality of teaching, and grading attitudes. To do so, you should read the school catalog and talk to faculty members and senior-level students. The choice should be the one in which you will be academically most successful and in which you stand a good chance of developing a good relationship with members of the department staff. A correct decision as to your major will help ensure that your GPA, science cumulative average, and the quality of your recommendations — three critical medical school selection factors — will be strong.

Most premedical students major in biology (zoology) or chemistry, but some major in biochemistry, physics, or even computer science, all of which have a relevance to medicine. However, choosing to major in a science unrelated to the art of healing, such as geology or engineering, will certainly not impede an applicant from gaining admission.

It should be strongly emphasized that being a nonscience major is not a liability so far as medical school admission is concerned, but may even be an asset. Humanities majors, although representing the smaller segment of the applicant pool, have as good an admissions track record as science majors. Thus, should your current interest lie in the classics, foreign languages, history, or philosophy, and your career goal is medicine, you should pursue a humanities major and seek to develop an attractive set of credentials supported by solid achievement in the premedical science prerequisites. This approach is especially valid now that medical educators are stressing the importance of developing and retaining the humanistic attributes as medical and postgraduate students. Thus what is critical is not your major, but the nature of your achievement and development as a college student.

These remarks should alleviate the concerns of those who fear that being a liberal arts major would impede their chances for admission into medical school. Another factor influencing prospective medical students against becoming liberal arts majors is the concern that they would then be less competitive in facing the demands of a science-oriented curriculum. A comparative study of science and nonscience majors from three medical schools has shown, however, that this is not the case. This conclusion was based on performance on both parts of the National Board Examination (now USMLE) and on clinical-year grade point averages. There is no reason not to assume that the same is applicable to medical students as a whole. This finding should further encourage college freshmen to feel free in their choice of a major.

In support of the conclusion mentioned above, it is useful to consider the relevant statistics with regard to the choice of a major by recent acceptees to medical school. It was reported that they fell into groups.

These findings demonstrate that while the overwhelming majority of acceptees (70%) were science majors, a significant number (at least 17%) were not. These facts demonstrate that the acceptee is no longer almost exclusively made up of science majors, as it was for many decades. Thus, prospective applicants can, under appropriate circumstances, seriously consider majoring in one of the nonsciences if their interests and talents encourage them to do so.

Bottom Line

The following considerations should be taken into account when choosing a major:

• • Past experience indicates that you have talent in and interest in the area.
• • You have good reason to believe that you would enjoy the subject matter.
• • You could be able to utilize the knowledge obtained in the major, if you were to drop out as premed or not get into medical school.
• • You should be able to meet all basic premedical requirements at the same time as fulfilling those of your major.
• • As a nonscience major, you will need to demonstrate your strong ability in the basic premedical science courses.
• • If you do not major in science, it is preferable to select an area that is “people”-oriented.
• • It is appropriate to take a biochemistry course, regardless of your major, since it can prove to be a significant help in lightening your first year of medical school.
• • In whatever area you focus your efforts, develop good problem-solving and critical-thinking skills; they will be vital assets in medical school.
• • Organic chemistry courses, while in themselves are of little future benefit, are essential areas of study for the MCAT, which is critical for admission.
• • Be flexible when choosing your major by preparing options that may be used if the situation calls for it.
• • To protect your future interests, you should also have an alternative career choice. This will allow you to remain calm in the face of any unforeseen adversity, which is a key to success.

Premedical Requirements

Regardless of your choice of a major, you should arrange to include the basic premedical science courses plus lab requirements, namely, two years of chemistry and one each of biology and physics, in your first three years of college study. The purpose of premedical science course requirements is twofold: (1) to determine the compatibility between the student and science, since medicine academically is the science of the human body, and (2) to provide the premedical student with a background on which to launch future studies in the basic medical sciences.

The required premedical science courses you take should not be those designed for the nonscience major. If possible, stagger your laboratory courses so that you don't take too many at one time. These courses require additional time both in the laboratory and outside of the classroom. However, none of these courses should be deferred to the senior year. They are all needed in preparation for the MCAT. One or more of these courses may be in progress when taking the spring MCAT.

The science course requirements are purposely limited in order to allow broad latitude for the planning of individualized programs. Table 3.1 lists the courses required by medical schools.

You need to recognize that you should strive for at least a 3.5 (B+) science commutative average; this will keep you competitive during the admission process. To maximize your chances of obtaining superior grades, you should avoid registering for courses catering to specialty students (such as inorganic or organic chemistry for chemical engineers). Similarly, avoid courses whose instructors are known to be outrageously demanding or have a reputation for rarely giving out As. If really necessary, take a course in summer school or even at a community college, but do not do so for the majority of your science course requirements and certainly not for all of them. This will generate a “red flag” when your record is reviewed, and require an explanation. Moreover, it would mandate your getting especially attractive science subtest scores on your MCAT to confirm your abilities in the sciences.

It should be noted that some advanced science courses, as well as some nonscience courses, while not officially required for admission by some schools, may nevertheless be listed in their catalogs as “recommended” or “desirable.”

In summary, while the premedical core studies in the sciences will usually absorb the greatest portion of one's time and energy, one must place these in the proper perspective of the entire program of undergraduate education. For just as the patient should be viewed as a whole rather than as merely a collection of organ systems, so too should the person be educated as a whole in order to face both the academic as well as the nonacademic challenges that lie ahead. In essence this means that the student should attempt to secure a meaningful balance between the physical and biological sciences, and the humanities and social sciences. In this way, not only will the college experience be more pleasurable, but also one's sense of purpose and ethical values will be developed, and a more humanistic physician can evolve in a mechanistically oriented society.

Special Educational Opportunities

Most liberal arts colleges offer special educational opportunities that can enhance the character of your program of study. These programs not only improve the quality of your college educational experience but also increase the strength of your medical school application and thereby improve your admission chances. You should not arbitrarily utilize any of these programs but should incorporate them into your program only if you are sure that they will definitely help you attain your career goal. The six special programs discussed below are advanced placement credit, honors courses, independent study, graduate-level courses, pass/fail courses, and summer school courses.

Advanced Placement Credit

When a student has acquired advanced placement credit for excelling in a science on the high school level, one or more required premedical courses will be waived. As a result, there will be a gap in grade information in this area. It is frequently desirable in such cases to substitute a suitable number of elective courses for the waived courses. You should select substitute elective courses carefully, determining that your high school background is adequate, and discussing the course requirements with the instructor. You should also consider auditing the basic science course from which you have been excused in advance of taking the elective; this would not only provide a useful background but would also enable you to develop a set of lecture notes that could prove helpful for review when you are studying for the MCAT. For example, if your general biology requirement has been waived, you should review the principles of biology by yourself or audit a course if possible. This preparation is essential, even if you do not major in biology. In this case, your elective course grades will serve to indicate to the admissions committee your academic potential in this important area. If you do major in biology, a good grounding in its principles will serve you well for a variety of electives you choose during the course of your studies.

Honors Courses

There is no question that completing an honors section of a course can strengthen your admission potential. This, however, is true only if you get an A in such a course. Receiving a B grade may serve to depress your GPA (and, where applicable, your science average) even though in reality a B in an honors section may be equivalent to an A in a standard section. In some cases, however, grades for honors courses may be weighted, in order to provide an equivalency factor. Thus, before enrolling in an honors section, you should determine, by talking to the instructor and students involved in the course, just how much additional work it requires and how the grade is evaluated. If you have the time and are confident of your ability to master the requirements, then enrolling in an honors section is reasonable. In any case, the honors credit should be noted in your application documents. The course can be educationally rewarding and provide a good source for securing an impressive letter of recommendation.

Independent Study

Another approach that can add significantly to the attractiveness of your credentials is satisfactory completion of an independent study program. Such an undertaking can demonstrate that you are willing and able to accept the responsibility of a special educational challenge. Your motives must, however, be sincere so that you will apply yourself maximally in order to ensure that your research is impressive and is completed on schedule. As a result of such an activity you will undoubtedly develop a special favorable relationship with your mentor, who will then be able to strongly support your candidacy for admission to medical school at the appropriate time.

Independent study should be undertaken only if you are sure that it will not have a negative impact on your educational responsibilities as a whole. You need to be especially careful in selecting a project that can be realistically completed by the date you set. It is best if you can complete any independent study project before you apply to medical school so that recommendations resulting from this work can be submitted when they can be most effective. A good time to carry out such a project may be the summer after you complete your junior-year studies. By then you should have completed all your premedical science course requirements and satisfactorily taken your MCAT. You only remaining commitment will be preparing your application(s) to medical school. There is no objection, if time is available, to undertake independent study during the regular academic year.

Graduate Courses

Occasionally, the option of taking a graduate-level course is available to undergraduates. You should not assume, unless specifically told, that you will be graded differently from the graduate students taking the course with you. Thus the note of caution regarding the impact of the grade applicable here. Graduate courses can be demanding, and successful completion of such a challenge can demonstrate impressively your ability to respond effectively to the academic challenge of medical school. If you do successfully complete graduate courses, make sure to bring it to the attention of the medical school by noting it on your essay or in your interview.

Pass/fail Courses

These are courses that your school permits you to take for credit without getting a grade. It is not advisable to take any courses in biology or chemistry on this basis since the implication would be that your level of performance was not satisfactory. Thus while the absence of a grade would preclude any negative impact on your GPA and science average, your image could suffer. On the other hand, taking a medically unrelated science (such as geology) or a nonscience course of special interest on a pass/fail basis is quite legitimate. It shows evidence of your desire to secure a broad education, which certainly is desirable.

Summer Courses

There is no inherent objection to the completion of courses during the summer. Moreover, it may prove useful or even desirable to do so in order to get some required nonscience courses out of the way and thereby lighten your course load during the regular academic year. Thus some students take one or two nonscience courses at the end of their sophomore year so they can lighten their course load during their junior year when they have to take organic chemistry or physics and also study for the MCAT.

It may even prove advantageous to take one or more science electives during the summer, if they are not offered at your school during the regular academic year, or if you cannot fit them into your schedule. In addition, summer electives can help improve your science average. Thus if your BCPM (biology, chemistry, physics, and math) average comes close to a critical level, taking summer courses can bring these figures up. It is worthwhile to consider attending summer school to do so. Again, it is important to realize that it can take an A or two A's to do this, and that special care needs to be taken before utilizing this double-edged option.