Applying to Medical School

Gearing up

Having come to the conclusion that medicine is an appropriate career for you, it is vital to become mentally charged up to face the potential changes in your lifestyle that may be necessary on the long road toward admission into medical school. It therefore, is necessary for you to:

• • decide to remain calm, regardless of any problems that may arise. In other words, never panic, no matter what obstacles you come up against. By maintaining your composure, you will more easily be able to resolve the issues that may arise and find solutions to the problems that lie in your way.
• • prepare yourself mentally by recognizing that you are facing a lengthy, stressful period in which you will, by necessity, be competing against other able applicants for a place in a freshman medical school class.
• • carefully review all the potential issues that you can anticipate and plan how you might possibly respond to them in a constructive manner, in order to overcome any difficulties.

How to Apply

Traditional Application

There are currently two means of applying — directly to the school and indirectly through the American Medical College Application Service (AMCAS).

Non-AMCAS Schools

The direct approach involves submitting a separate application to any school that is not a member of AMCAS. The application for each of these schools should be returned with a check covering the fee, which varies in amount from school to school. Table 6.1 in Chapter 6 gives the application fee for each of the non-AMCAS schools. The non-AMCAS schools requiring separate applications are

• Baylor
• Brown
• *Texas A&M
• *Texas — Galveston
• *Texas — Houston
• *Texas — San Antonio
• *Texas — Southwest
• *Texas Tech.
• University of Missouri–Kansas
• University of North Dakota

As is indicated by an asterisk (*), six non-AMCAS schools receive their applications through the University of Texas Medical System and Dental Application Center. For further information check the Web site www.system.edu/tmdsas.

AMCAS Schools

Most premedical students quite properly apply to a considerable number of medical schools. Originally it was necessary to apply to each institution individually, a time-consuming, costly, and cumbersome process. To expedite matters, the Section for Student Services of the American Association of Medical Colleges (AAMC) developed a booklet containing a lengthy standardized application form. Upon its completion, it had to be sent, along with relevant fees, to The American Medical Colleges Application Services (AMCAS), 2501 M Street, NW, Lobby 26, Washington, DC 20037, Phone: (202) 828–0600, mcas@aamc.org. The application, along with supporting transcript(s) and MCAT scores, was then duplicated and transmitted to all schools designated by the applicant. The cost to apply was determined by the number of applications submitted to AMCAS-linked schools. Currently, 115 out of 125 U.S. medical schools are affiliated with AMCAS.

The paper application system, while convenient, worked very efficiently for a long period of time. In the late 1990s AMCAS introduced an alternative electronic medical school application process. Starting in 2001, however, AMCAS mandated exclusive use of a Web-based application, hoping to be more efficient than the traditional format. Unfortunately, this new approach was plagued by serious difficulties. There were very lengthy delays in executing applications. This was especially frustrating for all concerned, since the Web-based application was designed to make the process smoother and quicker. Apparently AMCAS servers were unable to adequately cope with the high volume of incoming applications. Later, to relieve the congestion, computer servers were reconfigured.

The extraordinarily slow electronic application procedure induced an additional level of stress to an already tension-filled admission process. This situation forced some schools to revise their admission timetable, while others provided their own paper applications. As a result, a more reliable system will soon be available for applicants.

While completing your AMCAS application, consider the following suggestions:

1. Answer all questions carefully, accurately, and fully.
2. Use available space for comments judiciously.
3. Outline your motivation for applying to medical school (see page 3 and Appendix C, page 629).
4. Where clarification is required, such as a transfer to another school or a poor grade due to an illness, explain the circumstances appropriately.
5. Arrange to send your transcript(s) to AMCAS.
6. Request that letters of recommendation be directly mailed to all schools that receive your AMCAS application.
7. Make sure that letters of recommendation to AMCAS are identified by your personal AMCAS ID.
8. Use the AMCAS Transcript Request Form for submission of transcripts.
9. When applying to non-AMCAS schools (see Appendix B, page 621), submit individual school applications directly to their admissions offices.
10. For non-AMCAS schools, make sure that your transcript(s) and recommendations are sent to the admissions offices.
11. If browser-related problems occur while preparing your electronic AMCAS application, try to change from Internet Explorer to Netscape or vice versa.
12. You cannot simultaneously apply through AMCAS for both standard (MD) and combined medical/graduate (MD/PhD) degree programs at the same medical school; however, you can do so to different institutions.
13. After applying, if you wish to designate additional medical schools to receive your AMCAS application, it is necessary to resubmit your application.
14. Make sure to enter all official transcript grades in the application.
15. Determine if there is a grading system conversion applicable to your situation.
16. Enter an estimated end date for postsecondary experiences you are involved in at the time the application is being completed.
17. Repeated postsecondary experiences should be entered only once.
18. Check drop-down menu before making the choice of “other” to identify your race.
19. Make sure that your e-mail notifications are not blocked by filters used by some e-mail providers. Do this by turning the filter off or having a junk mail file.
20. It is essential that you keep a printed copy of your application for future reference in order to insure against loss due to an unforeseen computer crash.

When to Apply

The earliest date when medical schools begin accepting applications varies; the exact dates for each school are indicated in Table 6.1. As a rule, your application should be submitted in July or August of the year preceding your planned enrollment. Naturally, the earlier your application is received, the earlier you will receive consideration. Thus, in the case of superior students, it may ensure an early acceptance that would reduce anxiety and make it unnecessary to apply to additional schools. Moreover, prolonged delay in applying means that you will be competing for a smaller number of openings since part of the class may be filled by the time your application is received. Deadlines for receipt of applications at each college are also listed in Table 6.1.

Early Decision Program (EDP)

From the students' point of view, applying to medical school is both an expensive and an emotionally trying experience. From the medical schools' point of view, selection is both a time-consuming and laborious process. To reduce the burden somewhat for both parties, the procedures of early decision have been introduced and adopted by some schools. Thus, if you are anxious to attend a particular school and you feel that you have a good chance of gaining admission, you should submit your application before the early decision deadline (usually August 1) to the selected school (but to none other at this time). Once your supporting data have been received, an interview will be scheduled if desirable and a prompt decision will be sent to you (usually about October 1). If this decision is in the affirmative you are obligated to accept the offer and refrain from seeking admission elsewhere. If you are rejected, you can then go ahead and apply to as many schools as you wish. Only if you have a sincere interest in attending a particular school and only if you have a good chance of being accepted should you use the early decision approach.

Medical schools participating in the early decision plan are indicated in Table 6.1. It should be realized that schools offering this option will fill only a part of their freshman class by this means. The remainder of the places, which will probably be the bulk of the class, will be filled by students applying under the standard procedure.

How Many Schools to Apply to

There are over 125 U.S. medical schools. Most of these will undoubtedly not be suitable for you to apply to because a very large number of schools offer places almost exclusively to their own state residents. This makes you eligible for admission only to schools in your home state as well as privately owned institutions nationwide. Many individuals, for a variety of personal reasons, are not willing or able to relocate very far from their existing residence. In addition, private schools are very costly and thus may be out of range, especially for those not willing to run up a large debt. Prestigious medical schools are inundated with very highly qualified applicants, making it extremely challenging for an average, solid applicant to secure a place. All of these factors significantly reduce the number of medical schools potentially available to you.

Making matters more difficult in this regard is the fact that the list of prospective schools will shrink further if you eliminate minority-run schools and institutions designed to develop a specially focused physician, such as primary care or research-oriented one. Nevertheless, your choices of prospective schools, while reduced, will still be adequate in number.

When selecting from the preliminary list you formulate, your approach should be to:

1. Apply to your state schools but only if you would seriously consider attending if accepted, no matter what the location. Thus, for example, not every New York City resident will apply to SUNY — Buffalo when there are state schools nearby (Stony Brook and Downstate).
2. Apply to schools where, for some reason, you can be considered equivalent to an in-state resident on the basis of an existing cooperative program (such as WICHE).
3. Using Table 6.1, identify which schools on your tentative application list accept students with a GPA and MCAT scores in your general range and also are affordable.

These three steps will help narrow down your list to those schools to which you have the best chance of being admitted. Once this prospective list is prepared, you may wish to take into consideration the other factors discussed in the next section to, if necessary, further narrow down your choices to a desirable number.

The actual number of schools you should apply to is suggested in Table 4.1; this table should merely serve as a general guide. You can apply to more or fewer schools, depending how comfortable you think you are with the choices you make.

Regarding whether to apply or not, which is relevant to a borderline student, the basic rule of thumb should be whether you believe that you have even somewhat of a chance to get in. If you do, then don't even hesitate to apply, even if your chances are remote. If you don't make it, you will never say in later life that had you applied you might have gotten in. Should you not get in, you still have a good number of options, such as reapplying or applying to an allopathic school or seeking entrance to an osteopathic or foreign medical school (see Chapters 13 and 14), or obtaining a doctorate in one of many health-associated professions. (See page 102 for more detailed advice.)

Table 4.1 RELATIONSHIP OF ACADEMIC RECORD TO SUGGESTED NUMBER OF APPLICATIONS

Academic Record	Number of Applications
A− to A+	5–10
B+ to A−	10–15
B to B+	15–20
C to B	20–30

Where to Apply

The decision as to which schools to apply to is in part determined by the total number of applications you plan to file. The estimated national average for the past 20 years has remained 9–10 per applicant. The actual number you should send out is best determined by your financial means and a realistic evaluation of your chances for gaining acceptance. One of the financial considerations that should be taken into account is the cost for out-of-town interviews.

Table 4.1 offers a generalization regarding the number of applications that should be submitted in accordance with your academic record. The exact number of applications within each range should be determined by financial considerations, test scores, and possibilities for favorable interviews. A large volume of applications may be less important than selectivity as to which schools you should apply to since, in many cases, applications to some schools for some students are a waste of time, money, and effort.

Consider the following criteria when determining which schools to apply to.

• • School's track record. Where have students from your undergraduate college been accepted in recent years?
• • Finances. Which schools can you afford to attend? Determine what your financial means are and exactly how much you can pay for tuition and living expenses without overextending yourself excessively by borrowing too heavily.
• • Location. Which schools are located in areas that meet your personal needs? Do you prefer a large metropolitan area or a smaller town environment?
• • Out-of-state schools. If you are planning to apply to an out-of-state school, does the institution accept a significant number of nonresident students? Consider the possibility of attending a suitable school located further from home, even though it may not be the choice of your fellow students. This may enhance your chances.
• • Curriculum. Determine whether the school's curriculum is amenable to your style of intellectual endeavor. Carefully evaluate it to determine if you find it most appealing, challenging, and stimulating. Review the school's performance in Chapter 7.
• • Mission. A key piece of information that you should seek, is to uncover the school's mission. Does it focus on producing primary care physicians, clinicians, or research-oriented doctors? The school's literature and Web site may clue you in as to the type of physician the school aims to produce. School profiles are also useful.
• • Class size. Regarding class size, the faculty-to-student ratio for the preclinical years is important, as well as whether there are adequate clerkships available for training during the clinical years. To get answers regarding these two issues, contact current medical students or alumni. Ask your advisor for suitable individuals that must be contacted.
• • Teaching. Be sure to become familiar with the teaching methods used at the schools you are considering. There currently are a variety of approaches being used, aside from the traditional lecture-laboratory sequence. These include problem-based learning, integrated teaching, and computer-assisted teaching/learning. The school's Web site, as well as its profile, should be able to clarify this issue.
• • Evaluation. It is also important for you to learn what student performance evaluation methods are used. There are generally five different types used in medical schools: multiple-choice exams, oral exams, structured patient exams, computer-based simulation exams, and personal observation. Different types are used, depending on the course. Check the school literature regarding this issue. In addition, the national standardized tests, required by almost all medical schools, are the USMLE and the objective structured clinical examination (OSCE). You may wish to learn to what extent they are required for promotion and graduation.
• • Grading. Another consideration of interest is the nature of the grading system employed by prospective medical schools. There are two basic systems currently in use: a numeric/letter or pass/fail. Some institutions use a combination of both grading systems, with the least significant courses usually employing the pass/fail standard. The pass/fail approach is currently favored by most medical schools since it serves to diminish the level of stress at examination time. It also encourages the student to focus on learning rather than on just achieving good grades. To facilitate the residency evaluation process, most schools currently are using a three-tier grading system: honors/pass/fail, which probably approximates the letter grades A, B-, F. This approach facilitates better differentiation between students when recommendations for residency appointments need to be prepared.
• • Faculty. To judge the overall quality of the school's faculty is quite difficult. For prospective women medical students, it may be of interest to note that on average, 25% of preclinical and 30% of clinical faculty currently are women. The percentages at a school you are interested in may have some implications as to your comfort level at the institution. This information, obviously, should be taken in thecontext of the number of women enrolled in the school, which likely is the major consideration relevant to this entire issue. Tables 6.1 and 9.1 can provide you with this information for the preceding academic year.
• • Reputation. A school's reputation can, to some degree, influence one's chances for securing a residency. How important this factor is depends on how competitive the specialty is. The Dean of Students at a medical school, upon request, may be prepared to inform you as to the school's residency placement for the last graduating class. This data will allow you to determine how many residency appointments of the school's graduates were secured at prestigious training institutions.
• • Attrition. A final factor that might be of possible interest is the attrition rate at the school. Nationwide, it has been calculated that less than 3% fail to graduate for academic or other reasons. If you wish, you may inquire from the Dean of Students office about the attrition rate at his or her school. But based on national statistics, you can assume that once you gain acceptance and enroll in medical school, the odds are very much in your favour that you will in due course be awarded an M.D. degree.

After reviewing the above criteria, determine which of them are most significant for you. Obtain and take note of the data regarding the issues of concern to you, then make a determination of each school's suitability. Prepare a prioritized list of schools, based on the recommendations in Table 4.1 and use this list when filling out your AMCAS application.

Advice to Borderline Applicants

Your GPA and MCAT scores, as discussed earlier, are the key factors impacting on your chances for admission to medical school; therefore, these two parameters should provide guidelines for future action.

• • If you have potential acceptance-level credentials, namely a GPA of at least 3.5 and 9s and 10s on your MCAT, then you should definitely apply. This obviously assumes that you have such attributes as motivation, competence in science, and a desire to serve others.
• • If you are a borderline applicant, having a GPA of 3.3 and 9s or less on your MCAT, then your admission chances are uncertain or precarious. Under these circumstances: (1) elect to apply to an increased number of medical schools (see Table 4.1); or (2) consider postponing applying until your academic record improves.
• • If your science cumulative average is weak (less than 3.3), taking some advanced science courses and doing well (B+ or better), will improve your position. Your choice of courses clearly should be in an area where you have already demonstrated academic strength.
• • If your MCAT scores are week (9s or less), retaking the exam may be advisable. This is valid only if you and your advisor believe that the scores will definitely improve. This can be done preferably in the fall of your senior year (which allows the preceding summer for test preparation), or if necessary, in the spring of your senior year; then apply soon after graduation.

A borderline candidate should determine the following:

1. Is your essay impressive enough? Does it maximize your admission potential? Find this out by getting an opinion from your premedical advisor and/or an English professor, then make any necessary improvements.
2. How strong is your school's track record in getting people into medical school? Where have your school's applicants been most successful? Don't hesitate to contact your premedical office, which should have this information and be willing to provide it. This will clue you in as to where it is most worthwhile applying.
3. How supportive do you think your recommendations will be? Have you selected the most suitable faculty to write on your behalf? Talk to those who know you well and think highly of you. Explain your borderline situation regarding admission and ask them for as strong supporting letters as possible.
4. How adequate are your financial resources? Could you afford to apply to more schools than originally planned and, if necessary, in more than one academic year? Talk to those who are assisting you financially to see if this is feasible.
5. How strong are your interview skills? How well do you perform on mock interviews? Ask your interviewers for their frank criticism. Strive to improve your interview potential to an optimal level.

In the event you decide to defer applying, your time can best be spent, besides taking courses, for research work at a medical school. Where possible, this should be at one to which you plan to apply and stand a chance of getting in. An impressive recommendation from a faculty member can help facilitate admission at any medical school. The downside of this approach is that you will have to invest two years beyond college, one to do your research and a second to apply and await the result.

In summary, a borderline applicant can best determine the desirable course of action by judging how far away he or she is from the threshold for admission, as defined above. If you are relatively close and the other factors are positive, such as essay, recommendations, and interview skills, it may well be advisable to apply. This is especially true if you can afford, if necessary, to try again. Try to obtain impressive grades in your lower senior year. These should be sent off in January to all medical schools to which you have applied. If, however, you are a substantial distance from the borderline acceptance level, deferring applying may be the wiser alternative. Taking additional courses and/or securing a research position should improve your chances for admission. In any case, before selecting from the various options available, discuss this issue thoroughly with your premedical advisor. In addition, it may be worthwhile to consult an authoritative individual at the admissions office at a local medical school. This matter merits careful consideration before you finalize your future path.

The Essay (See also Appendix C)

The AMCAS application is four pages long and the questions asked are straightforward. Detailed instructions are included.

Page 2 of the application is entitled “For Personal Comments” and is completely blank. It enables you to communicate directly with the admissions personnel who screen the applications and with those who evaluate the candidates. Your essay can thus be considered your brief or appeal for a place in the next freshman class. It affords you the opportunity to express yourself and to present your attributes in the most appealing manner possible, so the reader will want to get to know you personally by means of an interview.

One approach to drafting your essay can be to itemize all the information you wish to convey: biographical highlights, motivational factors behind your career choice, significant life experiences, and information about yourself or your past performance that needs elaboration or clarification. Having identified the key elements, you can next proceed to preparing a preliminary draft. The lead and concluding paragraphs probably deserve special attention since they will more likely be read during an initial scan of your essay. Once the draft is prepared, put it aside for a few days and then reread it and revise it as much as you feel is required. You may want to repeat this once again before your rough draft is completed.

You should next seek one or more outside reviewers to read and frankly criticize your essay. This may come from an able senior premed student, an English professor at your school, a young physician, or your premedical advisor. Since the essay is yours, you have the final decision of how much to revise your draft essay. You should realize that the more people you ask, the more pressure for revision there will be. Thus, a reasonable cutoff point is desirable; that is, when you are satisfied that your essay presents an honest image of you in the best possible light. When you reach that point, have your essay typed neatly and accurately and make sure it stays within the allotted one page.

There is no “ideal” essay; the samples of conventional and unconventional essays shown on pages 104 and 106 are designed only to give you an insight into what other premeds have written. If your essay “sells” you as a potential attractive candidate, you have done your job. Appendix C contains sample essays that will be very helpful.