Applying to Medical School

The admissions process is theoretically geared to recognize applicants who measure up to a hypothetical image of the person who, in the consensus of the medical school's admissions committee, will prove to be a successful medical student and in time a qualified and dedicated practitioner. Those who are accepted may not have all the qualities that a committee seeks. There may even be some areas of weakness in a candidate's profile. The weaknesses, however, can be offset by strengths in other areas so that on balance the applicant's overall picture is one that meets the standards that each school sets. In other words, one need not be the ideal candidate in order to achieve success.

It should also be realized, as was implied earlier, that some applicants may, at first glance, possess an impressive array of qualifications but nevertheless do not succeed in gaining admission. These candidates unfortunately proved unable to effectively project to the committee, either indirectly through their application or directly at their interviews, all the strengths they possess. Having solid credentials and being able to market yourself as a prospective good physician make up the winning combination that will open the door to a place in a freshman medical school class.

Some selection factors, such as GPA or MCAT scores, can readily be put into quantitative terms, while others, such as personality or motivation, cannot. Nevertheless, both types of factors are important and have a strong bearing on the outcome of the admissions process. Specifically, they determine if you qualify to be placed at some point into the applicant interview pool and at a later time into the applicant acceptance pool.

Academic Achievement

Academic achievement is measured in terms of your grade point average, science course performance, and college(s) attended.

Grade Point Average (GPA)

The application that each medical school receives on behalf of an individual applicant will contain a facsimile of the candidate's college transcript and, where applicable, any postgraduate record. It will show the courses taken and grades received during the regular academic year as well as during any summer. (Those high school courses and grades for which advanced placement credit were given are also listed.) Courses that the applicant is taking or is planning to take are also frequently requested. This self-designed record is checked for accuracy against official transcripts sent by your school and will form the basis of your GPA.

Recently, with the competition for places in entering classes intense because of the large number of applicants, the GPA for the average matriculant was 3.5. This can be interpreted to mean that a significant number of the approximately 16,000 students accepted — which represents only 35% of the applicant pool — had an average below 3.5. On the other hand, the entire pool average was 3.3. This indicates that some applicants with 3.5 or higher failed to gain admission, thus emphasizing that a high GPA by itself does not guarantee acceptance into medical school. The corollary is also true, namely, that having an average below 3.3 also does not mean you will not be accepted. As a matter of fact, 5% of those accepted had averages of 3.0 or less. All this suggests that your chances will be markedly diminished if your average goes below 3.3. The lower the GPA, the greater the need to compensate for this weakness by high MCAT scores and recommendations. Also, achieving improved grades in the later years of college, especially in the sciences, will contribute to a more favorable reception of your application. All this emphasizes the fact that you should not view the GPA as an entity in itself; rather, it has to be taken along with all other considerations, and a low GPA by itself should not discourage you from applying. Therefore, the quantitative factors will remain a very vital, and for most applicants, a critical element of the selection process. You should strive to attain as high a level of achievement as possible. This is essential because passing the initial admissions screening is usually dependent on your academic achievement.

While the GPA is one of the major factors examined as part of the initial screening process, it is usually viewed in the context of the applicant's overall educational data. The reasons are that the GPA is subject to grade inflation, is relative to the college attended and the course of studies pursued, and only represents an overall level of performance rather than the direction of the performance.

Medical school admissions officers know that grade inflation — namely, artificially high grades that do not accurately reflect the level of academic achievement — is a common phenomenon of undergraduate education. Thus, while they do not minimize the value of a high GPA, they do not necessarily take it at face value. Admissions officers seek to establish how authentic the GPA is by checking to see at which college the grades were earned. Therefore, an applicant with a good GPA attending a college with low admission selection standards will not be much better off than another applicant with somewhat lower grades who is enrolled at a more selective school. Also, the GPA is viewed in the context of the applicant's course of study. An applicant who met the premedical course requirements by completing bona fide courses designed for science majors will obviously be favored over one whose courses were intended for nonscience majors. Similarly, an applicant who is successfully completing a science major will tend to be more credible than one who is not doing so.

The breakdown of an applicant's GPA frequently provides a more significant insight into an applicant's achievement than does the numerical value of the GPA. Thus, a consistent level of performance would tend to imply that this is the applicant's optimal achievement level. On the other hand, an erratic performance pattern, either upward or downward, may well reflect a person's response to the academic challenge being faced. An upward pattern suggests an ability to adjust to college, overcome an initial disappointing performance level, and then proceed to attain a high level of achievement even when the educational demands are increasing. A downward pattern would tend to indicate the reverse — namely, the inability to maintain a sustained high level of achievement in the face of increased educational pressures. In other words, when the values of GPAs are the same, a GPA with a consistently good achievement level and an upward pattern will have a greater impact on the screening and selection process than a similar GPA with a downward achievement trend.

Science Course Grades

The science course grades on your record are another factor considered in the admissions process. This is reasonable since medicine is the application of scientific principles that are intensively studied during the first two years of professional school. While a straight A science average is certainly not mandatory for admission to medical school, a solid level of consistently good performance (3.5 or better) will serve to demonstrate the potential to cope with the intellectual demands of the basic medical sciences.

Your science grades and the effort it took to achieve them will also help you evaluate your own abilities and the wisdom of your career choice. Incidentally, it is not essential to enjoy all your premedical science courses, but a genuine interest in science is essential.

It should be emphasized that just as the GPA's impact is relative to the college attended, so too is the science coursework judged. Similarly, the grade pattern for work completed over a three-year period can be of special value. Consistently good grades and an upward trend clearly present a positive image of your science potential.

College Attended

It has already been noted that the college attended affects the evaluation of an applicant's GPA and science coursework by the admissions committee. It also has an overall impact on admission chances in general, for three reasons. First, attendance at a university that has an affiliated medical school offers a degree of priority for acceptance into the university's own medical college, because medical schools traditionally accept a significant number of freshman from their own college. Second, it appears, at least statistically speaking, that an applicant from a private undergraduate institution has a greater chance of acceptance at a private medical school. Third, coming from a college that has established a good medical school admission track record is a decided advantage. There is an initial favorable bias because of the positive image that such an institution's name generates.

Intellectual Potential

Your academic performance, usually after a three-year period of undergraduate studies, provides a reasonable measure of your intellectual potential. Its usefulness, however, is tempered by the status of the school you attend, by the possibility of grade inflation, and possibly by the impact of pass/fail grades. For these reasons there are two additional factors considered in obtaining a comprehensive and reliable determination of the future performance of a medical student: MCAT scores and recommendations.

MCAT Scores

The Medical College Admission Test (MCAT) is a lengthy, standardized, multiple-choice examination that is given twice each year. It is designed to determine your skills in problem solving in the natural and biological sciences, your verbal reasoning ability, and your written expository aptitude. The MCAT is an indicator of your academic potential. The test is designed in such a manner that the value of memorization is deemphasized, while analysis and synthetic intellectual capabilities are tested. This clearly implies that one of the major goals in college should be to develop “thinking” skills in exactly these areas. This can best be done over an extended period of time rather than by cramming for a few weeks or even months, and/or depending on commercial MCAT preparation programs.

The MCAT score is particularly important because it provides a quantitative measurement that easily lends itself, together with your GPA (and science average), to a screening formula. Because of the large volume of applications, such formulas are used by some medical schools as a rapid preliminary evaluation technique. The formula baseline figure, which can be adjusted during the admission season, can determine if your application deserves more careful examination. This may involve reviewing your recommendations, essay, and extracurricular activities to determine the possibility of an invitation for an interview. The MCAT score by itself will also be used to assess the validity of your academic record. This is especially true when the problem of grade inflation exists and when the academic caliber of a school is unknown or uncertain.

The MCAT is therefore an admission obstacle that must be overcome by all premedical students because almost all schools require this examination (for exceptions, see for example, the University of Rochester or Johns Hopkins profile, Chapter 6). This examination should not be looked upon as a major admission barrier, but rather, from a positive perspective, as a potential asset that can enhance your admission potential. Therefore, if you have a high GPA, good MCAT scores will confirm your status as an attractive applicant and thus speed processing your application toward the interview stage. On the other hand, if you are a borderline or weak applicant, impressive MCAT scores can significantly strengthen the chance of having your application reviewed more thoroughly. It is at this point that your letters of recommendation will have a special influence in determining your true intellectual potential.

Letters of Recommendation

Letters of recommendation supplement the quantitative data provided by transcripts and MCAT scores. They add a positive or negative tone to the overall impression that your college work and aptitude test have established. All medical schools expect recommendations, preferably from your Health Professions Advisory Committee or from several natural science and other faculty members at your school.

Personal Attributes

Aside from your academic achievements and intellectual potential, a number of personal attributes can have an impact of varying degree on your admission chances. These attributes can be placed into categories, which will be discussed below.

Extracurricular and Summer Activities

See discussion in Chapter 3, page 48.

Exposure to Medicine

This factor was, in part, discussed in Chapter 3, Extracurricular and Summer Activities. It should be noted that in addition to unstructured observation and service opportunities as a hospital volunteer, some institutions offer formal premedical observation programs on a group basis. In the course of such a program, premedical students, like medical interns, rotate through various departments and may even be given lectures by attending physicians on the staff. Some programs provide a small stipend. These types of programs can provide an invaluable opportunity for prospective medical students, by permitting them a direct personal view of the actual world of medicine and the realities of medical training. To learn about such exceptionally meaningful opportunities, make inquiries at the volunteer office of local hospitals; also ask your premedical advisor or senior premedical students who may have already participated in such a program.

Special Achievements

Medical schools usually look for applicants who, for one reason or another, stand out among the large pool of qualified individuals seeking admission. Therefore, gaining acceptance into honor societies or receiving awards for scholastic achievement or service will strengthen your admission potential. Demonstrated leadership capacity will also enhance your appeal. Achievements such as serving as a student senator at your college, gaining election to an important student office, organizing a band, forming a volunteer group of students to visit the sick at your school infirmary or the elderly and handicapped in the neighborhood, or tutoring underprivileged youngsters would all be a strong plus on your credentials. These kinds of accomplishments demonstrate that you have initiative, concern for others, an ability to interact constructively as part of a team effort (a requirement for modern patient care), and the determination to succeed. All these qualities are desirable in applicants seeking to enter such professions as medicine.

Individual Status

Your individual status can have a significant bearing on your chances for admission. Five factors are involved: citizenship, state of residence, age, sex, and minority status. Each of these factors is discussed separately, below.

Citizenship

U.S. medical schools have more qualified applicants than places available to train them. Moreover, the tuition paid by medical students covers only part of the actual training costs, with the balance made up by the school, state, and federal funding. Consequently, medical schools naturally have as their primary obligation the training of U.S. citizens and thus only rarely accept noncitizens into their freshman classes. Applicants not holding citizenship status, including Canadians, are clearly at a great disadvantage when applying for admission to U.S. schools. This handicap can be somewhat diminished if the applicant can secure a green card and establish permanent residency status, as well as initiate the first formal steps toward citizenship.

State of Residence

The state where you reside is another major factor in determining your chances for success. Many state schools have significantly lower tuition levels for their residents and exclude nonresidents from admission as well. They have this policy because they are funded by state taxes and thus believe that their primary obligation is to train professionals who not only live in the state but who are likely to set up practice there. The state of your residence should be carefully considered when the time comes to make up the list of schools to which you plan to apply.

If your state has only a few medical schools, you need not consider this an insurmountable obstacle because there are quite a few private schools that do not discriminate against out-of-state residents, although they may demonstrate geographical preferences to applicants from a general section of the country.

To be classified as a legal or bona fide resident of a state, you usually must maintain domicile in that state for at least 12 months preceding the date of first enrollment in an institution of higher education in that state. Student status at an institution of higher education (for example, as an undergraduate) does not constitute eligibility for residence status with regard to graduate-level work in the same state. You must maintain residence in a non-student capacity for the prescribed time in order to gain residence status. The student's eligibility to establish residence is also determined by his or her status as an adult or a minor. (A minor is any person who has not reached the age of 21, 18 in some states.) For minors, the legal residence is that of his or her parents, surviving parent, or legal guardian. As a result of Supreme Court rulings, the right of state schools to charge higher fees for out-of-state students has been upheld, but it may now be easier for such nonresident students who are 18 or older to establish legal residence and thus take advantage of the lower rate.

Two groups of states generally offer prospective applicants a statistically better chance of admission: those with many freshman places and relatively few in-state applicants (such as Illinois and Texas) and those with no in-state medical school but with special admission arrangements with other state schools (such as Maine and Wyoming).

Age

Medical schools prefer applicants who are in the 20–25 age group. Exceptions are made for select individuals, but the upper acceptance limit is usually about 35. The most favored applicants of the older group are those whose postcollege careers have been associated with medicine: research assistants, physician assistants, graduate students in one of the biomedical sciences, or holders of advanced degrees in one of these areas. Less attractive are applicants who would like to give up established careers as dentists, podiatrists, engineers, lawyers, accountants, or physicists, and who now seek to become physicians because of personal disillusionment with present activities. The latter group, seeking a career change instead of personal advancement, represent a higher risk than the former, because of concern that the pattern of giving up one's existing career might be repeated at a later time when this same individual is in medical school, training, or practice.

In the light of the aforementioned, an applicant whose age is above 25 (and preferably under 35) should present solid credentials in science course requirements, acceptable MCAT scores, good evidence of familiarity with the demands and responsibilities of a medical career, and above all, very convincing reasons for giving up a current career and seeking one as a physician (see Appendix A, page 618).

That there exists a significant pool of postbaccalaureate students who become premeds is evident from the fact that there are many schools (see list in Chapter 3) that offer special programs designed so these students can meet the premedical science course requirements. In addition, the University of Miami may offer advanced placement for those having a science PhD. Thus, it is possible that highly motivated and well-qualified career changers can succeed in spite of inherent difficulties, if they can establish a strong case for themselves and present it effectively.

Sex

The applicant's sex can influence the admission process. All medical schools accept both males and females as applicants and most encourage strongly motivated and well-qualified women to seek admission. Women currently make up at least 40% of the national freshman class admitted. Some schools are more liberal in admitting women than others (see Table 8.1). A detailed discussion of women in medicine is found in Chapter 8.

Minority Status

If you can claim minority status — namely, if you are African-American, Native American/Alaskan native, Mexican American, Puerto Rican, Asian or Pacific Islander, or other Hispanic — you will be given special consideration, because most schools actively seek to enroll minority group members in their freshman classes. As a result, minority students currently make up about 10% of the national freshman class. A more detailed discussion of minority opportunities can be found in Chapter 9.

Disability

Reliable surveys indicate that there are over 100 medical students with disabilities and upwards of 1,000 physicians-in-training with physical or learning disabilities. In 1970 Temple University Medical School in Philadelphia accepted a blind student who is currently a practicing child psychiatrist. The goal of disabled students is to gain admission on their own merit, and to secure reasonable accommodations from the school in order to be able to attend it. However, what constitutes “reasonable” accommodations and whether severely impaired students can be adequately trained has been a subject of considerable debate. The Americans with Disabilities Act (ADA) has greatly enhanced educational opportunities for disabled students; however, the law's loophole of allowing tests to measure skills provides a legal basis for a medical school to reject disabled applicants, claiming that they are lacking critical faculties and abilities that are fundamentally essential to practice medicine. Therefore, deficiencies in sensory skills could prevent them from observing patients or taking a history, deficiencies in motor skills could prohibit performing diagnostic procedures, and problems in communication skills may inhibit contact with patients or fellow physicians. Such limitations may serve as a basis to disqualify a disabled individual from gaining admission to any medical school. Not everyone shares this view, and a small, active group of disabled physicians is seeking to educate the medical community about the compensatory technology available for the handicapped medical student or physician.

Disabled students who feel that they have been rejected because of their disability can sue on grounds of discrimination as this is a violation of the ADA legislation. A blind Ohio premed student did so and won (but only after years of court battles). More recently, profoundly deaf and quadriplegic premedical students were admitted to medical school.

The current effort toward encouraging production of more primary care physicians, a physically demanding practice area, is not favorable to potential disabled applicants. Nevertheless, no generalization can be made regarding the chances of disabled premeds to gain admission. All individuals seeking a medical career have to judge for themselves their chances for gaining admission, satisfactorily completing their studies and training, and establishing a successful practice. Indeed, while there are major obstacles in the path of the disabled, they do not need to be insurmountable in the face of solid ability and intense determination.

Personal Characteristics

These include a wide variety of factors, such as personality, maturity, appearance, and ability to communicate, many of which become evident at the interview. They can have a decisive impact on your admission chances at that time.

In summary, there are more than ten factors that, to varying degrees, play a role in the admission process. An honest assessment of yourself in terms of each of these factors will give you an insight into your own chances for admission.

Bottom Line

Serious consideration should be given to the following suggestions to enhance your admission potential.

• • Nonacademic qualities. Undoubtedly your GPA and MCAT scores are the critical and decisive factors in determining the outcome of your application process. There are, however, other qualitative issues that are of special concern to admissions committees. These include evidence that you have sensitivity for the needs of others, an appreciation of the complexity of patient care, as well as a sense of responsibility to face challenges in a mature manner and resolve them properly. It is your task to demonstrate that you have such qualities during the course of your interviews and in your personal statement.
• • Being a nonscience major. In this situation, attractive science course grades and MCAT scores are especially essential in order to demonstrate your innate abilities in the sciences. If your academic record does not effectively demonstrate this, advanced science courses (such as cellular and/or molecular biology, genetics, biochemistry, etc.), and doing well in them, is essential to becoming a competitive candidate for admission.
• • Older applicants. These individuals usually complete postbaccalaureate programs that are now widespread. They usually are judged on the same basis as traditional applicants, so they need suitably impressive academic credentials in order to be accepted. Older applicants need to convincingly demonstrate what specifically motivates them to change careers in order to enter the medical profession. A well-written personal statement is the key to achieving this goal.
• • Application enhancements. The potential of your application will increase when you demonstrate that you have acquired some organizational and communication skills during the course of an activity not related to your college work. In addition, some service activity in a health field is important so as to develop an awareness of some of the issues associated with being a professional in this area.
• • Selling yourself. The decisive element that frequently determines one's fate is the interview. Demonstrating that you are a mature, motivated, and committed individual is essential. You should aim to leave a clear impression that your career goal is realistic in terms of your intellect, personality, and character. Your argument relative to these three elements needs to be supported. This is usually evident from your academic record, as suggested by your transcript, what your faculty thinks of you, as reflected by recommendations, and by your personal statement as well as interview performance.
• • Maximize your efforts. Work diligently and effectively to achieve the highest level of academic performance that you possibly can. At a minimum, your GPA should be 3.3–3.4 and your total MCAT scores should be 29–30. These numbers should still keep you in the running, but you should aim for more than borderline status.
• • Emphasize your strengths. Both in your personal statement and during your interviews emphasize the fact (if true) that you have been able to manage a tough undergraduate curriculum and still have time for extracurricular activities. Prepare yourself adequately to respond to a wide range of questions at the interview to demonstrate that you have strong communication skills.
• • Don't procrastinate. Submit your application in a timely fashion, namely, after thorough review of the completed form; send it off in early or mid-summer (June–July).

In summary, remember, that the admission process is a highly subjective one, as demonstrated by the fact that the same individual may gain several acceptances as well as several rejections. As with a social date, not every person will appeal to you, nor will you appeal to every person. Take the outcome in stride. Your job is to do your best and then hope for a favorable outcome.