There is a ton of diversity across Canada (let alone the world) when it comes to medical school admissions processes. The following is what I would do if I ran a medical school. If there are any medical school admissions committees seeking advice, you know how to reach me .

GPA / MCAT

I’ve said before that if I were forced to only use one item for selecting candidates, it would be GPA. So there’s no way I could leave it out if I got a chance to re-design the entire process. GPA is useful because it shows a candidate’s academic ability over a fairly long period. Due to the nature of GPA calculations, you need to be consistent to score well. You need to be able to work hard for several years. Qualities like intelligence, work ethic, organizational skills, etc. are highly suggested from a good GPA, and you need those skills to be a good medical student, first and foremost. If you don’t have the ability to learn well and study hard, you won’t be able to acquire the knowledge you need to be a competent doctor. GPA is one of the only ways for students to prove that.

Of course, one of the problems with GPA is that everyone takes different courses from different programs in different institutions. This is where the MCAT comes in, to standardized the process a bit. The MCAT allows us to compare certain abilities of students from many different programs and backgrounds. The drawback to the MCAT is that it only represents a single event, which students study a few months for – which does not tell us much about the student’s ability to be a learner for a much longer period of time. In addition, the material tested on the MCAT and its relevance to medicine are debatable, and it is problematic in the sense that it is organized by someone else and limits the medical school’s ability to control what type of skills should be tested.

As such, I think using both GPA and the MCAT is important. However, I disagree with the strict cutoff method that some medical schools use. It doesn’t make sense to me for someone scoring 14/14/8/T with a 4.0 GPA to not have an interview, while someone with a 10/10/9/Q and 3.7 GPA to be guaranteed one.

I think it makes much more sense to use an algorithm that combines the GPA and MCAT into a single score, and then rank applicants that way for the interview.

Scrap Personal Essays and Autobiographical Sketches

The problem with personal essays is that they are subjective (because you wrote it and of course you will say good things about yourself) and they are often only as good as they are written (that is, people who are better at essay writing will be graded better – the problem, however, is that you want to find doctor candidates, not essay candidates). Not to mention that no one really knows how much of the writing is yours versus that of your family, friends, or any other outside help. You can write that you are a great leader and that you’ve developed good communication skills, but committees shouldn’t just blindly accept that as true.

Autobiographical sketches (that is, lists of your experiences) are similarly problematic. Someone listing that they were the president of X club does not tell the admissions committee anything definitive about the skills actually developed – the only thing committees can conclude with certainty is that you won the election. Two individuals with the same item on their list could have vastly different experiences (i.e. one person could’ve worked their tail off, while the other could’ve done nothing). What skills and traits you actually possess now is what committees need to know, not what skills/traits you “might” have based on the experience you “might” have.

In a perfect world, committees would see candidates in action, and evaluate them on traits like compassion, problem solving, communication, etc. Unfortunately, admissions committees aren’t going to waltz into your club or volunteer program to see exactly how you are in your environment (and even if they could, unless they could become invisible, what they see of you would obviously be a biased sample).

So, what can we do? The closest thing I can see for a medical school’s own evaluation of a candidates traits at this moment in time is through the Multiple Mini Interview, which is why I think that should be used, and essays/lists, etc. should be scrapped completely.

Multiple Mini Interview

I would probably interview a number of candidates around 2.5 times the number of seats in the class. Interviews would be made automatically to the top X candidates based on the GPA/MCAT algorithm. Once you make the interview, I wouldn’t make GPA/MCAT count anymore because in my opinion, once you’ve meet that standard of academic scrutiny, it’s more than good enough to be a good doctor. From here on out, I would want to see whether you possess the skills, traits, and potential to fulfill the other aspects of being a physician (the non-academic side).

The traditional interview style has a lot of variance (since you are often only evaluated by 2 or 3 individuals, who are just a few of many interviewers – so how do they fairly compare all the candidates?). While variance still exists in the MMI format, it’s reduced because each candidate is being seen by 10 to 12 different evaluators. In addition, the ability to test specific traits in the traditional interview is very limited. For these reasons, I would go with the MMI format all the way.

Unlike with personal essays or autobiographical lists, the MMI allows evaluators to evaluate various traits in real time. While the MMI is based on a smaller sample size, it gives medical schools a closer, more objective look at your traits than an applicant saying what they know medical schools want to hear. Given two individuals with identical autobiographical sketches, the MMI will provide some information on which applicant actually has the traits they claim to and which don’t. It is of course not perfect, but I think it is both better and more relevant than relying on essays and item lists.

I personally would suggest MMI stations that focused on problem solving, decision making, compassion, empathy, and ethics/professionalism. I wouldn’t want stations testing specific healthcare and medicine knowledge because, well, isn’t that what medical school is for? (I have actually heard of Canadian medical schools asking candidates about factual medical knowledge and I think that’s pretty “huh”?).

In addition to that, I would want one longer station with the simple question “Why medicine?”. The focus of this station will be to tease out the candidates motivations for pursuing medicine, find out whether they have actually attempted to explore the profession, and etc. It will be a bit more intense, challenging the applicant’s motivations to get down to what’s real. Do they really want to be a doctor? Are they actually ready? The answers to these questions will likely affect the type of doctor they would be.

Reference Letters

I think reference letters are somewhat useful because I think if you can find 3 individuals to say you would make an awesome doctor, that’s saying something. Of course, it too has the problems of variability among letter writing skills of referees. For those reasons, I wouldn’t weigh the reference letters to highly, but I’d way them a decent amount because I think there is good value in them.

Cliff Notes

In short, I would use a combined GPA/MCAT score to select interviewees, and then I would choose the medical school class primarily based on MMI scores, with a touch of reference letters.

But those are just my thoughts. What do you think? How would you do the admissions process, and why?

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Disclaimer: We are in no way affiliated with McMaster Medical School nor with anyone involved with the development or implementation of CASPer (Computer-based Assessment for Sampling Personal characteristics). We have also never seen or participated in any CASPer session. All information in this article is publicly available through a simple Google search. Furthermore, this article provides links to all of those resources, and we encourage you to read them for yourself. The purpose of this article is to simply consolidate publicly available information on an interesting and innovative medical school admissions tool and promote discussion.

Here at MedHopeful, we are constantly striving to provide new insight and information to readers as the admissions process changes, and with that present this article on CASPer.

Why CASPer?

The assessment of non-cognitive skills is a crucial component of any medical school admissions process, and is usually done through the evaluation of personal essays, autobiographical submissions, and interviews. However, interviews are resource intensive (need interviewers, rooms, etc.) and cannot be done for all applicants. In addition, while all applicants can write personal essays/autobiographical submissions, it is hard to know how much of application is the writing of the applicant or that of outside help.

In recent years, McMaster has performed studies (see here and here) analyzing the effectiveness of its five question Autobiogaphical Submission (ABS) pre-interview tool. These studies have shown the ABS to be limited in both reliability and ability to predict future candidate performance. As a result, they developed a “Computer-based Multiple Sample Evaluation of Noncognitive Skills (CMSENS), which eventually became CASPer. More information about the CMSENS and the original research article can be found here.

CASPer Basics

As quoted from the McMaster’s official webpage on CASPer, “CASPer, the Computer-based Assessment for Sampling Personal characteristics, is a web-based assessment of interpersonal skills and decision-making, to be completed at a computer.” All applicants to McMaster medical school are required to complete the CASPer beginning in fall 2010. Please see here for more official information.

Being used for the fist time, CASPer consists of twelve sections. Each section involves providing short-answers to two or three questions. Eight of the twelve sections begin with a one-minute video-clip showing a certain situation, followed by a few questions. The other four sections involve “self-descriptive questions”, also followed by a few questions requiring short answer responses.

You will be allowed five minutes to provide answers for each section, and you are also allowed up to 15 minutes of break time halfway through the session. After last and 12th section, you must complete an exit survey to finish. The CASPer will takes approximately 90 minutes in total.

What to Expect on CASPer?

As we have never seen or used CASPer, we cannot be certain. However, the resources publicly available have given us a basic idea of what we might be able to expect. From that, we can develop some ideas on how to best prepare for CASPer given the limited information we do have.

The article on CMSENS mentioned previously provides some brief information on the type of concepts being tested for with the videos, and it’s possible (and rather likely) the same or similar concepts will be assessed on CASPer.

The video clips used in the CMSENS presented “ethical dilemmas and group dynamic challenges, all lacking an obvious response”. The topics in the videos covered issues like professionalism, confidentiality, communication, and collaboration. These scenario video clips were followed by a few questions.

The self-descriptive questions used in the CMSENS were “similar to traditional interview questions”, and one example provided was “What makes your heart sing?”. These self-descriptive questions were also followed by a few questions requiring short answer responses.

Do we have any idea what an example section on CASPer might look like?

Surprisingly we do, thanks to a presentation given by McMaster at AACRAO’s 96th Annual Meeting in April 2010. You can find a copy of the slides for this presentation here. You can skip to slide 22 if you want to go straight to the CASPer information.

To summarize the important points from the presentation, there is an example CASPer section. In it, there is a video clip showing some sort of situation involving a surgeon, followed by the following three questions posed to the applicant:

1. You must make the decision now (as the surgeon). What is your answer? Why?
2. Should insistence for this surgery relieve the surgeon of all liability? Explain.
3. Should a patient be allowed to sue if the surgeon refuses to operate in these circumstances? Defend your response.

You are allowed up to 1024 characters for each short answer (which is about the size of a decent paragraph). Although we can’t watch the video-clip, it seems pretty clear that it is an ethical dilemma revolving around a surgeon’s decision to operate in a situation where there is no obvious answer.

In addition, it may be worth nothing that the marking scheme for each question is on a 9 point scale ranging from unsatisfactory to superb.

So how should I prepare for CASPer?

Again, it’s hard to say given that there is very little public information on what an example CASPer would look like. But based on what we’ve learned so far, there are a few things we suggest you keep in mind.

First, based on McMaster’s published research studies, it seems very likely that the eight video clip sections will ask for your approach to situations involving ethics, professionalism, confidentiality, communication, and collaboration. It might be worth doing some research into theory and concepts relating to these areas, as well as common problem types that arise and how to approach them. For example, when it comes to communication and collaboration, ideas surrounding conflict resolution would be good to know. I would personally suggest forming a group of friends to research these topics and possible scenarios to discuss and debate (keep in mind that you must complete the CASPer alone, but teamwork can be very valuable during preparation time).

As for the self-descriptive sections, there is very limited information available. The best advice I can suggest is to know yourself as well as possible. What are your experiences and what did you learn from them? Why medicine and how have you prepared for it? What are your goals for the future? What are your strengths/weaknesses? What do you enjoy doing? What motivates you? What annoys you? How do you deal with failure? Just really look into yourself, so these ideas are on the tip of your tongue (or rather, tips of your fingers).

A Reminder

We want to remind everyone that we do not have any inside knowledge regarding CASPer, and all that we do know and the ideas we have discussed are simply the combination of publicly available information on CASPer and our own thoughts. Take everything we have written with a grain of salt, please read all of the resources we have mentioned for a more complete understanding, and good luck!

References

1. Hanson M, Dore K, Reiter H, Eva K. Medical school admissions: revisiting the veracity and independence of completion of an autobiographical screening tool. Academic Medicine 2007;82:S8-S11.
2. Dore K, Hanson M, Reiter H, Blanchard M, Deeth, Eva K. Medical school admissions: enhancing the reliability and validity of an autobiographical screening tool. Academic Medicine 2006;81:S70-S3.
3. Dore K, Reiter H, Eva K, et al. Extending the interview to all medical school candidates–Computer-Based Multiple Sample Evaluation of Noncognitive Skills (CMSENS). Academic Medicine 2009;84:S9-S12.
4. CASPer — Computer-Based Assessment for Sampling Personal Characteristics. 2010. (Accessed July 11, 2010, at http://fhs.mcmaster.ca/mdprog/casper.html.)
5. The Multiple Mini-Interview: Origins and Opportunities. 2010. (Accessed July 12, 2010, at http://handouts.aacrao.org/am10/finished/R0115p_H_Reiter.pdf.)

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When I took the Princeton Review Prep Course three years ago, I got a N on my first diagnostic exam writing sample (i.e. from my full length online practice exams). After that, I got T’s on all of my subsequent diagnostic exam writing samples. I went on to get a T on my actual MCAT.

You don’t need to be a great writer to get a T on the MCAT writing sample – in fact, you can be a great writer and not score high on the writing sample. Rather, what you need is a combination of things: be a competent writer, have enough knowledge to come up with good examples, and be able to think critically about those examples and how they relate to the overall theme of the prompt. The MCAT writing sample section can be solved with a systematic approach, and in this article, I hope to impart some specific strategies to help you do just that. While I won’t tell you how to attack the writing sample section from scratch, I think there are a lot of tid bits in this article that will help you significantly improve your score from where it currently is.

Before we begin, it is probably a good idea to review the writing sample section overall. I will go ahead and quote what the AAMC has to say about the writing sample:

Each Writing Sample item consists of a topic statement (printed boldly) followed by instructions for three writing tasks. Your first task is to explain or interpret the topic statement. Because the first two sentences of the instructions are the same for all items, they are stated once here rather than beneath each item. These instructions are: Write a unified essay in which you perform the following tasks. Explain what you think the above statement means.

The instructions for the second and third writing tasks vary from item to item and are printed immediately beneath each topic statement. When using this list for practice, you should be sure to follow the instructions for all three tasks in writing your essay.

So the first task is clearly to explain the statement/prompt. In general, the second and third tasks are some variant of providing a counter example to the prompt, and then designing a “rule” (or guideline) to explain when the statement is true and when it is not.

Now that we’re all on the same page, here are some specific things I did that I think helped in me getting a T.

Find an Example to Both Support AND Oppose the Prompt

The MCAT writing sample prompts only require you to explain the prompt, but not provide an example to support it. Rather, they ask you to explain the prompt and provide one counter-example.

I’m going to go ahead and ask you to do more than that. I’m telling you to also provide an example to support the prompt.

While it isn’t necessary, it’s what I was taught to do and it worked for me. Having an example that proves and supports the prompt makes your essay that much stronger. It also makes task 3, the rule, much stronger because the reader will be able to see how the rule was applied to derive both an example to support the prompt and an example to go against it.

Use Specific Examples

When I say specific examples, I mean events that have actually happened (and if possible, elaborate and include details about them). What I don’t mean are hypothetical or generic examples. If you want to use a computer software company as an example, don’t say “a computer software company” – say Microsoft (or any other real software company). It doesn’t even matter if you don’t elaborate further about Microsoft – at the very least, use it instead of “generic computer software company”. Of course, an even stronger example is to write about a real computer software company and something that actually happened to them. In any case, just don’t use generic examples.

Don’t fret too much about how popular or well-known the example is – the most important thing is that it is real, and thus, provides a more vivid picture. On my actual MCAT writing sample, the four examples I used were Mothers Against Drunk Driving, Stephane Dion and the Liberal Party of Canada, Google, and my father’s old computer software company. As you can see, I used examples that ranged from well known (Google) to unknown (my dad’s local computer software employer). In the end, the important thing is that my examples were specific and real, and thus, vivid in the mind of the reader. Moreover, real examples (as opposed to hypothetical ones) are stronger for the very fact that they have happened and are thus evidence (whereas hypothetical examples are, at best, theoretical).

Oh, and if you’re Canadian, use Canadian examples! The markers are American and this has two main implications. First, your Canadian examples, while “local” to you, will seem “international” to the reader (which is a plus). In addition, since your Canadian examples will likely be unknown to the American marker, it’s okay you get some of the facts wrong. Contrast that with well-known American examples, where a fact mishap might hurt your score!

Come up with the Rule First

It is natural instinct for us to do things in the order tasks are presented to us, and the writing sample is no different. In fact, many MCAT prep courses teach us to do the tasks in order. That is, think of the required examples first and then create the rule to bridge them. However, I don’t think this is the best way.

Consider the following writing sample prompt:

Education occurs when the student has a desire to learn.

Describe a specific situation in which education might occur without the student’s having a desire to learn. Discuss what you think determines when education requires that the student have a desire to learn and when it does not.

One example of when a student has the desire to learn is when he enters into a program (e.g. MBA) to improve his knowledge/understanding of his career field and, therefore, his job prospects. One example of when education doesn’t require the student to have a desire to learn is when premeds take certain prerequisites just to satisfy medical school requirements. Say you were to attack the writing sample prompt by coming up with these two examples first before doing anything else. Sure you might have the first two thirds of the essay now written, but then you get to task three and… can you come up with a rule to connect these two examples (as well as a rule that can be used to evaluate future examples)? I think it’s rather difficult to come up with a good rule/guideline to connect these two specific examples.

In cases like this, you suddenly realize you cannot think of a rule/guideline to bridge the two examples! (or even if you do, the rule is rather weak) Without this rule, your essay is incomplete, and you scramble to make up something that barely connects the two examples.

Instead, I think it makes much more sense to think of the rule/guideline first(that is, first determine when the prompt is true and when it is not), and then use that rule to derive the supporting example and counter example – this way, you know for sure that the two examples can indeed work together.

So for this prompt, I would first come up with a rule like: “What determines whether or not education requires a desire to learn is at what time point of his education the student is in, with high school graduation being the dividing line”. From there, the examples are easy to derive: If the student is in high school or below, then education is mandatory and doesn’t require his desire to learn (supporting example). However, after graduating from high school, university/college is not mandatory, and thus post-secondary education requires the students desire and initiative to learn (counter-example).

By developing the rule first, you ensure you don’t waste time writing an essay that can’t be united by the end. Moreover, once you have the rule, the examples become very easy to derive.

Write A LOT

Each of your writing samples is graded by a human marker, as well as a computerized scoring system. It’s important to consider the implications of how the writing sample is graded, especially since this is the only section of the MCAT where marking isn’t an exact science.

Let me preface this by saying that I don’t know how the computer marks the writing samples. But if I had to speculate (which I love to do), I’d guess that the computer marks you on spelling, grammar, and length. I don’t think it’s a proportional marking scheme (i.e. I don’t think the more you write, the better, since writing too much is bad too), but I do think there might be a certain range of word length that is looked for. But given the time restrictions, I think it’s near impossible for someone to overwrite. The fact is that a one word essay is probably not very good, and neither is a 10 word one, and nor a 50 word one. Longer is probably better.

In addition, a decently long essay is impressive at first glance, and could sway a human marker in your favour. So feel free to write a lot, elaborate on your ideas, and make sure what you’ve written is clear to someone who knows nothing about the subject.

Practice, Practice, Practice!

This should be obvious, but yeah, practice doesn’t hurt. Looking for prompts? Look no further than the official AAMC Writing Sample Prompts – many of these tend to show up on actual MCAT tests (I know mine are on there!).

I don’t think it’s necessary to write a lot of full length writing samples, unless you feel the actual writing part is your weak point. For many students, the problem is in coming up with the ideas, examples, and rules. I was in this boat, and I found it helpful to just pick random prompts and discuss/debate them with friends to get into the habit of generating examples and prompts (as well as learning from the thought processes and ideas of others).

Well, that’s all I have to say. Hope this helps!

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Today I got an email from a reader asking me for some advice on which referees he should ask to write his three letters for medical school admissions. If you haven’t read my first article on reference letters, I urge you to do so before reading this one. If you’re too lazy, the cliff notes of that article are that you should pick referees who know you very well and who you know genuinely want to support you in your quest to become a doctor. Simply put, unless your referee has known you for a long time, he will have nothing of substance to say about you. And unless your referee really wants you to become a doctor, then he has no reason to producing something with substance.

Of course, the question that remains is: “but what if my three strongest references are too similar”?

Why Diversity is Good

We have established that the strength of the letter is more important than who wrote it. It’s easy to see that what is written is significantly more important than who it is written by. For example, a one page letter written by your research supervisor is probably going to be better than one paragraph written by the dean of your faculty. However, one clear exception would be if your strongest possible letters would end up being too similar in content.

Reference letters can become redundant if they are focused on the same thing, and worse, they can leave out important information. For instance, if your three referees were all professors / researchers you worked with, chances are a lot of the same traits will be mentioned (e.g. intelligence, work ethic, problem solving, etc.). While these are most definitely traits necessary for a good physician and traits you want highlighted by your referees, you want to ensure that your reference letters hit on as many relevant traits as possible. You also want one or more of your referees to evaluate your abilities in compassion, empathy, etc. – traits less likely to be seen in a research environment, but commonly utilized in various community/volunteer experiences (which many of you are bound to have).

One quick way to think about this (at least for Ontario medical school applicants) is to check the OMSAS reference form and see what traits the referee is supposed to rate you on: intellectual capacity, initiative, leadership capabilities, maturity, cooperation, integrity, problem solving, fluency in spoken/written English, ability to communicate, ability to relate to others, ability for self-directed learning, and critical thinking ability.

Knowing that you are being rated on these qualities, you want to select referees whose relationship/experience with you is diverse enough to achieve high ratings across all of these traits, even if those high ratings don’t necessarily come from the same referee. The point is to prove you are strong in all of these categories in some way or another, and it may be hard to do that if all of your referees are commenting on the same few traits. Two referees saying you are smart and one saying you are compassionate is way better than three referees saying you are just smart (That being said, it would be even better if all three said you were both smart and compassionate, so let’s aim for that when picking our referees!).

Long story short, physicians are multi-dimensional and therefore, you want your reference letters to reflect the same about you. It can be hard to do this unless your referees themselves come from diverse backgrounds and have different experiences with you.

So how should we go about obtaining diversity? The 2+1 Rule

To make it easier, let’s start by simply dividing up all possible referees into two groups: academic vs. non-academic. Academics would be individuals like course professors, research supervisors, etc – basically anyone who has seen you in an academic setting and can comment on you as a scholar and student. Non-academics would be individuals like volunteer supervisors, club facilitators, team coaches, etc. – anyone who has seen you in a non-academic, and more extra-curricular capacity.

We’ve established that if possible, we don’t want all three referees as academics, and nor do we want all three as non-academics. In that case, the only satisfactory solution is what I will now name as the 2+1 Rule of reference letters: you should aim for at least one academic and one non-academic reference letter, with the third letter being anything that you want (leading to 2 academic/1 non-academic or 2 non-academic/1 academic, and hence, the 2+1 Rule).

Personally, I had one academic (research supervisor) and two non-academic (two volunteer/community experience supervisors). While my research supervisor could most definitely account for my intellectual capacity, problem solving and critical thinking ability, there’s no way he would have been able to comment on my cooperation and ability to relate to others to the extent that my choir director was able to, and vice versa. But taken together, all three reference letters were able to create a complete picture of me, as a candidate with all of the traits sought for.

In the story I referenced at the beginning of the article, the student who emailed me listed all of his potential referees, and it was clear that he felt his strongest three letters would come from three academics. But once I saw that he had a volunteer supervisor who he had worked a fair bit of time with and whose strength of letter he predicted would be almost as good as the other three, in my mind, it was an easy decision to pick the two best academic letters and include the volunteer supervisor as the third, even though the three academic letters would each have been better in a vacuum. The key point here was deciding on which three letters work together best in combination, and that is best achieved using the 2+1 Rule as a foundation.

What if I can only find 3 strong references of the same type?

One caveat to the 2+1 rule is if you feel you lack a strong reference in either the academic or non-academic field – if this is you, it might be important to ask to what degree you are exploring both your academic and non-academic aspects of your life, and if there is something you should explore further. However, sometimes you may simply have to go with three academic or three non-academic referees – and that’s fine. There are most definitely medical students who had three academic or three non-academic referees.

That being said, I would ask your referees to comment on as many traits as possible, beyond what they normally would (e.g. if you have three academic references, ask them to comment on more than the usual academic-related traits). Bring up specific experiences of yours that you think they should keep in mind. For example, if you have three academic references, ask them if they know of your experiences beyond the academic setting. Have any of them see you do things in the academic setting that would demonstrate compassion or empathy, for instance?

Who writes your letter isn’t as important as the letters presenting you as well-rounded, complete candidate. As long as they can do that, I think it’s fine if your referees are all academic (or all non-academic).

To sum up, you want to pick referees who have known you the longest, who genuinely want to help you get into medical school, and who as a group, can positively comment on all of your different qualities.

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*Please turn up your volume

Thanks a bunch to Shelly, Jess, and Roy for the awesome surprise.

And an extra special thanks to Shelly for organizing and producing the video! =)

Oh and I’m sorry for ruining the ending guys…

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About a year and a half ago, I wrote an article on my thoughts about what to keep in mind when applying to university, using my personal experience as an example.

In that article, I focused mostly on figuring out which university fits you best based on program, location, opportunities, etc. However, there is one more important question you need to ask yourself when thinking about your education that I completely failed to mention.

In short, that question is: what do I want out of my education?

At first glance it may seem like an odd question to ask, but it’s really not. It seems odd because many of us have our own ideas about what the purpose of your educational experience is or should be – but the truth is that your educational experience is whatever you want it to be. There is no one right way to view your education, and it’s important to always realize that, despite what people may argue.

Some people just want to learn. Very often they are genuinely and strongly interested in the topics at hand, and want to sponge up as much as possible.

On the other hand, some people go to university purely for the degree. Usually this in terms of job prospects or further education requirements (e.g. professional schools, graduate schools, etc.).

Of course, if you’re applying to professional school (such as medical school), marks matter. So some people go to university primarily to get the grades required to move on to something else.

In my opinion, these are all legitimate. It bothers me when people try to act as if there is some universal agreement as to what we should want out of our education (e.g. “You shouldn’t be picking your school just for the sake of getting good marks!” There are reasons why doing so is often not a good idea, but it has nothing to do with a right or wrong way of looking at education). Quite often, what we want out of our education will be some combination of 2 or 3 of these views, and there’s nothing wrong with that.

When you are thinking of where you want to go to university, you need to reflect on all of these issues, because different undergraduate programs will be more conducive to one of these aspects than the others.

So take the time to figure out what you want out of your university education – it’ll save you a lot of head ache down the road!

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If you applied to medical school this past year, you probably know where you’ll be this fall by now. Some of you may have been accepted into medical school and are excited for the journey that lies ahead. If so, congratulations, and best of luck as you start a brand new chapter in your life! Getting into medical school is an amazing accomplishment, but a lot of hard work and challenges still lie ahead. I’d suggest enjoying your summer as much as you can before the work really piles on =).

Others, however, may have fallen a bit short in the process and are now wondering what your next steps should be. If that’s you, then this article is for you. Before we go any further, you need to do something first.

Give Yourself a Pat on the Back

I know giving yourself a pat on the back won’t change the results of this past year, but fact is, you deserve it. Applying to medical school is hard, especially when you consider that you’ve really been “applying” since day one and not just when you started writing your application last fall. I’ll say it again: applying to medical school is hard. And tiring.

From filling out applications, to getting references letters, to doing interviews (not to mention staying on track of your school work, extra-curricular involvements, and your personal life) – the whole process is draining. And don’t delude yourself into thinking the process ends once you get into medical school. It keeps going because, well, you will have to compete for residency spots as well. Of course that is ways into the future, but it’s important to keep in mind that you’re still going to have to compete in the years that follow entering medical school. It is what it is.

So congratulate yourself for getting through this year. Even though you didn’t get in this year, going through the application process can only make you a better applicant for next year’s cycle. You will learn from your mistakes. Not only that, but you can build on last year’s application – a lot of the basic grunt work (for example, figuring out who your references will be, creating a list of all your achievements/experiences, etc.) is now done, and what happens now is more about improving than starting from scratch. That makes a huge difference.

Still, we can’t start analyzing what you should do in preparation for applying again. There’s still one more important question to ask at this point.

Should I even apply to medical school again?

Just because you have applied once or twenty times already, doesn’t mean you have to apply again this year, or ever again. Before you consider how to improve your chances, you need to decide whether this is something you want to try for again.

Perhaps you have realized there is something else you want to pursue instead of medicine. Maybe your responsibilities in life are increasing and taking a chance on medical school is no longer an option (e.g. you have a growing family, and you need to start your career now). Maybe you think you’ve done all that you can and you won’t be able to do this again.

Whatever the case, take the time to think about whether you really want to apply again. As we have established, the application process is time consuming, draining, and hard.

If your answer is still yes, you want to apply, then keep reading.

GPA / MCAT

As I have written many times before, if you are applying to medical school, you should care about your GPA and MCAT scores the most. Your academics are what get your foot in the door. It doesn’t matter how good the rest of your application is – if your academics aren’t good enough, you have no shot.

You need to ask yourself if your GPA is preventing you from being eligible or competitive for certain medical schools. If not, can you do well enough with another year of undergraduate courses to give yourself a better chance at more schools? For instance, if you had a <3.70 GPA for your first three years of undergrad, but a >3.70 GPA for your last year, it may be worth doing a fifth year of undergraduate studies and hopefully be eligible for Western and Queen’s medical schools, which require two years with a GPA >3.70.

Similarly, is it worth re-taking your MCAT? If you know you’re capable of doing better, and it could open up doors to more schools, then maybe it’s worth retaking. For example, you have a 40M on your MCAT, and have not gotten into the few medical schools you’ve applied to the past few years. It might be worth taking the MCAT again to give yourself a shot at Western/Queen’s (which require a higher WS score), especially since having scored 40, it’s likely you will do more than well enough on the non-WS sections. On the other hand, if you struggled to get a 30P, then it might not be worth taking the risk of writing the MCAT again unless those schools you will apply to again only look at your best score, and not your most recent.

Volunteering, Extra-Curriculars, etc.

Do you have medically/health care related experiences? Do you have leadership experience? Do you have teamwork experience? If your answer is no to any of these, then I’d suggest starting to do something in those areas.

Medically/health care related experience like shadowing physicians, volunteering in a hospital, attending a conference for students interested in medicine, etc. demonstrate a real interest in medicine and show that you have some basic understanding. It shows you are at least somewhat serious about a career in medicine – that you’ve really though about it and taken the time to explore medicine.

Physicians often need to take on leadership roles, such as in a health care team. You want to have some sort of leadership experience, such as running a school club.

Of course, physicians aren’t always in charge, and are very often team players. If you haven’t yet, get involved in something where you have to work with others, such as a team sport, musical band, school club, etc.

If you want to be really safe, read the CanMEDS roles, and see if you have some sort of experience that demonstrates those qualities.

Reference Letters

It would also be a good idea to think about whether you got the best reference letters possible the last time around. Is there someone who would write you a stronger letter? Could you benefit from a bit more diversity (e.g. are all your referees academics? Are they all non academics? etc.)?

Remember, most importantly, you want a referee who wants you to get into medical school. If you don’t think they support you that much, I would suggest looking for an alternative referee if you can.

Essays

If your essay(s) were good enough to get an interview, then it is probably not worth changing completely.

But if you didn’t garner an interview, it is probably worth starting completely from scratch and coming up with new and improved angles to answer the question.

And don’t think it’s too early to start thinking about something as challenging as revising, or perhaps, re-writing your essay. A friend of mine asked me for advice on an essay that wasn’t successful in this past year’s cycle, just a few months ago. I am confident his hard work will pay off in the upcoming application cycle.

Have a Contingency Plan

I have to conclude by saying that no matter what, you need to be planning long term. Although you don’t have to stick to this plan, it’s good to think about your alternatives. If I don’t get in the next time, is that it for me? Should I apply again? Should I take a year off first?

These are all important questions you want to have at least some vague answer to so that you can form an outline for not just the coming year, but for the next few years to come.

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It has been a month since I last blogged. To be honest, blogging has not at all been on my mind up until this past week when my “summer break” finally started (I use that term loosely because I am, like many of you guys, working this summer, but it’s a break from school nonetheless).

The last month of medical school at UofT was the most hectic! May started off with our Brain and Behaviour final exam (passed!), followed by our Clinical Skills final exam (a practical exam known as an OSCE – probably the most fun exam of the year), then our Determinants of Community Health final, and finally, our Pharmacology exam (good thing this exam was only covering the last two weeks of school!). Without a doubt, we had more exams in our final month than any other month during the year – but I guess that made finishing all the more sweet.

Medical school was a brand new educational experience for me. While it is similar in many ways to undergrad, there are of course many huge differences. I definitely had to make adjustments, and when I couldn’t, had to deal with heavy lessons (that hopefully I better take into account during my 2nd year of medical school). The following are a few things I wish I could’ve told myself before starting the year.

Pace Your Studying

This might sound obvious to those of you who already do this, but there are a lot of medical students who got through undergrad learning everything they needed for an exam the night or two before. I still procrastinated a lot this year, but as everyone knows, procrastination makes things really difficult (stress, exhaustion, etc.). If I could do things over again (and if I could muster up the motivation), I would spend one or two days a week reviewing everything covered that week. That doesn’t even mean necessarily studying hard; at the very least it means familiarizing myself with the material so that when I do need to study for the exam, I will have the key concepts already ingrained in my memory. Of course, there are students who study/review everyday or every other day. Do what works for you so that you aren’t cramming so much at the end.

Practice Clinical Skills Regularly

Our final OSCE required us to know all the practical clinical skills we learned throughout the past year (history taking, physical exams, etc.). The week leading up to the OSCE, many of us put in a lot of heavy review and practice. When I look back at it now, clinical skills was relatively easy – if you put in the practice. Many of us didn’t practice regularly, which led to a lot of practice in the week(s) leading up to the OSCE. But once you have the stuff done pat, it’s basically muscle memory. I wish I practiced more regularly so that my clinical sessions during the year would have gone more smoothly, and then I could have just walked into the OSCE with little practice required. Moreover, you will be using these clinical skills all throughout clerkship, residency, and for some physicians, the rest of their lives. It’s arguable that if there is one thing you should make sure you know inside and out from 1st year of medical school, it’s the clinical skills stuff.

Ignore the Rush and Take Your Time

It’s easy to get caught up on the rush of choosing your residency. Although you don’t apply for residency programs until your 4th year of medical school, it helps to begin exploring early. However, given the competitive nature of the process (with some programs being significantly more competitive than others), it’s easy to get caught up in the rush of trying to position yourself to have a strong application. Research, networking, extra-curriculars – it’s easy to feel pressured and scared to fall behind when you see some of your classmates getting involved and building their C.V.’s to a specific specialty from day 1.

That being said, I think it’s more important to realize that the choice you make for residency is huge – where you end up significantly determines much of your medical career. You might feel pressured to decide very early on and start working towards something specific without fully exploring your options. It doesn’t help that a lot of opportunities become available early on in the school year. It is so easy to, for example, apply for a research position early on in the year and then realize months later that you would never want to work in that field ever (and then wish you had waited to apply for a completely different research position, or spend your summer doing something completely unrelated to research entirely). I myself felt like I changed my mind constantly throughout the school year in terms of where I saw myself being in medicine.

So take your time, explore, and don’t get swept up in the rush.

Learn How You Learn Best

Feel free to take initiative in your learning. Some people learn best by coming to class. Some people never come to class and just watch the recorded lectures later online. Beyond mandatory things, don’t feel obligated to do things a specific way. You know what works for you!

Take Advantage of Everything Being a Medical Student has to Offer

A friend of mine recently shared the following quote with me: “school really begins at 3pm” (or the case of UofT med school, 5pm, haha), basically referencing how much of our education comes through additional opportunities outside the classroom. Medical students have relatively easy access to the medical world in terms of shadowing, electives, research, etc. Often times it’s as simple as just asking.

Summer Plans

I’m really enjoying my summer break so far. I’m doing a research project at a hospital right now full time, but it’s not stressful which is great for me. Spending my time seeing lots of friends and pursuing side projects.

In an attempt to make myself more productive this summer, I set up a personal planning document listing my goals for the summer, and coming up with the necessary action plans to achieve them. I’m going as far as setting end of month goals, and then coming up with an action plan each week for what I need to achieve those goals. Having this plan has made me a lot more organized, and thus, more likely to get things done because I always know what needs to be checked off on my list.

Unfortunately, my goals might be a bit too ambitious. My goal last week for this blog was to write 3 times. Fail. Oh well, here’s to a more productive week!

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Last Friday I went out with my close high school friends to watch Iron Man 2. I’ve never actually seen Iron Man 1 – I heard it was pretty good though, so I was excited to see this nonetheless (on a side note, I’ve seen Dark Knight but not Batman Begins – movie catch up this summer?). Don’t want to give much away, except that I thought that I loved the Tony Stark character (Iron Man’s real name for those who don’t know. I guess I just find the cocky, funny, sarcastic character-type entertaining) and the first half or so of the movie was very entertaining. Unfortunately, I thought that the ending was pretty bad.

To me it felt like the film team made 2 hours of the movie, and then realized “oh no, we only have 10 minutes left, so we better find some way to end it!”. At first it boggled my mind that people who are really good at making movies and do it for a living could make an ending so bad (yah yah I guess this is debatable…). But then I started to wonder whether they actually cared (if most movie goers will be pleased and the film rakes in the bucks, which is does, how much do they really care…).

My Left Pinky

So as you guys know, I had an X-ray done for my left pinky. As it turns out, it wasn’t what I thought it would be. On the results that imaging clinic sent to my family doctor, the radiologist says he “suspects” that it is an old fracture that healed improperly. So basically I fractured my left pinky and didn’t even realize it, and it healed in a somewhat deformed position (basically my pinky can’t hyperextend and is constantly dipped).

The good news is that my pinky is completely functionally fine except that it’s can’t completely extend. My doctor tells me that the only concern would be aesthetics, and that a plastic surgeon may or may not be able to fix it. No one I know even noticed it except my dad, and it’s not bothering me, so I’m just going to leave it for now. If it starts bothering me then maybe I’ll get it looked at, but for now, it’s really not a big deal.

Last Month of School

So the school year is winding down. I have four exams coming up: Brain and Behaviour Final, Clinical Skills OSCEs, Community Health Final, and Pharmacology. The last two exams should be pretty easy, so I just need to get past the next week and a half and I think it’ll be a relative breeze. My final exam is on May 31 (Monday). Our class voted to have the final exam on May 31 as opposed to Friday May 28 (to have more studying time), but I really regret voting that way now, because I don’t think having the extra weekend will really affect how much I would end up studying.

It’s crazy how fast this year has gone. I guess that happens every year though. School always seems to fly by really fast. It’s also strange to think that I’ll be mostly done with class in a bit more than a year when I start clerkship. That will be the next big transition. I’m actually trying to not think too much about it and just enjoy where I am in my training.

Healthcare Innovation

As I have sort of reflected on before, I feel like healthcare innovation is where I see myself being most in medicine in the long run. I have always believed in the “if you know what you want, why wait?” mentality. And yet I wasn’t really following that for a long time. After some thinking and thanks to support/encouragement from close family and friends, I started taking some steps to make this a part of my life starting now.

I don’t really want to disclose details until I get the ball rolling, but I’m currently in the progress of getting involved with a group that does the very things that interest me in the hospital setting. Finding new and innovative ways to reduce wait times, improve communication within the health care team, reduce medical error, etc. etc. – they do exactly these things, and then work on getting them implemented in major hospitals. Very cool stuff and very close to what I want to do long term. I finally feel like I’m going where I need to go.

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Last night I was at dinner with a couple of friends. A good friend of mine from class was sitting across from me, and at one point, the topic of generosity came up. The discussion helped elucidate a concept that I’ve always believed, but never really put onto paper, so I guess now is a good enough time than ever.

I have always been really big on kindness. I like kind and courteous people. A lot.

The basic concept I want to propose is that when it comes to success, being nice and kind goes a long way. I think more so than we often realize.

Appreciation

I have to admit, it’s nice to feel appreciated when you do a good deed, like when you help someone. It actually really annoys me when I help someone out and I don’t get a simple thank you in return – thanking someone for taking their time to help you is so simple and makes such a huge emotional difference, that it boggles my mind when people don’t do this.

I remember one time in an undergraduate biology class a complete stranger asked me if I could send them the notes I had typed up that day since they came a bit late. I said sure. I emailed them to her and never heard back.

I receive quite a few emails here at MedHopeful and while I’m more than happy to answer questions and provide personal advice, it leaves a bitter taste in my mouth when nothing comes back in return – not even a simple thank you.

What happens? The next time you email me, I’m going to remember you as the person who wasn’t even courteous enough to say thank you – and it would probably be naive to think that wouldn’t consciously or subconsciously affect any advice I provide in the future.

And I’m sure you might be a nice, great person, but look at the impression that was left behind instead. Not saying thanks implies being ungrateful, even if you were in fact grateful.

When you get help, take the time to say thanks. All it takes is a second, but it goes a long way to building good, strong relationships.

Generosity

This was actually what my friend I were discussing last night. The conclusion we came to at the end of the discussion was basically that while being selfish was good short-term, being generous pays huge dividends long term.

When you give, people want to repay you back, often with more than you originally gave. I’ve learned the most about generosity from my close high school friends. They are insanely generous with me without ever asking for anything in return. All it makes me want to do is figure out a way to be just as generous, if not more so, back to them for years to come.

Contrast that with being selfish. While being selfish helps you out tomorrow, it burns bridges for years to come.

Just Being Plain Nice

I remember when I was in high school, and a friend of my brother’s was running for student council and he had been successful in elections every year. While talking to him, I remember thinking to myself “wow, he’s so nice. I can’t even find one reason to not like him.” I bet he got my vote that year.

We think with our emotions more than we’d like to admit. We also find it easier to look for reasons to dislike something as opposed for reasons to like something – that is, we tend to go for “process of elimination”. It’s just easier to single out things we don’t like than point out things we do. And the same goes with people.

Look at how patients rate their physicians, for example. Recall that last physician who ticked you off – was it because of their attitude, or because of their quality of treatment? Or remember your favourite physician – are they your favourite because they are nice to you? Pretty sure the physician I dislike most provided me with sound advice but was extremely condescending.

So take the time to be nice. It’s not that hard, and it’ll go a long way.

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