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?