This is almost not worth the post. It’s not worth the post because it’s fatiguing and paints Haiti in a poor light. But what other light can I paint them in then my experience here? I cannot give you someone else’s experience. Only mine.
In the ongoing discussion over what is appropriate, I was recently explaining to someone how in medicine treating an “n of 1” is your job on a daily basis. A patient comes in (number in study = 1) and you must use what you know to treat them. The knowledge you know was generated from many studies in which large numbers (n>1) were used to uncover the most common responses. Thus, statistics are used to determine what the error is with which you may say a treatment works when it really doesn’t. If we just treated one person and determined medicine on that, then medicine would be in world of trouble. That one person may have been an outlier.
Thus when I go down the street and kids beg for money, I cannot escape the idea that my inclination to “give” to the “n of 1”, the child who is sitting there, is actually not based in reality. What does my giving do besides make me feel good inside? Perhaps this child eats for one more day, and then what? Westerners cannot come over and hand out money so that other countries may thrive. But we can influence their society so that they can thrive on their own. Perhaps we are still afraid of that; perhaps we don’t want that – we want to give them handouts so we can dictate how they behave. We can then throw out presidents we don’t like, presidents that are for the poor people, the oppressed.
What is wrong with Haiti? Why do tourists not visit here? The news is full of horrible stories about Haiti. A friend from home asked me if people were poor because they did drugs and drank so much. That isn’t the Haiti I know. The Haiti I know and see is full of poor people. Poor people that want your money.
There is a cute kid that always comes to my office at the clinic to play. I usually play with him. Today, I realize his speech is full of “Ba’m” this and “Ba’m” that (give me!). Today he just came in and searched through my bag. He found three packs of gum still in a larger wrapper. He asked for some and I said ok. He then proceeded to take out the packs of gum and try to leave with them. An older man (a social worker) walked in. I know this man. He is always very nice to me and speaks with me. I tell the child no, that he can have one piece of gum. I have to grab him and take the packs of gum out of his hands (actually pry them out of his hands). I give the man and the child a piece; I also chew a piece. The man talks some and then leaves. The child proceeds to grab my pens and sticks them in his pockets and says he wants them. He tries to leave. I am disgusted. I have to grab him again, dig in his pockets to get my pens. He finally pouts off, only to return and ask for money. I am disgusted. I say no. He goes away.
I sit at my desk and reflect. He blatantly tried to steal my pens when I wasn’t looking. His mom has a job here at the clinic. They eat. Just then I am interrupted by the man that was in earlier, the social worker. In his best English he says “Give me ten dollars.” I ask him for what and he cannot explain. I tell him firmly no. I also don’t feel compelled to explain myself. I am a student who is severally thousands of dollars in debt, who has decided to come here for six months to try to help, and you walk in here to ask ME for money? And with no reason? We talk some in creole; I firmly tell him no, I don’t have money for him.
I understand these people are poor. I understand that these people don’t live great lives. I don’t understand why the folks with jobs feel it is ok to ask the white students for money. The sad thing is I think many white expats here feel some “prestige” of being white here. Many here treat you like you are rich and special. It’s disgusting.
For how long have we given handouts? For how long will we give handouts? And for what? So we can be above them and dictate their moves? Own them?
Can we blame them for continually seeking these handouts when we continually give them? Is there no better way?
In Sinclair Lewis’ Arrowsmith, a physician-scientist goes to an island infected with the plague with what he is almost positive is the antidote (think penicillin for syphilis). Only he has not done a scientific study on it. His mentor preaches over and over the importance of staying strong and seemingly “cold-hearted” in his approach. There is no scientific evidence suggesting it works, so he MUST have a control group that gets placebo, for the medicine may not actually work. The young doctor struggles with this, as he knows his mentor is right, but also thinks what he has will work. Ultimately, more are saved if he can show with a well-controlled study it is effective.
I digress. I lost my train of thought. Our ride came and I had to pack up and go. On the way out a woman stopped me to ask me for money. This was a clinic employee, not a beggar. I just said no. When it rains it pours. Of course, they aren't all like this. I spent my sunday having a beautiful brunch with haitian friends from the clinic. But those aren't the things that get to you here. Those moments sustain you. I apologize for not writing more about the beautiful moments here.
As of now my opinion is that hand outs are a terrible thing. They breed the wrong attitude. What we need are Haiti-friendly policies in government; policies that support their direction as an independent nation. Policies that aren’t about making people feel good, but rather are about creating a sustainable environment in Haiti and other developing countries. That is something I can get behind. That is something worth giving money to.
Monday, April 27, 2009
Wednesday, April 15, 2009
Take back your hand...
I was asked today by someone in the states how Haiti has changed my views on life, etc. There is no easy answer to this. First, it seems that every ex-pat here breaks down at some point. Not from the workload or the language or the isolation (although those things all help), but rather from the unending pressure that people put on you here. Almost everyone you meet wants a handout or something; in turn relationships take a strange twist. What’s innocent? What’s sincere? Why does it matter? And in response to this, almost everyone here trying to help feels helpless in so many ways.
One thing that comes to mind are handouts to people on the street. Every day you are asked for money. Sometimes it's aggressive, sometimes it’s nice, usually it’s awkward. Not because I feel bad about not giving money; I don’t. It’s instead awkward because the questions that you must answer in these conversations, “Come on, I have a job, but I only make 100$ a month…what do you make?” “I have no work and my mom is sick”, etc. So what to do?
If you give the handout, what good does it do? Does it not just propagate some idea that they should seek handouts rather than seeking education and innovation? What if you give a kid on the street 10 bucks? Let's say that his household brings in 5 dollars per week (about the mean income). You just gave them two weeks salary. So what do they do? Go back to school? Why? Money is waiting somewhere with the white man.
Let’s pretend that handing out cash did NOT propagate this attitude. Even so, what good does it do? I’m not sure I know. So there is money in someone’s hand; how does that help them in two weeks or next year? How does that help this economy? The infrastructure? The government?
I wish I knew.
So how has Haiti changed me? It has made me more aggressive, because this is a more aggressive society. It has also made me more willing to laugh. Without humor to soften the mood, life for so many people is just too bleak (including me); it has made me want to be funnier for the same reason.
It has also made me miss basic science, because I don’t get to do any here. And I miss presenting and teaching in front of groups. But I will get those things back. I won’t get back having no memories of seeing these people each day.
So how has Haiti changed me? I have pictures and frustrations in my head to last a lifetime. And I’ve only been here three months. Imagine how these people feel.
One thing that comes to mind are handouts to people on the street. Every day you are asked for money. Sometimes it's aggressive, sometimes it’s nice, usually it’s awkward. Not because I feel bad about not giving money; I don’t. It’s instead awkward because the questions that you must answer in these conversations, “Come on, I have a job, but I only make 100$ a month…what do you make?” “I have no work and my mom is sick”, etc. So what to do?
If you give the handout, what good does it do? Does it not just propagate some idea that they should seek handouts rather than seeking education and innovation? What if you give a kid on the street 10 bucks? Let's say that his household brings in 5 dollars per week (about the mean income). You just gave them two weeks salary. So what do they do? Go back to school? Why? Money is waiting somewhere with the white man.
Let’s pretend that handing out cash did NOT propagate this attitude. Even so, what good does it do? I’m not sure I know. So there is money in someone’s hand; how does that help them in two weeks or next year? How does that help this economy? The infrastructure? The government?
I wish I knew.
So how has Haiti changed me? It has made me more aggressive, because this is a more aggressive society. It has also made me more willing to laugh. Without humor to soften the mood, life for so many people is just too bleak (including me); it has made me want to be funnier for the same reason.
It has also made me miss basic science, because I don’t get to do any here. And I miss presenting and teaching in front of groups. But I will get those things back. I won’t get back having no memories of seeing these people each day.
So how has Haiti changed me? I have pictures and frustrations in my head to last a lifetime. And I’ve only been here three months. Imagine how these people feel.
Monday, April 13, 2009
Sunday, April 12, 2009
RAM
Besides discovering what the iTunes “genius” button does, this week has been filled with events funny and sad and great. Such is Haiti.
Thursday night we ended up going to the legendary Hotel Oloffson to here RAM play. Because RAM and what RAM is to Haiti is incredibly hard to convey, I am including a Wiki link:
http://en.wikipedia.org/wiki/RAM_(band)
This is an incredibly magical and fascinating group. Richard A Morse (where RAM got its name) is the front man, an interesting guy, born in Puerto Rico, who now lives here and owns the hotel. Basically, if you want to kick back OR move around to the beat, RAM is an intense mix of African drum beats and horns. Makes for a great time. My friend Paul has a blog with video clips – you should check them out:
http://paulsjourneyyoureinvited.blogspot.com/
(Please read Paul’s account of us trying to get some food from a waitress. A sad account of what we run into each day here.)
More interesting than the music of RAM is their political history. I won’t bore you with the details that you can read elsewhere, but their past has included kidnappings during the show, threats on their lives, an incident where the government made them perform at Kanaval and the driver of the truck went nuts and ran over people, etc.
Yesterday we walked down to the hotel to grab a drink and who greeted us at our table but Richard Morse himself! We spoke with him for about 30 minutes; he spoke about everything from music to politics to "ever leaving Haiti." It was refreshing; he is such a revolutionary figure here I imagined him to be more reckless with his life. Instead he told stories of being scared for his life and wanting to keep playing music. He spoke about how he was “simply a musician”, with a twinkle in his eye. It was refreshing to hear such a figure talk about how he merely has a good gig in Haiti and he tries to do some of the right things with the platform he does have. He told us the firsthand account of police grabbing him off stage and trying to take him away, of band members being arrested at midnight during a show, and of the 1998 Kanaval accident, in which his chief security man was killed. He joked that nowhere else in the world would offer him a job. “I mean, I asked a friend about teaching elementary school in the states – you gotta get a teaching degree for that now, which would mean more school! I’m just a musician man, and I have a decent gig here in Haiti. Just a gig man, just a gig.”
To return to my struggles with Creole, I’ve learned that I get along well if I just accept what people say in Creole and try to get the overall meaning from a few of the words and the body language. For instance, today I was playing with two dogs outside our place. A man walked by and asked me something. I thought he said the word friend, pointed to the dogs, and was smiling. I thought maybe the question was “are the dogs friendly?” I just said “oui” and he smiled and called the dogs over to him to pet them. Beautiful. What’s so hard about that?? Now flashback to work. I was going to make copies in a backroom and I stopped to ask the guy who works in that wing (the door was shut) if it was ok for me to go in. Apparently he told me in too-nice a way NOT to go in there. What did I do? Oh, I smiled and said “merci” and barged into the room. Bad idea. I barged into a sensitive meeting with a few patients and the psychologists. They gave me the death look. Ooops. As I walked out the guy I spoke with on the way in looked at me like I was an idiot. (Imagine this in the states, Me: Can I go in back here to make copies? Boss: No, there is a very sensitive meeting with big-wigs and sick patients going on back there, Me: Oh great, thanks! (Barging in.))
I digress. Last story. I bought chicken off the street the other day while walking around. They chopped it and cooked it for me. We couldn’t eat it there because a guy was harassing me to buy him a coke. (This guy wanted a coke, and 10 kids were standing there behind him. “What about them?” I asked. “I buy you one and not them?” “Forget about them man, just me.”) So I ended up eating my chicken on a bridge. As I ate it, I put the chicken bones on the bridge, figuring that a dog would be able to easily get them and chew on them (as opposed to my throwing them into the trash below). So a pile of bones was sitting on the railing next to me. Next thing I know a man is yelling at me from behind, grabs my discarded bones, and bites into a bone! He continues to yell at me as he walks off. From what I gathered this was some form of “you wasteful America.” He was not happy that I wasn’t eating the bone. The act itself, grabbing someone else’s chicken bones and biting into them, sums up the situation here.
Thursday night we ended up going to the legendary Hotel Oloffson to here RAM play. Because RAM and what RAM is to Haiti is incredibly hard to convey, I am including a Wiki link:
http://en.wikipedia.org/wiki/RAM_(band)
This is an incredibly magical and fascinating group. Richard A Morse (where RAM got its name) is the front man, an interesting guy, born in Puerto Rico, who now lives here and owns the hotel. Basically, if you want to kick back OR move around to the beat, RAM is an intense mix of African drum beats and horns. Makes for a great time. My friend Paul has a blog with video clips – you should check them out:
http://paulsjourneyyoureinvited.blogspot.com/
(Please read Paul’s account of us trying to get some food from a waitress. A sad account of what we run into each day here.)
More interesting than the music of RAM is their political history. I won’t bore you with the details that you can read elsewhere, but their past has included kidnappings during the show, threats on their lives, an incident where the government made them perform at Kanaval and the driver of the truck went nuts and ran over people, etc.
Yesterday we walked down to the hotel to grab a drink and who greeted us at our table but Richard Morse himself! We spoke with him for about 30 minutes; he spoke about everything from music to politics to "ever leaving Haiti." It was refreshing; he is such a revolutionary figure here I imagined him to be more reckless with his life. Instead he told stories of being scared for his life and wanting to keep playing music. He spoke about how he was “simply a musician”, with a twinkle in his eye. It was refreshing to hear such a figure talk about how he merely has a good gig in Haiti and he tries to do some of the right things with the platform he does have. He told us the firsthand account of police grabbing him off stage and trying to take him away, of band members being arrested at midnight during a show, and of the 1998 Kanaval accident, in which his chief security man was killed. He joked that nowhere else in the world would offer him a job. “I mean, I asked a friend about teaching elementary school in the states – you gotta get a teaching degree for that now, which would mean more school! I’m just a musician man, and I have a decent gig here in Haiti. Just a gig man, just a gig.”
To return to my struggles with Creole, I’ve learned that I get along well if I just accept what people say in Creole and try to get the overall meaning from a few of the words and the body language. For instance, today I was playing with two dogs outside our place. A man walked by and asked me something. I thought he said the word friend, pointed to the dogs, and was smiling. I thought maybe the question was “are the dogs friendly?” I just said “oui” and he smiled and called the dogs over to him to pet them. Beautiful. What’s so hard about that?? Now flashback to work. I was going to make copies in a backroom and I stopped to ask the guy who works in that wing (the door was shut) if it was ok for me to go in. Apparently he told me in too-nice a way NOT to go in there. What did I do? Oh, I smiled and said “merci” and barged into the room. Bad idea. I barged into a sensitive meeting with a few patients and the psychologists. They gave me the death look. Ooops. As I walked out the guy I spoke with on the way in looked at me like I was an idiot. (Imagine this in the states, Me: Can I go in back here to make copies? Boss: No, there is a very sensitive meeting with big-wigs and sick patients going on back there, Me: Oh great, thanks! (Barging in.))
I digress. Last story. I bought chicken off the street the other day while walking around. They chopped it and cooked it for me. We couldn’t eat it there because a guy was harassing me to buy him a coke. (This guy wanted a coke, and 10 kids were standing there behind him. “What about them?” I asked. “I buy you one and not them?” “Forget about them man, just me.”) So I ended up eating my chicken on a bridge. As I ate it, I put the chicken bones on the bridge, figuring that a dog would be able to easily get them and chew on them (as opposed to my throwing them into the trash below). So a pile of bones was sitting on the railing next to me. Next thing I know a man is yelling at me from behind, grabs my discarded bones, and bites into a bone! He continues to yell at me as he walks off. From what I gathered this was some form of “you wasteful America.” He was not happy that I wasn’t eating the bone. The act itself, grabbing someone else’s chicken bones and biting into them, sums up the situation here.
Saturday, April 11, 2009
N of 1 Interviewing Experiences
Given the most recent, relatively boring post about applying to medical school, this is my “n of 1” experience of interviewing for medical school. This experience was way more fun than I thought it would be. First, a word to the wise- PREPARE for interviews. This extends beyond medicine. Think of what you would ask you in an interview. Also, go through as many questions as you can so you know what you will say in any interview session. As mentioned, pick up the “Pfizer Medical School Manual” and read/rehearse the interview questions.
If you’re on the free throw line, down 1 point, with 2 shots and no time on the clock, it would be pretty impressive if you hit the 2 shots with no practice. BUT, it’s not about being impressive – the point is to win. And if you’ve shot 10,000 free throws in practice, then you have a way better chance of making these 2. Same with the MCAT – impressive to get a 30 with no practice or studying, but MUCH better to get a 34 after a summer of studying. Besides, would you rather have a doctor that is brilliant and unprepared or smart enough and very thorough and prepared? I hate to break it to you, but much of medicine is being prepared and double checking, NOT being brilliant. Let’s leave being brilliant to the physicists.
Finally, when you interview, remember that there may not be a “right” answer per se. It is important that you discuss the sides of an issue in a professional and adequate way. Many things will not be back and white, but gray. Learn to intelligently discuss these things.
Also, I was VERY lucky to get 10 interviews from the 12 schools I applied to. I think the main reason is I had a PhD in physiology. Otherwise, I would say that applying to 12 schools in the hopes of interviewing at 6 is reasonable. Use your score to determine which schools you will apply to, realizing that much of this process is a crap shoot – you’ll get in somewhere you didn’t expect and get rejected from somewhere you thought was a lock. For starters, Yale and the Mayo Clinic rejected me without an interview. This was bizarre to me because on paper (before visits, etc), Yale was my number 1 choice and Mayo my number 12. It’s a bizarre process!
I can’t exactly remember the order, but this is pretty close to the order and how they went:
1) Cornell. Their med school is located on the Upper East Side of Manhattan. This was my first trip to NYC, so I was a bit overwhelmed. The day started with us sitting around a table waiting for the Dean to greet us. I was surprised by how interesting the people were and how they were all from schools like Harvard, Columbia, Cornell, Brown, etc. I wasn’t overwhelmed as much as surprised. After touring the facilities (which includes 3 hospitals that each year are considered among the best in the world – Memorial Sloan-Kettering Cancer Center (MSKCC), New York-Presbyterian (NYP), and Hospital for Special Surgeries (HSS)). HSS is considered by many to be the best ortho place in the world, and MSKCC is considered the best or second only to MD Anderson for cancer treatment. At lunch I met MANY first and second year students, all of which were very down to earth, relaxed, and funny people. I loved it. It felt like home – the type of people I’d like to hang out with. My first 30-min interview was with an older pediatrician. He asked the normal interview questions, and then we got off into talking about his workout routine. He was like, “ok, you’re an expert in this area, so give me some advice here. So I have been working out three times a week…” So I obliged and gave him a bunch of workout advice. He walked me out and thanked me for the advice. It was all good.
On my way to interview number two I passed a girl coming out of the Dr’s room I was about to interview with. Her face was flush and streaked with tears. I asked her how it went. She replied, “About as bad as an interview can go. He just grilled me with strange questions for over an hour.” It was awkward for me. So I walked in the room, “Well Matthew, you parents must be awfully proud of you.” He spun around in his big leather chair. “You’ll have a PhD, you published some work, you have excellent grades, a great MCAT, and lots of great experiences.” And then he kicked into bizarre rapid-fire questions. “If your sister were sitting here, what would she tell me about you?” I answered. He didn’t reply, just on to the next question. “Quick, three words your best buddies would use to describe you.” “Three adjectives to describe your family.” Finally he was pointing at figurines on his desk – “what about this?” I leaned in, “I can’t tell to what you are pointing….the elephant?” He shook his head no and just kept pointing. After chuckling at the absurdity of his just pointing and my just having to ask “the duck?...the tiger?” I finally figured out he was pointing at Sherlock Holmes. So of course I launched into how in the clinic you have to be inquisitive, curious, use rational thinking, etc. He asked me the difference between my lab science and being in the clinic. I replied with my best interview answer of the season, “Well, in the clinic an “n of 1” matters!” He loved this. Finally, after about 15 minutes of quizzing he totally switched modes. He began telling me why Cornell was a great place to be, the hospitals, the teaching, the community, etc. For the next 15 minutes he told me what a great applicant I was and sold Cornell to me. He then gave me his card and told me to contact him at any time. It was awesome. I folowed up with him via email and he was very encouraging. I understood the interview and LOVED how he did it. He was assessing how people stood up under pressure. I think I agree with him; he was using the interview to assess something about people that couldn’t be gleaned from paper. Given how much I like interviews and situations like that, I was VERY happy I got an interview like that, as I knew it would distinguish me from the other 900 people interviewing for 100 spots (roughly 5,000 people apply). At any rate, I could go on and on about why I loved Cornell, but the bottom line is that I felt at home there. It was full of smart people that liked to joke around, drink some beer, study, discuss ideas big and small, and they were from all walks of life. I was accepted “early” in December and was THRILLED.
2) Univeristy of Alabama School of Medicine. I followed up the Cornell interview with UAB. UAB is a GREAT school with lots of funding and good research. But at the end of the day it is an Alabama state school and thus accepts mostly Alabama kids. In general the scores are a bit lower, etc. I really liked the people I met at UAB; there were just a few too many kids that thought they were God’s gift. It was weird, because this began a trend I saw across my interviews that surprised me. Again, this is my “n of 1” experience, but it seemed that at the “state” schools with the lower scores, there were way more students that wanted to tell you how smart they were and how they studied, and what you needed to do when you got there. I remember thinking, “Hey, no offense there, but I think everyone here is pretty smart and will do fine. Studying from 5-7 in the morning worked for you, that’s great. I’m sure I’ll figure out my own plan.” My working hypothesis is that a lot of these kids have always been the smart ones, in HS, in college, in their family. And so perhaps they develop this view of themselves as knowing the way, knowing how to study, being the expert, etc. I had the feeling that at some of top schools that the students had been around enough crazy-brilliant people that they knew they were nothing special. I certainly learned that I am a bottom feeder at Cornell! As Mandy pointed out on revisit weekend last year as we flipped through the “who we are book” of current Cornell Med students, “Matt, are you sure you’ve been accepted here??” These folks are rock stars!
Funny UAB interview stories: In one interview, I had a middle-aged black doctor who was pumping me up, “Matthew, listen to me here man, you got this PhD thing in physiology, and you want to do Oncology. I’m telling you, this could be big man. You’ll go into a field with a totally different perspective, that’s what it takes!” I loved this guy. Then I had a stuffy middle-age white doctor interview me. He kept telling me I needed to continue with Exercise Physiology stuff. I told him that I love physiology but was interested in Oncology. He was awkward all around, but finally asked me what type of music I liked. For some reason I responded with “everything from classical to good ol' southern Atlanta rap.” He just stared at me and said nothing. That’s right, good ol' southern ATL rap. Haha. I got into UAB and received a small scholarship. I even revisited here and really enjoyed the people. I would have gone here in a heartbeat if I were in state in Alabama or if they had given me a bigger scholarship. But the little bit they gave me didn’t justify going there.
3) USC in Columbia (South Carolina). I enjoyed this school. In fact, I had another “tough” interview which I thought was great. It was full of tough questions which I thought were great. In fact, this one faculty member asked me, “You have good scores and I presume you’ll get into to several “top” schools, why should we even waste our time by offering you a spot?” I replied with the facts – “USC is a state-subsidized school and claims to want to educate SC’s students. In that vein, it should seek to keep the best students of the state in the state. I love SC and would have no problem staying here. If a student is judged to be “one of the best” SC students, then it makes little sense to not offer him/her a spot – that should be the applicant’s choice. The university owes it to the taxpayer to try to retain the best of the state.” (Or something like that.) Ultimately I was accepted and offered a scholarship but had to turn it down. I actually liked the school, but there wasn’t a lot of major research going on, no major lab or hospital facilities, and matching to an “academic” residency would have been very difficult from here. Career-wise it made no sense.
4) Medical University of South Carolina (Charleston, SC). Interesting trip. Ultimately this school was nice, but there was a bit too much “selling” themselves as a major research institution. Not that great research isn’t happening there. It is. At any rate, one interviewer absolutely tried to rake me over the coals about whether I would finish my PhD on time to begin med school. In fact, she was quite rude about it. (Insert boring details here.) She actually went so far as to tell me about her PhD and how long it took and blah blah blah. Later, she eventually CALLED my PI on the phone to ask him if I would finish my PhD on time. The ironic thing is that the drugs I used in my dissertation didn’t work and I indeed did not finish my PhD on time. Ultimately, this school was going to cost about the same as Cornell (or maybe 10k per year cheaper) after grants, etc. It just wasn’t worth it for someone wanting to go into academic medicine.
5) Georgetown. This place was nice, although I hardly met any students and the school is NOT in the heart of DC like I thought it would be. My dad and I took this trip together and we tried to grab a beer the night before and couldn’t find a place! The students also seemed, well, not all that happy, although I’m not sure why. There was also a strange talk about life and abortion that one of the deans gave. Scientifically it was a bit off, which bothered me. Ultimately it costs too much for a school that I didn’t think could give me what other "top" schools could and wasn’t in the heart of the city. There were some nice facilities though. As for the interview process, I had a big argument about the healthcare system and what needs to be done to fix it. Basically, I was talking about ideas from one of Obama’s books, about how the government’s role should be to stimulate and check the free market. It was the type of discussions/arguments I was having on a near-daily basis then so it was a lot of fun. Ultimately I got accepted here, but I just didn’t like it as much as the other programs I visited.
6) Chicago (Pritzker). This was a very nice school. In fact, I REALLY liked this place. Nothing unusual about interviews really. They didn’t house me and I had to pay to stay in the International house (which really annoyed me), but other than that no problems. After the weekend I was sent a letter saying I should continue to show interest as my file would continue to be in review. I thought this was crap. I had spent my own money to apply, written their specific application, traveled up to Chicago, taken time off from school and work, housed myself, and they want more interest? Well in typical Matthew-fashion, I said shove it, it wasn’t THAT great. Seriously, at that point it was too much. So I effectively withdrew; I never contacted them except to say I was going to Cornell. Show more interest? In my view it was time for THEM to show a bit of interest.
7) UC San Diego. This school was great. I stayed with a student who took me over in the morning to the 8 o’clock session. He told me not to worry about being late, everything in San Diego happens late. So I rolled in at 8:10 with him because we stopped to have coffee. I was there for a few minutes when someone burst into the room and said “San Diego is on fire – everything is being shut down and evacuated!” Yes, you saw this on the news. So the lady told us to go home – interviews and tours were canceled, we would have to reschedule. I spoke up “Woa woa woa, I can’t fly back out here. It costs too much. If you send me home now I am just not coming here.” I think the other students were surprised at my saying this (after all, this is UCSD, a top-tier program). But the dean came back and said that for students from out of town, they would do a few quick interviews for us. So they did, and they went very well. Then we went and ate and drank a few beers with the first years. It was great. The only points of concern were the insane curriculum (lecture 8-5 each day….uh) and the students’ perception that UCSD was not that good. When I told them it was my only California school because I liked it on paper better than the others, they thought I was crazy (why not Stanford, UCLA, UCSF?). Also, they seemed to think Cornell and Harvard were way out of their league – I should go to one of those. It was a bit weird. BUT, I loved the school, research, atmosphere and weather. I ultimately revisited here and decided Cornell was just better. If this were free I would have gone there over Cornell, but it actually was going to be more expensive.
8) NYU. Nice school. Great trauma hospital. Didn’t get to meet many students. By the time I took this interview I was pretty set on Cornell, and ended up hanging out with Cornell students while I was in town. One funny interview moment: After a great interview, and right after my interviewer told me I was a great candidate and he hoped I seriously considered NYU, we got up to leave. Now, this was a small room with just enough room for one person to get by the table to the door to leave. I was seated closest to the door. I tried to open the door, but it was one of those fancy handles that lifts up and then you turn it (hard to describe). Basically, I couldn’t open it; I’m pushing it like a button, trying to slide it, pushing with my shoulder. All the while he’s trying to explain how to open it. Finally he awkwardly tries to slide by me to open it. Awkwardness all around. In the end I got in here, but financial aid wasn’t great, and I was still in love with Cornell.
9) Harvard. This was actually a very nice program. The hospitals here are world class (Brigham and Women’s, MGH, Beth Israel) and they have research money coming out the butt. It was also cool to see all the historical stuff there. There is no doubt that this name carries heavy weight outside of the medical world (and in). It is strange though, because you could go to Mayo Clinic or Harvard for med school and I’d be hard-pressed to tell you which is better; but most people outside of medicine love the name Harvard. Nonetheless, interviews here were actually a bit too “boring” and non-confrontational. It was a case of where I didn’t think we really discussed anything important. Later I found out that at Harvard, rather than one of your interviewers going to an admissions meeting and presenting you (“this is a kid we want, our kind of person”), they simply gave you a number score and passed your folder on to the next committee, where they evaluate everything all over again. This kind of annoyed me ‘cause it seemed like a poor way to select your medical class. At any rate, the people seemed really nice, although a bit stuffier than the Cornell folks. I actually felt like my interviews went so well I was going to have to decide between here and Cornell (the name vs. the school I love). Ultimately, I got rejected post-interview! Easy decision.
10) Duke. This was LATE in the interview season (late Feb). Nevertheless, I thought the school was very nice, but it left something to be desired. The students didn’t seem as happy or fun as Cornell, and they kept telling us how Duke was as good as a Columbia, Cornell, and Harvard. Which is weird because Duke has so much funding they are generally considered as good if not better than those programs. This was my only interview where an interviewer told me I would probably get in and she hoped I considered Duke, but then I got waitlisted. Ultimately I took my name off the waitlist. It wasn’t close to Cornell in my mind. Duke is no doubt a great program, but there was some strange aura to it; why did they keep having to tell me how competitive and great a program it was? I would have gone here if it was paid for, but otherwise it wasn’t worth it to me.
That was the interview season! Exhausting but fun…In the end I got my first choice- I was lucky. I was also well-prepared. If you are interviewing now, just be as prepared as you can be and have fun with it. For those of you who could care less about this, I’ll be back to Haiti posts now! I just posted the Med Application info and had some interest to post more (I’m a slave to the few readers of this blog! I’m working for the people here!).
If you’re on the free throw line, down 1 point, with 2 shots and no time on the clock, it would be pretty impressive if you hit the 2 shots with no practice. BUT, it’s not about being impressive – the point is to win. And if you’ve shot 10,000 free throws in practice, then you have a way better chance of making these 2. Same with the MCAT – impressive to get a 30 with no practice or studying, but MUCH better to get a 34 after a summer of studying. Besides, would you rather have a doctor that is brilliant and unprepared or smart enough and very thorough and prepared? I hate to break it to you, but much of medicine is being prepared and double checking, NOT being brilliant. Let’s leave being brilliant to the physicists.
Finally, when you interview, remember that there may not be a “right” answer per se. It is important that you discuss the sides of an issue in a professional and adequate way. Many things will not be back and white, but gray. Learn to intelligently discuss these things.
Also, I was VERY lucky to get 10 interviews from the 12 schools I applied to. I think the main reason is I had a PhD in physiology. Otherwise, I would say that applying to 12 schools in the hopes of interviewing at 6 is reasonable. Use your score to determine which schools you will apply to, realizing that much of this process is a crap shoot – you’ll get in somewhere you didn’t expect and get rejected from somewhere you thought was a lock. For starters, Yale and the Mayo Clinic rejected me without an interview. This was bizarre to me because on paper (before visits, etc), Yale was my number 1 choice and Mayo my number 12. It’s a bizarre process!
I can’t exactly remember the order, but this is pretty close to the order and how they went:
1) Cornell. Their med school is located on the Upper East Side of Manhattan. This was my first trip to NYC, so I was a bit overwhelmed. The day started with us sitting around a table waiting for the Dean to greet us. I was surprised by how interesting the people were and how they were all from schools like Harvard, Columbia, Cornell, Brown, etc. I wasn’t overwhelmed as much as surprised. After touring the facilities (which includes 3 hospitals that each year are considered among the best in the world – Memorial Sloan-Kettering Cancer Center (MSKCC), New York-Presbyterian (NYP), and Hospital for Special Surgeries (HSS)). HSS is considered by many to be the best ortho place in the world, and MSKCC is considered the best or second only to MD Anderson for cancer treatment. At lunch I met MANY first and second year students, all of which were very down to earth, relaxed, and funny people. I loved it. It felt like home – the type of people I’d like to hang out with. My first 30-min interview was with an older pediatrician. He asked the normal interview questions, and then we got off into talking about his workout routine. He was like, “ok, you’re an expert in this area, so give me some advice here. So I have been working out three times a week…” So I obliged and gave him a bunch of workout advice. He walked me out and thanked me for the advice. It was all good.
On my way to interview number two I passed a girl coming out of the Dr’s room I was about to interview with. Her face was flush and streaked with tears. I asked her how it went. She replied, “About as bad as an interview can go. He just grilled me with strange questions for over an hour.” It was awkward for me. So I walked in the room, “Well Matthew, you parents must be awfully proud of you.” He spun around in his big leather chair. “You’ll have a PhD, you published some work, you have excellent grades, a great MCAT, and lots of great experiences.” And then he kicked into bizarre rapid-fire questions. “If your sister were sitting here, what would she tell me about you?” I answered. He didn’t reply, just on to the next question. “Quick, three words your best buddies would use to describe you.” “Three adjectives to describe your family.” Finally he was pointing at figurines on his desk – “what about this?” I leaned in, “I can’t tell to what you are pointing….the elephant?” He shook his head no and just kept pointing. After chuckling at the absurdity of his just pointing and my just having to ask “the duck?...the tiger?” I finally figured out he was pointing at Sherlock Holmes. So of course I launched into how in the clinic you have to be inquisitive, curious, use rational thinking, etc. He asked me the difference between my lab science and being in the clinic. I replied with my best interview answer of the season, “Well, in the clinic an “n of 1” matters!” He loved this. Finally, after about 15 minutes of quizzing he totally switched modes. He began telling me why Cornell was a great place to be, the hospitals, the teaching, the community, etc. For the next 15 minutes he told me what a great applicant I was and sold Cornell to me. He then gave me his card and told me to contact him at any time. It was awesome. I folowed up with him via email and he was very encouraging. I understood the interview and LOVED how he did it. He was assessing how people stood up under pressure. I think I agree with him; he was using the interview to assess something about people that couldn’t be gleaned from paper. Given how much I like interviews and situations like that, I was VERY happy I got an interview like that, as I knew it would distinguish me from the other 900 people interviewing for 100 spots (roughly 5,000 people apply). At any rate, I could go on and on about why I loved Cornell, but the bottom line is that I felt at home there. It was full of smart people that liked to joke around, drink some beer, study, discuss ideas big and small, and they were from all walks of life. I was accepted “early” in December and was THRILLED.
2) Univeristy of Alabama School of Medicine. I followed up the Cornell interview with UAB. UAB is a GREAT school with lots of funding and good research. But at the end of the day it is an Alabama state school and thus accepts mostly Alabama kids. In general the scores are a bit lower, etc. I really liked the people I met at UAB; there were just a few too many kids that thought they were God’s gift. It was weird, because this began a trend I saw across my interviews that surprised me. Again, this is my “n of 1” experience, but it seemed that at the “state” schools with the lower scores, there were way more students that wanted to tell you how smart they were and how they studied, and what you needed to do when you got there. I remember thinking, “Hey, no offense there, but I think everyone here is pretty smart and will do fine. Studying from 5-7 in the morning worked for you, that’s great. I’m sure I’ll figure out my own plan.” My working hypothesis is that a lot of these kids have always been the smart ones, in HS, in college, in their family. And so perhaps they develop this view of themselves as knowing the way, knowing how to study, being the expert, etc. I had the feeling that at some of top schools that the students had been around enough crazy-brilliant people that they knew they were nothing special. I certainly learned that I am a bottom feeder at Cornell! As Mandy pointed out on revisit weekend last year as we flipped through the “who we are book” of current Cornell Med students, “Matt, are you sure you’ve been accepted here??” These folks are rock stars!
Funny UAB interview stories: In one interview, I had a middle-aged black doctor who was pumping me up, “Matthew, listen to me here man, you got this PhD thing in physiology, and you want to do Oncology. I’m telling you, this could be big man. You’ll go into a field with a totally different perspective, that’s what it takes!” I loved this guy. Then I had a stuffy middle-age white doctor interview me. He kept telling me I needed to continue with Exercise Physiology stuff. I told him that I love physiology but was interested in Oncology. He was awkward all around, but finally asked me what type of music I liked. For some reason I responded with “everything from classical to good ol' southern Atlanta rap.” He just stared at me and said nothing. That’s right, good ol' southern ATL rap. Haha. I got into UAB and received a small scholarship. I even revisited here and really enjoyed the people. I would have gone here in a heartbeat if I were in state in Alabama or if they had given me a bigger scholarship. But the little bit they gave me didn’t justify going there.
3) USC in Columbia (South Carolina). I enjoyed this school. In fact, I had another “tough” interview which I thought was great. It was full of tough questions which I thought were great. In fact, this one faculty member asked me, “You have good scores and I presume you’ll get into to several “top” schools, why should we even waste our time by offering you a spot?” I replied with the facts – “USC is a state-subsidized school and claims to want to educate SC’s students. In that vein, it should seek to keep the best students of the state in the state. I love SC and would have no problem staying here. If a student is judged to be “one of the best” SC students, then it makes little sense to not offer him/her a spot – that should be the applicant’s choice. The university owes it to the taxpayer to try to retain the best of the state.” (Or something like that.) Ultimately I was accepted and offered a scholarship but had to turn it down. I actually liked the school, but there wasn’t a lot of major research going on, no major lab or hospital facilities, and matching to an “academic” residency would have been very difficult from here. Career-wise it made no sense.
4) Medical University of South Carolina (Charleston, SC). Interesting trip. Ultimately this school was nice, but there was a bit too much “selling” themselves as a major research institution. Not that great research isn’t happening there. It is. At any rate, one interviewer absolutely tried to rake me over the coals about whether I would finish my PhD on time to begin med school. In fact, she was quite rude about it. (Insert boring details here.) She actually went so far as to tell me about her PhD and how long it took and blah blah blah. Later, she eventually CALLED my PI on the phone to ask him if I would finish my PhD on time. The ironic thing is that the drugs I used in my dissertation didn’t work and I indeed did not finish my PhD on time. Ultimately, this school was going to cost about the same as Cornell (or maybe 10k per year cheaper) after grants, etc. It just wasn’t worth it for someone wanting to go into academic medicine.
5) Georgetown. This place was nice, although I hardly met any students and the school is NOT in the heart of DC like I thought it would be. My dad and I took this trip together and we tried to grab a beer the night before and couldn’t find a place! The students also seemed, well, not all that happy, although I’m not sure why. There was also a strange talk about life and abortion that one of the deans gave. Scientifically it was a bit off, which bothered me. Ultimately it costs too much for a school that I didn’t think could give me what other "top" schools could and wasn’t in the heart of the city. There were some nice facilities though. As for the interview process, I had a big argument about the healthcare system and what needs to be done to fix it. Basically, I was talking about ideas from one of Obama’s books, about how the government’s role should be to stimulate and check the free market. It was the type of discussions/arguments I was having on a near-daily basis then so it was a lot of fun. Ultimately I got accepted here, but I just didn’t like it as much as the other programs I visited.
6) Chicago (Pritzker). This was a very nice school. In fact, I REALLY liked this place. Nothing unusual about interviews really. They didn’t house me and I had to pay to stay in the International house (which really annoyed me), but other than that no problems. After the weekend I was sent a letter saying I should continue to show interest as my file would continue to be in review. I thought this was crap. I had spent my own money to apply, written their specific application, traveled up to Chicago, taken time off from school and work, housed myself, and they want more interest? Well in typical Matthew-fashion, I said shove it, it wasn’t THAT great. Seriously, at that point it was too much. So I effectively withdrew; I never contacted them except to say I was going to Cornell. Show more interest? In my view it was time for THEM to show a bit of interest.
7) UC San Diego. This school was great. I stayed with a student who took me over in the morning to the 8 o’clock session. He told me not to worry about being late, everything in San Diego happens late. So I rolled in at 8:10 with him because we stopped to have coffee. I was there for a few minutes when someone burst into the room and said “San Diego is on fire – everything is being shut down and evacuated!” Yes, you saw this on the news. So the lady told us to go home – interviews and tours were canceled, we would have to reschedule. I spoke up “Woa woa woa, I can’t fly back out here. It costs too much. If you send me home now I am just not coming here.” I think the other students were surprised at my saying this (after all, this is UCSD, a top-tier program). But the dean came back and said that for students from out of town, they would do a few quick interviews for us. So they did, and they went very well. Then we went and ate and drank a few beers with the first years. It was great. The only points of concern were the insane curriculum (lecture 8-5 each day….uh) and the students’ perception that UCSD was not that good. When I told them it was my only California school because I liked it on paper better than the others, they thought I was crazy (why not Stanford, UCLA, UCSF?). Also, they seemed to think Cornell and Harvard were way out of their league – I should go to one of those. It was a bit weird. BUT, I loved the school, research, atmosphere and weather. I ultimately revisited here and decided Cornell was just better. If this were free I would have gone there over Cornell, but it actually was going to be more expensive.
8) NYU. Nice school. Great trauma hospital. Didn’t get to meet many students. By the time I took this interview I was pretty set on Cornell, and ended up hanging out with Cornell students while I was in town. One funny interview moment: After a great interview, and right after my interviewer told me I was a great candidate and he hoped I seriously considered NYU, we got up to leave. Now, this was a small room with just enough room for one person to get by the table to the door to leave. I was seated closest to the door. I tried to open the door, but it was one of those fancy handles that lifts up and then you turn it (hard to describe). Basically, I couldn’t open it; I’m pushing it like a button, trying to slide it, pushing with my shoulder. All the while he’s trying to explain how to open it. Finally he awkwardly tries to slide by me to open it. Awkwardness all around. In the end I got in here, but financial aid wasn’t great, and I was still in love with Cornell.
9) Harvard. This was actually a very nice program. The hospitals here are world class (Brigham and Women’s, MGH, Beth Israel) and they have research money coming out the butt. It was also cool to see all the historical stuff there. There is no doubt that this name carries heavy weight outside of the medical world (and in). It is strange though, because you could go to Mayo Clinic or Harvard for med school and I’d be hard-pressed to tell you which is better; but most people outside of medicine love the name Harvard. Nonetheless, interviews here were actually a bit too “boring” and non-confrontational. It was a case of where I didn’t think we really discussed anything important. Later I found out that at Harvard, rather than one of your interviewers going to an admissions meeting and presenting you (“this is a kid we want, our kind of person”), they simply gave you a number score and passed your folder on to the next committee, where they evaluate everything all over again. This kind of annoyed me ‘cause it seemed like a poor way to select your medical class. At any rate, the people seemed really nice, although a bit stuffier than the Cornell folks. I actually felt like my interviews went so well I was going to have to decide between here and Cornell (the name vs. the school I love). Ultimately, I got rejected post-interview! Easy decision.
10) Duke. This was LATE in the interview season (late Feb). Nevertheless, I thought the school was very nice, but it left something to be desired. The students didn’t seem as happy or fun as Cornell, and they kept telling us how Duke was as good as a Columbia, Cornell, and Harvard. Which is weird because Duke has so much funding they are generally considered as good if not better than those programs. This was my only interview where an interviewer told me I would probably get in and she hoped I considered Duke, but then I got waitlisted. Ultimately I took my name off the waitlist. It wasn’t close to Cornell in my mind. Duke is no doubt a great program, but there was some strange aura to it; why did they keep having to tell me how competitive and great a program it was? I would have gone here if it was paid for, but otherwise it wasn’t worth it to me.
That was the interview season! Exhausting but fun…In the end I got my first choice- I was lucky. I was also well-prepared. If you are interviewing now, just be as prepared as you can be and have fun with it. For those of you who could care less about this, I’ll be back to Haiti posts now! I just posted the Med Application info and had some interest to post more (I’m a slave to the few readers of this blog! I’m working for the people here!).
Thursday, April 9, 2009
Applying to Medical School
This past week I spent in New York City, meeting with faculty and students and, in general, getting no sleep. It was great. It was “revisit” weekend at Cornell, where accepted students come and visit the school before picking the school they wish to attend this fall. Since many people reading this are not in the field, and I get asked often about the application process, I will give a brief recap of the medical application process:
1) Pre-reqs: As many know, most medical schools require the following: 2 semesters of Biology, 2 semesters of Chemistry, 2 semesters of Physics, and 2 semesters of Organic Chemistry. This is the core of what is required. I think some schools require random other things (notably math), but these are the main courses needed to study medicine. If you are applying, pick up a recent copy of “Medical School Admission Requirements” (MSAR). This book gives a full page on everything about each school, from MCAT scores to size of class to how grades are given and what percentage of students are accepted. As you will learn, name of school and rank don't mean as much as you would hope, so reading about each school is very important in choosing one. Where do you want to live? What type of people do you want to be around? What was your MCAT score? Are you interested in being in Academic Medicine? In general, if your goal is to do primary care practice, I would say save money and go to your state school. However, if you plan to be in Academic Medicine to some degree OR want to go into a very competitive specialty, then go to a "big-name" place (Stanford, Harvard, Cornell, Penn, Hopkins, etc). That being said, going to a school somewhere makes it more likely you'll do residency in that area (NE, Cali, etc). So consider that. Also, try to look at "match lists" of where students do residency. While it is true you can "match" from any school, it is MUCH easier to match at a big-name place if they have a relationship with your school. In other words, board scores and grades are the same, one kid is from Hopkins, which has always given us great students, and the other kid is from South Carolina Medical School, which we've never had a student from. In filling my house staff at the hospital, I'm going to go with what I know is a quality product. Also, there are MD schools and DO schools (Medical Doctor vs. Doctor of Osteopathy). While I do not have room to give the whole history here, suffice it to say that DO's are legally granted the same practicing rights as MD's. DO schools were originally formed by an MD with the idea that medicine should be more holistic and focus on the whole body. It was a good idea, but DO school has become the "less competitive" degree over the years. MCAT scores, GPAs, etc are significantly lower in DO students. In turn it is more difficult to match to a competitive specialty if you get a DO. However, if your goal is family medicine, it probably won't matter.
2) MCAT: At some point, every applicant must take the Medical Colleges Admissions Test (MCAT). This test, originally designed to cut down on the attrition rate in medical schools, now allows schools to admit a select group of students. In the 1920’s, 1st year medical students were failing at an alarming rate (attrition was as high as 50%). The first MCAT version was implemented in 1928, and by the 1940’s attrition was down to under 8%. Today’s MCAT has 4 timed sections: Physical Sciences (Chemistry, Physics), Verbal Reasoning, Writing Sample, and Biological Sciences (Biology, Organic). PS, VR, and BS are all scored from 1-15 (low-high). These are then combined to give your total score. The writing sample is graded J-T (low-high), but is not really looked at unless 1) it is really low, or 2) you are applying to a Canadian medical school. Score wise, the exam is graded on a bell curve. So the average score per section is around 8. The average total score of all people that sit for the MCAT is about 24. The average student that gets into medical school scores about a 30-31, depending on the year. In general, the lower end of the spectrum for MD schools have average MCAT scores around 27-28, while the higher-end of the spectrum are schools that have an average of 34-35. In general, you probably will not get into medical school if you have a 26 OR less than 8 on any one section. Also, if you score 34-35, then you can apply to any school in America, as many of the other factors will now become important. In other words, 34-35 is around 95th percentile, so if you score between 35-45, the chances of schools "caring" about your MCAT goes way down; it is the difference between 95th and 99.99th percentile. Most students should study 300-500 hours for this exam, and many students will be forced to take it more than once. There are numerous practice exams on AAMC's website. In fact, if you are curious, you can go take MCAT 3R on the AAMC website for free. Good luck! This is considered by many to be the hardest part of getting in. Personally, I would recommend using "Examkrackers" study books. I by no means had a great SAT score (1250), but studied for 2-3 months and managed a 34 on the MCAT. Again, it's my "n of 1" experience, but I have also tutored many MCAT students with Examkrackers and now have many students in different medical schools.
3) “Other experiences” matter. Schools like to see that you are involved in things besides studying. Who wants a doctor that is very smart but knows nothing about the world and thus cannot relate to patients? Also, medical schools look for shadowing experiences that “validate” your interest in medicine. (How do you know you want to do medicine if you’ve never been around it?) Although there are no requirements, applicants should try to get meaningful experiences that they can talk about during an interview. (Consequently, “meaningful” experiences generally help the applicant begin deciding on specialty and school best for that.) Try to shadow a range of physicians and pick the physician's brain as you shadow about current medical problems. Don't be afraid to argue - they are people just like you! Just make sure you are polite and diplomatic about your views; and always back your views up with DATA! (In other words, don't argue unless you really can back it up; but it's ok to have an opinion and discuss it.)
4) Research experience. Although not a pre-req, many schools like to see some involvement in research, as the job of a physician is at the very least to keep up with the cutting edge research in his/her field. Try to spend at least one summer in a research lab. Really get to know the research so that you can meaningfully talk about it. Also, try to get a poster presentation out of some part of the research. Also, the lab PI could be a very valuable letter of rec.
5) AMCAS application. The applicant will apply via a computer-system two summers before matriculating (so apply summer 2009 to begin fall of 2010). On this application, you basically give curriculum vitae or resume. You also write a personal statement and list all grades, schools, experiences, etc. At this point you also check which schools you will be applying to. (I applied to 17 schools at this point.)
6) Secondary applications. Each school will get your application and then request that you fill out a “secondary” specific to that school. These range from one simple page to 6 long essays. (I filled out 12 secondary applications.)
7) After this, you send in recommendations from professors and physicians. If you are unsure as to how good the letter of rec will be, find a different person to write it! These letters of rec should be full of comments as to how outstanding and unique you are. A great letter of rec won’t get you in on its own, but a lukewarm letter could sink you.
8) Now you just wait on an interview. Interviews are from September to March. Interviews are extremely fun. This is usually a whole day where they take you around the school and all the major facilities, hospitals, etc. You also usually get to meet other like-minded applicants and students and get a “feel” as to whether you would like it there. (I received invitations to and took interviews at 10 schools.) Although it is hard, try to relax and have fun with interviews. You should also come prepared with questions about the school – you should interview them as well. Also, pick up a copy of the “Pfizer Medical School Manual” by Mike Magee. Use the potential interview questions in this book to prep.
9) You then wait for acceptance/rejection/waitlist letters. (I was accepted to 7, waitlisted at 2, rejected at 1.)
10) By mid-March most programs have decided whom they are inviting to come to school.
11) By mid-May applicants must decide on a program to attend.
12) Between March and May, applicants attend “revisit” weekends to decide where they would like to attend school. Not all schools have revisit, but many of the high-ranked schools that know their accepted students have more than one acceptance usually do so. (Last year I attended UCSD and Cornell revisits.)
13) Don’t forget that many students move off waiting lists and into schools between May and August.So, this past week I was in NY for Cornell’s revisit (and to look at housing). I will write more on the actual interviews I took last year in the next segment, as those experiences were full of humorous moments and interesting perspectives on schools.
This is by no means an exhaustive list! Please feel free to email me with other questions!
1) Pre-reqs: As many know, most medical schools require the following: 2 semesters of Biology, 2 semesters of Chemistry, 2 semesters of Physics, and 2 semesters of Organic Chemistry. This is the core of what is required. I think some schools require random other things (notably math), but these are the main courses needed to study medicine. If you are applying, pick up a recent copy of “Medical School Admission Requirements” (MSAR). This book gives a full page on everything about each school, from MCAT scores to size of class to how grades are given and what percentage of students are accepted. As you will learn, name of school and rank don't mean as much as you would hope, so reading about each school is very important in choosing one. Where do you want to live? What type of people do you want to be around? What was your MCAT score? Are you interested in being in Academic Medicine? In general, if your goal is to do primary care practice, I would say save money and go to your state school. However, if you plan to be in Academic Medicine to some degree OR want to go into a very competitive specialty, then go to a "big-name" place (Stanford, Harvard, Cornell, Penn, Hopkins, etc). That being said, going to a school somewhere makes it more likely you'll do residency in that area (NE, Cali, etc). So consider that. Also, try to look at "match lists" of where students do residency. While it is true you can "match" from any school, it is MUCH easier to match at a big-name place if they have a relationship with your school. In other words, board scores and grades are the same, one kid is from Hopkins, which has always given us great students, and the other kid is from South Carolina Medical School, which we've never had a student from. In filling my house staff at the hospital, I'm going to go with what I know is a quality product. Also, there are MD schools and DO schools (Medical Doctor vs. Doctor of Osteopathy). While I do not have room to give the whole history here, suffice it to say that DO's are legally granted the same practicing rights as MD's. DO schools were originally formed by an MD with the idea that medicine should be more holistic and focus on the whole body. It was a good idea, but DO school has become the "less competitive" degree over the years. MCAT scores, GPAs, etc are significantly lower in DO students. In turn it is more difficult to match to a competitive specialty if you get a DO. However, if your goal is family medicine, it probably won't matter.
2) MCAT: At some point, every applicant must take the Medical Colleges Admissions Test (MCAT). This test, originally designed to cut down on the attrition rate in medical schools, now allows schools to admit a select group of students. In the 1920’s, 1st year medical students were failing at an alarming rate (attrition was as high as 50%). The first MCAT version was implemented in 1928, and by the 1940’s attrition was down to under 8%. Today’s MCAT has 4 timed sections: Physical Sciences (Chemistry, Physics), Verbal Reasoning, Writing Sample, and Biological Sciences (Biology, Organic). PS, VR, and BS are all scored from 1-15 (low-high). These are then combined to give your total score. The writing sample is graded J-T (low-high), but is not really looked at unless 1) it is really low, or 2) you are applying to a Canadian medical school. Score wise, the exam is graded on a bell curve. So the average score per section is around 8. The average total score of all people that sit for the MCAT is about 24. The average student that gets into medical school scores about a 30-31, depending on the year. In general, the lower end of the spectrum for MD schools have average MCAT scores around 27-28, while the higher-end of the spectrum are schools that have an average of 34-35. In general, you probably will not get into medical school if you have a 26 OR less than 8 on any one section. Also, if you score 34-35, then you can apply to any school in America, as many of the other factors will now become important. In other words, 34-35 is around 95th percentile, so if you score between 35-45, the chances of schools "caring" about your MCAT goes way down; it is the difference between 95th and 99.99th percentile. Most students should study 300-500 hours for this exam, and many students will be forced to take it more than once. There are numerous practice exams on AAMC's website. In fact, if you are curious, you can go take MCAT 3R on the AAMC website for free. Good luck! This is considered by many to be the hardest part of getting in. Personally, I would recommend using "Examkrackers" study books. I by no means had a great SAT score (1250), but studied for 2-3 months and managed a 34 on the MCAT. Again, it's my "n of 1" experience, but I have also tutored many MCAT students with Examkrackers and now have many students in different medical schools.
3) “Other experiences” matter. Schools like to see that you are involved in things besides studying. Who wants a doctor that is very smart but knows nothing about the world and thus cannot relate to patients? Also, medical schools look for shadowing experiences that “validate” your interest in medicine. (How do you know you want to do medicine if you’ve never been around it?) Although there are no requirements, applicants should try to get meaningful experiences that they can talk about during an interview. (Consequently, “meaningful” experiences generally help the applicant begin deciding on specialty and school best for that.) Try to shadow a range of physicians and pick the physician's brain as you shadow about current medical problems. Don't be afraid to argue - they are people just like you! Just make sure you are polite and diplomatic about your views; and always back your views up with DATA! (In other words, don't argue unless you really can back it up; but it's ok to have an opinion and discuss it.)
4) Research experience. Although not a pre-req, many schools like to see some involvement in research, as the job of a physician is at the very least to keep up with the cutting edge research in his/her field. Try to spend at least one summer in a research lab. Really get to know the research so that you can meaningfully talk about it. Also, try to get a poster presentation out of some part of the research. Also, the lab PI could be a very valuable letter of rec.
5) AMCAS application. The applicant will apply via a computer-system two summers before matriculating (so apply summer 2009 to begin fall of 2010). On this application, you basically give curriculum vitae or resume. You also write a personal statement and list all grades, schools, experiences, etc. At this point you also check which schools you will be applying to. (I applied to 17 schools at this point.)
6) Secondary applications. Each school will get your application and then request that you fill out a “secondary” specific to that school. These range from one simple page to 6 long essays. (I filled out 12 secondary applications.)
7) After this, you send in recommendations from professors and physicians. If you are unsure as to how good the letter of rec will be, find a different person to write it! These letters of rec should be full of comments as to how outstanding and unique you are. A great letter of rec won’t get you in on its own, but a lukewarm letter could sink you.
8) Now you just wait on an interview. Interviews are from September to March. Interviews are extremely fun. This is usually a whole day where they take you around the school and all the major facilities, hospitals, etc. You also usually get to meet other like-minded applicants and students and get a “feel” as to whether you would like it there. (I received invitations to and took interviews at 10 schools.) Although it is hard, try to relax and have fun with interviews. You should also come prepared with questions about the school – you should interview them as well. Also, pick up a copy of the “Pfizer Medical School Manual” by Mike Magee. Use the potential interview questions in this book to prep.
9) You then wait for acceptance/rejection/waitlist letters. (I was accepted to 7, waitlisted at 2, rejected at 1.)
10) By mid-March most programs have decided whom they are inviting to come to school.
11) By mid-May applicants must decide on a program to attend.
12) Between March and May, applicants attend “revisit” weekends to decide where they would like to attend school. Not all schools have revisit, but many of the high-ranked schools that know their accepted students have more than one acceptance usually do so. (Last year I attended UCSD and Cornell revisits.)
13) Don’t forget that many students move off waiting lists and into schools between May and August.So, this past week I was in NY for Cornell’s revisit (and to look at housing). I will write more on the actual interviews I took last year in the next segment, as those experiences were full of humorous moments and interesting perspectives on schools.
This is by no means an exhaustive list! Please feel free to email me with other questions!
Wednesday, April 1, 2009
Si Dye Vle
Yesterday we had a meeting to discuss patients/the clinics, etc. Although I had some trouble keeping up, as it was conducted in Kreyol/French, I had friends around me who would periodically bring me back up to speed on the meeting. Basically, there was a big argument about how more and more patients are stopping their drugs and saying that God will heal them. Apparently, they were saying more and more patients are responding during counseling with “If I get HIV that is OK, it must be from God.” There was a heated discussion about why this attitude is becoming more and more prevalent. Some were saying that the more missionaries and others teach the power of prayer and the almighty power of God, the more people think that is that answer to their HIV, not the medicine. Whether or not this attitude is stronger because of missionaries or because of local church authorities is hard to say. But it was the same attitude I faced when in the STI clinic – women having husbands with multiple partners and feeling that whatever God wants will happen. Doesn’t matter if that is HIV, death, etc. One can’t help but wonder if this is the attitude one must adapt when life is full of circumstances that are as harsh as here, regardless of what these people do. Stay in school, study, work hard. And yet at best you get a job which brings little fulfillment and little opportunity. Most people are unemployed, half cannot read, and those that have jobs have very little room to advance. So it must be God’s will. God’s will that you endure these circumstances, at least until the afterlife. Most sentences about the future in Haiti are ended with “Si Dye vle”. This literally means “if God wants” or really “God willing.” So they don’t say “N'a we demen” (see you tomorrow), they say “N’a we demen, si Dye vle.” (see you tomorrow, God willing).
From a healthcare perspective this is a disaster. Imagine if your dad was having a heart attack and rather than rush him to the ER to open a coronary artery you sat around him and prayed instead. Imagine your three-month old is vomiting and has diarrhea and rather than calling your Dr. or getting him to a hospital or trying to get fluids in him you sat around and prayed. Unfortunately, prayer won’t get fluid into your blood vessels. Prayer won’t open an occluded coronary artery. Otherwise medical care would be very different. In fact, many people have tried to “study” the effect of prayer on medical outcomes. While there are some studies suggesting that the psychology of prayer is complex (i.e. some people do worse when they know they’re being prayed for, etc), nothing suggests that prayer in any medical sense “works”.
I once was in a discussion and the following was posed. If prayer does work in a medical setting as so many espouse that it does, then the test for this is simple. (Bear in mind that the value of prayer as part of meditation or culture or ritual is very different than “does it work?” The test for “does it work” is simple – pray for someone to be healed. Then look- did it work, were they healed?) There are many things in medicine we do not understand. Some cancers spontaneously go into remission. Some patients respond to certain medicine regimes while others do not. Many times a patient's remitting cancer will be credited to God or a higher power. The truth is we just don’t understand cancer. At all. It doesn’t take much to look back over recent history and see that all too often when we don’t yet understand a natural phenomenon we attribute it to "God". We do know that God doesn’t make dirty water clean; boiling it does. God doesn’t reset broken bones; orthopedics putting them in casts do. God doesn’t kill syphilis, penicillin does. But things we don’t fully understand yet, that are too vague, are attributed to God. Imagine how strange it will be in 50 years when medicine IS personalized, and we understand why people with certain genetic profiles do and do not respond to certain medicines. This work is already being done across the US at major medical centers.
To get back to the point, the test is simple. If prayer works, then pray for tangible results in a medical area we understand. Take a cohort of patients that have had limbs amputated. Then have groups pray for them to regenerate new limbs. Then see how much/if regeneration happens. If regeneration occurs, prayer works. Most people would say this is not possible; limbs cannot regenerate. But indeed, in other species limbs can regenerate. But no one would do this study. Why not? We like our religion and convictions too much to put them in a situation in which we know they will fail. And if you think prayer would work for this, then let's do the study. Perhaps you'd think "do not put the lord your God to the test". But then this begs the question, if earnest prayer from a believer could result in easing suffering in this world, what type of God would refuse this because he didn't want to be "put to the test"?
If this characterizes a God that exists then we should be frightened. He knows our suffering, he hears our pleas. Many believe he created this all, including the laws of the universe. So now we have a system that was created in which people suffer and their pleas are not answered; it's as if there was no other way to do this.
If you were God, would you create a system in which the large majority of people in your creation would spend their existence in eternal torment and suffering? Would you really choose to damn people for eternity because they were born into a different belief system? A belief system in which many of the themes are the same - help each other, love your neighbor. Would you damn these people that you allowed to be born into loving families and cultures that provided JUST as much evidence for truth as what was true according to you? Would you really provide so little evidence that your truth was the right way and then damn so many people to eternal suffering?
If this is the type of God you would be, I'd like you to meet those people from other cultures, look them in the eye, and tell them that despite their earnest seeking, loving hearts, and promotion of love in this world, you will be damning them to eternal suffering.
My hope is that you would be a better God than that, si Dye vle.
From a healthcare perspective this is a disaster. Imagine if your dad was having a heart attack and rather than rush him to the ER to open a coronary artery you sat around him and prayed instead. Imagine your three-month old is vomiting and has diarrhea and rather than calling your Dr. or getting him to a hospital or trying to get fluids in him you sat around and prayed. Unfortunately, prayer won’t get fluid into your blood vessels. Prayer won’t open an occluded coronary artery. Otherwise medical care would be very different. In fact, many people have tried to “study” the effect of prayer on medical outcomes. While there are some studies suggesting that the psychology of prayer is complex (i.e. some people do worse when they know they’re being prayed for, etc), nothing suggests that prayer in any medical sense “works”.
I once was in a discussion and the following was posed. If prayer does work in a medical setting as so many espouse that it does, then the test for this is simple. (Bear in mind that the value of prayer as part of meditation or culture or ritual is very different than “does it work?” The test for “does it work” is simple – pray for someone to be healed. Then look- did it work, were they healed?) There are many things in medicine we do not understand. Some cancers spontaneously go into remission. Some patients respond to certain medicine regimes while others do not. Many times a patient's remitting cancer will be credited to God or a higher power. The truth is we just don’t understand cancer. At all. It doesn’t take much to look back over recent history and see that all too often when we don’t yet understand a natural phenomenon we attribute it to "God". We do know that God doesn’t make dirty water clean; boiling it does. God doesn’t reset broken bones; orthopedics putting them in casts do. God doesn’t kill syphilis, penicillin does. But things we don’t fully understand yet, that are too vague, are attributed to God. Imagine how strange it will be in 50 years when medicine IS personalized, and we understand why people with certain genetic profiles do and do not respond to certain medicines. This work is already being done across the US at major medical centers.
To get back to the point, the test is simple. If prayer works, then pray for tangible results in a medical area we understand. Take a cohort of patients that have had limbs amputated. Then have groups pray for them to regenerate new limbs. Then see how much/if regeneration happens. If regeneration occurs, prayer works. Most people would say this is not possible; limbs cannot regenerate. But indeed, in other species limbs can regenerate. But no one would do this study. Why not? We like our religion and convictions too much to put them in a situation in which we know they will fail. And if you think prayer would work for this, then let's do the study. Perhaps you'd think "do not put the lord your God to the test". But then this begs the question, if earnest prayer from a believer could result in easing suffering in this world, what type of God would refuse this because he didn't want to be "put to the test"?
If this characterizes a God that exists then we should be frightened. He knows our suffering, he hears our pleas. Many believe he created this all, including the laws of the universe. So now we have a system that was created in which people suffer and their pleas are not answered; it's as if there was no other way to do this.
If you were God, would you create a system in which the large majority of people in your creation would spend their existence in eternal torment and suffering? Would you really choose to damn people for eternity because they were born into a different belief system? A belief system in which many of the themes are the same - help each other, love your neighbor. Would you damn these people that you allowed to be born into loving families and cultures that provided JUST as much evidence for truth as what was true according to you? Would you really provide so little evidence that your truth was the right way and then damn so many people to eternal suffering?
If this is the type of God you would be, I'd like you to meet those people from other cultures, look them in the eye, and tell them that despite their earnest seeking, loving hearts, and promotion of love in this world, you will be damning them to eternal suffering.
My hope is that you would be a better God than that, si Dye vle.
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