David discusses the 15-15-1 Theory

In my glorious two-plus decades on this planet, I have been many things: scholar, playwright and, most recently, emo-blogger extraordinaire. Today, I add intellectual revolutionary to that storied list as I unveil a strategy that will forever alter the landscape of medical school admissions.

Just kidding. The following is more of a thought experiment. Nonetheless, ladies, gentleman, our #1 fan (that’s you, Julia), maybe even Kevin (but probably not Kevin), I present to you the 15-15-1 Theory:

As many of you know, the journey to medical school is filled with hurdles. One must do well in school and have a decent complement of extracurricular activities and/or research experiences to make the cut at many schools. On top of all that is the MCAT, perhaps the greatest, most-feared obstacle of all. The MCAT, in a nutshell, is comprised of three main multiple-choice sections – Biological Sciences, Physical Sciences, and Verbal Reasoning – each scored on a 15-point scale. There is also a short essay section that students generally believe carries less weight in admissions decisions. According to the American Association of Medical Colleges (AAMC), the group that administers the exam, the national average for applicants in 2007 was 27.8, while the average for matriculating students was 30.8.

According to conventional wisdom, a strong applicant has both a high MCAT score and a reasonably even distribution of scores among each subsection. A student with a 9-9-9 breakdown, ceteris paribus, is probably more desirable than one with a 15-6-6, as the former score may indicate a more well-rounded student. This rationale makes perfect sense; a strong medical student should be less a genius in only one subject and more a jack-of-all trades who is competent across the board. We’re not doing hardcore physics or PhD-level biochem here.

Yet how would you choose between a 15-15-1 and 10-10-11, again assuming all other primary characteristics are roughly the same? Here, the choice may not be so clear-cut. Let’s assume for a moment the school has no minimum subsection requirement – which may be highly unlikely, but potentially true in extreme circumstances such as this – and thus does not immediately exclude the 15-15-1. In this scenario, which student is likely to become the more competent physician?

Well, the lopsided genius (LG) is probably a lot more intellectually gifted than the jack of all trades (JT). Two perfect scores indicate LG is very bright and most likely hard-working, both desirable traits for a medical student. JT did fine in each section, but a 31, as evidenced above, is objectively average. Since the margin for error diminishes disproportionately as one approaches the higher scores, the difference between 15 and 11 on any given section is actually quite significant,. So, at least for those two subsections, LG is a world ahead.

But what about the third? Is LG a science whiz who struggles mightily in verbal? (That would be bad, since the VR section correlates most strongly with future clinical performance because it best approximates one’s ability to synthesize new, foreign information and make analytical choices without the benefit of tomes of background information and months of fact-cramming. It’s an extremely loose simulation of any clinical situation, sure, but the critical thinking it demands is a crucial asset for any physician.) Well, maybe LG is or isn’t, but looking at that score breakdown, my guess would be he/she was the victim of some unfortunate twist of fate. Perhaps LG mis-bubbled one of the earliest answers and thoroughly messed up the scantron. Maybe there was a scoring error that wasn’t corrected or some other inaccuracy that was no fault of LG’s. Contingent probability would suggest it’s extremely unlikely that someone capable of a 30 in two sections could possibly score 1 on the third. In fact, I imagine it improbable that LG would even get below a 10 if capable of such dual-section wizardry on the previous two.

What if we assume LG is not even capable of half of his typical brilliance, grant him the slight benefit of the doubt that something strange happened during his exam, and give him a 7. Now his conservative 37 is out of shouting distance from JT’s 31. And since these two candidates are more or less equally qualified in other respects, where does that leave them? At the very least, LG would deserve an interview and a chance to explain what happened, whereas JT might not even make that cut.

Admittedly, this is a unique, rather improbable scenario. To the extent that this would ever occur, the solution would likely be for the admissions committee to recommend LG take the test again to confirm his/her brilliance in all three subjects, reapply the next year, and then choose among the top med schools. But that’s just plain boring.

I’ve discussed this randomly with a number of people, most of whom would favor JT. I’m not so sure. As an extension, if it is completely inconceivable that someone with a 1 in any subsection could ever warrant admission, what if you had to choose, right now, who you’d prefer as your doctor in 10 years? That 1 might be a dealbreaker for acceptance, but who is more likely to pan out in the end?

Clearly, the only way to resolve this amazingly profound debate is for me to drop out, change my name to Lopsided Genius, retake the MCAT and get a 15-15-1, and see what happens. Might be unfair though – that name alone is probably worth an interview.

Kevin debunks 2 myths about medical school

1. Medical students are really smart

There seems to be some kind of general assumption that you have to be really smart to do medicine. Not true. Medical schools come in all shapes and sizes and with that, different entrance requirements. While the kids over at WashU are probably phenomenal test-takers and would be considered “smart”, the average med school is quite different. People come from all walks of life and while we’re certainly not dumb, most of us really aren’t that smart. The majority of medical students would not hack it in physics, mathematics, even engineering. Hell, looking at averaged VR MCAT scores, most of us are bad at reading as well. Unlike some other fields, medicine doesn’t require its applicants to be the sharpest knife the drawer, only the eagerest. Those who have academic deficits can more than make up for in volunteer work, perhaps save a few African babies. So what people lack in intelligence, they make up for in good ol’ fashion gumption. This isn’t really a bad thing. Medicine is ultimately a service industry and intelligence alone isn’t always enough (unless you’re a neurosurgeon, then it’s probably good enough). But regular people out there: your doctor may be smarter than the average Joe, but that doesn’t mean he’s a genius.

2. Medical school is difficult

The materials covered in medical school are not difficult. Everything is mostly memorization and regurgitation. Rarely do you have to take what you know and apply it to a truly novel situation. Perhaps this will change in second year but so far, it’s been pretty mundane. That’s not to say classes are not time consuming. Memorizing a lot of random facts takes a decent amount of work, but then again so is laying bricks and neither is really that challenging. A lot of my non-medicine friends really believe medical school is the pinnacle of academic rigor and honestly I don’t have the heart to tell them otherwise. Instead, I play into their assumption and pretend I’m just busy all the time with work. Sometimes I’ll tussle my hair up a little bit before approaching some non-medical friends so I look a bit more frazzled (ok not really but I’m willing to go this far if they catch wind of my ruse).

David advises pre-meds against Biology

It probably seems counterintuitive that anyone would seek my advice about anything. Yet, believe it or not, I often get asked for words of wisdom about navigating the pre-med and med school application process. For any current or prospective pre-meds, here is perhaps the best advice I have: unless you absolutely love biology, enjoy it on a profound and fundamental level that resonates within your pre-med soul, do not major in Biology*. (And if you do love it that much, I’d also argue you should eschew medicine entirely, get a PhD, and cure cancer instead of learning how to treat it. But that is a rant for another day.)

Why? I’m glad you asked. Not majoring in Bio*

1) will help you decide if medicine is really for you.

I know every 4th freshman in college has felt some burning, innate desire to become a doctor and save the world. They played with stethoscopes as toddlers, volunteered at the local children’s hospital during high school, and have told every teacher, relative, and college admissions officer that they’re going to become a whatever-ologist because they really want to help people. Yet despite that medical love-fest, most people have no clue what being a doctor really means. They’ve settled on the ideal of making a difference and saving lives, but haven’t necessarily explored alternative career paths or taken the time to really understand what a physician does on a day-to-day basis.

In high school, everyone takes more or less the same classes and meets roughly the same requirements. College is the best chance to learn new stuff and explore new opportunities. Why pigeon-hole yourself if you don’t have to? The path to physician-hood is a ridiculously long process that requires a lot of personal and financial sacrifice. Pre-meds too often do a disservice to themselves by not exploring other options. So delve into a new subject, not just on a superficial level or even to get that minor you think med schools will care about, but all the way into upper-division classes that really show what the field has to offer. At the same time, do all the shadowing/pre-med club stuff too. The point is to see what’s out there and what you like the best, rather than mindlessly following the rest of the sheep without a second thought.

Finally, what if you major in Bio* and decide medicine is not for you. That’s better than entering med school and hating it, but you’re still looking at an uphill battle. Unfortunately, a successful career in research is going to demand a hell of a lot more than your BS, and non-science employers won’t be that impressed that you know about cells. Again, if you just love the natural sciences and want to pursue the next step in education, this isn’t a problem, but if you’re banking on med school and it doesn’t pan out, things don’t look as bright.

2) will teach you something new and valuable.

Ok, so you KNOW you want to become a doctor. There’s no point in even exploring another field, the ingrained instinct to save the children is that strong. If for some unknown reason you couldn’t get that coveted MD, you’d be so distraught that you’d forsake the professional world, tie up a hobo sack, and ride the rails. Well, that’s awesome, congrats on the choice. Now go find something besides bio to learn about for four years.

Contrary to popular belief, biology, chemistry, biochemistry, etc. do not equal Medicine in College. Sure, your O-chem prof might spice up his lectures by talking about the structure of taxol or have you make god-awfully impure aspirin in the lab, but you don’t get to play doctor until MS-1. And once you reach med school, you’ll have two intense years of science and a whole lifetime of literature to satisfy your urges for knowledge. Why not take the chance to put another shot in your bag while you have the time? Major in English and learn about rhetoric. There will be exactly one gazillion times in your life where being a good, persuasive writer will help you. Major in Economics, Finance, Accounting, etc., so you’ll be better able to invest in the future, understand financial markets, and read The Wall Street Journal while holding your glasses loosely with one hand so that the tip of one earpiece is touching the edge of your mouth (then bust out terms like ‘basis point’ and ‘expansionary’ and watch all hell break loose). All of eternity awaits for that medicine-only focus. Learn something cool that you can use later on and you’ll never regret missing that extra bio class on the mechanisms of something the cell does that no one cares about.

3) will HELP your chances of getting in to med school.

Even though I don’t advocate going the non-bio route purely as a way to game the system, I still find it exceedingly obvious that being a non-science major is an effective way to stand out from the crowd.

Sad though it may be, your 3.9/35 (or whatever strong combination you offer) from Look How Awesome I Am University doesn’t impress anyone on any admissions committee at any med school. They’ve seen you and a million more just like you come down the application pipeline over the years. Sure, there are amazing kids every so often that probably get in by virtue of their academic accomplishments alone, but that isn’t a feasible option for the average student. A History major, however, is relatively unique. Assuming you’ve done well in your science courses, the fact that you would bolster the intellectual diversity of an incoming class can only help. People reading your file are probably thinking “Wow, this kid did something cool and unique that will add to our student body,” not “Uh-oh, not enough science, he/she won’t cut it.” And in your interview, you’ll have the rare ability to talk about something you know more about than the interviewer. Who is Prof. Blah going to remember better, the mechanical engineer who worked on the solar car team or that other kid who did that one experiment with those flies?

4) will NOT hurt you once you reach the Promised Land.

“OK, David,” you say. “Sure, I can learn cool non-medical stuff and maybe even get a boost in the application process, but what about once I get accepted? It’s going to be all science, all the time, and my crappy Math degree is going to come back to bite me in the ass.”

Not so! There’s a reason med schools demand all those prerequisite courses in bio, chem, and physics. Those classes test your ability to work hard, internalize large amounts of information, and apply all the concepts you’ve memorized in new, unfamiliar situations. They also give you the necessary knowledge base to succeed in med school. Med schools aren’t in the business of accepting people who lack the requisite scientific background to keep up in class. Assuming you did well in your pre-reqs and got a good MCAT score, you definitely won’t be behind. If you can’t already tell, I was a non-science major in college, and I guarantee a PhD in biochem would not have had an appreciable influence on my experience in biochemistry so far as a med student.

—————

So, there you go, several reasons not to major in Biology*. Take ‘em or leave ‘em. Hopefully the former, since I knew from my earliest moments that all I wanted to do is help people…

*This extends to Bio, Biochem, and any hybrid pre-health major that pre-meds gravitate toward just because they think it’s relevant or helps their application

David discusses the neurosurgery interest group

All medical schools have a wealth of student interest groups in a variety of medical specialties such as psychiatry, OB-GYN, IM, family med, surgery, etc. These groups can be extremely helpful; they provide students with information about the specialty, the associated lifestyle, potential practical workshops, networking opportunities, and some useful guidance about how to strengthen a residency application for that field. Still, I find it a bit curious that our school has a neurosurgery interest group.

As many people know, neurosurgery is not one of those fields someone just wakes up and decides to enter. It is one of, if not the most competitive specialties, and demands a kick-ass application with top board scores, clinical evaluations, recommendations, and probably some strong research too. Those qualifications – and I know it is nearly forbidden to say people can’t do something if they really, really, really try – are realistically beyond the average, above-average, and maybe even the near-excellent student. If I devoted my life to becoming a neurosurgeon, there’s a ridiculously strong chance I just wouldn’t cut it no matter how much I wanted it. Out of the 20,000 or so med school grads that match each year, only ~150 are able to do so in neurosurgery. That’s more or less one spot per med school in the entire country, meaning one has to be, on average, the top pre-NSG student in one’s school to snag a spot. Even Best Medical School has a snowball’s chance in hell of sending more than a couple in a given year. So while learning about future career options is extremely valuable, and no one should ever be discouraged from dreams/ambitions, all of this seems similar to having a Fortune 500 CEO interest group in B-school or NFL player interest group in a DIII football program.

OK, enough musing. I’m running late for my plastics interest group meeting…

Musings: Med School Seating Chart by Maturity Level

David discusses med school by correspondence

Normally, my rant:rave ratio here is pretty high, and hopefully that’s something the six dedicated readers have come love. For once, however, I’m going to discuss something neither rant nor rave, but rather simply a part of med school I never expected.

I’m not exactly sure what I thought med school class would be like, but I imagined it would more or less follow the structure of my undergrad pre-med courses: go to class, take some notes, maybe read a textbook, study for exams, bubble in the scantron to make a funny picture and hope to live to do it all again in a few weeks. I figured there would be great, inspire-you-to-learn teachers, other, less effective profs that droned on and on, and a wide variety in between. One thing I did not expect was how much of the first year could be just as easily taught by correspondence as in class.

It may be no great revelation that the MS-1 curriculum is mostly about learning the vocabulary of the body and disease and important background information about biochemical, immunological, blahblogical processes, etc. Beyond the obvious exceptions – anatomy lab, clinical stuff – most of this information can be effectively taught through textbooks or a solid syllabus. Of our many classes, a few have concise, well-written syllabi that comprehensively present the important information, some interesting extra details, and do a generally excellent job of teaching the material. It’s no coincidence that the professors for these classes, as a result of good preparation/organization/whatever, also tend to deliver good lectures. Yet since the provided written materials are so strong, and because it takes even the most gifted lecturer much more time to deliver a talk than it takes a student to read that content in condensed form, many people appropriately choose to skip those lectures. And it’s not because they’re lazy students. I imagine they make the calculated decision that they can save time going over the material at home or would rather dictate their daily schedule and decide exactly when they want to review that information.

On the flip side, in classes without dependable syllabi, where the organization is relatively poor and the expectations for students consistently vague, attendance skyrockets. Not surprisingly, these lectures are often disjointed, even incomprehensible, and sometimes I come away far worse for the wear with almost no new knowledge to show for it. (Loyal reader, you might be thinking, “David, that’s probably because you’re an idiot.” True though that may be, I assure you that I am not the only one that feels this way.) This theme doesn’t necessarily depend on the content of the class or even the attitude of the professors towards student learning, it’s just a product of how well the course and study materials are organized.

Maybe this isn’t surprising, but it seems odd to me that the most engaging professors who have the most well-developed lectures are the ones that face an empty auditorium, while those running the classes that most frequently frustrate the students get a full house. What’s more, if the latter profs emulated the former, there would be virtually no reason for many people to attend class at all. Students would have high-quality study material, complete all of the educational objectives set forth by the faculty, do well on exams, and basically be med students by mail. This dynamic would collapse later on during the transition to the wards, as well as in those aforementioned pre-clinical classes that provide exceptions. Still, on the whole, a University of Phoenix-style curriculum would be about as pedagogically sound as the one we have now (that’s right, I used ‘pedagogically’, what of it?).

Not to complain, because I do think we are getting a good education, but isn’t that still a bit strange?

Comic: Oops

Kevin Realizes Mistakes Happen All the Time in Surgery

For those who don’t know, I’m in a surgery preceptorship this quarter where I get to watch a surgery once a week. This is quite an amazing experience since I’m literally standing shoulder to shoulder with someone who is wrist deep into someone’s heart (not metaphorically either, although im not sure what that metaphor would imply). Of course this intimate glimpse into the OR is not without its surprises…

Just last week, I was observing an ascending aortic composite graft procedure when out of the corner of my eye I noticed the scrub nurse engaged in a muffled conversation with the circulating nurse about something.  Then the  circ nurse suddenly drops to the ground and starts crawling around.  5 minutes of her best illegal immigrant maid impersonation later, she comes up and  seems to wave a “Negative” to her sterile compatriot.  The scrub nurse then turns to and asks:

“Kevin, can you look around for a needle, it should be attached to some blue suture.”
“Uh… sure,” I said, fumbling around my little section.  By the way, the universal “fumbling and patting the pockets” motion when pretending to look for something makes you look retarded while gowned up in an OR.

After 5 more minutes of my fumbling, I was forced to give a negative as well.  So finally the nurse tells the surgeon: “Doctor, we’re going to have to x-ray this guy after you’re done, I can’t find a needle.”  Oops.

Kevin and David Present: The Top 10 Things We’ve Learned in Med School

To commemorate the completion of our first half-year of med school, we present the top 10 things we’ve learned so far:

10)  Experts tell us having kids and being married both suck.

9)    Experts consist of random 38 year-old “young” adults.

8)    Eighty percent of future doctors are brunette white women.

7)    Kevin wants to learn, David wants The Truth.

6)    (Kevin doesn’t really want to learn, but David really does want the Truth.)

5)    You can teach an entire lecture with inspirational quotes alone.

4)    We have something in common with a football player from Duvall (pronounced “Dooooo-         vuhl”).

3)    Kevin is 1/32nd cardiothoracic surgeon but he’s pretty sure he’s ready now.

2)    David still thinks he’s in business school. 

1.5) Your patients won’t care how much you know until they know how much you care.

1)    Never donate your body to science.

Comic: Bad sign for the future

Inspired by Linda’s adventures with electronics:

I had just gotten the coffee maker, and I made coffee almost everyday. It was exhilerating[sic]. Then one morning, while I stood in the kitchen and Penny sat at the dining table, I was horrified to find that when I pressed the on button, nothing happened. No coffee.

NO COFFEE.

Shit! I said to Penny. Look! The coffee maker’s broken.

She told me to check if it was plugged in. Oh, I said. So I picked up the white plug behind the coffee maker and plugged it in. But still, nothing happened, no red light. Now I was really scared; I started to panic.

I frantically pulled and replugged the cord into the wall socket. Oh no! It’s broken! It’s broken!

Then I looked emphatically back at Penny to see why she was not also panicking.

She said, Linda, that’s the rice maker.

Apparently she had been sitting at the table watching me freak out while the light on the rice maker went on and off, on and off.

So I changed plugs, made coffee and we both went back to studying.