by Jessica Freedman, MD
What are the latest trends in medical admissions? At the annual meeting of the Association of American Medical Colleges (AAMC), 3,800 medical education professionals from around the country addressed changes in the MCAT, criteria for evaluating applicants, predictors of success in medical school, what elements of the residency application are most important, and a wide variety of other subjects that may interest premedical and medical students and residents. Here are some of the meeting’s highlights.
MCAT Update
Quick facts:
- In 2009, there will be 28 test administrations and 18 score release dates.
- A March date for the MCAT was added to assist students who are on quarter systems with scheduling.
- Scores are delivered 30-35 days after the test is taken.
- A change for this year: since applicants can be registered for only one test date at a single time, they will be allowed to cancel their test after the deadline (and forfeit the fee), enabling them to register for a future test date.
- The MCAT administration plans to review and modify policies regarding testing accommodations in the near future.
- A new publication, The Official Guide to the MCAT Exam, which will include testing tips and strategies, is to be released shortly.
In preparation for the fifth comprehensive review of the MCAT, surveys were sent to 142 US medical schools to find out what factors are important for evaluating applicants. The response rate was 90%. Survey results showed that the undergraduate GPA and MCAT scores are used to determine academic capability and success in the basic sciences. The MCAT score is also used to predict the USMLE Step 1 performance
Personal characteristics and qualities that were identified as important for success in medical school and beyond are:
- Integrity
- Critical thinking skills
- Professionalism
- Motivation for medicine
- Reliability
- Ability to integrate information
- Logical reasoning
- Maturity
- Work ethic
- Team work
- Compassion
- Self discipline
- Oral communication skills
- Intellectual curiosity
- Scientific and verbal reasoning
- Resilience
- Altruism
The MCAT staff discussed how standardized tests do not assess these qualities and that the tools and testing modalities to evaluate them need to be developed. This is why written documents (personal statement, application, and letters of reference) and interviews are so vitally important because they offer admissions members an opportunity to evaluate personal attributes.
The Holistic Review of Medical School Applicants
The AAMC is trying to ensure that applicants “are evaluated by criteria that are institution specific, broad-based, mission driven, and that are applied equitably across the entire applicant pool.” In an effort to increase the overall diversity of physicians (without considering race and ethnicity), the definition of diversity must be multidimensional and to more accurately assess applicants, the entire record must be considered as a whole (the so-called holistic approach). The definition of diversity may also differ from institution to institution so applicants must consider the mission statement of each school. It is also important to understand that with a looming doctor shortage (especially of primary care physicians), the need to increase access to primary care for everyone, including underserved populations, needs to be addressed at the level of the medical school application. There is also evidence that the care provided to racially and ethnically diverse patients is often affected by provider bias and stereotyping, which is why today’s physicians must be culturally competent. Medical school admissions committees must select not only the most capable students but also those who will make a valuable contribution to our society as a whole.
Predictors of Success in Medical School
There are few accurate predictors of future performance as a physician, though past academic performance and MCAT score predict future academic success and USMLE performance. Because past behaviors are usually predictive of future behaviors, and this is all admission committees have to go on, it is best to give admission committees enough material to provide a clear and multifaceted view of who you are. Interviews are important not only because they give the school a chance to really know you, but they give you an opportunity to show your warmth and provide a sense of how you will interact and communicate with patients. Remember, admissions officers aren’t out to get you. They are kind people who carry a tremendous responsibility and have a very important mission.
National Residency Matching Program (NRMP) Update
Quick facts for 2008:
- 25,066 residency positions were offered
- 23,674 positions were filled
- 883 US allopathic seniors didn’t match
- The number of IMG applicants has increased during the past 10 years
Many IMGs register for the NRMP just to get the list of unfilled programs for the scramble. About 13,000 people compete in the scramble to gain an unfilled position. With only 1,390 positions remaining unfilled on scramble day, many of which are preliminary programs, the odds of getting a spot through the scramble are not good. As the scramble now stands, schools and students find out if they didn’t match on Monday. On Tuesday at 11:30 AM, programs find out if they didn’t fill. The list of unmatched programs is released at noon on Tuesday and unmatched applicants begin contacting programs. In 2008, by 4 PM on Tuesday, 50% of the unfilled positions were filled. By Wednesday, 147 positions remained open. Clearly, the scramble is stressful and you should do everything in your power to avoid it. The NRMP website gets more than 5 million hits on the Tuesday of match week. Because of many “for profit” companies that fax materials to programs for clients, faxes and phone lines are often jammed at programs that have unfilled positions.
The NRMP is proposing a possible change for the scramble but this likely will not be put into effect until 2011. The goal of this change would be to allow applicants and programs more time to interview applicants (by phone), create more time to make decisions, and decrease stress for everyone involved. A scramble work group has been formed to address these issues and the pros and cons of the current system and to make suggestions for improvement.
Electronic Residency Application Service (ERAS) Update
While growth of allopathic medical school enrollments is projected, the greatest increase of applicants using ERAS is of osteopathic students and international medical graduates (IMGs). The number of IMG applicants to ACGME accredited programs has increased by 14% since 2001, and the number of US ECFMG certified applicants, most of whom are Caribbean students, recently has increased significantly as well.
US allopathic students increasingly are choosing specialties with “controllable lifestyles,” such as anesthesiology, emergency medicine, dermatology, radiology, and pathology. Fewer and fewer medical students are choosing family medicine and internal medicine (primary care). Fifty five percent of those who match in internal medicine choose to subspecialize. IMGs continue to fill the void for specialties that US graduates are not choosing. Interestingly, a survey done by the NRMP of physicians over 50 found that 47% of primary care physicians versus 44% of “controllable lifestyle” physicians felt that they had control of their lives. So, perhaps medical students should start to reevaluate what specialties offer the best work/life balance – primary care might be the answer.
Specialty Choice
What are the factors guiding medical students’ specialty choice?
- Whether the specialty “personality” matches the applicant’s personality
- Mentors and exposure to the field
- Lifestyle
- Income/job market/debt
- Length of training
Getting Into Residency
What are the most important factors for getting into residency? The answer to this question depends on the specific program and the specific specialty. All programs consider the following factors important but not necessarily in the order presented:
- USMLE Step 1 score
- Grades (if not pass/fail), AOA, class rank
- Subinternship performance
- Letters of reference
- Personal statement
- Interview
- Medical School Performance Evaluation or MSPE (formerly known as the Dean’s letter). The usefulness of the MSPE and the timing of release is being evaluated. More to come on this.
Changes Ahead
With the election of Senator Barack Obama as our next president, the country is expected to undergo health care reform, making this a truly exciting time for the future generation of physicians to be a part of medical education. While it is important to understand what it takes to “get in” to medical school and residency, you should also keep bigger issues in mind. For example, how will we improve the access to and quality of medical care for everyone? How will we decrease the income disparities among specialties so students will pursue the specialties where the need is greatest?
Dr. Freedman’s Bio:
Jessica Freedman, MD, is a former medical admissions officer and president of MedEdits (www.MedEdits.com), a medical school, residency, and fellowship admissions consulting firm. She is the author of the MedEdits blog (www.mededits.blogspot.com). Dr. Freedman is also a practicing emergency physician.
As a faculty member at a leading medical school in the US, this article provides useful and cutting-edge information. It is refreshing to read something for medical school and residency applicants that provides more than just anecdotal information regarding the admissions process.
As someone who is in the midst of this process, the depth and brevity of this information is extremely helpful. Thank you.
I’m someone who is considering a medical school in the Caribbean. This article seems to indicate that there are 13,000 IMGs vying for only 1,390 spots. So only 10% of the graduates from a medical school in the Caribbean actually get a residency spot, assuming the percentage of acceptance is the same as all other IMG’s…. Am I understanding this article correctly?
“There is also evidence that the care provided to racially and ethnically diverse patients is often affected by provider bias”
No patient or ethnicity of patient is “racially diverse.” by themselves. If you want to say minority, or non-Asian minority (when discussing handouts), say what you mean. Otherwise, I really liked this article.
The number of IMGs includes both US citizen IMGs (ie Caribbean students) and non US-IMGs citizens. The 1,390 spots refers to unfilled positions.
Very good article, but what about the differences between US osteopathic students compared to US-IMG’s from the Carribbean schools? Is there any evidence to the support the often cited statistics bandied around by DO’s that they are more competitive for US allopathic residency slots compared to US-IMG’s? They also often say that DO’s have an easier time matching into residency because they go to school on the Mainland US–is this true too?
In response to Oskie’s comment: the only data to address these questions is from the NRMP:(www.nrmp.org/data/resultsanddata2008.pdf). If you have any other data, please share.
According to the NRMP 2008 match data, 1,339 of 1,870 osteopathic applicants matched into PGY1 positions.
1,541 of 2,969 US citizens of international medical schools (most of whom are Caribbean students) achieved PGY1 positions. Keep in mind, however, that 929 students withdrew from the match and 659 did not submit rank lists suggesting that some signed outside the match.
You also need to consider the actual school when making these calls. There is a tremendous amount of variability regarding the quality of medical education at the 56 Caribbean medical schools (see my blog entry: http://www.mededits.blogspot.com/search/label/Caribbean%20Medical%20Schools)
I don’t think there is any other data to really answer the question that it is “easier” for osteopathic students to match into allopathic residencies. The competitiveness of the specialties to which students are applying and matching must also be considered.
DO and caribbean is just a backdoor for people who couldn’t make it into real american MD programs. Don’t let anyone tell you otherwise. It’s 2008 guys, enough with saying that DO is more “patient focused” It’s the same exact thing, just much easier to achieve (lower MCAT + GPA)
I wouldnt call DO a “back door”. They are US medical schools. Easier to get into in terms of grades/MCAT? Yes, and I dont think anyone is pretending they arent. Thinking they are easier to complete is just ignorance.
Unfortunately there will always be elitists who slander the DO as a lesser degree, and plenty of pre meds who will believe them.
For further discussion on MD vs. DO vs. IMG, please go to the SDN Forums. This article is not intended to create debate over the academic criteria for different physician training pathways.
Dr. Freedman is absolutely awesome. Ive worked with her for over 5 months now. She’s a stellar editor and an amazing consultant. I recommend her advice to anyone trying to approach the match in any field!
I agree with Rich. Thank you Dr. Freedman for providing this cutting edge information. I have been working with Dr. Freedman for over 7 months and there is no better advocate that is as resourceful for students applying to medical school.
Great piece.
It’s good to get an overall impression of application porcess from the professionals who do it.
Thanks so much.–Ben.
I agree with MM. Osteopathy is hardly a backdoor. I know several people who were accepted to allopathic schools but chose osteopathy because it aligned more with their personalities and ideologies. Osteopathic physicians can get into any of the residencies that MD’s can get into. People who think otherwise should change their attitudes, because youre going to be working with DO’s no matter where you end up.
Please follow the direction of the admin above who noted, “For further discussion on MD vs. DO vs. IMG, please go to the SDN Forums. This article is not intended to create debate over the academic criteria for different physician training pathways.” Thank you.
Cleared boards and applied for Match 2000. Did not match. Went through Post Match Scramble – Back in those days -Snail mail route. Missed key unfilled spots. In all that flurry, a messy divorce had tangled itself mercilessly. Did not bother to apply again with all the burn-out. Worked in research after.
Just checked the message boards online for year end 2008 – seeing a newer applicant crowd with the same old issues. Can’t see much to have changed in 10 years.
If the country is facing a shortage of MDs looking ahead, then policy heads- please increase the residency slots and train for basic care. Focus on re-entry training. Have a broad vision far ahead. Pentagon to start to hire professionals from abroad on temporary visa (Citizenship offered as hook) to fill in their MD shortage in the US (pilot program 2009).
I am going to be starting medical school in August. Is there anything else, like research, that I can start working on now and in the summers after 1st and 2nd year to be a strong applicant for the more competitive programs? Would it matter if my research were in a field other than that which I applied for? It would be unreasonable, it seems, to expect 1st and 2nd year students to have known which field they were going to pursue.
Do you have any other “If only I had known…” advice regarding matching?
I appreciate your contributions to SDN and any feedback, Dr. Freedman.
Dear NM,
Even if you don’t know the specialty you will pursue, it is still wise to become involved in research. Everyone in medical education understands that most first and second year medical students do not have enough clinical exposure to make a well informed choice regarding specialty selection.
Become involved in quality research (basic science or clinical) that illustrates your analytical skills and ability to complete a project. A project that results in a publication, abstract or presentation would be best so, be sure to ask the person under whom you work, if this might be possible.
There is alot of “If only I had known” type of advice — too much to write about here. The biggest mistake medical students make is not doing enough electives in the specialty to which they are applying and not getting the “right” letters from faculty in that specialty.
I hope this helps. Visit my blog for lots of useful tips: http://www.mededits.blogspot.com.
Great article! I loved it. I’m just starting the pre-med journey and have been researching day and night for many months now on the whole process. Anyway, this is informative.
ted, I do not care if I go to Harvard or the easiest ‘back door’ school in the country as long as I can practice medicine and treat patients who need treatment. Being a doctor is not about making the big bucks or having the flashy MD next to your name; it’s all about the patients and the doctor’s compassion and skill in assisting people with their health concerns so they can live life to the fullest. If you are going to be a doctor for any other reason then you need to pick a different career.
From an ex-administrator of a competitive medical school’s GME program (alleopathic), I loved this article. This information was great. The sad thing is that some students still find a way to differentiate between DO and MD. I agree that another forum is the place for that. Just know that most MD schools understand that DOs can pass the USMLE but MDs cannot pass the COMLEX. Bottom line is the residency will judge the individual and not the letters following the name but how well the applicant prepares himself/herself. (for 3 years running our head resident was a DO.)
Follow the tips given in this article and a person will do well with their match.
Thanks
“How will we decrease the income disparities among specialties so students will pursue the specialties where the need is greatest?”
This statement scares me. Dont think that I am bashing anyones specialty….but why should an orthopod who trains for 5-6 years and works 70+ hours in private surgical practice make the same amount (without the same liability) as a family practice doctor who trained for 3 years and works maybe 50 hours/ week doing “more cerebral work”, like preventative medicine, monitoring BP, diabetes, asthma, copd?
I am impelled to add to Rich and Current Client’s comments. This article gives only a glimpse of Dr. Freedman’s expertise and meticulous services. I have worked with Dr. Freedman for the past ten months and her guidance has helped me to attain multiple medical school acceptances. SDN has found a valuable contributing author.