"Why Our School" Secondary Essay: How to Get Started

Secondary essay prompts vary, but there are a few that are standard fare. See my recent blog entry for guidance on the familiar "diversity essay." "Why do you want to attend our school?" is also a common topic pre-meds will encounter.

Medical school admissions officers want to be assured that you know their institution, are seriously considering it, and will fit in well there. In approaching the "why-our-school" question, do your research on the institution and link something specific about you with the school's philosophy, curriculum, patient population, and/or extracurricular programs.

For instance, if you were a teaching assistant for chemistry in college, you might link your use of the Socratic method with a school's tutorial-based learning. In that way, you demonstrate knowledge of the school, show that you connect well with it, and showcase your accomplishment.  

The paradox here is that - although you are theoretically focusing your essay on one school - because so many institutions have overlapping philosophies, curricula, and objectives - you can oftentimes use the same essay framework for many different schools.

That's one strategic way to cut down the overwhelming workload that secondary applications present.

Secondary Essays: The Diversity Prompt

I’ve had several questions recently on how to approach secondary essays, so I'll address some common prompts over the next month or so in this blog.

In considering your strategy and content for the diversity prompt, I’d recommend you ask yourself the following question:

What ethnic, religious, racial, gender, language, socioeconomic, or sexual orientation aspects of me, my family, or my experience make me distinctive?

Please note that experience is part of the question I have posed. An applicant I mentored a few years back wrote to me concerned that she did not fit into a minority category and thus, could not answer the prompt effectively. I suggested she consider an experience that targeted the prompt’s theme, and she wrote a strong essay about her successful efforts to increase diversity during sorority rush. When I applied to medical school, I crafted one of my secondary essays on my experience hearing Spike Lee speak on my college campus. 

Don’t be afraid to think outside the box.

Medical School Help: What are the Next Steps Once the AMCAS is In?

Once you've submitted your AMCAS, what can you do next to best prepare for what's to come in the medical school admissions process?

Here are a few tips:

1. Start drafting secondary essays. Even if you haven't yet received the prompts, you can begin to craft responses to common themes like "how would you add diversity to our school?" and "describe an extracurricular activity that might be of interest to the committee." Good writing takes time, but if you wait for the onslaught of secondary applications, you won't be able to impart your essays with your highest quality effort.

2. Get a head start on preparing for the medical school interview. Practice, practice, practice. Start mocking up answers to interview questions so that you distinguish yourself.

3. Consider what you want. Do some soul searching to determine what you are really seeking geographically, philosophically, and educationally. You want to make considered decisions when the time comes.

Inaccuracies in Medical Student Grades Translate into a Residency Application Strategy

Here's an oldie-but-goodie New York Times piece by Dr. Pauline Chen on medical student grade inaccuracies. In reading the article, medical students should reflect on how important the quality and content of their letters of recommendation are for residency applications, especially in the setting of medical school grades that may be inflated or faulty. The 2020 NRMP Program Director Survey (which is the most current version) supports the importance of letters, as well, with statistics. Make sure your letters are very strong; remember that mediocre letters should not be a part of your residency package.

An Offer you Can't Refuse: Writing Your Own Letter of Recommendation

In the last few weeks, several medical school applicants have contacted me saying that potential letter of recommendation writers are asking the candidates to write their own letters.

If you have this opportunity for medical school, dental school, residency, or fellowship, first, realize that it is not unethical to write your own letter if you're asked to do so. If you'd like to explore the scruples of this issue, take a look at this New York Times Ethicist column about the topic.

The mistake I see candidates make in this situation is that applicants don't write strong enough letters for themselves because they feel awkward about showcasing their accomplishments fully. If you have the opportunity to write your own letter, craft a glowing one. Be effusive and full-throated in your remarks about yourself! Remember that the letter-writer can choose to tone down the recommendation if s/he doesn't agree. But if s/he does, you've utilized an opportunity fully and bolstered your candidacy tremendously.

Medical School Applications are at their Highest Level Ever

In 2021, medical school applications from first-time candidates increased a startling 18%. More than 62,000 students applied to medical school in 2021, compared to approximately 53,000 the year prior. It's unclear what caused such a large jump: It's possible the pandemic was not a factor and that many students had planned to apply prior to COVID-19's emergence. After all, it takes many years of planning to have a ready candidacy. Or perhaps individuals may have been inspired by healthcare workers' dedication during the beginning of the pandemic. Interestingly, there was a significant increase in applications from Black and Hispanic students, which is encouraging.

With increasing numbers of candidates, medical schools will be more selective about which applicants they accept. Perhaps some students will consider physician assistant training as an alternative, however, enrollment there is up as well.

Take a look at this short piece by Dr. Thomas Cook, the Program Director of the Emergency Medicine Residency at Prisma Health in Columbia, for more analysis.

Is There a Doctor on Board?

Those are words no physician wants to hear. Even as an emergency physician, I hated the few times I heard that phrase. Fortunately, the passengers I tended to were not terribly ill, but this story, written by a medical student who cared for a critically ill passenger, is well told and worth the read.

Choose the Right Category for your AMCAS Experiences

AMCAS provides 18 categories in which you can classify your experiences. They are:

Artistic Endeavors
Community Service/Volunteer – Not Medical/Clinical
Community Service/Volunteer – Medical/Clinical
Conferences Attended
Extracurricular Activities
Hobbies
Honors/Awards/Recognitions
Intercollegiate Athletics
Leadership – Not listed elsewhere
Military Service
Other
Paid Employment – Medical/Clinical
Paid Employment – Not Medical/Clinical
Physician Shadowing/Clinical Observation
Presentations/Posters
Publications
Research/Lab
Teaching/Tutoring/Teaching Assistant  

Sometimes an activity matches two categories. When that happens, lean on the clinical classificiation, if applicable. (For example, if your activity is both Leadership and Community Service - Medical/ Clinical, choose the latter.) If clinical is not relevant, then choose the category in which you have the fewest activities.

A client who came to me as a re-applicant a few years back told me that a school from which she was rejected indicated that they had not counted a clearly clinical activity as clinical because she had classified it differently. So be sure you consider the categories deliberately in crafting your AMCAS.  

Rolling Admissions: What's the Big Deal?

This year's AMCAS application opens on May 4 at 9:30 AM EST, and candidates will be able to submit their AMCAS applications beginning on May 28 at 9:30 AM EST. 

Because of rolling admissions, submitting a complete application early in the cycle has distinct advantages at many schools. That doesn't mean you should submit suboptimal written materials on the twenty-eighth; instead, you should start early enough that you're presenting your best work.

Rolling admissions means that a school takes applications in the order in which they are received and makes decisions about interviews and then acceptances, accordingly. So, as time goes by, there are fewer interview and admissions offers remaining to be made. Think of an auditorium whose doors open to allow guests in. Those in the front of the line get the seats, and those who come later may not have a chair to sit in. 

If your application is not complete, your candidacy may not be evaluated early when there are more opportunities for interviews and admissions. So, if you have not already, get started immediately. It could make a huge difference in your available opportunities. 

Study Shows Women Earn $2 Million Less Than Men in Their Careers as Doctors

A survey of 80,000+ physicians estimated that women make 25 percent less than their male counterparts over a 40-year career, according to a New York Times article. The troubling findings were published in a paper in Health Affairs. Of note, factors like specialty, type of practice, and patient volume were controlled for. Had they not been, one of the authors said, the discrepancy would have doubled. The salary gap starts at the beginning of women's careers and then only worsens.

According to the Times article, the pay gap is wider among healthcare practitioners than among those in computer and engineering jobs. Considering that, women pre-meds who are on the fence about a career as a doctor have every right to seriously consider another profession...

Positively Influence your Letters of Recommendation by Making the Job of Letter Writing Easy

When pre-meds, residents, nurses, and physician colleagues asked me to write them LORs when I was Assistant Residency Director, the first thing I requested was that they send me background information to make my letter robust…and my job easier. Accordingly, whether you are applying to medical school, dental school, residency, or fellowship, I strongly recommend you create a “LOR packet,” which can include the following:

1. A brief, well-written cover letter defining all of your important accomplishments
2. Your curriculum vitae (CV)
3. Your personal statement in its final form
4. Your transcripts.

With regard to the cover letter, keep it streamlined. No one will skip the beach or her two-year-old’s birthday party to read your exhaustive biography :), so you want to thank the writer and highlight your pre-professional achievements on one page. The point of the cover letter is to supplement a writer’s knowledge of your candidacy and offer flattering content for inclusion. A college professor may know that you made the only A in an organic chemistry class, but her LOR for medical school will be more complete, and she will demonstrate a more intimate familiarity with you if she knows enough to write that you volunteer regularly at a homeless shelter.

With regard to the CV and personal statement, these make useful supplements to the LOR packet only if they are in professional and final form. Don’t include rough drafts, as poorly organized background information leaves your writer the impression that you are a disorganized person. Also, only include the transcript if it bolsters your candidacy, demonstrating academic achievement. Don’t shoot yourself in the foot if you have some bad grades you’d rather not showcase.

Bottom line: An applicant who offered me a list of her accomplishments in a tidy, accessible package was more likely to get a strong, comprehensive letter that was submitted promptly. She also distinguished herself from the majority of candidates who requested letters without demonstrating a comparably sophisticated understanding of the demands this process made on my time. If you can make a letter writer's job easier, your forethought is likely to pay dividends in the letter you receive. The savvy applicant can take subtle advantage of her ability to "lead the witness."

The Single Most Important Thing Applicants Should Focus on in a Medical School Application

Varsity Tutors interviewed me a decade ago regarding mistakes to avoid in a medical school application, best undergraduate majors for pre-meds, how to approach MCAT prep, and the most important factor a medical school applicant should focus on in her candidacy. My answers still hold true today and might improve your angle on the process. Take a look at this short interview. (Note that there are some typos in the piece that are not mine ;)).

AMCAS opens in three and a half weeks!

Time to Take A Break

It's a stressful time of year for those applying to medical school; I'd recommend taking a reading break between your application obligations. 

Here's a piece I wrote for Student Doctor Network regarding great books for doctors in training. (Additionally, I'd include When Breath Becomes Air as a must read.)

Also, I just finished a (non medical) novel called The Lincoln Highway that was truly magnificent. 

Enjoy!

NRMP Match

Congrats to all those who successfully matched the week before last! The NRMP just published statistics from this year's Main Match:

Of interest, there were 42,549 applicants who submitted certified rank order lists in this year's Main Match, and 34,075 of those matched to PGY-1 positions (80.1%). This was a 1.6% increase over last year.

The NRMP also reports that out of 39,205 total positions offered, 36,943 filled (94.2%), and of 36,277 first-year positions offered, 34,075 (93.9%) filled. These rates were similar to last year's. Of 6,087 total certified programs, 5,367 filled (88.2%), which was a decrease from last year, per the NRMP.

For more numbers, take a look at this NRMP press release.  

Studies Show that Physicians are More Likely to Use Negative Terms in Black Patients' Medical Charts

Here's a disturbing and important New York Times article detailing two studies showing that physicians were more likely to use negative language in the medical record about Black patients than about those of other races. 

Medical notes from emergency departments and inpatient settings were more likely to use this pejorative language, possibly because of a lack of long-standing relationships with patients.

Along these lines, a term like "refused" should not be used in the medical record. If we, as medical professionals, believe the patient is truly in charge of his/her body, "declined" is an appropriate replacement.  

Medical School Letters of Recommendation: Asking the right people

For those applying to medical school this cycle, if you haven't already, it's time to start asking for letters of recommendation (LOR).

Beyond simply fulfilling requirements, you want to get the strongest letters you possibly can from the most influential writers. Choosing the right individuals can be a challenge, and advisees often ask me what to look for in a letter writer. Here is my suggested wish list for potential letter-writers:

1. Explicitly state they will write you a strong LOR

2. Senior faculty

3. Weighty academic titles
4. Well known in their field
5. Spent significant time with you
6. Experienced letter-writers

Of course, all of these qualifications are not possible for all writers. But the more of these you can garner the better. 

With regard to #1, don’t be afraid to ask a potential letter-writer if she will write you "a very strong" LOR. It may seem awkward at the time you ask, but, believe me, getting a wimpy letter will be much thornier. If the faculty member says no, hesitates, or tells you in March that she has to plan her Thanksgiving get-together ;), politely thank her and move on. Although disappointing, acknowledge that she has done you a huge favor. You are far better off avoiding her letter, and you now have the advantage of substituting a stronger LOR written by someone who loves you.

With regard to #2 through 4, admissions officers are human just like the rest of us: Receiving a LOR from an accomplished, known colleague will be weighed much more heavily than one from someone deemed less successful and unfamiliar. If you are better connected to someone without a title, consider asking the professor (a more senior person who has a weightier title) if she would consider writing the LOR with significant input from your closer contact (i.e., the TA who taught your section, or the postdoctoral fellow who directly supervised your research project). That way you get a LOR that includes insight from someone who knows you, signed by a name that packs a punch.

Fee Assistance Program

As the 2021-22 medical school application process ramps up, I want to remind candidates about the Association of American Medical Colleges' (AAMC) Fee Assistance Program (FAP) and Insider Medical Admissions' available discount for those with a current FAP. The FAP is designed to offer help to individuals with financial limitations who cannot pay the MCAT registration or AMCAS application fees without financial support.

If you think you are eligible, it's worth applying for an FAP grant early: If an applicant submits his/her AMCAS prior to receiving a decision on his/her FAP application, that candidate will be ineligible to receive the FAP for the AMCAS. In other words, the candidate will not receive a refund.

For more information on the FAP, please click here. I offer reduced rates for applicants demonstrating financial hardship through a current AAMC FAP grant. After researching the issue, I believe Insider is the only medical consulting company that currently supports a discount for FAP grant recipients. (I apologize if I'm missing a company.) Once you have been granted the FAP and thus, can prove receipt, please feel free to contact me for more information.

Final Tips for Making Your Match List

Applicants must have their rank order lists certified by 9 pm EST this Wednesday (March 2). As I've mentioned in a previous post, the algorithm for the Match is relatively simple.

The bottom line:

1. Rank programs so they represent your true preferences. Your first choice should be first. Your second should be second and so on. Do not try to "outthink" the system, as it will only be to your disadvantage.

2. Because of the way the Match algorithm works, what programs think of you (or what you think they think of you) should have zero bearing on how you make your rank order list. 

3. Except in highly usual situations, rank all programs at which you interviewed. If you would truly rather not match than be at a specific program, then that program should not be on your Match list; however, do think carefully about the prospect of not matching, entering SOAP, and possibly having to reapply next year.

4. Prioritize your happiness.

Medscape's National Physician Burnout Report 2021 is out - and it's Troubling

The Medscape National Physician Burnout & Suicide Report 2021 is now available, and it seems rather evident that the pandemic has negatively affected physicians who were already under a lot of stress, especially those in critical care medicine.

More than half of critical care physicians report being burned out (51%), and critical care ranks as the highest specialty in the burnout questionnaire, followed by rheumatology (50%) and infectious disease (49%). Those numbers compare with last year's report at 44%, 46%, and 45%, respectively. This year, my field of emergency medicine (EM) was at 44%, which sounds high, but, sadly, EM was not even in the top ten burned out specialties. That gives you an idea of the severe scope of the problem.

Women reported burnout at 51% compared to 36% for men, and while this disparity has been present for many years, the discrepancy between the genders was greater in this most recent report.

Seventy-nine percent of those surveyed relayed that their burnout started before COVID, while 21% reported after. Bureaucratic tasks and too many hours at work were the major reported contributors to burnout.

Take a look at the Medscape National Physician Burnout & Suicide Report 2021 slide deck yourself for more interesting details, and check out my Kevin MD piece on EM burnout here.

Your Residency Application: Six Factors to Prioritize When Creating your Rank List

Creating your Match rank list can be absolutely agonizing because it feels like so much is at stake. Sometimes it helps to step back and look at the big picture. Below, I briefly note a few important considerations when making your list:

1. Make sure you understand how the NRMP algorithm works. See my previous blog post regarding errors to avoid at all costs. The key is to rank in the order you want - first goes first, second goes second, etc.

2. Consider your happiness and life balance. Blasphemy perhaps, but I would argue that they are more important than the strength of the training program.

3. Reflect on the culture, geography, size, and even maturity/age of the program. Think about whether you will fit in.

4. Consider whether you could spend your whole life at the institution or in that program's location. It's a lot to grapple with, but many residents graduate and stay for the rest of their careers.

5. Decide whether you liked the program director, chairperson, and faculty generally. They could make or break your happiness and success.

6. Realize that most programs will train you well if you work hard. Their prestige and quality may be more similar than you think. For that reason, note that your personal preferences and intuitions are paramount.