Saturday, January 31, 2015

Things To Do In Undergrad If You're Looking Towards Medical School

premed tips medical school
I've written previously about things to think about in high school if you're looking towards medical school and the medical school application timeline. In this post I'll elaborate a little more about what you might want to consider if you're in undergrad and are thinking about medical school.

What undergraduate degree program should I choose?
Any program you want! It's a misconception that you have to be a science major to get into medical school. So long as you complete the medical school prerequisite courses, you're eligible to apply. Some of the best physicians I know were music or creative writing majors!

So what is the advantage of majoring in science?
It's no secret that the bulk of medical school applicants are science majors. I think this is mostly due to the fact that the medical field is science-based, so people who are interested in medicine tend to share the curiosity and logical thinking appreciated in other scientific fields. 

A second reason is that majoring in science (particularly in life science like biochemistry or microbiology) undeniably makes it easier to complete the medical school prerequisite courses, as they overlap with most science program requirements. If you choose to major in something else, it can be trickier to fit the medical school prerequisites in due to overlap with your other courses (I fit some in as electives and took the rest during the summers after first and second year).

A third reason is that the MCAT is science-based, so would in theory be easier for a science major. That being said, all of the material on the MCAT is covered in the medical school prerequisite courses (plus high-school level physics), so you really don't have to take any science courses beyond the first- and second-year medical school prerequisites to succeed in the MCAT.

What are the medical school prerequisite courses?
These vary by medical school (check the admission websites), but generally involve two courses each of: first-year English, first-year biology, first-year chemistry, second-year organic chemistry, and third-year biochemistry. Physics is generally not required -- some people take it to help them with the physics section on the MCAT, but honestly a knowledge of high-school physics is all it takes to get by.

What about GPA?
If you're thinking about medical school, your undergraduate grades (unfortunately) matter. That means studying. Hard. You've got to push for those A's. Residents will tell you that medical school was the hardest part of their education, but I disagree -- undergrad was. Once you're in medical school there is no more competition for marks (in Canada, med schools are pass/fail and unlike in the US with their USMLE, grades on Canadian board exams are not taken into consideration in the competition for residency positions). In medical school there are no midterms, no weekly assignments, and no lab reports. Yes, there's a lot of studying, but without homework, deadlines, or competition for grades, I thought medical school was far less busy and stressful than undergrad.

Speaking of grades, it's no secret that certain undergraduate courses and programs are easier to score well in than others. I'll admit that this was on my mind when I was selecting my degree program. I ended up choosing physics after really enjoying it in first year, but at the same time was terrified that I'd be throwing my chances at medical school away by choosing a program where perfect GPAs were reserved for classmates who are now working at CERN or MIT. I'm glad I didn't let fear dissuade me from pursuing physics. If nothing else, it's important to choose a major that you would be happy ending up in if medical school falls through. I knew that I didn't want to end up a biochemist if I didn't get into medical school, but would be happy in a career related to physics, so started out on that trajectory, looking at medical school as a turn off that I might have the opportunity to take.

In summary, choose whatever major truly interests you. If you enjoy what you're doing, you're more likely to work hard and do well. Don't be afraid to take a route that's a bit different from the typical med applicant -- if anything, it will help to distinguish you from the rest.

When do I have to decide that I want to do medical school?
There's no real timeline for making the decision that you want to go to medical school. If you're at all interested in medical school, I'd suggest signing up for the prerequisite courses to keep doors open (and to avoid the time and expense of backtracking to take them later). If you don't decide until later that you want to go to medical school, you're not alone -- I know many people who have gone back to school for a couple of years to take the prerequisites and write the MCAT, and are better physicians for the life experience that they bring to their practices.

So, you've picked medicine -- please don't identify yourself as a pre-med.
In physics, I knew plenty of pre-astronauts...but they didn't feel the need to self-identify as such. I know I'm being facetious, but I'm just trying to make the point that it doesn't seem healthy to build your identity around a future profession. On the first day of one of my first-year biology courses, three quarters of the class raised a hand in response to the professor's inquiry of who was "pre-med". Statistically, the majority of those students were not successful in the mysterious lottery that is medical school admission, and I can only hope that they spent their four years of undergrad studying something that they found interesting and might make a career of, rather than getting caught up in the competition and anxiety of pre-med culture.
(Note: I know that some universities offer programs labelled as "pre-med", but in Canada (as far as I know) there is no such thing as a pre-med major!)

When do I write the MCAT?
I wrote the MCAT the summer after my second year of university, which I think is the best time to do so, while your organic chemistry (and general chemistry, biology, and physics) are still somewhat fresh in your mind. Also, if you write the MCAT during the summer you can use the score to apply for medical school that same September (see the UBC application timeline as an example). I've written a little more about how I prepared for the MCAT on my medical school application timeline post. The most important thing to know is to register as soon as the online registration opens (usually sometime in February for July and August sittings) to get your date and location of choice!

Should I do a co-op program?
My university had a highly regarded co-op program, where students would take work terms intermittently and take five instead of four years to complete their degree. The administration tried hard to sell this program -- and showed a graph demonstrating that co-op improved one's chance of being accepted into medical school ...though I think there was some selection bias involved. I'm sure that co-op is a great program, but it's definitely not the ticket to medical school. The majority of medical students did not do co-op. While co-op can help you to gain research experience and reference letters, sometimes the jobs you get are not directly related to your field of study and may not be very helpful in advancing your career. Plus, considering that you may have four years of medical school and two to five years of residency ahead of you, you may not wish to extend your undergrad by an extra year to accommodate co-op. (Keep in mind though that, not having done co-op myself, my opinion is a biased one -- and may be plain wrong.)

Should I do research?
I'd say that while it is not necessary, a little research experience will probably strengthen your medical school application (it's nice to have something to put under the "research" section). I struggled with finding research to become involved in during undergrad -- partly due to most research projects taking place over the summer months, with conflicted with summer studies. If you're not taking courses over the summer though, I'd suggest applying for a research program (which are often paid quite well through grants). In addition, talk to professors to see if they are looking for research assistance during the school year -- there are ones who wouldn't mind having a keen student helping out in their lab for a few hours a week, especially if they don't have to pay you!

How can I get reference letters?
When I was offered a medical school interview by UBC, they requested that I submit three reference letters -- one academic, one community, and one personal. Though there's some flexibility in who may write the community and personal letters, the academic one should ideally come from a professor (a lab TA is acceptable and could probably write a better, more personalized letter than a professor, but I think, somewhat unfortunately, that this is a case where the number of letters behind your referee's name matters). The question is, how do you get to know your professor in a class of 200 students? While my shyness prevented me from asking questions in class and I preferred an obscure corner to sitting front and centre in the lecture theatre, I got to know a couple of my professors -- strategically the ones whom I thought might write decent letters. I went up to ask questions after class and attended office hours when I needed help. Over the years my classes became smaller and I had the same professors for several courses. It was one of those whom I asked to write my letter for medical school. Alternatively, if you've worked on research with a professor, he or she would be a good person to ask for an academic reference letter.

How about extracurriculars and volunteering?
Though I've spent this post discussing the academic side of things, the other half of the medical school application evaluates non-academic experiences. As I've written about in more detail previously, it's important to keep up with volunteering (not necessarily in healthcare -- in any area that interests you!) and extracurriculars (sports, music, hobbies, classes) while in university. The UBC medical school application requires applicants to list non-academic activities within five categories: leadership, service ethic, capacity to work with others, diversity of experience, and high performance in an area of human endeavour. It may be a good idea to keep these categories in mind and to think about where your extracurricular activities fit within them. The UBC guidelines also state that "No preference will be given for applicants gaining experience abroad, versus those seeking to choose activities close by." -- so no, you need not build schools in third-world countries to get into medical school.

When do I actually apply to medical school?
For most Canadian medical schools, the earliest you can submit your application is at the beginning of your third year of university (for entry after your third year of university, forgoing completion of your undergrad degree). On my application timeline post, I've written in more detail about the timing of different steps in this year-long process.

To summarize, undergrad is the time to choose a major you genuinely enjoy, take the medical school prerequisite courses, study hard and get good grades, write the MCAT, keep up with your extracurricular work, try to get a bit of research experience, and, in third or fourth year, apply to medical school. See, undergrad is the tough part. Once you get through all that, medical school will be smooth sailing (and things will only get better from there!).

It may also be helpful to check out these posts:

If you're in undergrad and have any questions about medical school, please comment or email! And if you're in medical school feel free to contribute any advice!

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