Half-Measures

( Disclaimer: Those of you with weak stomachs or who are excessively idealistic may skip this article in which I describe how one may subvert the conventional wisdom and get accepted to medical school. As you know, I believe the medical school admission process is idiotic. It encourages self-aggrandizement and has more hoops to it than a traveling poodle circus. It is also weighted heavily against the older, more stable applicant who may have a job, a family, and no time for the usual mock compassion of the typical pre-med student.

My favorite character from literature is Odysseus. He was neither the strongest, the bravest, nor even the smartest of the Achaeans but he was certainly the most cunning. Wiley Odysseus could keep his head and accomplish through cunning and a little chicanery what others with more overt prowess couldn’t. Somewhat like Odysseus, I’m not stupid but on the other hand I am not nearly as intelligent, talented, motivated, or even as passionate as the medical heros with whom I had to compete. -PB)

I wouldn’t say I had it harder than a typical pre-med student but I did have some unique problems. First, I had a full-time engineering job at a firm that expected some real work out of me. This would complicate the task of taking the pre-requisites I lacked, about 18 month’s worth at the rate of one course a quarter. But I did have contacts and a solid reputation so by virtue of being a licensed Professional Engineer I was able to start my own engineering firm and get a little more schedule flexibility.

Next, my GPA “blew hind titty” as my advisor was so kind to point out. This only confirmed what my mother warned me about: You do have permanent record and it will bite you in the ass some day. There wasn’t much I could do about it but I did have a couple of advantages. First, from the point of view of an engineer, classes in the biological sciences, at least at the level required for medical school admissions, are ridiculously easy. There are no formulas to memorize, no design problems to solve, and no math is required. It’s all just reading and a little binge-and-purge memorization. Organic chemistry was challenging but I latched onto a professor who didn’t believe in grades and rode out those classes with no worse damage then having to listen to his philosophical ramblings.

Second, I have always been good at math and had gotten good grades in just about every math course from Algebra to Differential Equations. This is important because a big component of your AMCAS application is the BPCM (Biology, Physics, Chemistry, and Math) GPA. The upshot of this was that my BPCM GPA was almost perfect, considering the easy A in organic chemistry, the easy physics A when I was just out of the Marines and studying like a real student, and the child-like simplicity of “Biology 101” and “Anatomy and Physiology (for Sociology Majors).”

Not to mention that Engineering classes, as they are neither math nor physics don’t count in the BPCM GPA, or at least that was my assumption and I guess I was right because the AMCAS bought it. The only ones I counted as either Math or Physics were the ones were I got an A (very few actually) and that I could stretch a bit. I listed Statics as physics and Finite Element Design as math but left Structural Concrete and Fluid Mechanics alone. Hey, at that time I was angling for every advantage I could get. I really enjoyed college in the early eighties and my cumulative GPA was really, really low. (2.8).

Then there was the question of volunteering. As there was no online pre-med community at that time I never felt it necessary to go to Africa to hold dying babies. I figured EMT training might be interesting and, as I had no disdainful premed friends to talk me out of it, I took a course at the famous Delta Ouachita Community College (or the “Harvard of Ouachita Parish” as it is commonly known).

I did the minimum possible volunteering as an EMT, and I mean minimum, to let me put it on my AMCAS application with a clean conscience. What’s the point, really? At that time my wife and I had a new baby in the house who refused to sleep, I was taking classes, working full-time, my father had just died, and I was gearing up for the MCAT. Medical school admissions, as I realized even then, was a game and if I needed to show some volunteering, well, I’d check the box but there was no need to get stupid about it. There are just not enough hours in the day, especially as I now know for sure that none of it really matters. The top students in your medical school class, the ones who shadowed doctors so much that they could get board certified, are all gunning for radiology just so they don’t have to touch patients ever again.

Or, to put it another way, medical school admissions is a big fat guy standing between you and the basket. You’re going to have to get by him. He’s fat but suprisingly agile. You can charge him and hope he backs down or you can try to sneak around him. Sometimes he’ll fall for a feint and you can get around clean but the odds are you will make contact and he will get some sweat on you. Getting past him is the challenge and it doesn’t matter how you do it. I’m not advocating kicking him in the nuts or anything like that but fortune favors the crafty and the bold. Later, as you eat the cheeses and hams of victory, you’re not going to look back and regret outwitting the fat guy.

The MCAT was a big hurdle but more of a psychological one. I geared up to study, as I said, but I never actually did except for a few desultory attempts to read the MCAT “Gold Standard.” I figured I would do well enough on the Physical Sciences section, would eat the Verbal Reasoning Section for lunch, and could fake my way through the Biological Sciences section which is pretty much how things went down. I got a 29. Not spectacular but good enough for Louisiana. When I got my scores, my wife read me the sample scores from the front page over the phone which added up to 24. “That’s it,” I thought. All that effort for nothing. She called me back a few minutes later, apologized, and read the actual scores.

The MCAT is a standardized test. It is all multiple choice and designed to test your knowledge in a broad but still limited number of subjects. None of the MCAT questions will come from left-field or require any creative thinking on your part. The concepts are fairly simple, the questions don’t go into great detail, and in the rare case that a question might absolutely turn your guts, you can skip it and write it off to bad luck. You have to know a lot, no question about it, but the most efficient way to study for any multiple choice, standardized (emphasis on the “standardized”) test is to do practice questions. You can take an MCAT review course, you can buy review books and read them religiously. I’m not saying this is useless. But, like the USMLE, to truly focus on testable subjects you need to pay for any or many online question banks and go to it. And make sure the question bank includes explanations for the right and wrong answers.

The authors of standardized tests have a limited repertoire. There are only so many ways, for example, to ask you a multiple choice question on the basics of circuit analysis. If you do enough practice questions you will recognize the pattern. If you just read about it you will rapidly forget the specifics. The same with sitting in Kaplan and listening to some graduate student drone on about it. It is easier to remember a pattern than facts and the facts will come if you remember the pattern. If you don’t agree with me you may do as you please or go to the devil for all I care. The object here is not learn the subjects, you should already have a grasp on them.

The object is to get by the fat guy.

I only completed applications for my two state medical schools. I figured, probably correctly, that if I couldn’t get in at either of these I probably didn’t have a chance anywhere else. I did apply to a few more schools but got bogged down in the secondaries, most of which asked for essays on truly ridiculous topics like “Qualities that Will Make You a Good Physician” or “Describe your Greatest Weakness.” Not to mention, “Why Did You Select Tulane?”

Hey, I’ll do what it takes but I do have some self-respect. The secondary application questions for LSU were along the lines of, “Have You Ever Been Convicted of a Felony?” which I believe is the only legitimate question that should be asked of anybody applying to medical school. It has a simple, easily verifiable yes or no answer and allows no room for the usual cringe-inducing tripe.

After the usual nail-biting, I was accepted to LSU Shreveport and, after a late interview invitation, was also accepted at LSU New Orleans. I liked New Orleans better but Shreveport was closer and the real estate was cheaper. Hey, I’m not fussy. Harvard, LSU, Duke, the Carribean…it’s all the same. Or at least the differences are not worth getting worked up about.

We moved to Shreveport and the rest of the story can be found on my blog.