Pre-med

Let me sum it up for all of you prospective pre-med students: Don’t wear scrubs to class. You are not in medical school yet. Don’t be a poseur.

Except at a handful of schools, “pre-med” has no official meaning. You do not major in “pre-med.” If you are the quiet type you can spend your entire four years as a pre-med and nobody will know that you are applying to medical school. (Assuming you are not wearing scrubs to class, I mean.) What you actually do is select a major just like everybody else but structure your schedule to take certain medical school pre-requisite courses. Although the pre-requisites vary slightly for different medical schools, they generally include a couple of semesters of General Chemistry, Organic Chemistry, Biological Sciences, as well as a smattering of math and Physics.

In what should you major?

The answer is simple. Major in anything you want to provided you can stay interested in it long enough to get good grades. Naturally, if you major in Biochemistry you will hit all of the pre-requisites automatically as most of them are also required for your major. If you major in Art History, on the other hand, not only will you take the full course load for Art History but you will also have to schedule the additional forty credits of the medical school pre-requisites.

So you should major in Biochemistry to avoid the extra classes, right?

Not so fast. Although college administrators don’t like to admit it, some majors are inherently more difficult then others. An Electrical Engineering Major, for example, works considerably harder then a Psychology major. Sorry. This is why the psychology department at most universities is huge while the electrical engineering department is relatively small. Everybody starts college thinking they’ll be “pre-med” or an engineer but as the reality of studying sinks in many will naturally gravitate towards the less intellectually stimulating majors which grant degrees without interfering too much with the serious business of partying.

It seems to me that most of our universities are “diploma mills” which for the sake of tuition revenue have developed many non-rigorous degrees to ensure that anybody with a couple of firing synapses can get some kind of expensive degree. This is the topic for another post, of course.

The point is that it is better to get extremely good grades in an easy major then mediocre grades in a difficult one. On some level, medical school admission committees must know that Biochemistry is more difficult then Art History but since medical schools look for reasons not to admit you before anything else, a 4.0 in art history just looks better then a 3.4 in biochemistry. In other words, although a good percentage of medical students majored in science-heavy fields, not everybody does and it is not required that you do. In fact, the trend today is to admit applicants who are more “well-rounded.”

The key is to ace all of the pre-med prerequisites whatever your major. You need to do this for several reasons. First, because the common medical school application used by almost all medical schools breaks down your GPA into several categories beyond the standard “cumulative GPA.” The most important is your BPCM GPA (or Biology, Physics, Chemistry, and Math).

You can have all A’s all the time in your Mickey Mouse degree program but a low BPCM GPA will be the kiss of death. It shows the medical school admissions committee that you can’t handle difficult coursework. On the other hand, you can have all A’s in your basket weaving major but have a 4.0 BPCM GPA indicating to the admission committee that you are a smart person, capable of handling the coursework, who happens to have a commendable interest in baskets.

The second important reason to master the material of the pre-med prerequisites is that whatever your major, you will have to take that great equalizer, the MCAT, in your junior year. Your background for this test might only come from the pre-requisites if your major is Art History.

But more on the MCAT later.

I suppose that some of you think a third reason might be that these basic science pre-requisites will help you later in medical school. I suppose so, but the utility of these courses is somewhat over-rated. Take organic chemistry, for example.

Organic chemistry, as taught in college, emphasizes a completely different knowledge set then that stressed in your first year medical school biochemistry course. Memorizing chemical structures and the movements of electrons in chemical reactions which is the basis of undergraduate organic chemistry is relatively unimportant in medical school biochemistry which tends to focus on the big picture.

Actually, very little in the way of a science background is required on your first day of medical school other then a reasonable grasp of high school level chemistry and biology. You pretty much start from scratch.

On the subject of majors, you also have to prepare for three possibilities which are unthinkable to the young pre-med freshman just starting college. The first possibility is that you might not be smart enough to get into medical school. Or, you might be smart enough but you lack the discipline to get good grades. Whatever the case, it is very hard to recover from a string of Cs and Ds in the medical school pre-requisites.

The third possibility is that you may realize that you don’t want to be a doctor. Maybe your volunteer experience in the local emergency room has revealed your absolute intolerance for other people’s bodily fluid. Maybe you are too immature.

With this in mind, make sure to select a major which offers you an alternate career path. Trust me: you will never really know if you like medicine until you do it. It is not uncommon for medical students, and not always the ones from the bottom of the class either, to quit in the middle because they find they just don’t like it as much as they thought. Sure, popular culture makes the job of a physician look glamorous and exciting, and it has its moments, but the hours can be brutal and the many aspects of it are frankly disgusting and would turn the stomach of anybody who isn’t dedicated.

The next important step as a pre-med is to obtain a pre-med advisor. This is a faculty member who will guide you through the complicated process of matriculating into medical school. But beware. As a class, pre-med advisors can be a mixed bag. First of all, they are not (except in the rarest of circumstances) medical doctors. Ideally they have contacts with medical school admissions departments and have a good idea of the requirements but this is not always the case.

Second, they are not always as gung-ho as you are about your chances for admission. This is not a bad thing in itself because a sober, unvarnished appraisal of your qualifications is essential. On the other hand you don’t necessarily want to be told, as I was, that my aspirations towards a career in medicine were at best a crap-shoot.

Snowballs and hell were also mentioned.

Shop around. I ended up with an excellent pre-med advisor from my university’s mechanical engineering department. Don’t settle for the first one you are assigned.

The other not-so-obvious reason to get a good pre-med advisor is that he will be your link to your schools pre-medical advisory committee. This committee (which goes by different names at different schools) will evaluate you in your junior year and write an important letter of recommendation. You will need to get other letters, of course, but this is the first one the admissions committee is likely to read.

Extracurricular Activities

It is a sad commentary on our society that it is not enough to express a desire to be a physician and get good grades but you must also take part in extra-curricular activities to prove your worthiness and dedication. The theory is that a little bit of exposure to the world of medicine will somehow make you a better applicant although I wish somebody would explain exactly how.

Honestly, no medical knowledge whatsoever is required on the first day of medical school. It doesn’t matter if you spent the last five summers running an inner-city STD clinic or flipping burgers, you are all going to start at the same level and learn the same information.
With this being the case, and with the credo to “never fight city hall” firmly in our minds let’s discuss a few common extracurricular activities along with their potential pitfalls and benefits.

It’s axiomatic that you will get out of an extracurricular activity what you put into it. Some are shameless exercises in self-aggrandizement. Others are worthwhile in and of themselves.

First consider the “Pre-Med Club.” Not to generalize too much but this club is generally the domain of the pre-med gunner. Nothing much of use is discussed at meetings that you can’t get from skimming any number of medical school advice books. Occasionally members of local medical school admissions committees will come and speak to you about admission, always telling you exactly what you already know and never quite getting around to telling you their criteria for selecting applicants. I would rate this a one on the ten point scale. I suppose if you have nothing better to put on your application you might mention your involvement. Maybe you were the President although I don’t think it makes a dime’s worth of difference. Avoid the “Pre-Med” club or anything of its type if for no other reason then it will probably demoralize you to be surrounded by so many type-A personalities “gunning” for your spot in medical school.

Let’s talk about research. Research is the lifeblood of academic medical centers. Not only is it the vehicle by which medical knowledge is incrementally advanced but it brings vast sums of money into the institution. Every one of your basic science and clinical instructors in medical school will be involved in research. With this in mind, meaningful undergraduate research activities are bound to look good on your application and if you are that type, then God love you.

The ideal situation is to take such an active role in a research project that you get mentioned as an author. (Look in any medical or academic journal and you will see that many articles have a list of authors.) This explains the section on the medical school application form for “publications.”

But what about the rest of us? For my part, I quit graduate school because I didn’t like research. In fact, the last meaningful research I ever did was a little paper entitled “Our Friend the Badger” in the third grade. Clearly, research is not for everybody and you will be relieved to know that a majority of medical students didn’t do any either.

Having no research experience will certainly hurt your chances of getting into Harvard or another ultra-prestigious medical school but most medical schools are not ultra-prestigious. If you are a solid student with a decent MCAT score and a few good extracurricular activities there is a place for you in medical school and you will do fine.

Bottom line: Research is a great and looks good on your application. But realistically it is not feasible for many students either from a lack of interest of a lack of opportunity. Don’t sweat it.
As I have mentioned your goal in any extra-curricular activity should be to demonstrate to the admission committees a genuine interest in the medical profession. Some of you may already have medical experience as nurses, ER techs, or the like. You are in good shape and can dedicate more of your time to getting good grades.