What I Wish I Knew

As a second year medical student, looking back on my own interview and application process, there are certainly some questions I wish I had asked. In no particular order:

-What does the school do to prepare students for step 1? Specifically, are there review sessions? How many weeks off do they gate? Do students take NBME shelf exams ?

-What are the step 1 scores of your classes over the last 3-5 years (mean +/- SD)? I would ask this to know whether the school does better or worse than expected given its average entering MCAT score. You can compare the difference between the school’s scores and the national average of USMLE scores (~220) to the difference between the school’s admitted student MCATs and the national average of matriculant MCAT scores (~31, each school is published in the MSAR).

For example: UVA in 2010 STEP 1 vs. MCAT (class of 2012):

STEP 1: mean of 236. National average of 222, SD= 24. So they are about 0.5 SD above the mean step 1.

MCAT: 33Q. National average of 31. National average of 30.9, SD = 4.2. So they are about about 0.5 SD above the mean MCAT.

Conclusion: they do as well as expected given the quality of their admitted students.

-How many students have failed step 1 over the last five years? Ideally <2% of students per year on a long term basis. 2-5% is poor, but acceptable. Any school with >5% failure rate is not supporting its students sufficiently or is not admitting appropriate candidates.

-How many students withdraw or fail before taking Step 1/ finishing the second year? Again, <2% of students per year on a long term basis. Anything >5% should be setting off alarm bells.

-How many small groups and PBL do you have per week for each class? Is the curriculum lecture based or small group based? (for me, this would be a negative. everyone is different).

-How much elective time do students have in the third and fourth year? More is better; 20 weeks in the fourth year is the minimum that I would consider okay. Choosing between mandatory courses does NOT count as true elective time. This is important because after medical school you might never get the chance to experience anything outside of your own speciality.

-Do students have early clinical experiences? How many (>1/month in the first two years, ~1/month or <1/month)? How are these integrated into their curriculum? Specifically, how is the physical exam taught?

-Do students have planned opportunities to participate in research? n.b. any block of time shorter than six months will not be sufficient for a research project (and even that is only sufficient for the most rudimentary projects with significant outside support).

-How does the school teach statistics (pet peeve)? When?

-How responsive is the administration to the students? Look for concrete and major changes to courses, don’t accept vague promises.

-How are students exposed to different types of medical practices (e.g. VA hospital vs. teaching hospital vs. community hospital vs. big hospital vs. small community clinic vs. rural medicine)? Is this a standard part of the curriculum (for instance, by having a variety of different clinical sites for third year and first and second year students) or do students have to seek this out independently? (a bad thing!)

How does University Medical School stack up?

Well, our MCAT scores are consistent with our step 1 scores, although too many students fail step 1 (2-5%/year). Additionally, too many students withdraw or fail overall (2%/year). We have mostly (75%) lectures with few small groups and other activities. We have early clinical experiences at an appropriate rate of about 1/month, although the teaching quality is varied. The physical exam is taught well but then largely unsupervised until the third year, except for students who make flagrant mistakes. We do not have enough time to undertake research projects although we are encouraged to apply for Doris Duke or other fellowships and to take an extra research year. UMS teaches statistics haphazardly and poorly, although this has improved for the current first year class and it will improve again for the next year’s class. One of the school’s strengths is that it is extremely responsive to student feedback, although often slow to act. Major courses and policies have been overhauled as a result of student dissatisfaction.

Would I have decided on a different medical school if I had know what I know now? Probably not. Strange as it sounds, I’m actually pretty happy with my choice. Cognitive Dissonance? Maybe.



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