Student Profile: Summer Service

I was browsing through the OCS Peer2Peer Network the other week and came across an interesting way that a student chose to spend her summer. A couple summers ago, Meaghan Lyons '11 was a Personal Care Assistant at North Shore Association for Retarded Citizens in Danvers, MA. Since many premed students are looking for "clinical" positions where they are able to provide direct service, I asked Meaghan to describe how this opportunity came about and what her experience was like. Here's what she said:

Working for the North Shore ARC while I was in high school, and intermittently during my college summer breaks, was the result of a longstanding relationship with my neighbors. I started out as a mother’s helper for a family that lived two houses down from me with two Autistic children. As a middle school student, I was never left alone with either of the children, but acted more as another set of hands to help with the daughter. The family I worked for became my second family and I grew very close to both children and their parents.

When I got to high school I made the transition from being a mother’s helper to being a paid employee of the North Shore ARC. The ARC is a non-profit group located in Danvers, MA that is dedicated to providing programs and resources to families with members who are disabled. My job was often extremely challenging. It can be frustrating to try and communicate with someone who has Autism; both of the children I worked with had severe communication barriers and conversation on their end never extended beyond one-word answers. On the other hand, I have had few experiences that have been as rewarding as taking the older son out into the community to go bowling or go to the mall and seeing how happy it makes him.

When I go home for breaks from Harvard, I always make sure to visit my neighbors and occasionally still babysit for them. I am lucky to have had a job that taught me so much about patience and caring for others. No matter what my career, Autism advocacy is something that will always be important to me. There are so many avenues to help people and family with disabilities, both mental and physical. We need politicians and advocates who support legislation and funding that assists families with members with disabilities, just as much as we need scientists who can find the cure for Autism. I am not sure which camp I will fall into, but, regardless, my work with the North Shore ARC will always be a life-shaping experience.

This should go to show you that a good place to start when looking for internship and volunteer positions is in your own community. A large component of clinical medicine is direct service to people and there are many related opportunities right in your backyard.

If you have questions for Meaghan about her experience, feel free to email her at mlyons@fas.harvard.edu. For other ideas and to ask other students about their summer experiences, please give Peer2Peer a browse. Good luck with your summer search!

Specialty vs. Primary Care

The NY Times did an interesting (video) piece on med students' dilemmas about which type of medicine to pursue in residency. They feature the opinions of several University of Washington students. There are a lot of considerations here--lifestyle, money, values, etc.--all in the context of the changing landscape of healthcare. Hopefully some of these issues will be discussed tomorrow afternoon at our Exploring Careers in Medicine panel discussion.

MCATs before and after AMCAS submission

This is a somewhat mundane technical detail about MCATs and the AMCAS application but we've gotten quite a few questions about this this year.

A number of applicants each year decide to retake the MCATs. Assuming this happens in the summer after the AMCAS application has come out (early June), the question is how to notify medical schools of their upcoming test date and new scores.

The main thing to know is that the AMCAS verification process runs completely independently of MCATs. For instance, if you do not yet have an MCAT score on the books, this won't slow don't the verification process. So long as you are committed to applying to medical school no matter what score they receive, you should submit your AMCAS as early as possible and not wait for your score. In the case that an MCAT score comes out after your AMCAS has been verified, you do not need to contact each medical school about your new score (so long as you've indicated in AMCAS this new test date). Schools are automatically notified.

Here is what the AAMC says about the process:

Applicants can, at anytime pre or post submission, let medical schools know they plan to take another MCAT and the date they plan to take the test. They log into their AMCAS application go to the STANDARDIZED TEST tab (Section 9) and select Next MCAT from the options available on the right, they’ll be presented with the list of MCAT dates and they need to select the date they plan on taking the test. If they decide, later, not to take the test, they can change their answer again. They need to be sure to re-submit their application by selecting SUBMIT APPLICATION on the Main Menu in order for the changes to save and be sent to the medical schools. This will have no affect on their processing time; if they are already processed we will make the new data available to the schools.

MCAT scores are automatically inserted into the AMCAS application, if the examinee has applied to AMCAS, once the scores are available. The applicant doesn't need to take action once the scores are in, he or she can check the AMCAS application though to double check that the scores appear in the application.

Advice from Current Applicant about Financial Assistance

Following up on last week's post about financial assistance from the AAMC, here's some advice from a Harvard student currently applying to medical school:

I didn't think that I would be eligible for FAP because my family hasn't generally been eligible for fee assistance programs like this in the past---but they actually have rather generous criteria, and I discovered that I would have been eligible only after submitting my AMCAS. I'm getting lots of fee waivers for my secondary apps (which is awesome and very helpful) but I missed getting the waiver for MCAT registration and for AMCAS.

As this example points out, FAP does not offer fee assistance retroactively. Especially with the MCAT, it's very easy to miss applying for FAP. But even if you do miss the MCAT, you are still eligible for assistance on AMCAS application fees provided that you qualify. For the AMCAS alone, this makes a big difference. For instance, if you applied to 13 schools, you would save $532. Also keep in mind that even if you don't qualify for FAP but are on significant financial aid at Harvard, you may still be able to receive fee waivers for your secondary applications.

Other health professional graduate schools often offer programs similar to FAP such as AADSAS's Fee Reduction Program (FRP) for the dental school application. Note: this is a partial refund program (post-application) rather than a waiver program (pre-application).

Thoughts about the MCAT

How important are the MCATs?
A medical school admissions dean answered in this way: "... the MCAT is important -- in context, though... It does not project who will be a good physician and so, we try to balance the whole picture: academic performance (which includes # of credits per semester and type of courses taken), MCAT scores, family background (educational and economic -- need to work while in college and/or obstacles overcome, distance traveled), leadership roles, extent and depth of involvement in clinical/ extracurricular activities/ community service/ research, the personal statement and, last but not least, what ... evaluators tell us about the applicant. "

Jeff and I have found that a high MCAT score will not overcome poor grades, minimal clinical experience, poor personal statement, etc. We have also noticed that med schools respond negatively to students who take only three courses the semester they take the MCAT. Because the admissions office reviews your transcripts carefully, they will be concerned if your abilty to score high on the MCAT was due to taking only three courses. However, many students do take a fourth course pass/fail that semester, which is fine.

Should I take Kaplan or Princeton Review or Examcrackers to prepare for the MCAT?
We don't endorse any particular course, especially as they can be incredibly expensive! The MCAT consists of hard questions on basic material. Many students study on their own, or with friends, by using online material, review books, etc. The best way to prepare is preparing is to take as many practice tests as possible, in a setting similar to the real test (with timed breaks, etc.) Whatever way you prepare, we suggest you make sure to check the official MCAT website for access to full-length MCAT practice tests composed of previously administered MCAT items.


How long will my MCAT score last?
Recently, some students have asked whether they can take their MCATs the summer after sophomore year even though they do not plan to go to med school until a few years after graduation. Alumni have contacted us asking if their MCAT "is still good". Unfortunately, despite the fact that med schools like applicants who have taken time off post college, many of these med schools also require that your MCATs be taken within three years of application. You will find that med schools really do vary in their policy regarding when MCAT scores expire. The Medical School Admissions Requirements book, published by the AAMC, lists the oldest MCAT considered for each medical school. (You can find a copy in the OCS library). For example, Harvard Medical School would accept an applicant who took her MCAT in 2007, and then applies in 2010 to enter in 2011. However, Dartmouth probably would not.

It would be a lot easier if the policy was more consistent and if schools would allow the MCATs to last at least four years. But, until that happens, we suggest that you keep your options open by taking your MCAT closer to the time of your application.

Financial Assistance from AAMC

The following is a message from the AAMC about their new program to support financially needy students who will be applying for accommodations for the MCAT. Please note that the AAMC's Fee Assistance Program (FAP) is a separate program. Students must first receive approval for FAP before they are eligible to apply for this accommodations financial assistance program.

The AAMC has developed a new financial assistance program for MCAT examinees applying for accommodations. Some examinees applying for accommodations do not have documentation of their disabilities or medical conditions that meet our currency requirements. Our program is designed to assist low-income students and provides support to reduce the cost of re-evaluations. Please take a look at the program details on our web site which also describes the eligibility requirements and application process.

Math for Med Schools

Most medical schools do not require math; of those that do, some require only one semester, some accept APs, some require calculus specifically, and some accept statistics (see list). Depending on your background, you may need to take math to a certain level in order to be fully prepared for your concentration or for future coursework. Therefore, freshmen should not feel compelled to take a math course their first year just to meet a possible premed requirement.

About 16 medical schools require at least one semester of calculus; a few (including Harvard Medical School) require one full year. If you have Calculus APs, this may be enough for some medical schools.

Admission vs. Matriculation Requirements

We wanted to clarify something about course requirements for med schools. For the majority of medical schools, their premedical requirements are matriculation requirements meaning that the applicant must complete these prior to enrolling at the med school.

In general, we recommend completing all basic science requirements (e.g. bio, chem, physics) prior to admission in order to be a competitive applicant. However, there are additional courses--including those in math, biochemistry, and biology beyond two semester--that are not necessarily required in order to be considered for admission.

Sometimes students think that if they don't have every single requirement completed, a med school will simply not consider them. This is generally not the case.

Tulane Med & the Early Decision Program (EDP)

Dr. Barbara Beckman, Associate Dean of Admissions at Tulane School of Medicine, spoke yesterday about Tulane and their admissions process. Dr. Beckman mentioned that many students are drawn to New Orleans because of the city's culture as well as its particular challenges post-Katrina. Applicants who have been abroad, doing service work in places with broken infrastructures, are often good fits for Tulane.

Regarding the interview process specifically, Dr. Beckman reiterated what you've hopefully heard elsewhere:

• Know something about the school! Do your homework and make sure you can articulate "Why Tulane" specifically.
• Don't blow off your student interview. Tulane has current med students conduct interviews with applicants and they have a say in the process as do faculty members. The lesson here is to treat every aspect of your visit as the interview (because it is).
• It's okay to wear something other than a black suit to your interview. You don't need to dress in investment banking interview garb.
  

Dr. Beckman also spoke a bit about their Early Decision Program (EDP). A number of other med schools have such programs. The idea is that if you are very interested in attending the school, you apply to that school only and are required to matriculate if offered acceptance.

However, you may hear back your decision from a school as late as October 1. This is the sacrifice you make. If you are not admitted early decision, your applications to other schools would be very late in the application cycle, significantly affecting your chances of admission. So you really need to make sure that you are a competitive applicant for the EDP.

Because of the gravity of this decision, many programs are willing to consult with students before they apply to give them a sense of their competitiveness. It is rare for a Harvard student to apply to an EDP. More info on EDPs can be found on the AMCAS website.

MD/PhD Considerations

The Harvard Premedical Society put on a terrific program last night featuring MD/PhD directors from four different programs: Cornell/Rockefeller/Sloan-Kettering, Washington University at St. Louis, Baylor College of Medicine, and Harvard-MIT. Here are some things that I took away based on the directors' opinions:

Basics

• Types of research possible: (a) basic research, (b) disease-oriented research, (c) patient-oriented research, (d) population-oriented research.
• Keeping in mind the various levels of analysis (e.g. environment, body, molecular, etc.), a successful MD/PhD learns how to sync productively all these levels.
• Two pathways into the MD/PhD: (1) enter MD/PhD program directly from college, or (2) begin an MD program and apply for transfer into the school's MD/PhD program.
• A typical timeline is 2 years of the MD program (basic sciences with some research), then 3-6 years completing the PhD, and finally 1-2 years finishing up the MD (clinical work). (And then there are residency training and fellowships!
  
• MSTP programs are a subset of all MD/PhD programs. MSTP programs receive support from the NIH. They have been evaluated comprehensively on the quality of their training (to determine if it's valuable for the government to invest money in).

MD/PhD vs. MD or PhD

• What makes an MD/PhD different from an MD is an interest in the "why?"
• For the PhD component, find out which programs are good for the discipline you're interested in. This is important!
• Reputation of MD/PhDs: Clinicians say, "They're all basic scientists!" PhDs say, "They're all clinicians!"
• Pluses to the MD/PhD: Broad education and broad perspectives.
• Minuses to the MD/PhD: Long education and training, pressures placed on you by lab, striking clinical balance, and pressures on family.
• As an MD/PhD graduate, no one remembers your thesis research. The benefit of an MD/PhD education comes in the form of training and mentoring.

A Successful MD/PhD Application

• The most important quality of an accomplished research/applicant is being hardworking, not smart.
• MD/PhDs have the qualities of an MD (i.e. those that make a good clinician) plus dedication, talent, and performance in the lab.
• Students serious about the MD/PhD should consider doing summer research beginning the summer after sophomore year.
• Figure out which lab is the best for you. Once you have, be very involved in it over a significant length of time.
• In your application, you need to be able to tell a story about your science research.
• Contrary to popular belief, only about 15% of MD/PhD applicants have publications under their belts when they apply.
• Best advice: Apply early!

You're in, now where do you go?

• Many of the same considerations of MD applicants (e.g. nature of a school's patient population, curricular differences, etc.).
• Some MD/PhD programs require you to have a lab chosen in advance of entering medical school; this varies between programs.
  
• Think about working with a wide range of faculty. If you are set on only one faculty member, what will you do if he/she leaves the school?
• These are many years of your life! Consider proximity to family, location, community, etc.
• With the final decision, trust your gut feeling.

Odds and Ends

• About 25% of MD/PhD graduates spend 75% or more of their time performing research.
• Since international citizens are eligible for institutional funding only, applicants should contact admissions and ask: Do you fund international students? How many matriculate into your program every year?
• 30-50% of MD/PhD students ultimately do their theses on topics different than those they had intended to pursue.
• Does an MD/PhD application hurt an applicant's chances of being admitted to the MD program? No, said the panel. But if an applicant is denied by the MD/PhD program and is really interested in the MD, they should be proactive, writing to MD admissions and asking to be considered.
• If there is a hole in your research (or other) experiences in your application, you need to account for this. For instance, a year of research without a recommendation letter from that lab would raise a flag.

Selecting Medical Schools

US News and World Report?

Joni Krapec, Director of Admissions and Outreach at the University of Chicago Medical School recently spoke to students about how to choose medical schools. I was happy to hear her start the discussion with a critique of the U.S. World and News Report on "Best Medical Schools". So many times students come into our office with a list of the "top ten" medical schools taken from this list. Yet students (and their parents) usually don't consider the relevance of factors used to create this list. For example, research dollars weigh heavily in the US News and World Report ranking of medical schools. But does the fact that one medical school received more NIH dollars than another school last year tell you anything about the strength of the faculty who will be teaching you clinical skills?

Learning About Medical Schools

When you were trying to figure out where to apply to college, you probably had a chance to visit some colleges and listen to admissions presentations before deciding where to submit your application. The process is different for applying to medical school. You won't be offered tours or informational interviews until you are invited for an interview at the medical school. So, in order to make up your list of medical schools, you will want to check medical school websites, seek advice from premedical advisors, review comments from alumni who are now in medical school,(check out our alumni evaluations) and study the AAMC Medical School Admissions Requirement (MSAR) book. Ms. Krapec pointed out that as an admissions director, she is asked to fill out lots of surveys on applicant data. However, she is only required to complete information for the MSAR, which is the official publication of the AAMC. So, if you are using other books on "best medical schools" be aware that the information may be out of date and incomplete!

Jeff and I will be offering a workshop on selecting medical schools March 10th and March 11th, so please feel free to join us at one of these workshops if you are planning to apply to medical school this summer.

Fin Aid for Med School

A couple nights ago, Bob Coughlin, Director of Financial Aid at Harvard Medical School, spoke about the ins and outs of financing a medical education.

He covered a lot of ground, e.g. explaining the differences between subsidized (does not accrue interest while still in school) and unsubsidized loans, how financial aid works for international students, and how family and/or spouse circumstances factor into an aid award.

The following were some of my own take-aways though the talk was certainly more comprehensive:

General info & process

• The median expense estimates for 2008-2009 are $43,360 for a public med school and $62, 243 for a private med school (notice the significant difference).
  
• Generally speaking, the process of applying and submitting paperwork for financial aid happens after being admitted to a medical school.
• Get to know your med school financial aid officer! Med school classes are small so fin aid offices can work more closely with students and their families. If you have unusual circumstances, let the fin aid officer know. There are usually appeals processes.
• There are two types of aid: need-based and merit. Merit aid comes from a med school's institutional funds.
  

Need-based aid

• For federal loans, you would be considered an independent. For institutional funds, you would be considered a dependent and/or your family information is taken into account. This varies school to school but parent information is typically requested even for older students.
• If you are married or will be in the immediate future, a med school will take your spouse's information into account. So they'll look at both your family (i.e. parents) and your spouse.
  
• Med students (U.S citizens/permanent residents) can always get federal loans, e.g. Perkins and Stafford, to cover expenses, regardless of your family situation.
  

Merit aid

• Merit aid is given at the discretion of the medical school and varies considerably from school to school. Such awards are not based on need, i.e. income, assets, etc.
• Admitted students are usually automatically eligible for merit awards so there is no separate process outside of the admissions process.
• It's to your advantage to find outside scholarships. Scholarship money takes away from the need-based aid in a package, meaning that it would typically replace loans (money you would ultimately have to pay back).
  
• Outside scholarships are minimal but can add up. Look to regionally-based scholarships as possible sources.
• Avoid fee-based search services. Instead, use free scholarship search engines (e.g. finaid.org) or simply google search.
  

Aid packages

• The med school aid package looks very different from most college packages: it's common for 3/4 of a med school package to be covered by loans whereas loans for college are usually capped at a much lower amount.
• 87% of 2008 U.S. medical school graduates borrowed money.
• The median public med school debt is $145,000; the median private med school debt is $180,000.
  
• When comparing aid packages from med schools, do not look just at the dollar amounts, i.e. how much grant and how much loan. Scrutinize the details and understand what the debt will look like after medical school and beyond, e.g. subsidized vs. unsubsidized, fixed vs. variable interest rates, etc. Also, consider the cost of living depending on location (e.g. NYC vs. Iowa).
  
• Avoid credit card debt (for med schools reasons but in general too)! Schools cannot factor in this type of debt when putting together your aid package.
• At HMS, all need above $24,500 is covered by scholarship.

International students

• Many medical schools do not consider international students for admission. Those that do may not provide funding (some schools will ask to see up front that you have 4 years of tuition in escrow!). The reason being, international students are not eligible for federal loans so a school would need to use exclusively institutional funds to cover expenses.
• Talk to your home government to ask about possible aid sources.
• The vast majority of med students will not need private loans (vs. institutional or federal loans) though some international students do require these to close the gaps.
  

Odds & ends

• There are few options if any to help students with the costs of flying to medical schools for interviews so it's important for applicants to plan ahead.
  
• However, an AAMC program called FAP (Fee Assistance Program) helps students with need to afford MCAT and AMCAS costs.
• There are several programs that offer medical graduates loan forgiveness in exchange for service, e.g. Public Service Loan Forgiveness and National Health Service Corps.
• Create a budget. Learn more about how you spend your money and where it is going.
• Given the low salaries for medical residents, graduates are not expected to be able to repay loans immediately (meaning loans can be deferred).
• Despite declining salaries, physicians make incomes far above the national average so loans can be repaid!