PRE-MED HANDBOOK

IV. The Admission Process : Factors in Medical School Selection

Medical schools utilize an admissions committee appointed by the Dean of Medicine for selection of the entering class. The size of the committee will vary from school to school, but it will normally be composed of MD’s from the clinical faculty, PhDs from the basic sciences faculty, and medical students who are typically in their third or fourth year. Some schools also appoint alumni (practicing physicians) and most have some representation from the general public (consumer representatives). Year-to-year changes in the composition of the committee at any particular school are often reflected in slightly different emphasis on selection factors. However, all medical schools will select students to fill their entering class who show evidence of high intellectual ability, a good record of accomplishments, and personal traits that indicate ability to communicate with and relate to patients in a realistic yet compassionate manner.

Admissions committees strive for objectivity in making their decisions regarding admission. There is, therefore, a great deal of emphasis on grades, scores on the MCAT, and other factors that can be easily measured. They also consider any information that is available regarding an applicant’s overall suitability and promise as a physician. If such factors as state of legal residence and other absolute factors are ignored (i.e., you comply with their particular requirements or preferences, or you do not), there are four factors that will largely determine whether a particular applicant is accepted. These are: 1) overall academic record, 2) scores on the MCAT, 3) evaluations from faculty members who have had the applicant in class, and 4) impressions made during a personal interview with faculty and students of the medical school including members of the admissions committee. Other factors that may affect the decision are work or volunteer experience in a clinical setting, extracurricular activities, and leadership positions. Each of these will be discussed below.

Overall Academic Record
The undergraduate record, particularly grades in biology, chemistry, physics and math (BCPM), is the most important single factor in predicting whether or not a student will be admitted to a particular medical school. Most medical admissions committees feel that the quality of academic work leading to the baccalaureate degree is the most important indicator of probable success in medical school. The academic record may be viewed as including the cumulative GPA, subjects taken, rigor of the major and trends in performance (i.e., were grades mediocre in the freshman year with a constant improvement during the sophomore and junior years, vice versa, or was performance relatively constant?). A strong undergraduate academic record is considered evidence of both ability and motivation, hence, the heavy reliance by committees on this factor. The average overall GPAs for the 1998 entering classes at USC School of Medicine and MUSC are between 3.5 and 3.6.

Grades are not evaluated alone but in the context of the total academic program with such factors as part-time employment, participation in varsity sports and other severe demands on study time looked upon as extenuating circumstances.

The Medical College Admission Test
The Medical College Admission Test (MCAT) has traditionally been second in importance only to grades when evaluating an applicant for medical school. A number of AMCAS schools conduct a preliminary screening based entirely on GPA and MCAT scores and secondary applications are not invited unless certain minimum scores are exceeded. Even if a secondary application is accepted, most medical schools select applicants to be interviewed on the basis of combined GPA and MCAT scores. The importance of MCAT scores can scarcely be overemphasized. The average MCAT scores for the 1998 entering classes at USC School of Medicine and MUSC are between 9 and 9.5 in each numerically scored subtest.

The MCAT is given twice each year, in April and August. The latest that the MCAT may be taken is in August approximately one year before an applicant expects to matriculate in medical school. However, you are urged not to wait until the fall of the senior year to take the MCAT, but to take it in the spring, almost 18 months before the expected time of matriculation. If you do not achieve a competitive score on the April test, it is possible to retake the exam in August. Most medical schools will accept an otherwise well-qualified student who has poor MCAT scores in the spring MCAT administration, but good scores in August. If you take the MCAT for the first time in August as a rising senior and make scores that are not competitive, you would usually not be accepted in that application cycle, causing a delay in entering medical school for a full year.

There is considerable misinformation about the strategy which should be employed in taking the MCAT. Many pre-medical students have been advised to take the test "just for practice" the first time, and then to come back and prepare for the exam during a second and perhaps third test. This is generally very poor advice. Even if you suppress your scores, many schools will still ask you about them. All applications will be accompanied by the results of the last two scores made on the MCAT, and all other scores are available to medical schools. It is now very expensive to take the MCAT, $160 for 1998, and the price usually goes up each year. This is another excellent reason to prepare well for the test and to take it only once.

All applicants must present MCAT scores as a required part of the supporting material for their application at all but two US medical schools (Johns Hopkins and the University of Rochester). The test is described in detail in the MCAT STUDENT MANUAL, a booklet published by the Association of American Medical Colleges. This book also contains a separate practice MCAT. Students preparing to take the MCAT should obtain a copy of this manual and carefully read the test description several months before the test. Order information is given in Appendix A. The manual is also available in the University Bookstore. This is the most accurate and reliable description of the test available and the topics to be tested are described in detail in outline form. Pre-Professional Advising has a handout, MCAT Info Sheet, that describes the test in detail, and some general information has been included here.

The current MCAT has four sections: biological sciences, physical sciences, verbal reasoning and a writing sample. The AAMC believes that the new format enhances the MCAT’s predictive value and encourages students interested in medicine to pursue broad undergraduate study in the social sciences and humanities as well as the traditional natural sciences. The MCAT assesses the ability to comprehend, reason and think critically as well as expertise and knowledge in these disciplines. The writing test consists of two 30-minute essays, neither of which will be scientific in orientation. There is a numerical grade from one to fifteen, with eight as a mean assigned to the first three sections mentioned above, but a letter grade is assigned to the essay, with a range from J to T. You are encouraged to obtain a copy of the MCAT info sheet from our office.

Concerning commercial review courses, the following points are offered. A commercial review course may have value in that the problems and material are designed to teach a student "how to take the test" and the practice tests used may give students with poor test-taking skills good experience. The primary disadvantage of commercial review courses is that they are very expensive, usually costing hundreds of dollars. They may be worth the price for certain students, but it should be pointed out that some commercial reviews utilize instructors who do not know their subject matter as well as they should and "crash courses" which may be completed in only a few days have not been shown to increase scores in most cases. Students taking a full course load often do not have time to utilize the material available in a commercial review course. Whether or not a commercial review course is worth its cost can only be answered by the individual student.

Registration forms for the MCAT may be obtained from Pre-Professional Advising or by writing MCAT Program Office, PO Box 4056, Iowa City, Iowa 52243. The registration material should be mailed well before the deadline, for if there is a mix-up, such as failure to sign the application, failure to enclose the registration fee, or failure to provide a picture, the form will be returned. The regular deadline for registration is 30 days before the test. By paying an extra fee (of $50) this may be extended for 15 days, but there are no provisions for taking the test as a "walk-in." Complete registration forms with a check or money order must be filed before a test admission ticket will be sent. There is a fee reduction program for students with extreme financial limitations. Details of this program are found in the MCAT registration packet.

The Evaluation Letters and Optional Pre-Med Interview
An important part of the documentation used to support an application for admission to medical school is the faculty evaluation, often referred to as a recommendation. Evaluations are sent only to the medical schools that send the applicant a secondary or supplemental application, after an initial review of their initial AMCAS application information. Evaluations may be requested from faculty members at any time. Make an effort to meet your professors and teaching assistants. Most will be glad to talk to you during office hours. Since the introductory science courses tend to be large, students may find it difficult to get to know professors personally. You may ask laboratory and teaching assistants for evaluations, but it is a good idea to have the course professor co-sign the letter. Teaching assistants may not be as familiar with writing letters of evaluation, whereas experienced professors can very often put a student’s motivation and aptitude into excellent perspective with a few well-chosen words. The most important factor in selecting an instructor to prepare an evaluation is that he/she should know you well enough to be able to comment from personal knowledge on some fairly subjective factors such as motivation, interpersonal and communication skills, compassion, and general character. A good evaluation will not be a rehash of grades made in courses, for such information is already available in transcripts, but it will supplement the other information available and establish its own credibility based on what is said in the narrative. You should approach professors near the end of the semester, ask if they can write you a strong evaluation, and supply them with a copy of your transcript and a brief resume.

Transfer students may wish to obtain one or two evaluations from instructors at their previous institutions. Evaluations from employers, physicians with whom students have worked, volunteer supervisors, etc., may also be used, but usually only after four academic letters have been obtained. Letters from family friends, public officials, or character-type references are usually not useful in an applicant’s credentials packet.

Two or three evaluation letters should be requested from science professors and one or two from non-science professors (to equal four). If you are applying to schools that draw from the national pool of applicants (mostly private institutions), you should obtain two science and two non-science evaluations. The two medical schools in South Carolina will accept a majority of science letters, but one non-science letter is still a good idea. Certainly, you do not want to sacrifice a strong science letter for a not-so-strong non-science letter, but ideally, you will obtain a strong non-science letter to complement your science letters.

Letters of evaluation from public officials who know a student only slightly are frequently a waste of everyone’s time, especially if it is obvious that a staff person is writing a perfunctory letter for the son or daughter of a constituent. This is not to say that letters should not be solicited from people who know you well just because they may be rather prominent, for if they can comment from first-hand knowledge, their evaluation may have high credibility.

Pre-Professional Advising provides a credentials service that makes it easier for distribution of your evaluations. You may pick up the generic evaluation forms in our office and supply your letter-writers with these forms. They then should be returned directly to our office by the letter-writers. If using Pre-Professional Advising’s credentials service, we allow a maximum of six letters, four of which we recommend be academic letters. The other two might be from job supervisors, volunteer coordinators, advisors, or someone who can discuss you in terms of your work ethic, maturity, responsibility, motivation, etc.

If you choose to use our credentials service, we will maintain your file for four years from the time you register with our office after which time it will be destroyed. We will maintain your file longer with a written request.

Many medical schools provide their own forms for letters of evaluation or recommendation, but these need not be used. All of the medical schools in the country will accept our forms. This is a much more efficient system for you and your letter-writers.

An early decision that must be made is whether or not to waive right of access to the requested evaluations. Under the provisions of the Family Educational Rights and Privacy Act of 1974 (also known as the Buckley Amendment), students may have access to their official records, which has been interpreted as including evaluations unless they specifically waive this right. The applicant must be aware that a more candid, and therefore a more helpful, evaluation will usually be written if the professor knows that the confidentiality of the evaluation is to be respected. A waiver form indicating whether the student waives his/her right of access must be signed before letters of evaluation are distributed to faculty members. The signed waiver form is kept in each applicant's file and applies to all letters of evaluation. A waiver status indication is found on the evaluation form and the applicant must check the appropriate box before the evaluation letter is given to the evaluating instructor.

A credentials packet is prepared by Pre-Professional Advising for all USC students and alumni who request it. The packet includes a summary of the checklist portion of the evaluations and the written comments from the individual letters of evaluation. You may opt for a pre-med mock-interview (or practice interview), but this opportunity only allows the student to practice this particular section of the medical school application process. Information about your undergraduate experience (strength of academics, extracurricular activities, leadership experience, health care exposure, community service, etc.) should be provided to provide more information for the staff to utilize during the interview. The pre-med mock-interview is done in the spring of your application year. This interview is optional, but can supply the student with comprehensive information and practical experience to assist in the medical school application process. The interview is about thirty minutes long and performed by a director from the Pre-Professional Advising Office. The interviewers usually ask questions about your motivation for your desired profession, your strengths and weaknesses, exposure to health care, familiarity with health care issues, ethical questions, etc.

To obtain a pre-med mock-interview, you must first register with our office and collect at least three letters of evaluation. Students should check to see if letters of evaluation have been received by Pre-Professional Advising by calling (803) 777-5581, or personally checking during office hours. Once we have obtained at least three letters, you can request an interview by filling out the Request for Practice Interview form. Pre-med mock-interviews are done in the spring semester from the beginning of March through the end of May. We also do interviews in the fall semester from September through November. It is to your advantage to have your interview done by the end of September, for the most timely completion of your application.

As you begin receiving supplemental or secondary applications from schools to which you have applied, you need to request, in writing, that we send your credentials file to those schools. To do this, you must fill out the Credentials Forwarding form in our office, or write us a letter with your request. Those who wait until fall to complete their file will be at a disadvantage since the credentials packet will arrive at the medical school late in the admissions cycle. Most medical schools encourage applicants to apply as early in the process as possible (when the number of available seats is at a maximum).

Students applying under the Early Decision Program must take the Spring MCAT and have a complete file by the end of May. The credentials packet should arrive at the medical school by August 1. To ensure this, the student must request, in writing, by mid-July, that the packet be sent.

Extracurricular Activities and Work Experience
There is a common myth that pre-medical students sit with their noses in a book 18 hours a day and never participate in any activities other than studying. This is of course not true, for pre-medical students participate in as many extracurricular activities as students in most other programs and a number hold part-time jobs to assist in meeting expenses. A great many successful pre-medical students join service clubs and religious organizations, play varsity or intramural sports, participate in debating societies, theatrical groups, glee clubs, the band, and do all the other things done by a typical student, including leading an active social life. Successful pre-medical students, however, know how to order their priorities. They do the work first, then play later, but they don’t miss out on a great deal.

Involvement in extracurricular activities is viewed very favorably by admissions committees. If you can maintain a competitive grade point average in a rigorous curriculum and still have the time and energy to actively participate in extracurricular activities, both your aptitude and motivation must be rather high. There is no particular benefit to the student who is a "joiner" and who pays dues but never participates or becomes involved in an organization. A student who has been very involved in activities that are people-oriented, particularly someone who has held office in worthwhile organizations or who otherwise presents evidence of leadership might be considered a strong candidate for medical school. It must be emphasized, however, that no amount of involvement in extracurricular activities can substitute for a good academic record and strong MCAT scores. Such involvement is "icing on the cake" for it will make an academically competitive applicant much more likely to be accepted, but without good "numbers" to support the application, it may mean relatively little.

An applicant who knows very little about the practice of medicine or has unrealistic expectations about a medical career will be viewed with considerable apprehension by an admissions committee, but there are many ways this information may be gained. Work experience in a hospital, neighborhood health center or some other medical facility will also be viewed quite favorably by most admissions committees. This is not a prerequisite for admission, but is becoming increasingly important for serious consideration by an admissions committee. The primary value of working in a hospital, doctor’s office, public health clinic, or nursing home is to help you decide whether to pursue a career in medicine.

Some students take training (such as the Emergency Medical Technician course) which allows them to obtain employment in an emergency room, with an ambulance service, or in some other area as a regular or part-time paramedical employee. The experience gained may be of considerable value if the work schedule does not cause grades to drop. As a general rule you are urged not to seek part-time employment during your first year but wait until a strong academic record has been established if you must work. If grades begin to drop, the job may have to go. It is often better to work summers or holidays so as not to interfere with classes and suffer a drop in GPA that may jeopardize acceptance.

Obviously not every pre-medical student will be able to find a job that will give him/her a worthwhile experience in medicine and help financially as well. Volunteer work is usually available in the area hospitals in many different departments. Additionally, there are many other health-related opportunities available in the area. Information on volunteering may also be obtained by calling the USC Coordinator of Community Service Programs at (803) 777-5780. Paying jobs unrelated to medicine may also give you experience that will be beneficial when applying to medical school. Jobs that require considerable contact with the public, such as in sales, offer excellent opportunities to develop better human relations skills. Some jobs teach a person management skills and might help you assume increasing levels of responsibility. Any "people oriented" work experience may be valuable and will often be discussed in an interview.