Temple’s Katz School of Medicine Incorporates Local Community Into Medical School Admissions

For the selection of the Class of 2026 at Temple University’s Lewis Katz School of Medicine, the admissions team included members of the surrounding community. This made Katz one of the first medical schools to incorporate the opinions of local residents in admissions decisions. Among the five community members, all of whom live and/or work in the neighborhoods surrounding the medical school and hospital, one served as a voting member of the admissions committee (alongside medical school faculty and physicians) and the others interviewed and evaluated prospective students. 

The community members, who mostly hailed from social service backgrounds, received interview training prior to spending about four hours per week facilitating 30-minute interviews and writing evaluations for hundreds of candidates. The community member interviews, which included two to three prospective students at a time, engaged interviewees on topics such as: Why Temple? What does community mean to you? How would you engage with marginalized groups and groups that suffer disparate access to care? How would you handle a sensitive clinical conversation?

While the idea of incorporating local community members into the admissions team had been discussed previously, according to Jacob Ufberg, Associate Dean of Admissions, it was the medical school’s Student Diversity Council—a group of 60 students—who was responsible for implementing the plan. Randolph Lyde, MD, PhD, and Student Diversity Council Chair (at the time of implementation) described the Council’s work, “We feel it makes our admissions process better. It makes our school community better, and it makes us a better steward and partner in our community,” he said. “And hopefully, it will allow us to bring more culturally sensitive and culturally aware students into our medical school.”

Prospective students also found their interview experience meaningful. In a post-interview survey, 90 percent of the interviewees said that the community members had added value to their experience and given them a better understanding of the community and of the medical school’s values. 

New Study Casts Light on Higher Attrition Rates for Underrepresented Groups in Medical School

A recent JAMA Network Open study found that medical students from underrepresented groups have an attrition rate that is over three times higher than other students. The study analyzed allopathic medical student cohorts in years 2014-2015 and 2015-2016, and divided students into groupings for analysis based on personal (race and ethnicity, family income) and structural (youth neighborhood resources) metrics. 

The study showed:

• Attrition was highest among students with all three “marginalized identities”—low income, under-resourced neighborhood, and identifying as a historically underrepresented race and ethnicity. The total attrition for this group was almost four times (3.7) higher than for students who did not report any of the three marginalized identities.

• By race and ethnicity, students who identified as American Indian, Alaska Native, Native Hawaiian, and Pacific Islander had the highest attrition rate (11 percent), followed by Black students (5.7 percent), and Hispanic students (5.2 percent).

• Students from under-resourced neighborhoods had almost double the attrition rate (4.6 percent) of those who were not from under-resourced neighborhoods (2.4 percent). Similarly, those with low family income had an attrition rate of 4.2 percent compared to 2.3 percent for those who did not.

The researchers noted a need for targeted, structural reforms in medical schools to improve retention rates among high-risk groups. “Given the higher attrition rate among marginalized student groups, medical schools should consider reforms that dismantle structural inequities in medical culture and training that equate privilege with merit and physicians as an elite class of citizens,” they wrote. “These reforms may begin with tuition and debt reform and purposeful partnership and support of local and national under-resourced communities.”

Tips for a Successful Virtual Interview

According to the AAMC, medical students should still expect some virtual interviews this year. There are obvious pros to this format—reduced travel costs, scheduling flexibility, and the comforts of home—but in order to connect most meaningfully through a computer and make a lasting impression, you will likely need some additional preparation. 

HBR published a piece last year on succeeding in the virtual interview, which was written by Ben Laker, Will Godley, Selin Kudret, and Rita Trehan. They spent hours watching remote job interviews and reviewing the data to determine what drives success in a virtual interview. We’ve summarized their findings below. 

Ensure that the technology enables connection, not distraction. 

• Background: Opt for a clean, uncluttered space or select an unobtrusive virtual background. The HBR authors found that unconscious bias was less likely to appear when interviewees used a plain virtual background (forget the beach, mountains, or the Golden Gate bridge). 

• Lighting: Place a light in front of you so that your face is clearly visible on the screen (backlighting will result in shadows). Take a test run with a friend or family member around the same time of day as your interview to confirm that they are able to see you clearly (this will ensure any natural light in the room isn’t casting shadows).

• Bandwidth/connection: If possible, ask others in your home to log out of any high-bandwidth activities during the time of your interview, or consider hardwiring your computer into the internet. You may also want to perform an internet speed test (you can find via google).

Prepare yourself for glitches. 

• Understand the platform that you’ll be using; if it’s new to you, download the platform and practice with a friend or family member to gain some comfort prior to your interview. 

• Make your notes available, but don’t depend on them. Interviews—virtual or face-to-face—are dependent on connection, which gets lost if you’re buried in your notes. Ensure that your notes provide only key words (in large font) that are well organized (e.g., Why XXX Medical School, research experiences, clinical experiences, etc.). Don’t allow yourself to rifle through papers at the expense of eye contact, responsiveness, and active listening. 

• Stay calm. If there’s a glitch, or a question that you need to think about, ask for a few seconds to think or take a sip of water. Collect yourself and present your answer when you’re ready, rather than feeling the need to launch into a response prior to gathering your thoughts.

Practice both your interview responses and presentation.

• Note your pace. When nerves hit, people tend to speak more quickly. Practice providing your responses out loud in a steady cadence. While you don’t want to overcorrect and speak too slowly, you will want to ensure that you’re not rushing through the response and leaving your interviewer scrambling to understand what you’re saying. 

• Use hand gestures (and don’t cross your arms). The HBR article notes that hand gestures can make you appear more trustworthy and the authors’ study found that 89 percent of successful interviewees used hand gestures to emphasize big points. 

• Promote connection through eye contact. Look into the camera instead of at your own reflection. You may want to turn off the video mirroring capability (only after you’ve done a practice run so that you’ve confirmed that your lighting and position work well).

Finally, remember that an interview is about making a connection with another person. The interviewer wants to know you, to understand the person and personality behind your application. While you want to present yourself in the best light, a successful interview is not about coming across as flawless. Rather it is about allowing the interviewer visibility into your personality and character, and demonstrating the qualities that will make you a successful student and medical provider. The more you can focus on the interview as a point of connection, instead of a test to pass, the better your odds of success.

Related:

• The Medical School Interview: Preparing for the Multiple Mini Interview (MMI)

• The Medical School Interview: Preparing for the Traditional One-on-One Interview

• The Medical School Interview

• Temple’s Katz School of Medicine Incorporates Local Community Into Medical School Admissions

Implicit Bias Training Could Be a Starting Point for Improving Health Equity

In 2020 Maryland’s state legislature passed a law requiring all health care providers in perinatal units to receive implicit bias training once every two years. Delegate Joseline Peña-Melnyk, the law’s sponsor, cited the striking disparity in maternal mortality rates (four times as high for black women than white women in Maryland) as the initial reasoning. However, in 2021, after seeing the pandemic’s devastation concentrated in minority zip codes, she introduced and the legislature passed an expanded bill. Implicit bias training was mandated as a licensing requirement for all healthcare professionals. 

Implicit bias training is predicated on the belief that most people hold unconscious biases related to race, gender, socioeconomic status, or weight. For many, the hidden biases directly contradict their conscious or stated views. And these latent stereotypes can take hold in times of multi-tasking, stress, or fatigue, which, in a healthcare environment, can impact care. “Health care providers, like everyone else … have an active way of processing information that is very conscious, but then we have these unconscious or implicit ways of processing information,” said Dr. Lisa Cooper, a researcher on racial health disparities at Johns Hopkins University. “There are things we’ve been exposed to throughout our lives that lead us to think and behave in certain ways. We think certain things but aren’t aware that we are thinking them.” The training seeks to bring awareness and acknowledgement of those hidden stereotypes so that a provider can notice when they’re occurring and proactively work against biases. 

Since 2019, five states—including Maryland—have adopted policies requiring implicit bias training for at least some segment of health care workers. And, more recently, eight additional states have had lawmakers introduce bills. It doesn’t stop there. Medical schools, including leading programs like Harvard, Icahn School of Medicine at Mt. Sinai, and Ohio State, have incorporated the training into their curriculum.

Research substantiates that implicit bias plays a role in provider care and patient interactions, and research will likely continue. Michelle van Ryn, a researcher on implicit bias in health care and owner of a company providing diversity and inclusion consulting services, wants to know more about how implicit biases impact health disparities and the efficacy of training. “Lots of people are doing interventions,” she said, “but there’s not a huge body of evidence of what works.” 

Allopathic Medical School Applicant Guide to Secondary Essays

After you submit your AMCAS application, you will begin to receive secondary essay prompts. Some schools send the prompts automatically, while others are the result of a pre-screening process. It may seem overwhelming at first, but many of the schools will use at least some of the same prompts and you can start preparing now for some of the most common question types (listed below). 

But first, some advice:

Get organized. With a number of different schools, prompts, and a quick turnaround time, we cannot overemphasize the importance of setting up a system that will work for you. Pick what you like, a Word or Excel file, calendar reminders, file folders, a legal pad. But make sure you keep an overarching list that includes the name of each school you’ve applied to, secondary essay prompts, submission dates, and status. 

You’ll also want a way to organize your essay responses so that you can efficiently retrieve and recycle content when possible. Once you have final drafts, we recommend that you keep copies organized in folders by school and by question type, e.g., a Harvard Medical School folder, and a diversity essay folder. Name the files in a consistent convention that uses the school name, prompt type, and word count, e.g. “HarvardMed_Diversity_500”. This way if you receive a similar diversity prompt from another school, you will easily be able to access the final version you used for Harvard, make any necessary updates (e.g., wordcount, school name, etc.), and then save it with an updated name.

Reduce, Reuse, Recycle! Don’t hesitate to re-use content. You will—and should—recycle your secondary answers for different prompts and use aspects of your secondary drafts for your super-short answers too. 

Submit your essays promptly. Submit your responses no later than two weeks after receipt of the prompts.

Common Secondary Essay Prompts

Use these common prompts to get a head start on brainstorming and drafting your responses.

How will you add diversity to our student population?

This answer doesn't have to be about race, sexuality, or religion. What unique experiences and perspectives do you have to offer, which will show the reader your ability to thrive in a diverse environment? 

Tell us about a time you faced adversity.  

This one can be a trap because it tempts you to be very negative. While you don’t need to be all sunshine in your essay about facing adversity, be careful not to overly criticize others or paint yourself as pitiable. Instead, focus on how facing adversity gave you a formative experience that you learned from and grew or persevered through. 

Tell us about a time you failed.  

Talking about a failure or weakness can make you feel vulnerable—good. Vulnerability leads to bravery. When you share a failure, you want to spend about 20% of your answer explaining what happened and 80% on what you learned and you've done since to improve. Lastly, how are you feeling now? Hit these beats: Situation. Action. Result. You don't need to seem ever-resilient and impervious to future failure, just like you've grown.

How do qualities you have relate to our mission statement?  

Mission alignment matters to schools. They want to know that you share their values and goals. Will you be a valuable member of their community? Schools often hit similar themes: innovation, collaboration, servant leadership, and health equity and social justice. Even if you're not drafting this answer yet, think about experiences you've had that involve those things and jot down some notes. 

If this question isn't in the secondaries mix, you should be looking to reflect the mission statement back to the school in your other secondaries. For example, if a school especially values collegiality, you might include a story about how you collaborated on a class project in one of your answers. (This is another example of show don't tell.)

While you 100% should be researching schools individually to learn other specifics, AAMC has a convenient document that rounds up all allopathic schools' mission statements in one place. https://students-residents.aamc.org/media/6966/download

What will you be doing until matriculation or what have you done since graduating from college?  

You may have mentioned some of this elsewhere in the application. While you don't have to max out the word or character count, it is important (and fun!) to account for all your time, even if some of it won't be spent prepping for medical school. Check out this example: "Since graduating from Large Private University, I became a clinical research assistant at Near-My-Hometown Children's Hospital, coordinating 10 studies. I collected and analyzed study data for an academic paper on pediatric asthma and was asked to draft a section of it. It will be published this fall in Impressive Kiddo Journal, and I will be credited as a co-author. I will continue my work at Near-My-Hometown Children's Hospital until matriculation. On Saturdays this summer, I'll be volunteering at an organic farm. Nutrition matters to me, and I love to spend time outdoors. In August, I'll take a two-week trip to Europe (my first time abroad!), visiting relatives in Denmark and Sweden."

Why our school?  

Obviously, this is a place to mention courses you're excited to take, potential mentors you'd seek out, clubs you'd join, what the school's hospital affiliations and research opportunities mean to you, etc. You also might share how the school's location will set you up for the kind of career you want—say, for example, you want to work in an urban area. Mentioning that you love other aspects of the town or city or that it is located near friends and relatives is also relevant here. Schools love to hear that you'd have a local support system.

Have you applied to our program before? If, so how has your candidacy improved since your last application?

This one is self-explanatory. Even if you have no idea why you were rejected last time, you do know that you've gained more clinical experience, maybe some overall workplace experience, earned a Master's, and have matured since your last application. If none of those things are true, then perhaps you should be applying next year instead.

Frequently Asked Questions Related to the Secondary Essay Prompts:

What if I don’t have a hardship?

A "hardship" prompt is different from an adversity prompt. We've all faced adversity in our own way. But there might also be an optional essay asking about any hardships you've experienced. If you have had health, family, or financial issues, or any significant interruptions to your education, share them here. But if you don't have hardships, don't exaggerate a small hurdle, or massage any facts. 

Read our blog post on the Disadvantaged Applicant status here. 

When should I use the “is there anything else we should know” prompt? 

If you have no issues to address, you could use a secondary essay from another school here just to bolster your application. But this is also the school's nice way of saying: "What not-so-great thing did you do? Explain why we shouldn't be concerned about it." 

So, did you tank a class your freshman year? Does your lowish MCAT score not reflect your ability to thrive in a challenging academic environment? Did you get a citation for underage drinking at a campus music festival two years ago? You want to keep this answer concise no matter what your topic is, but for things like the latter, keep it very brief. Do not make excuses, simply address the situation, placing the emphasis on what you learned. Remember, everyone makes mistakes, taking accountability and moving forward demonstrates maturity. You do not have to max out this wordcount.

Related Blogs:

The Medical School Admissions Process is Long and Stressful. How are you Coping?

When to Use the AMCAS Disadvantaged Applicant Status

Student Bloggers Urge Medical Schools to Incorporate Gun Safety Training

Can medical schools play a role in preventing gun violence? David Velasquez, a fourth-year student at Harvard Medical School, and Jesper Ke, a third-year student at the University of Michigan School of Medicine think so. Their blog, published in StatNews, urges medical schools to take on gun violence by educating their students on the risks and empowering them to proactively speak with patients about gun safety and violence prevention. Just 15 percent of medical schools currently have gun-related material as a component in the curriculum.

The authors suggest the following curriculum updates:

• Teach the basics of responsible gun ownership and safety in class. The article notes that first-year medical students at the University of California, San Francisco used a small group discussion-based curriculum, which included a patient counseling role-play exercise.  

• Invite patients impacted by gun violence to tell their stories and discuss how guns have impacted them physically, mentally, and emotionally (similar to how patients battling disease are invited to share their clinical journey). 

• Incorporate relevant gun-related content into clinical rotations. The authors note that the Warren Alpert Medical School of Brown University updated their curriculum to embed firearm safety throughout the four-year program, and incorporate skills exercises into clinical rotations.

The Must-Knows if You’re a Premed Considering EMT Training

Many premedical students consider EMT training and certification because it can provide excellent clinical experience and patient interactions. Could it be the right fit for you? 

There are a lot of benefits that medical school admissions committees view favorably.

• As an EMT, you will develop your leadership skills and understanding of some of the work and challenges physicians may face. 

• You will gain foundational medical knowledge and clinical experience that will be useful throughout medical school and may ease the transition between your undergraduate and medical studies. In a recent study at the University of South Carolina School of Medicine Greenville, which added EMT certification into the first-year curriculum, most students agreed that the certification eased the transition into medical school (82 percent) and “increased awareness of patient’s lives and circumstances” (91 percent). 

• You will hone your ability to stay calm and clear-headed under duress, which will certainly benefit you as a medical student, resident, fellow, and attending physician.

EMT Certification Process. To become a certified EMT, you must take the equivalent of about six college credits at an accredited school, which includes CPR, controlling blood flow, and patient communication and interactions. You will then take the NREMT exam which is made up of two components: a written, cognitive section that measures your medical knowledge and a psychomotor skills assessment that measures practical skills in patient assessment and emergency response skills. After passing the test, you can apply for EMT certification through your local EMS agency. 

After certification, you will want to consider paid versus volunteer opportunities. Paid employment generally takes shift structures. Volunteer work is more flexible. If you consider paid employment, you will want to look for emergency response or ambulatory work, rather than interfacility transfers. Emergency work will provide you with the most opportunities for meaningful clinical experiences. To understand the opportunities available, check with your local EMS agency, fire departments or hospitals. 

Is it the right fit?:

• What types of clinical and/or research experiences have you already had? In what areas might your future medical school application benefit most?  

• Do you have the time… really? If you want to gain EMT certification, consider it earlier in your undergraduate career or as an activity during a gap year. You won’t want to combine EMT certification with studying for the MCAT, coursework, and medical school applications and interviews.

• What volunteer or employment opportunities are available for you locally? Are they a good fit with your schedule and interests? Gaining the certification without the associated patient experiences from working or volunteering will not provide you with any meaningful benefit as an applicant or medical student.

Are you a Pre-Med in Need of Summer Research or Clinical Experiences? Check out the SDN Activity Finder.

If you are a premedical student looking to supplement your learning and enhance your medical school application this summer, check out the Student Doctor Network (SDN) activity-finder. The activity-finder allows you to sort through summer or next-term experiences, organized into the following categories: medical/clinical work experiences, volunteer/community service experiences, research experiences, and shadowing experiences. Then it provides a list of organizations and resources for you to consider by location.  

Trends in Medicine: Shortening the Preclinical Timeline

American medical schools have traditionally followed a similar structure: two years of preclinical work followed by two years of clinical rotations. But there is an emerging trend within medical education, which accelerates preclinical studies in order to allow students more time to gain clinical experiences. According to the Liaison Committee on Medical Education, during the 2019-2020 academic year, six percent of medical schools ended pre-clinicals after one year, 29 percent ended them after 1.5 years, and 56 percent retained the traditional two year structure. 

Kim Lomis, MD, and Vice President for Undergraduate Medical Education Innovations at the American Medical Association, explains that the reasoning for the curriculum update is so that students are better able to contextualize learning within patient care. “Proponents argue that learners are able to better anchor their learning of foundational sciences in a meaningful context, fostering professional identity formation as well as knowledge base,” she said. Early adopters include the elite medical schools at Harvard, Duke, Vanderbilt, and NYU Grossman. Each of these schools now condense preclinical learning into the first year, with students beginning clinical clerkships at the start of their second year. 

Rutgers Robert Wood Johnson Medical School recently launched its updated curriculum, which starts the clerkship after 18 months. Carol A. Terregino, MD, and Senior Associate Dean for Education and Academic Affairs at Rutgers, notes that the curriculum change is beneficial because it puts an emphasis on “knowledge for practice.” 

“Anything that is going to increase students’ clinical knowledge and ability to apply that knowledge to clinical practice is going to make students stronger as future physicians,” she said. She also noted the presence of unknowns related to the recent pass-fail update of the USMLE Step One exam, which could potentially increase the importance of the Step Two exam. “To make sure my students are able to do well and prepare for the licensing exam, I want a longer launching pad to get them there,” she said.

Others say that looking just at “preclinical” and “clinical” years oversimplifies medical education. Students at Ohio University Heritage College of Osteopathic Medicine, for example, follow the traditional two and two calendar, but are exposed to clinical experiences through observations and interactions during the first two preclinical years. “Distilling a college’s program to the length of time in preclinical or clinical curriculum misses all the nuances of what each college does to prepare its students. We emphasize patient-centered care from the first day of medical school, making our students well-rounded when they engage in their clinical rotations,” said Jody M. Gerome, DO, and Heritage College’s Senior Associate Dean for Medical Education.

Related Blog: U.S. Medical Licensing Examination’s (USMLE) Step One Moves to Pass-Fail Scoring

U.S. Medical Licensing Examination’s (USMLE) Step One Moves to Pass-Fail Scoring

Last month, for the first time, the U.S. Medical Licensing Examination (USMLE) administered the Step One exam to second-year medical students in a pass-fail format. The USMLE finalized the decision to replace the scoring last December, explaining that the exam was intended for use as a benchmark and not to differentiate between students. They also acknowledged that students were prioritizing Step One preparation “at the expense of other curricula and their own well-being.”

Priya Jaisinghani, MD, an endocrinology fellow at New York-Presbyterian Weill Cornell Medical Center, called the move, “a step in the right direction” in an interview with MedPage Today. She suggested that early medical students can now re-prioritize critical medical skills as opposed to burying themselves in test preparation. "There was so much onus on the exam. Now [students can] shift focus to experiences, organizations, community health, and research," she said. DO students may also feel some relief at the update. While they are required to take the COMLEX, many elect to take the Step One in order to increase the competitiveness of their residency applications. 

Others suggest that the move will negatively affect some students seeking to differentiate themselves as applicants to highly-competitive residencies. While unofficial, many specialties are known to have score cut-offs for residency applicants. Among the 2019-2020 first-year residents, Step One scores among thoracic surgery, orthopedic surgery, and otolaryngology averaged 247.3, 246.3, and 246.8, respectively. Residents in emergency medicine (230.9), family medicine (215.5), and internal medicine pediatrics (235.5) received lower scores on average. A 2021 survey of orthopedic surgery program directors confirms this point, with 68 percent calling the Step One score “extremely or very important” for applicant interview selection. 

According to USMLE, removing the scores will encourage programs to review candidates more holistically. Practically, however, it is unclear what that may look like in the near term. Some students, speaking to Medpage Today, suggested that letters of recommendation and school rankings may play a more outsized role in residency considerations. "It makes it harder if you are coming from smaller institutions. It becomes more about who you know and who's making phone calls for you. Students with great medical pedigrees may have more advantages,” Lena Josifi, MD, a fourth-year orthopedic surgery resident at Southern Illinois University, said. 

A survey of orthopedic surgery program directors confirms Josifi’s hunch. Over one-third (37.7 percent) agree that the changes to Step One scoring would “probably” or “definitely” decrease the likelihood that applicants from lower-ranked medical schools would be selected for interviews. The majority, 81 percent, also agreed that Step Two results will grow in importance.  

The Medical School Admissions Process is Long and Stressful. How are you Coping?

Earlier this month, Dr. Anne Thorndike, a physician in internal medicine at Massachusetts General Hospital and an associate professor of medicine at Harvard Medical School, wrote that physician burnout starts with the medical school admissions process, which takes almost twice the length of time as other graduate admissions processes. In an opinion piece for STAT, an online health, medicine, and scientific discovery publication, she called for a shortened admissions timeline for medical school applicants and says the current process is time-consuming, expensive, highly-competitive, and intensely stressful. 

Referencing a plethora of studies, she goes on to describe the stress that medical school applicants face prior to even beginning their professional journey. A 2012 study showed higher emotional exhaustion, a symptom of burnout, in pre-medical students compared to non-premedical students. In another study, 33 Black and Hispanic medical students interviewed from across the country described medical school admissions as “very negative” because it was overwhelming and required an “extensive investment of time.” A 2020 online survey found that 73 percent of 556 medical school applicants had depression or anxiety symptoms, with half reporting uncertainty related to the application timeline.

So, how can you manage effectively this daunting process as an applicant? We encourage you to explore and refine various coping mechanisms—exercise, mindfulness, talk therapy, and/or outside adventure activities—that work for you. Taking this step will be just as critical to any application prep course you will take. And you will certainly carry with you these practices into your future career in medicine. 

A recent article in the Washington Post covers the physical effects of stress and the practices that may mitigate its impact. Ahmed Tawakol, Director of Nuclear Cardiology at the Massachusetts General Hospital and Harvard Medical School, recommends regular exercise, and high-quality sleep which “...can reduce stress activity in the brain, systemic inflammation, and your risk of developing cardiovascular disease.” Others interviewed point to the power of deep-breathing exercises, muscle relaxation techniques, meditation, and/or yoga, which can actually decrease your body’s reactivity to stress.

As you prepare for medical school, consider carefully how your habits may help or hinder you. Then you can work to integrate stress-reducing practices and positive choices into your daily life.  

Related Blogs:

Medical Students Offer Recommendations to Improve Medical Schools’ Ability to Promote Student Wellbeing

Pre-Med Students Face Stress as Clinical Experiences Become Harder to Find

Narrative Medicine Helps Physicians Gain Empathy, Make Connections, and Accept Difficult Experiences

When to Use the AMCAS Disadvantaged Applicant Status

Applicants to medical school may apply as a disadvantaged candidate through the AMCAS portal. If they opt in, they are allotted 1,325 characters to respond to an additional essay prompt: "Do you wish to be considered a disadvantaged applicant by any of your designated medical schools that may consider such factors (social, economic or educational)?" 

When determining if this designation is appropriate you will want to consider the following: 

• Does my disadvantage fall into one of these categories: economic, social, or educational? For example, did you attend an underfunded/underperforming high school that left you struggling to adjust to college (with associated impacts on your GPA)? Or were your individual or family assets below specified thresholds, which qualified you for state or federal assistance programs?  

• Did my disadvantage change my application to medical school in a way that necessitates additional context for the admissions committee? For example, did you grow up in a rural area that is medically underserved, which impacted your ability to obtain clinical experiences? 

If you feel that you’ve experienced a situation that merits the disadvantaged designation, use this essay to provide the admissions committee necessary context as they review your application. We recommend that you spend about 20 percent of your writing on the situation itself, using fact-based (rather than emotional) language. You want to clearly convey the reality of the situation and the direct impacts of your experience on your medical school application. The remaining 80 percent of your essay should focus on the actions that you’ve taken to combat the adversity you’ve faced, and what you’ve learned from it. And be sure to explain how your learnings will impact you as a medical student and physician. Are you more resourceful, hardworking, empathic, and adaptable as a result? 

New Study Finds that Affirmative Action Bans Result in Fewer Students from Underrepresented Groups in Public Medical Schools

A study published last week in the peer-reviewed journal, Annals of Internal Medicine, found that affirmative action bans negatively impacted enrollment of underrepresented students in public medical schools. The study showed that in states which enacted bans, five years later, the proportion of underrepresented racial and ethnic minority students fell by more than one-third.

The study, which was led by Dan Ly, MD, and an assistant professor of medicine at UCLA’s David Geffen School of Medicine, examined matriculants from 53 medical schools at public universities from 1985 through 2019. The researchers focused on students from underrepresented racial and ethnic groups including: Black, Hispanic, American Indian or Alaska Native, and Native Hawaiian or other Pacific Islander. Of the 53 medical schools, 32 were located within a state without an affirmative action ban and 21 were within a state with an affirmative action ban (Arizona, California, Florida, Michigan, Nebraska, Oklahoma, Texas, and Washington). The bans were enacted between 1997 and 2013, and Texas’s ban was reversed in 2003. On average, in the year prior to a state implementing a ban, underrepresented students made up 14.8 percent of the public medical school enrollment. Five years after the states’ bans, underrepresented student enrollment had fallen by an average of 37 percent.

Dr. Ly describes the importance of the findings. "We know that a more diverse physician workforce leads to better care for racial- and ethnic-minority patients," he said. "Our research shows that bans on affirmative action, like the one California passed in 1996, have had a devastating impact on the diversity of our medical student body and physician pipeline." 

The authors note that the study did have limitations, which included the indirect effects of affirmative action on undergraduate admissions, the impact that public discussion of affirmative action may have had on medical school enrollment prior to the bans, and the possibility that some students may not have identified with the racial and ethnic groups defined by the study. Additionally, the study authors did not confirm if any schools in states without bans opted not to incorporate race or ethnicity in admissions decisions. However, the authors are optimistic that the study will provide policy-makers with a clearer understanding of the lag in diversifying medical student and physician populations, as well as informing them of the impact of affirmative action bans.  

A co-author of the study, Utibe Essien, MD, and an assistant professor of medicine at the University of Pittsburgh, notes that the findings are particularly poignant at this juncture. "As our country has spent the last two years weaving through the twin pandemics of racial health disparities amplified by COVID-19 and structural racism at large, our findings are critically important," he said. "As we observed, affirmative action bans have resulted in a loss of underrepresented physicians, who could have been at the front lines of caring for vulnerable populations throughout the pandemic and helping to alleviate disparities in care.”

Related Blog: Medical Schools Limited on Use of Race in Admissions Decisions but Still Seek to Promote Diversity

New Physicians that Train in Surgery or Identify as a Sexual Minority are More Likely to Struggle with Mental Health During Intern Year

The trials of residency, particularly in the first year after completing medical school, are well documented. First year residents or interns work long and demanding hours in a high stress environment, and do so on little and irregular sleep. And two new studies out of the University of Michigan, which used data from the Michigan Neuroscience Institute’s Intern Health Study, show that two groups are at higher risk for developing negative mental health outcomes during this time: surgical trainees and those who identify as a sexual minority (lesbian, gay, bisexual, or other non-heterosexual).

The first study led by Tasha Hughes, MD, MPH, and an assistant professor in the University of Michigan Department of Surgery, explored changes in surgical residents’ mental health during the intern year, and also looked at how surgical residents’ experiences compare to those of other (non-surgical) residents. 

Hughes and her team found that, initially, surgical interns enter the program with lower rates of existing depression symptoms than a similar age cohort within the general population. However, after the intern year, almost one-third (32 percent) of interns screened positive for depression, based on their scores from at least one mood survey. 

Among the surgical interns, some demographic groups were more likely to develop depression—females, sexual minorities, singles (those with no partner), those working the most hours on average, and those with a history of negative childhood experiences. However, even after adjusting for these demographic factors, surgical interns were more likely than other interns to develop new-onset depression, except for when work hours were taken into account. Additionally, among those who screened positive for depression, 64 percent continued to report signs of depression on a later survey. 

Perhaps, equally worrisome, was that many of the surgical interns did not seek assistance. Just 26 percent of those whose scores were consistent with depression sought mental health care during their intern year. Hughes explains the importance of the findings for promoting a healthier learning environment. “Surgical training, especially in the United States, can be a period of intense stress, which we find is linked to new onset of depression,” said Hughes. “These findings suggest a need for surgical program directors, leaders, and health systems to continue to find ways to mitigate the effects of surgical training, normalize help-seeking, make mental health support easily available, and pay special attention to those with characteristics that might put them at increased risk.”

The second study, led by Tejal Patel, a student in her senior year at the University of Michigan, looked specifically at interns who started training in 2016 through 2018 and who identified as lesbian, gay, bisexual, or other non-heterosexual. 

At the commencement of the intern year, the sexual minority group’s depression scores were higher than those of the heterosexual group. However, rather than remaining consistent over time, the study found that the gap increased throughout the year with larger differences in mental health occurring in the second half of the year. “These results indicate that interns who are part of sexual minority groups may experience unique workplace stressors leading to a widening disparity in mental health,” said Patel. 

Early Learning Experiences in Med School Shown to Impact Burnout, Empathy, and Career Regret

Early learning experiences in medical school impact students’ burnout, exhaustion, empathy, and career regret levels at graduation. A longitudinal study, published in JAMA, finds that medical students who report experiencing mistreatment prior to their second year have higher levels of burnout and career regret two years later. And the opposite also holds true. Students with positive experiences report lower burnout levels, higher empathy, and less career regret at graduation. 

The study, led by Liselotte Dyrbye, MD, MHPE, Daniel Satele, BA, and Colin West, MD, PhD, includes over 14,000 students from 140 allopathic medical schools who responded to the AAMC Medical School Year Two Questionnaire and the 2016-2018 AAMC Graduation Questionnaire.

The study findings show that just over three-quarters of students reported no mistreatment (77.1 percent) on the Year Two Questionnaire. Among the remaining 22.9 percent of students, 11.3 percent reported mistreatment in one instance, and 11.6 percent reported mistreatment in more than one instance. Within the group who experienced mistreatment more than once, the Graduation Questionnaires were more likely to indicate:

• Career choice regret (6.4 percent for those who never experienced mistreatment, 7 percent for once, and 11.4 percent for more than once)

• Greater exhaustion (mean scores: 12 for never, 13 for once, and 13.8 for more than once)

• Higher levels of disengagement (mean scores: 5.3 for never, 5.5 for once, and 6.0 for more than once)

Among those students who reported a more positive emotional climate on the Year Two Questionnaire, the relationships were the opposite. Their Graduation Questionnaires were more likely to show:

• Lower exhaustion levels (for each 1-point increase in emotional climate, there was a reduction by .05 in exhaustion) 

• Lower disengagement scores (for each 1-point increase in emotional climate, there was a reduction of .04 in disengagement)

Students who reported positive faculty interactions on the Year Two Questionnaire were more likely to receive higher empathy scores on the Graduation Questionnaire. And, positive interactions with other students resulted in lower instances of career regret at the conclusion of medical school. 

The study authors note that medical school administrators may use these findings to craft learning environments that “mitigate burnout, decline in empathy, and career choice regret among their students.” The authors write, "Although the most effective approaches to addressing mistreatment of learners remain elusive, the frequency of mistreatment varies between educational programs, suggesting there are likely to be levers within the control of the organization that adequate commitment, leadership, infrastructure, resources, and accountability can lead to a meaningful reduction in mistreatment." The authors also suggest that schools consider strategies to reduce stress among students and promote positive learning environments, such as installing learning communities, pass/fail grading, and faculty development. 

MedPage Today quoted Charles Griffith III, MD, of the University of Kentucky College of Medicine, who noted in a commentary on the study that, while the authors’ use of student-level, rather than institution-level data, limited the utility of the analysis, it may still inform interventions. "Some students in this study perceived mistreatment and did not believe the learning environment was supportive, but students from the same school believed the learning environment was indeed supportive," he wrote. "For a school considering change, based on these findings, does the school focus on making global changes to aspects of the overall learning environment, or do they identify students not supported by the current learning environment to tailor support on an individual level rather than a macro level?"

Medical Researchers Gain Patient Experience Insights via Social Media Posts

Scrolling through Twitter may feel like a casual downtime activity, but a recent Wall Street Journal article describes social media’s growing utility as a medical research tool. Increasingly, researchers are using AI and other data-culling techniques, to sift through social media comments and gather real-time, unfiltered feedback on patient experiences—from the patients themselves. 

In an interview with the WSJ, Dr. Graciela Gonzalez-Hernandez, an Associate Professor at the University of Pennsylvania’s Perelman School of Medicine said, “Collecting abundant social-media data is cost-effective, does not involve burdening participants, and is available in real time.” She also points out that it may be more inclusive of populations often underrepresented in biomedical trials or cohort studies. And, most importantly, social media provides researchers direct access to unfiltered patient commentary on their experiences. “Healthcare providers report what they deem important, such that serious events are overrepresented, while bothersome side effects that may be of great importance to patients and lead to nonadherence and non-persistence are underrepresented,” Gonzalez-Hernandez said.

The article describes how researchers studying an opioid withdrawal drug have benefited from social media scans. Dr. Abeed Sarker, an Assistant Professor of Biomedical Informatics at Emory University, and his team used natural language processing algorithms to search Reddit for comments on opioid withdrawal experiences. Dr. Sarker’s team found that Reddit contributors frequently described concerns about withdrawal drugs causing “precipitated withdrawal,” or extreme withdrawal symptoms, among those who have used fentanyl. Importantly, many of these users’ comments expressed concern that their medical providers did not understand this condition. The study also found that the quantity of posts about fentanyl and withdrawal have increased over a seven-year period. These findings have played a key role in bringing to light the urgency of this issue for physicians researching withdrawal assistance drugs. 

In France, a similar study took place to better understand breast cancer patients’ quality of life. The researchers used an algorithm to scan comments left on Facebook and a French online forum for breast-cancer patients. Researchers compared these insights with the European Organization for Research and Treatment of Cancer’s quality of life questionnaire to ensure it was inclusive of the most pertinent topics. The online comments brought to light two additional topics that were top of mind for patients—nonconventional treatments and patients’ relationships with their families—which will be added to future iterations of the questionnaire for formal study. 

Many researchers seem intrigued by the possibility of using social media data in combination with traditional research. Su Golder, an Associate Professor at the University of York in England, is working on a medical literature review on HPV vaccines, which will incorporate Twitter and WebMD comments. “It’s important to research what the public is worried about,” Dr. Golder said. She notes that the benefits of social media data—patient perspectives and real-time information—can be meaningful, and that its shortcomings—comments that may confuse association with causation—can be overcome by combining the findings with traditional research efforts. 

Social media data might also work in combination with electronic medical records to improve patient care. A recent study by Dr. Munmun De Choudhury, an Associate Professor at Georgia Tech, created an algorithm to predict psychosis relapses and re-hospitalizations using the social media posts of 50 adult and adolescent psychosis patients who suffered relapses and hospitalization, along with their medical records. The study found that in the month preceding the relapse, there were distinct changes to social media usage in the form of language patterns—words related to “anger, death, or emotional withdrawal”—and the number of posts between midnight and 5am. The algorithm was able to accurately predict about 71 percent of relapses. Dr. De Choudhury is currently working with the state medical system to determine how to incorporate the algorithm into physicians’ clinical care processes. 

Medical Students Push for Climate-Related Health Courses

Emory Medical School, at the behest of its student population, has formally incorporated the health impacts of climate change into the medical school curriculum. The addition, which follows many public health programs throughout the country, makes Emory the latest elite medical school to incorporate climate-related health courses. 

Emory’s decision—and the student pressure behind it—falls in line with an article published last fall in The Journal of Climate Change and Health. In the article, survey results (including responses from 600 students from 12 medical schools) showed that most medical students want to include climate change in their studies. 83.9 percent of respondents believed that climate change and its health effects should be included within the core medical school curriculum. 13 percent believed that their school currently provided adequate education on the topic. And just 6.3 percent of students said that they felt “very prepared” to discuss how climate change can affect health with a patient. 

Momentum around educating students on climate change is growing within the medical community. Emory joins Johns Hopkins University, Harvard, Yale, and the University of Washington among others. Johns Hopkins created its Environmental Health Institute in 2007, and in 2017 Columbia University unveiled its Global Consortium on Climate and Health Education. Columbia’s Consortium, which develops best practices for teaching climate health, has now grown to include 47 U.S. medical schools as members, as well as more than 240 schools of medicine, nursing, public health, dentistry, and veterinary medicine globally. 

Additionally, the American Medical Association has endorsed teaching medical students about the impacts of the climate on health. “All physicians, whether in training or in practice for many years, have to be able to assess for, manage, and effectively treat the health effects of climate change,” Lisa Howley, PhD and AAMC Senior Director of Strategic Initiatives and Partnerships said. 

The AAMC understands that there will be some resistance to climate health’s inclusion in already packed curriculums, and have highlighted a few ways climate change has been meaningfully integrated into current medical curriculums:

• At the University of Illinois College of Medicine (Urbana-Champaign), climate-related health risks have been incorporated into case scenarios to promote a physician’s consideration of the environment along with other contextual factors. The physician also learns to incorporate and consider not just medical treatment, but also environmental mitigation factors (masks, HVAC filters, etc.).

• At the Icahn School of Medicine at Mount Sinai (New York City), climate information has been integrated into existing medical content for first- and second-year students. For example, slides that cover Lyme disease also include information on how climate change impacts tick habitats. The information is designed to complement existing content.

• At the University of Colorado School of Medicine, an elective course for fourth-year students titled “Climate Medicine,” incorporates op-ed writing in addition to climate and health content.

• At the University of California San Francisco Medical School, medical students partner with nursing and dentistry students to create the Human Health and Climate Change group to facilitate educational forums and on-campus sustainability initiatives.

Medical Student Calls for Greater Transparency in Residency Match Data

National Match Day took place on Friday, March 18, 2022. According to the National Resident Matching Program, NRMP, it was a successful day, which “realized many significant milestones” including: 

• Consistent or increased match rates across applicant types: 

--US MD Seniors PGY-1 matched at 92.9 percent (+0.1 percentage points from 2021)

--US DO Seniors matched at 91.3 percent (+2.2)

--US citizen international medical graduates matched at 61.4 percent (+1.9)

--Non-US citizen international medical graduates matched at 58.1 percent (+3.3)

--And it was the highest match rate on record for previous year graduates, with US MD graduates matching at a rate of 50.5 percent (+2.3), and DO graduates matching at a rate of 53.6 percent (+9.3).

However, a recent article written by Nicole Mott, a student at the University of Michigan Medical School, and published in the New England Journal of Medicine, with a follow-up interview on MedPage Today contends that most current match reporting only tells part of the story. Mott is calling for the NRMP to reconsider how the match rate is calculated and to provide additional transparency into the match data. 

She starts by pointing out aspects of the current reporting that can be misleading or confusing. 

• The published NRMP “match rate” doesn’t include all specialties and programs; it excludes ophthalmology, urology, and military training programs. 

• The variation in match rates by applicant type should always be called out explicitly (as seen above) in recognition of the significant variation in match rates between applicant types: MD Senior, DO Senior, IMG (citizen or non-citizen), and graduates (MD, DO). The media often just reports one overall (or applicant type) match rate, which can be misleading and create inaccurate expectations among applicants regarding the likelihood of receiving a match. 

Next, she calls for a reconsideration of how the current match rate is calculated. Currently, the match rate is the proportion of “active applicants” who match into a participating residency program. However, an “active applicant” is someone who registers for the NRMP match and submits a rank order list. Mott points out that approximately eight percent of NRMP registrants withdraw or do not submit a rank order list and are thus excluded from the calculation. This includes participants who apply to programs but are not invited to interview and therefore do not submit a rank order list. This definition of active applicant likely inflates the match rate and underestimates the number of physicians who are unable to find a residency placement. 

She also provides suggestions for data that, if made publicly available, would help inform medical students as they make plans for the future.

• The number of applicants who register for NRMP match and don’t submit a rank order list, as well as the characteristics of this group. This would provide insight into potential inequities in the process, as well as applicant competitiveness for specialties. 

• The number and characteristics of unmatched physicians including those who only match into a preliminary first-year position. It would also be helpful to include information on the careers these physicians pursue and where they ended up, which could inform physician workforce planning. 

• Detailed match outcomes relevant to students going through the process, which could inform students pursuing a match, and also drive systemic improvements. This may include the specialty-specific matching positions on rank order lists, which could also inform decisions such as application or interview caps. 

Mott notes that the proportion of MD and DO seniors matched to their top-ranked programs has “subtly declined” over the past 15 years and, during the same period, the number matched to their fourth-ranked choice or lower has increased. Additionally, she calls out the “over-congestion” in the residency application process. Applicants are now applying to more programs than ever, just as programs are receiving more applicants. She recommends a review of the data to determine if caps should be placed on the number of applications and interviews. Similarly, she calls for more transparency from residency programs in their selection criteria. Programs should be explicit in the criteria they seek in an applicant, and applicants should be more specific about their goals and geographic preferences. 

Ultimately, better data, and more visibility into the match process will benefit students and residency programs, and allow each to make the best possible decisions.

Harvard Medical School and University of Washington School of Medicine Maintain Top Ranking in US News’ Ranking of Research and Primary Care Medical Schools

Among research-oriented medical schools, Harvard and NYU Grossman maintained their positions in the top two spots of the US News ranking. However, the top ten did see movement with Johns Hopkins University School of Medicine moving up into the third spot, from a tie at seventh place last year. Johns Hopkins shares the third rank, in a three-way tie, with Columbia University and University of California San Francisco. University of Pennsylvania’s Perelman School of Medicine also moved upwards, from ninth place last year to a tie at number six this year. Perelman shares the sixth rank with Duke University.

Find the complete 2023 Best Medical Schools: Research ranking.

For the primary care ranking, the top two schools maintained their places with University of Washington first, followed by the University of California San Francisco. Two new schools entered the top ten—University of California Davis moved up three spots to the eighth rank, from eleventh last year, and University of Pittsburgh had a meteoric rise into the top ten from the thirty-fourth rank last year. The school shares the tenth rank, in a three-way tie, with University of Kansas Medical Center and University of Massachusetts Chan Medical School.

Find the complete 2023 Best Medical Schools: Primary Care ranking.

Narrative Medicine Helps Physicians Gain Empathy, Make Connections, and Accept Difficult Experiences

Creative writing may not be the first course that comes to mind when you think about a pre-med or medical school curriculum. But, writing—along with other arts and humanities courses—can play a vital role in preparing medical students for life as a physician. 

Rita Charon, along with a multidisciplinary group of scholars, founded the discipline of narrative medicine in 2003, in response to the increasingly bureaucratic direction of medical care. Narrative medicine’s goal is to recenter physicians on the humanity of their patients by providing tools to allow physicians to contextualize patients outside of the hospital setting and uncover ways to connect by considering a patient’s pain, stories, life, and loved ones. Charon describes narrative medicine as a “...commitment to understanding patients’ lives, caring for the caregivers, and giving voice to the suffering.” 

The benefits of incorporating narrative medicine, or the study of arts and humanities into the medical curriculum are clear. In 2010, Columbia Medical Students were required to take a half-semester arts and humanities course in narrative medicine, and these students were then interviewed in focus groups about the experience. The findings, published in the Journal of Academic Medicine in 2014, were summarized: “Students’ comments articulated the known features of narrative medicine—attention, representation, and affiliation—and endorsed all three as being valuable to professional identity development. They spoke of the salience of their work in narrative medicine to medicine and medical education and its dividends of critical thinking, reflection, and pleasure.” 

In addition to promoting empathy and connection, Pulitzer Prize-winning journalist Michael Vitez, Director of Narrative Medicine at Temple University’s School of Medicine, spoke to the value that writing can provide in helping students work through complex and painful experiences. He described a medical student who wrote a poem after a difficult day in her psychiatric rotation. “It helped her process her emotions and turn a really bad day into something valuable,” he said. 

Narrative medicine can also bolster physicians who are struggling with symptoms of burnout. “No one was talking about clinician burnout at that time. But, as narrative medicine programs began to spread across the country, some physicians trained in its principles began to see how it can protect clinicians from feeling a sense of depersonalization and other symptoms of burnout,” Dr. Charon told Neurology Today. In the same article, Sneha Mantri, MD, MS, and Assistant Professor of Neurology at Duke University School of Medicine, described how her struggle caring for critically ill patients during residency led her to seek an MS in Narrative Medicine. In her view, the degree gave her the tools to return to medical practice and deal with the “burnout-inducing frustration of treating chronically ill patients with difficult-to-manage symptoms” and replace it with empathy for the patient’s perspective and the reminder “that knowing medical facts is just one part of caring for a patient.”

If you are a premedical or medical student with an interest in the arts and humanities, pursue it! It will likely play an invaluable role in preparing you to analyze, contextualize, and show up for patients with empathy and understanding. And as you prepare your applications for medical school, residency, or fellowship, be sure to highlight the skills that you have gained through previous humanities coursework and experiences, and the perspectives you have gained. 

Examples of narrative medical texts here: 

“How to Tell a Mother Her Child Is Dead,” Naomi Rosenberg, MD, New York Times

“What We Talk About When We Talk About the Code,” Lilli Schussler, JAMA Cardiology

Related blogs:

Covid Crisis Brings Attention to the Need for Humanities in Medical School Curriculum