Medical School Admissions

AMA and AAMC Urge Supreme Court to Continue Allowing Medical Schools to Consider Race/Ethnicity in Admissions Decisions

The U.S. Supreme Court is taking two cases that could prevent medical schools’ current practice of considering race/ethnicity in admissions decisions: Students for Fair Admission Inc. v. President and Fellows of Harvard College and Students for Fair Admission Inc. v. University of North Carolina et al. The first considers if Harvard’s admissions processes penalize Asian Americans and in turn violate Title VI of the Civil Rights Act. The second North Carolina case asks if the Supreme Court should overturn a 2003 decision, Grutter v. Bollinger, which allows race to be used as a component of admissions decisions. 

In response to the Supreme Court’s review of the upcoming cases, the AMA and AAMC, along with 40 other organizations, submitted an amicus brief urging the court to “take no action that would disrupt the admissions processes the nation’s health-professional schools have carefully crafted in reliance on this court’s longstanding precedents.” The brief notes the key role that diversity in medical school admissions plays in reducing health disparities by increasing the number of minority practitioners, who are more likely to serve in minority communities, and also by increasing the effectiveness of all physicians through a more diverse learning and training environment. The brief points to scientific research and studies showing the benefits of diversity, saying that “Preventing medical educators from continuing to consider diversity in admissions … would literally cost lives and diminish the quality of many others.” The brief also suggests the possibility that overruling the use of race in admissions decisions may, “...potentially trigger a spiral of severe and self-reinforcing decreases in diversity in the health care professions. States that have banned race-conscious admissions have seen the number of minority medical school students drop by roughly 37% as a result.”

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Biden to Announce Student Loan Debt Relief for Earners Making Less than $125K

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According to the New York Times, President Biden is expected to announce today that his administration will cancel $10,000 in student loan debt for Americans earning $125,000 or less per year (or households earning $250,000 or less per year). The administration will also extend the payment moratorium until December 31st of this year, with borrowers expected to resume payments in the new year. 

Along with this announcement, the President is expected to report that college Pell grant recipients will receive an additional $10,000 in debt forgiveness. 

Legal challenges to the loan forgiveness program are expected, which may make the timing for implementation uncertain. 

Pandemic Spurs Medical Residents to Unionize

Residency is known to be grueling. And during the covid-19 pandemic, the pressure upon residents only increased. As a result, a growing number of residents at hospitals within the U.S. are forming unions to formalize decisions related to pay and working conditions. Sunyata Altenor, Communications Director for the Committee of Interns and Residents (CIR), the nation’s largest resident’s union, said, “Every year, we had one or two new organizing campaigns, but once COVID hit, that number pretty much tripled.” She continued, “It was a massive wave, and we anticipate that it will continue to grow.” Currently, 15 percent of medical residents in more than 60 hospitals are unionized and represented by CIR, while a smaller proportion have either formed a local union or joined a larger medical provider union. 

Oversight organizations, including the AAMC and the AMA, provide high-arching policy guidance on unions but leave the decision-making to the hospital and the residents who work there. According to Janis Orlowski, MD and AAMC Chief Health Care Officer, “The AAMC leaves it to each institution and its house staff to determine how to achieve the best possible education, working conditions, and patient care.” The AMA, for its part, notes that its policy on resident unions strongly encourages separating academic issues from union-covered employment conditions. They note also that unions must abide by the AMA Principles of Medical Ethics, which disallow “such organizations or any of its members from engaging in any strike by the withholding of essential medical services from patients.”

The benefits of unions include providing medical residents a collective voice to negotiate more favorable pay and working conditions. The Accreditation Council for Graduate Medical Education (ACGME) regulates the maximum number of working hours for residents, but not salary. In 2021, according to AAMC data, first-year residents earned just below $60K on average, with many working up to 80 hours weekly. And while working conditions vary by hospital and department, unions can also provide residents more control over their intense work schedules and demands. For example, University of Washington’s Resident and Fellow Physician Union-Northwest (RFPU) won the right for pregnant residents to decline 24-hour shifts. 

Other union benefits include encouraging departments to clearly delineate the rules and rights of residents, and improve social justice efforts through additional support and means to report racial (or other) discrimination for residents of color or sexual minorities. Proponents of resident unions including Kaley Kinnamon, MD and Resident at the University of Vermont Medical Center, which recently voted to launch a residents’ union, noted that unions also bolster the conditions that allow residents to focus on providing the best patient care. “In order to take good care of others, we need to be able to care for ourselves,” she said. “We love being residents and caring for patients. But we can’t do that well if we neglect ourselves.” 

There are also downsides to resident unionization. For one, there is a significant financial cost, particularly post-pandemic when many hospitals are still financially vulnerable. While hospitals receive federal funding to support resident salaries, most come from the hospital itself. There is also a drawback in creating blanket conditions for all hospital residents during training, as there is a need for flexibility and differentiation between departments based on residents’ learning needs. One resident, interviewed by AAMC, noted that surgical residents are required to fulfill a certain number of cases and hours—regardless of union negotiations—in order to qualify for board certification. Furthermore, hospitals have raised the concerning nature of a strike, which would make it almost impossible to adequately staff the hospital.   

Jason Sanders, MD, and Executive Vice President for Clinical Affairs at the University of Vermont Health Network, suggests that hospital leaders pay attention, but look beyond immediate questions of unionization, to focus on the bigger picture. “Whether or not residents have a union, their concerns exist. The question we leaders need to ask ourselves is, how are we going to address them?” he said.

Israeli Medical Schools will No Longer Accept American or Canadian Students

Israeli medical schools—Tel Aviv University’s Sackler Faculty of Medicine, the Ben-Gurion Faculty of Health Sciences (BGU), and the Technion-Israel Institute of Technology’s Rappaport Faculty of Medicine—will no longer accept American or Canadian students. A physician shortage in Israel led to this decision by the Israeli government, along with the large number of Israelis unable to gain admittance to medical school domestically. The Class of 2026, which includes students who matriculated this fall, will be the last to include American and Canadian students.

The decision comes as a shock to the international community as the Israeli medical schools have a long history of educating foreign students; Tel Aviv University’s Sackler has graduated foreign doctors for over 40 years, BGU for 30, and the Technion for about 20. Tel Aviv University’s executive dean, Dr. Stephen Lazar, wrote to the school’s foreign medical students, “It is with the deepest regret that I must inform you that the Israeli government has directed all foreign medical programs, including American medical programs, to stop accepting new students,” he wrote. “This political decision was made in order to increase the availability of seats in Israeli medical schools for the Hebrew programs, so that many Israeli students will not have to travel abroad for their medical education. TAU president Ariel Porat and dean Ehud Grossman have assured us that enrolled students, including the class of 2026, entering this week, will be permitted to complete their medical studies.”

Both the former and current presidents of BGU, Professors Rivka Carmi and Daniel Chamovitz, noted their disappointment, while also pointing to the need for Israel to focus on its own physician supply—only about 900 Israeli students per year attend domestic medical schools. Chamovitz put it succinctly, “There was no choice. We need more Israelis to study medicine here. Those who worked in our international school will teach Israelis instead of foreigners. Nothing will change,” he said. Carmi pointed out that among OECD countries, the average proportion of doctors is 3.4 per 1,000. In Israel the average falls below that, at 3.1, and in some parts of the country, it is 2.7. 

In addition to the low number of Israeli-educated doctors, the physician shortage has been amplified by mass retirements from Soviet-born doctors who immigrated to Israel, and to some extent the pharmaceutical, health technology, and other high-paying private businesses that lure physicians away from clinical practice. Most North American medical students who studied in Israel returned home post-graduation.

Osteopathic Medicine Continues to Grow in Popularity

Osteopathic medicine is one of the fastest growing segments in healthcare, according to the American Osteopathic Association’s (AOA) Osteopathic Medical Profession Report. The number of osteopathic medical students has grown by 77 percent in the last ten years, which has led to an 81 percent increase in the total number of DOs (including practicing physicians, residents, and medical students). Today, there are an estimated 122,236 in the physician workforce, just over one in four medical students are currently pursuing a Doctor of Osteopathic Medicine (DO) degree, and an estimated 36,500 medical students are expected to matriculate into a DO program this school year (up 2,700 from last year). 

Demographic highlights:

  • Practicing DOs predominantly fall within a younger cohort. Just over two-thirds of practicing physicians are under 45 (35 percent are under 35, and 32 percent are between 35 and 44). 

  • In 2022, 43 percent of the practicing DOs were female, an upward trend that has continued over time (40 percent in 2015, and 32 percent in 2010). Almost half of practicing physicians (47 percent) are female and under 45. 

  • Most DOs tend to practice near where they completed their education, and DO programs are typically located in medically underserved regions. The states with the largest number of DOs include: California (8.3 percent), Pennsylvania (8.1 percent), Florida (7.9 percent), Michigan (6.6 percent), New York (6.4 percent), and Texas (6.1 percent).

  • Since 2020, the Accreditation Council on Graduate Medical Education (ACGME) has overseen the accreditation of all graduate medical education (allopathic and osteopathic). DO graduates also participate in the National Resident Matching Program (NRMP). The report notes that 2022 brought a new record level of placement for participating DOs, with 7,049 graduates placing into residency programs in 41 specialties. This is up 7 percent from the previous year. 

  • DOs predominantly work in primary care specialties. The top fields include family medicine, internal medicine, and pediatrics. Among the remaining 43 percent who opt into other specialties, the top fields include: Emergency medicine, Anesthesiology, Obstetrics and Gynecology, General surgery, and psychiatry. 

Related: Alternatives to Allopathic Medical Programs in the United States

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

More medical schools, including those at Duke, NYU, University of Massachusetts, and Rutgers, are using the Multiple Mini Interview (MMI) to evaluate applicants. This is because it is an effective way to evaluate an applicant’s ability to process a complex scenario or issue under pressure and use critical thinking, teamwork, and communication skills to provide a response. It also reduces interviewer bias by allowing prospective students the opportunity for numerous interactions, which decreases the relative importance of any one interviewer’s opinion. 

Multiple Mini Interviews typically consist of between six and ten interview stations, with some schools including rest stations in between. Interviewees are provided with a question prompt or scenario and are given a short period of time to think, before they are asked to engage with the interviewer for a five- to eight-minute response. The questions may ask the applicant to collaborate with other interviewees, act out a scenario, respond to an ethical dilemma, write an essay, or elaborate on a past clinical experience. Whatever the format, interviewers are looking for applicants to showcase a strong sense of ethics and the ability to see multiple viewpoints. 

To prepare for an MMI, you should review dozens of practice prompts. While there is no way to predict the exact questions you will be asked, if you practice, you will gain comfort processing a prompt, assessing a situation quickly, applying one of our many frameworks in your response, and you will come into your MMI interview day feeling confident and prepared.  

We also recommend that you...

Stay informed. Read newspapers and health journals every single day to ensure that you’re up to date on key topics in medical ethics and healthcare policy. Write down the topic areas that you encounter frequently and take an informed position. Practice speaking on your position(s), out loud, with an eight-minute time limit.

Participate in Mock Interviews. Mock MMI interviews will give you a realistic interview experience after which you can gather candid feedback. Record these meetings and critique your responses, focusing on how well you verbalized your thought process and supported your viewpoint. You should also take note of how adequately you made use of the available time. 

And on Interview Day…

  • Use your time carefully. Do not rush. During the two minutes of preparatory time, outline your response and the general timing you’d like to abide by to make each of your key points. 

  • If the question allows you to make a counter-argument, do so, and share why you opted for the conclusion you did. If it is an ethical or values-based question, be sure to point out areas of nuance.

  • Start fresh. Regardless of how well or poorly you did at the last station, leave it behind and focus entirely on current prompt. 

Related:

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

Begin preparing for your interview by thinking through your most meaningful experiences that will help demonstrate your skills and abilities in the areas of critical and creative thinking, problem solving, leadership, teamwork, and empathy, as well as those that reinforced your commitment to the study of medicine. As with your personal statement and secondary essays, you’ll want to show the reader your strengths and potential through specific examples, rather than limiting your content to claims.  

Below, we’ve compiled a list of common interview questions, by type, to help you with your preparation. 

Know yourself. This interview is about giving the admissions committee a view into who you are. They will be looking for you to demonstrate confidence and fortitude, but also authenticity, humility, and the ability to overcome adversity.

  • Tell me about yourself. You’ll want to prepare an elevator pitch (three minutes) that provides an overview of your background and interest in medical school. What were the three most meaningful experiences that reinforced your commitment to the study of medicine?  Why? Are there specific experiences that prompted an evolution in your perspective so notable you want to include them here too? What led you to make certain academic and professional decisions? 

  • Why Medicine? Your response to this question should demonstrate your understanding of and interest in a career as a physician (rather than as a nurse or physician’s assistant, for example). In other words, it should be more specific than wanting to help people, or having an interest in patient care. You’ll want to highlight key experiences in the areas of critical thinking, problem solving, research, or leadership in a clinical environment. Prepare also for related questions such as: Is there anything that makes you hesitate about going into medicine? What challenges do you expect to face in medical school and later in practice? 

  • What has been your most meaningful research experience to date? Why? Prepare to speak confidently on any of the experiences you have listed in your application materials, particularly those in the clinical or research category. What did the experience teach you about yourself? How did it challenge you? How did the experience reinforce your interest in pursuing medical school? How did it change or reinforce your views of patient care?

  • Would you change anything about your undergraduate education? Why? 

    • If there is a red flag pertaining to your undergraduate education (for example, a semester with a low GPA or a transfer between schools), this may present a good opportunity to address it.  Without making excuses, emphasize what you learned from the experience and/or point to other areas of your academic record that are much more indicative of your ability to compete in a rigorous academic environment. 

    • If you do not have a red flag to address, you may want to talk about that missed opportunity to study abroad or take a class in medical ethics. Did an early disappointment ultimately inspire you to take part in a clinical role abroad after you graduated? Be sure to link your chosen topic to qualities related to your medical school candidacy. 

Understand your fit with the school. You must prove to your interviewer that you know about their program and are confident you would be a great fit. 

  • Why [specific school]? Look at the mission of the school, student organizations, courses, faculty, key areas of research, and come to the interview prepared to explain how you would engage with their offerings. Beyond this, keep in mind that medical schools are integrated in their local communities, so consider your fit here too. Do you have experience, for example, working in a rural (or urban) hospital? Did it impact your decision to apply to this program? Why?

Share stories. Use stories from your life to show your interviewer who you are, how you’ve grown, and what you will bring to the incoming class. Spend some time brainstorming and reviewing anecdotes that can be tailored to different behavioral questions and demonstrate the qualities medical school admissions committees are looking for. 

  • Tell me about a time when you challenged the group consensus? For a situation-based question, use the SAR (Situation, Action, Response) model. Spend about 20 percent of your response on the situation, and the remaining 80 percent on the actions you took and what resulted/what you learned. The SAR model applies to a question like: What is your greatest weakness?  You will want to spend 20 percent of your response on the weakness, and 80 percent discussing the actions you took/are taking to improve and what the results have been/what you’ve learned since beginning your improvement plan.

  • What is your greatest strength? How would you sum up your leadership style?  For questions where a simple claim would seem to suffice for a response, always take it a step further. Make a claim, THEN back it up with a specific example to illustrate that claim in action—in a group project, clinical experience, or research role.

Related:

The Medical School Interview

Your medical school interview will be the most influential component of your application. It is your chance to showcase your personality, drive, and commitment to a medical career as well as those characteristics that will benefit your medical school class and future patients.

Scheduling the Interview

Most medical schools have rolling admissions so we recommend scheduling your interview as early as possible in the interview season, which runs from the fall to the spring. Before solidifying your travel plans, you should also contact nearby schools to which you’ve applied and let them know you have an interview in the area in case they have availability. This serves the dual purpose of letting the other school know that you are “in demand,” while also showcasing your strong interest in their program.

What are the Interviewers Looking for?

Most medical schools will offer prospective students one or two 30-minute interviews with faculty members or students. The interviewers are looking to assess your interpersonal traits, commitment to and aptitude for medicine, potential contributions to the school/community, and to discuss and resolve any red flags in your academic and/or professional record. They will also want to ensure that your interview is consistent with your application.

Interview Types

The Multiple Mini Interview (MMI) 

The MMI is growing in popularity within the United States and consists of multiple “stations” through which each applicant rotates. At each station, you are given a scenario, asked to role-play, or asked to do a team exercise. You are provided a couple of minutes to read each exercise and prepare, then you must have a discussion with the interviewers and/or perform the team task. 

The scenarios are designed to evaluate your ability to critically assess a situation under pressure by presenting a dilemma to which you must respond. Be sure to carefully consider the various sides of the issue and address them all. Role playing exercises specifically evaluate your communication skills, while team tasks assess your leadership and collaboration potential. Some stations may be clinically based while others are not. 

The Traditional One-on-One Interview 

This interview type is the most common and focuses on behavioral-style interview questions such as: 

  • Tell me about yourself.

  • Why School X?

  • Talk to me about a time that you challenged the group consensus. 

  • What has been your most meaningful clinical experience to date?  Why? 

  • What are your greatest strengths and weaknesses?

  • Tell me about your biggest failure.

In an “Open File” interview, the interviewer will have access to your submission materials, but don’t assume that your interviewer knows anything about you as he/she may not have had time to review your file. In a “Closed File” interview, the interviewer will have limited access to your application. 

The Group Interview 

This situation involves several interviewers and interviewees. The objective is to see how you interact with and respond to others. Be sure to listen attentively to everyone’s answers and showcase your ability to be a team player. 

The Panel Interview 

Typically, the panel includes multiple interviewers with just one interviewee. Their questions will likely be a mix of MMI-style and behavioral-style.

Apply Point’s Tips for Success

  • Outline the key points and experiences you would like to discuss within the behavioral interview and take responsibility for bringing up these points. It is most helpful to review all of your application materials again, and highlight those stories that will showcase your abilities and strengths in the areas of leadership, problem solving, teamwork, and empathy, as well as those experiences that reinforced your commitment to the study of medicine. 

  • Nearly every response to a behavioral interview question should have a story, even those that don’t ask you to recall a specific situation—Questions such as: What is your greatest strength?  Or what is your leadership style? Give one or two strengths, and then tell a story that will SHOW the interviewer that strength in action on a group project. A good story woven into every response will make your interview more compelling and memorable to the interviewer. 

  • Speak about any recent accomplishments or events not included in your application. Continue to improve your candidacy even after you’ve submitted your application.

  • Be proactive about bringing up red flags or weaknesses in your application. Address these head-on during the interview because they will inevitably come up within the admissions committee’s discussions. Rather than make excuses, talk about what you’ve learned and how you will continue to improve moving forward.

  • Practice delivering your responses to interview questions aloud, and be sure to limit most responses (to behavioral interview questions) to between two and three minutes. Ask us for a list of MMI and behavioral interview questions so you can practice and prepare for both types. 

  • At the end of the interview, thank your interviewer, reiterate to them if their program is your first choice, and send a hand-written thank you note.

Related:

  

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:

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? 

Your story set apart.