The Road to Medical School

Dr. David Frank

Chemistry Department

CSU Fresno

McLane 159 (278-2273; email is better)

davidf@csufresno.edu

11th Annual UC Davis Pre-Medical & Pre-Health Professions National Conference: “Passion for Life, Education, Service, and YOUR Future in Healthcare”

Saturday & SundayOctober 12-13, 2013

8:00am-6:00pmUniversity of California at Davis, Pavilion

For Bundle (Bus, Food, Lodging) contact Cristian Sarabia

cristiansinaloa@mail.fresnostate.edu

Malpractice Insurance•Cost depends on the state & location•Internal Medicine: $6K - $11K/year•OB/GYN: $55K/year (2009)•General Surgeons: $28K - $55K/year•Physician Assistant: $2K –$6K/year

Financing Physician Education•The median education debt for indebted medical school graduates in 2012 was $170,000, and 86 percent of graduates report having education debt•Debt: Public: $160K, Private: $190K•Cost: Public: $197K, Private: $275K•Scholarships (4 yr): Public: $14K, Private: $30K•Remember you need a good credit score to qualify for many loans.

Academic Medicine, Jan. 2013: Study shows that recent medical school graduates with the median amount of education debt ($160K-$170K) can enter primary care, raise a family, live in an expensive urban area, and repay their debt within 10 years without incurring additional debt. However, heavily indebted primary care graduates (who owe $250K+) must plan repayment and lifestyle choices carefully and strategically. The article includes debt repayment models across a variety of scenarios and specialties. It suggests that education debt need not play a determining role in specialty choice and illustrates the capacity of physicians to repay their education debt.

The Path to Becoming a Physician

• Bachelor Degree– Possibly Post-bac work to shore up soft GPA

• Medical School - 4 years

• Residency - Minimum of 3 years (1st year often called internship)

• Optional: Fellowships for further specialization

Have A Plan

• Academics - Required Courses, Bachelor’s Degree

• Extracurricular Activities (including medical experience)

• MCAT

• Research

• Letters of Recommendation

• Finances for the Application Process

Diploma

www.csufresno.edu/premed

www.fresnostate.edu/premed

1. Whatever interests you the most, BUT...2. English, philosophy, history, music majors, etc. may take

longer to graduate to get all of the pre-reqs, cannot get grants for units outside of their major, and the science GPA is vulnerable.

3. Advantages of Biology or Chemistry major• Premed prereqs are part of the degree requirements

-grants & scholarships can only cover units of MAJOR• Science (BCMP) GPA is buffered by taking more

science classes• Better preparation for first year of med school• Higher priority at getting into impacted first year Chem

1A/1B and Biol 1A/1B.

What Should I Major In?

• 1 year of General Chemistry (1A and 1B), even if you have AP credit. NOT 3A/3B

• 1 year of Organic Chemistry with lab 128 A & 129A, then 128B and 129B)

• 1 year of General Biology with lab (Biol 1A and 1B), even if you have AP credit. NOT Biol 10

• 1 year of physics with lab (Phys 2A/B; Does not have to be physics for physics majors).

• Math 75 and Math 101 (Statistical Methods; 4 units)

Undergraduate Academic Preparation

• In general we advise pre-med students to take general chemistry and biology at Fresno State (not a community college) even if they have AP credit for these courses.

• However, you can check with the medical schools in which you are interested to find out about their policy on AP courses.

• The medical school might allow an upper division course in the particular discipline to fulfill the requirement.– Hard to know early on which med schools you will

choose to apply to…

AP Credit

Academics - Courses Required by Many Medical Schools

(and really important for the MCAT)

• 1 year of EnglishUpper division with lots of reading, critical thinking, and writing; or Philosophy courses

• 1 year of Math (calculus, statistics, computer science)

• 1 semester of Biochemistry

Academics – Other Courses

• Physiology (Comparative or Human; can help with the MCAT)

• Genetics (can help with the MCAT)• Human Anatomy (just before entering; can

help with first year med school)• Cell Biology & Molecular Biology (can help

with first year med school)

Academics – Other Courses

Because the the MCAT in 2015 will change, we strongly advise students who may take this exam to take…

• One or two semesters in introductory psychology -PSYCH 10. Introduction to Psychology (3 units) -PSYCH 40T. Topics in Research Design and

Statistics• One or two semesters in introductory sociology -SOC 1 or 1S. Principles of Sociology (3-3 units) -SOC 3. Critical Thinking about Society (3 units)• Introductory Biochemistry: Chem 150

Before applying, make sure that you have fulfilled the course requirements for the medical schools to which you intend to apply.

Academics Count

• Aim for a minimum 3.6 GPA, for BOTH your overall GPA as well as your BCMP (Biology, chemistry, math and physics) GPAs.

• For allopathic medical schools, the GPA is calculated based on all courses taken, even those for which you applied for grade substitution.

www.aamc.org/msar

Upper Division Biology

Statistics

Stanford = Irvine =

Nationwide: 20,518 seats and 46,454 appicants: 44%

Schools with multiple CSUF accepytances 2011-2013

32 other schools have accepted one CSUF student in this 3 year period.

GPA

# of Applicants

MCAT

26:48% - 20518: 44%

2013 Data

2013 Data44 CSUF students applied, 20 were admitted to at least 1 school: 45% acceptance rate.

Highest MCAT with acceptance: 39RLowest MCAT with acceptance: 23QHighest GPA: 4.0Lowest GPA: 3.57

What is Osteopathic Medicine?• Critical physician workforce shortage. By 2020, the gap between our physician supply and demand = 50,000 to 100,000+. • > 4,200 new osteopathic physicians/yr enter the workforce.• > 63,000 fully licensed osteopathic physicians practice the entire scope of modern medicine, bringing a patient-centered, holistic, hands-on approach to diagnosing and treating illness and injury. • > 20% of US medical students -> osteopathic physicians. • DOs can try for any specialty, prescribe drugs, perform surgeries, and practice medicine anywhere in US.• Osteopathic manipulative techniques to diagnose and treat patients. • Osteopathic physicians work in partnership with patients to help them achieve a high level of wellness by focusing on health education, injury prevention, and disease prevention.

Candidates for admission must have a minimum science GPA of 3.30, a minimum overall GPA of 3.30, and a minimum average MCAT score of 27.

Western University of Health Sciences College of Osteopathic Medicine of

the Pacific (Pomona, CA)

Osteopathic Medical CollegesAACOM.ORG

There are currently 29 colleges of osteopathic medicine, offering instruction at 37 locations in 28 states. Twenty-three of the COMs are private; six are public.

What is a Physician Assistant?

A physician assistant (PA) is a medical professional who works as part of a team with a doctor. A PA is a graduate of an accredited PA educational program who is nationally certified and state-licensed to practice medicine with the supervision of a physician. What can PAs do?  PAs perform physical examinations, diagnose and treat illnesses, order and interpret lab tests, perform procedures, assist in surgery, provide patient education and counseling and make rounds in hospitals and nursing homes. All 50 states and the District of Columbia allow PAs to practice and prescribe medications.

Prereqs for Physician Assistant Program - Tuoro

8 semester/12 quarter units (including labs) in each of the following categories:

Biological Sciences (may be comprised of general biology, genetics, immunology, embryology, etc.) Chemistry (may be comprised of inorganic, organic, biochemistry)

4 semester/5 quarter units (including labs) of the following: Human Anatomy (must be completed within 5 years of expected year of matriculation)Human Physiology (must be completed within 5 years of expected year of matriculation)Microbiology

Statistics (3 semester/5 quarter units)All pre-requisite courses must be completed with a “C” or better

Clinical Experience - Tuoro

Candidates must have obtained a minimum of 500 hours of health care/clinical experience, either as a volunteer or in a paid position.  Competitive candidates, however, will have obtained 1,000 or greater healthcare hours.

Evaluation Criteria for Clinical ExperienceTotal number of hoursSettingSpecific duties performed and/or skills acquiredDescription of the dutiesPatient population servedLevel of supervisionTime frame of the experience   

Prereqs for Physician Assistant Program - SJVC

• General Chemistry (with lab)• General Microbiology (with lab)• Human Physiology (with lab)• Human Anatomy (with lab)• Public Speaking or Oral Communication• Intro to Sociology or Cultural Anthropology• Reading and Composition• General Psychology• College algebra or higher*

2,000 hours of direct patient care experience is also required for admission (paid and volunteer hours are acceptable). Hours accrued as a student in a training program cannot be used towards this total.

Some “Pros” for a PA Career•Requirements for admission to PA school easier than med school•PA school is only 2 years: need not acquire huge student debt.•You can easily switch specialties without lengthy schooling & residencies•Work fewer hours and time off is really “off”(?)•Malpractice insurance less costly: $2K – 6K/year

Some “Cons” to a PA Career

•If you have a “leadership” personality and would prefer to give orders rather than take them, PA may not be right for you.

•PA salaries are capped and less than a doctor’s.

•Less status as a PA than as a doctor.

The “Old” MCAT (Before 2015)

• Three Multiple choice parts:– Verbal Comprehension– Physical Sciences– Biological Sciences– Writing Sample is gone in 2013

• Be sure that you have completed all the coursework required

• Take practice exams. Scores on these will determine whether you are ready to take the real one. These are available for only $35 each, after the first free one, from AAMC.

The “New” MCAT (Begins 2015)

• Natural Sciences: concepts in biology, general and organic chemistry, biochemistry, and physics

• Psychological, Social and Biological Foundations of Behavior: Concepts of introductory psychology and sociology, and introductory biology concepts that relate to mental processes and behavior.

The “New” MCAT (Begins 2015)

• Critical Analysis and Reasoning Skills: be able to analyze, evaluate, and apply information provided by passages from a wide range of social sciences and humanities disciplines. – Does not test specific knowledge– Does test the skills in analysis and reasoning that

you need for medical school– may prompt you to read broadly as you prepare– Along with many others, passages about

ethics and philosophy, cross-cultural studies and population health are included.

The “New” MCAT (Begins 2015)

https://www.aamc.org/students/applying/mcat/mcat2015/

MCAT Timing• The best timing is to take the MCAT in the spring* of

the calendar year prior to the year you plan to enter. (For most this will be April of their junior year.) However, do not take the MCAT before you are ready. *APPLY EARLY, SEATS SELL OUT.

• The MCAT is now offered on-line on 24 different days during the year. The exam is now a 7 hour test;. There is a test site in Fresno. Register early to be sure you get the date and site you want.

• Go to the AAMC website for information and registration.

MCAT Preparation

• While taking chemistry, biology and physics, remember you are preparing for the MCAT.

• Check the AAMC website and consult The Official Guide to the MCAT Exam available from AAMC

• For MCAT2015, visit

https://www.aamc.org/students/applying/mcat/mcat2015/• Remember to schedule in preparation time before taking

the MCAT. Consider the Kaplan prep course ($2000).• Don’t ever take the MCAT for practice: it’s expensive

($270). Plan to take it only once.

Change your high school study habits: • Rote memorization doesn’t work so well for the MCAT. • You need to develop conceptual thinking skills. • Start making notes from your text as well as lectures. • Organize the material by topic. • Look for logical connections between all of the facts, don't just memorize isolated facts. • Read and review notes for understanding. • This all takes TIME (2-3 hours of study for each hour in class) • Recommend Engl 101, 102, 103 for reading comprehension & critical thinking

MCAT Preparation

What Do I Do In The Summer?

• There are lots of summer opportunities for students interested in being physicians. Check the internet, the AAMC and the aspiringdocs & our websites.

• Applications are due between January and March and are extensive. Look into programs early.

Extracurricular Activities

• Medical Experience

• Leadership

• Volunteer Service

• Research

Keep Good Notes

• Keep track of your extracurricular activities and the hours you devote.

• You might want to keep a journal of clinical experience to record your experiences and maturation: its good material for that personal statement.

Letters Of Reference

• Two science faculty, one non-science faculty, and one or two others

• Remember while taking courses that you are going to need letters of recommendation.

• Doing research with a professor helps him/her get to know you and write a more credible letter.

• Have the letters on file the spring semester before you apply (April/May of junior year).

Letters Of Reference

• Most med schools use the AMCAS letter distribution service. They only accept letters from AMCAS.

• You must provide each letter writer with your AMCAS Letter ID found on your AMCAS Letter Request Form, as well as your AAMC ID#.

Letters Of Reference• Instruct the letter writer to either send your letter to

AMCAS directly, or to Ms. El-Bendary in the Information Center (S1-136). In either case, the letter must be accompanied with your AMCAS Letter Request Form, as well as your AAMC ID#.

• We shall send your letters to AMCAS on your instruction. If all are being sent to the same schools, they can be sent as a packet with the same Letter ID #.

• Advantages of our service: we keep copies of your letters which may be needed for scholarship applications, for non-AMCAS schools, and for AACOM applications.

The Application Process

• Primary Application - takes time!– transcripts from all

college-level schools– personal statement– record of extracurricular

activities– names of letter of

recommendation writers for those medical schools that use the AMCAS service for collecting letters of recommendation

• Secondary Applications

– more essays

– request letters of recommendation be sent to AMCAS, the MD application service*. (Letters to AMCAS can be sent after the primary application is submitted.)

*unless school is not using the AMCAS letter distribution service.

Institution 1

What is your interest in XYZ School of Medicine?

Insitution 2

Describe your motivation to become a physician. What do you see as the most significant issue the medical profession will face in the next 40 years? What personal benefits have you gained from your major extracurricular activity? What personal benefits have you gained from your research/teaching experience? Given the opportunity to share dinner conversation with one person (deceased or alive) who has made a significant contribution to science, medicine or human service, identify the individual you would select and why?

Secondary Application

Institution 3

•Please explain your reasons for applying to XYZ School of Medicine. We understand that you are probably applying to several medical schools. We are interested in why you have placed XYZ School of Medicine on your list of schools. (max character limit 1500)•Please describe any unique characteristics you have that will contribute to the diversity and bring educational benefits to the entering class. (max character limit 1500)•If you are not in a degree-seeking program, please indicate what you will be doing from the time you complete this application to the start of medical school.

The Interview

• Choose medical schools carefully. Know what they offer and what you offer them. Review your application and their catalog and mission statement. Talk to medical students. Find out about hospital affiliations, curriculum, student support.

• If possible, engage in a mock interview.

The Interview• Your experience in medicine. You need to explain

your experiences that have helped you to understand the reality of a medical career.

• You have the longevity, discipline, motivation, and resiliency to succeed in medical school. How can you convey the evidence of these traits?

• You have thought about, and to some degree understand, the current and future state of medicine.

• How can you convey to the interviewer that you are “one of them.”

Planning for Necessary Expenses

• All professions have application expenses.• Med school application: ~$4000 to $8000 (+)

– MCAT review class: $2000– # schools you apply to & where you interview. – AMCAS Application: $160 first school, $32 each

additional school (UC Berkeley avg: 20 – 25 schools)– Secondary applications: $70 to $100 each in CA

• AMCAS has a Fee Assistance Program. aamc.org/fap• Don’t short-change yourself on the application

process.

Item Cost

MCAT Test $270

MCAT Preparation $2,000

Initial AMCAS Application

$160

Each additional school (24 is average) @ $32

$768

Secondary Application (20 @ $100)

$2000

Travel Costs to Interviews

$3000

Total $8158

Stanford 463

interviewed, 86 accepted.

Rush: 399/130

(19%/33%)

Resources: Getting Started

• Premedical Web Site• Advising• Informational Sessions, Conferences on and

off campus (i.e., UC Davis conference)• HCOP (Health Careers Opportunity Program,

targets students from educationally or economically disadvantaged backgrounds.)

• AEW (Academic Excellence Workshops, NSCI 40T, LSAMP program)

• Student Clubs: Fresno State Premed Club (only premeds), AMSA Chapter (anyone interested in a health profession), Tri Beta Biology Club

• Natural Science class: The Art and Practice of Medicine (NSCI 1; spring class)

• Academic Research Associate Program at Community Regional Trauma and Burn Center headed by Dr. Greg Hendey and administered by Brandy Snowden. (NSCI 110)

• Research Opportunities-during the year and in the summer• Conferences Given by Medical Schools for Premed Students

More Resources

• Scribe Program at St. Agnes Hospital headed by Dr. David Claypool

• Other scribe programs via CEP America at Community, Clovis, and Madera.

• WorService to Collect and Send Out Letters of Reference. (You must open a file with me and sign a form to either waive or not waive your right to see your letters of reference.)

Yet More Resources

UC Postbaccalaureate Consortium

http://meded-postbac.ucsd.edu/Helps educationally and economically disadvantaged students get into medical school. Must be committed to practicing in underserved communities of California.Post-bac nationwide:http://services.aamc.org/postbac/

Plan B

Postbaccalaureate Programs: academic record-enhancement, career changing, underrepresented groups, economically or educationally disadvantaged groups..

• CSU Fullerton• CSU East Bay• Charles Drew University• Mills College• San Diego State University• San Francisco State University• Scripps College• UC Berkeley Extension• University of Southern California

Plan B

Caribbean Medical Schools

There are three medical schools in the Caribbean that stand out: St. George’s University in Grenada, West Indies, Ross University in the Commonwealth of Dominica, and American University of Antigua.  Students admitted to St. George’s have an average GPA of 3.34, and an average MCAT of 28. At Ross, the average GPA is 3.4, with a range of 2.7 - 4, but for early admission they require at least an overall GPA of 3.0 and a science GPA (BCPM) of 3.25, with an MCAT score of at least 24.

Also: UAG School of Medicine in Guadalajara, Mexico

Options1. Medical Doctor 6. Optometrist

2. Podiatrist 7. Physician Assistant3. Dentist 8. Nurse4. Pharmacist 9. Ph.D.5. Veterinarian 10. Clinical Lab

Technician

Plan B

Excellent Books

• Medical School Admission Requirements

• The Official Guide to the MCAT Exam

• Complications: A Surgeon’s Notes on an Imperfect Science by Atul Gawande, M.D.

• Better: A Surgeon’s Notes on Performance by Atul Gawande, M.D.

• The Checklist Manifesto, by Atul Gawande, M.D.

Useful Web Sites

• Interviews:www.studentdoctor.net/interview/index.asp

• Scholarships:www.fastweb.monster.com

• Advising Information:www.csufresno.edu/premedwww.aspiringdocs.org

• General Information: www.aamc.org/meded/start.htm www.aacom.org www.amsa.org

• Summer Opportunities: www.cmu.edu/hpp/intern.html www.swarthmore.edu/Admin/health_sciences/ summer_opportunities.html www.aamc.org/members/great/summerlinks.htm

ENJOY THE PROCESS!