Kaplan / Newsweek Medical School Admissions Advisor 2000

Kaplan / Newsweek Medical School Admissions Advisor 2000

Paperback(2000 Edition)

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Product Details

ISBN-13: 9780684859569
Publisher: Kaplan Publishing
Publication date: 07/20/1999
Series: Newsweek Medical School Admissions Adviser Ser.
Edition description: 2000 Edition
Pages: 256
Product dimensions: 7.43(w) x 9.25(h) x 0.66(d)

First Chapter

Chapter 4 Your Basic Choices

Choosing the medical schools to apply to is a major decision. It's important that you take the time to research medical schools in which you're interested, so you'll be in a better position to match their criteria with yours. After reviewing this chapter, you'll be prepared to start drafting your list of schools.

The Basics

Unfortunately, many applicants know very little, if anything, about the medical schools to which they apply. They enter the application process blindly, and base their decisions on "common knowledge" or "school reputation." This is a naive way of planning a future. Before plunging into the actual logistics of the application process, you need to review some of the main criteria for selecting schools.

MSAR: Your Premed Bible

There are currently 122 accredited medical schools in the United States, three in Puerto Rico, and 16 in Canada. Medical School Admission Requirements, which is published every April and is affectionately called the "MSAR" provides comprehensive information on all of these schools. When it comes to med school admissions, "doing it by the book" refers to the MSAR. The information in this book comes from the horses' mouths -- the schools themselves. It isn't filled with second-hand accounts or student opinions. It's the official stuff.

The first part of the MSAR includes over 100 pages relating to the admissions process. The second part includes profiles of all the Liaison Committee on Medical Education (LCME)-accredited schools in the United States and Canada. It's worth the $25 you'll need to purchase your own copy, since the information in there can help you decide where to apply. Every school profiled in the MSAR contains the following entries:

* General information
* Curriculum
* Requirements
* Selection factors
* Early decision program
* Tuition
* Financial aid
* Application and acceptance policies
* Information on previous year's class

In chapter 5, we'll tell you how to make the most of this excellent resource.

Narrowing Down Your List

At some point, you're going to have to bite the bullet and narrow down your list of schools. While there is no magical number of schools to apply to, the average is now around 12 or 13 schools. (California applicants average closer to 25 schools.) Naturally, if you're going to apply to lots of very competitive schools, you may need to construct a more extensive list. Work with your premed advisor to select schools that make sense for you. Check to see where students from your college with your GPA and MCAT scores have been accepted. Also, inquire whether your school has a historical feeder relationship with a particular medical school.

While you're agonizing over which schools to keep on your list, consider the following issues:

* Competitiveness
* Cost
* Accreditation
* Curriculum
* Teaching hospitals
* Location
* Affiliation with undergraduate institutions
* Student body
* Public versus private schools

Competitiveness

As we mentioned in the introduction to this section, competition to get into medical school is very intense. You need to be realistic about your admission chances. There are many qualified applicants who won't be accepted. Don't take anything for granted; apply to schools of varying degrees of competitiveness.

The entire notion of ranking schools is, of course, a highly subjective and controversial exercise. However, rankings can provide an idea of how competitive it is to gain admission into a school. For instance, so-called Top Ten medical schools (e.g., UCSF, Hopkins, Harvard, Stanford, etcetera) are very competitive. For a somewhat more objective method of evaluating a particular school's competitiveness, check your MSAR.

It's helpful to view schools in categories: highly competitive schools; middle-tiered schools; and finally the backup or "safety" school. (These days, however, there really is no such thing as a safety school.) You should not take the risk of applying only to the most competitive schools -- the outcome may be rejection from all of them.

By the way, don't get too hung up about a school's "reputation." All LCME-accredited schools provide a solid medical education and no matter where you go, you get the magical M.D. after your name.

Cost

You may have already taken out loans to pay your undergraduate education, or have mortgages or high rents to pay. Tuition to medical school will only add to your financial burden. Of the 122 LCME-accredited medical schools in the United States, 52 are private institutions and the rest are state sponsored. The difference in cost between attending a state and a private medical school can be striking. For example, consider the tuition at a state institution such as the University of Nevada Reno Medical School. In 1998-99, tuition for a resident was $7,483, as opposed to $21,292 for a nonresident. While the cost for a nonresident is by no means pocket change, compare this to a private institution such as Georgetown Medical School. The tuition at Georgetown ran $28,650 for 1998-99.

Remember, we're comparing only tuition. This doesn't figure in the cost of living (room, board, entertainment, etcetera). It is safe to say that the cost of living in Reno, Nevada, is significantly lower than in Washington, D.C. If you were a resident of Nevada, you'd be talking about a difference of at least $20,000; that's $80,000 in four years.

The solution seems all too obvious, right? Everyone should attend state schools! The problem: limited slots and strict residency requirements. State schools often strongly favor those applicants who are state residents (i.e., those who are already paying taxes to support the existence of the school). Unfortunately, residency requirements differ from state to state, so there is no one set way of establishing residency. Nonetheless, when considering the economics of going to medical school, state residency may become a vital issue. It is important that you decide which state schools are feasible for you, and that you clear up any misconceptions concerning residency requirements well before you apply.

Accreditation

It is essential that the medical school you attend meets the standards established by the Liaison Committee on Medical Education (LCME), the body that is responsible for accrediting M.D.-granting programs in the USA. The LCME is made up of representatives appointed by the AAMC, the Council on Medical Education of the American Medical Association, the Committee on Accreditation of Canadian Medical Schools, as well as representatives of the general public.

LCME standards state that a medical school's curriculum must be designed to provide a general professional education, recognizing that this alone is insufficient to prepare a graduate for independent, unsupervised medical practice. The LCME requires schools to have a program that provides a minimum of 130 weeks of instruction, usually over at least four years, and that allows students to:

* Learn the fundamental principles of medicine
* Acquire the skills of clinical judgment based on evidence and experience
* Develop an ability to use principles and skills wisely in solving problems of health and disease
* Acquire an understanding of the scientific concepts under-lying medicine
* Be introduced to current advances in the basic sciences, including therapy and technology, changes in the understanding of disease, and the effect of social needs and demands on medical care

The LCME goes on to specify a number of basic science and clinical areas that each medical school's curriculum must cover but it does not specify exactly how that curriculum must be organized. As a result, medical schools differ widely on how they present their educational programs.

Curriculum

Medical school alone will not prepare you to practice as a physician. What it will cio is give you the basic training that you need to continue into residency training (graduate medical education) in the specialty that best suits your talents and interests. Only after you have completed residency training and have met other licensure requirements are you ready to enter medical practice on your own.

Because medical school lays the foundation for the rest of your medical career, the curriculum of the medical school you attend is one of the most important criteria in selecting schools to which you will apply.

For most of the twentieth century, medical school has been divided into two phases: preclinical (basic sciences) and clinical. Up until recently, students were exposed to a two-year intensive close of the basic sciences before having any meaningful patient contact. The preclinical (also referred to as basic science) years were followed by two years of patient contact composed of clerkships and electives. The distinction between preclinical and clinical years has blurred somewhat in recent years as medical schools introduce students to earlier patient contact, often during the first year of the curriculum. Here are some of the ways in which medical school curricula differ today:

* Length
* Organization of the preclinical years
* Use of problem-based learning
* Organization of the clinical years
* Earliest patient contact
* Primary care focus
* Innovative educational methods and new technologies
* Student evaluation
* USMLE policies
* Special programs and opportunities

Length

The LCME requirement that schools offer a curriculum of at least 130 weeks of instruction has resulted in a standard four year program at nearly all medical schools. A few schools offer the opportunity for at least some students to take additional time (usually five years) to complete the program. Programs of less than four-year duration are relatively rare.

Organization of the Preclinical Years

Until relatively recently, the preclinical years of the medical curriculum were referred to as the basic science years. Students took traditional courses in disciplines such as anatomy, biochemistry, physiology, microbiology and immunology, pathology, pharmacology and therapeutics, and preventive medicine. Instruction consisted of long hours of lecture and laboratory work, and possibly some small group discussions.

A newer approach employed by some schools replaced the discipline-based curriculum with one organized on an interdisciplinary, organ system basis. In this type of curriculum, students study all aspects of each organ system before moving on to the next. Instruction is interdisciplinary, with faculty members from many departments forming teaching teams. Proponents of this approach believe that the organ system model provides better integration of the material to be learned.

Some schools use a hybrid of the two traditional curricular models. For example, the first year may be organized with traditional, discipline-based courses, while the second employs the interdisciplinary organ system approach. Or, elements of both may be mixed during parts of the curriculum.

Problem-Based Learning

A relatively new arrival on the medical education scene is Problem-Based Learning (PBL). In PBL, case-oriented problems are reviewed by small groups of medical students working together as a team under the direction of a faculty member. The PBL teams review the case material presented, identify learning issues, and assign those issues to group members. Each group member researches the issue s/he was assigned and reports back to the group at subsequent meeting. As the cases unravel, the students not only begin to learn the basics of clinical medicine (the vocabulary, normal lab values, etcetera), but they're challenged to understand the basic physiology, pathology, and pharmacology of the disease as well.

Some medical schools employ PBL almost exclusively. Others use PBL in conjunction with more traditional approaches, selecting the best approach for the material to be covered. The latter schools endeavor to coordinate the PBL cases with material covered in the traditional courses.

Earliest Patient Contact

There is a trend toward providing patient early in the curriculum, often as early as the first few weeks of the first year. Proponents of early patient contact argue that medical students will find their studies more meaningful if they are combined with the chance to work with patients right from the start of medical school. Those who advocate delaying such contact point out that students can do little but observe until they have obtained enough training to be of real help to their patients. Medical schools differ as to when and how they provide this contact.

Organization of the Clinical Years

The third and fourth years of medical school are designed to equip you with the knowledge, skills, attitudes, and behaviors necessary for further training in medicine. This is done by providing you with clinical experiences in a variety of clinical settings. You can expect some exposure to family medicine, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, and surgery. Some schools will require you to complete these core experiences, called clerkships, before moving on to other areas of medicine. Other schools will provide more flexibility in scheduling and may permit some electives or selectives throughout the third and fourth years. Schools will also differ in the extent to which they will permit off-campus, and even international, electives during the clinical years.

Primary Care Focus

Some medical schools clearly state that their mission is to increase the number of primary care (family practice, general internal medicine, general pediatrics, and possibly obstetrics and gynecology) physicians in practice. These schools structure their curricula to emphasize opportunities in primary care and may attempt to select applicants who show a higher likelihood of entering primary care specialties.

Innovative Educational Approaches

Medical education is evolving rapidly and new approaches are being tried at many schools. Computer-assisted instruction is widely utilized and some schools now require entering students to own their own computer. Simulated patients are used by many schools to help students learn to conduct patient interviews and to examine patients. Self instruction, also referred to as self-directed learning, is emphasized in many schools. New methodologies are being developed regularly.

Student Evaluation and Grading

An essential component to the curriculum is the method by which you will be evaluated. One way in which medical schools differ is in the grading system employed. Grading systems can vary from a simple pass-fail system to a 5-step system, such as A-B-C-D-F. Others use a numerical system. A three-point system of Honors-Pass-Fail is common. Some schools use different systems for different parts of the curriculum, such as Honors-Pass-Fail for required courses, and Pass-Fail for electives. Some schools will employ Objective Structured Clinical Examinations (OSCE) during the clinical years.

United States Medical Licensing Examination Policies

The USMLE is the series of examinations required of all applicants for a medical license in any state in the U.S.A. The USMLE is actually made up of three steps. Step 1 is usually taken at the end of the second year of medical school, Step 2 during the senior year, and Step 3 at the end of the first year of residency. The majority of medical schools require their students to pass Step 1 to be promoted to the third year or to graduate. Many schools also require Step 2 passage for graduation. Some residency programs also consider your scores on Step 1 when you apply for residency.

Special Programs and Opportunities

One of the ways in which medical schools differentiate themselves is with the special programs they offer. These may be in the form of research opportunities, opportunities for community involvement, international educational experiences, or in any number of other ways too numerous to mention.

These are all important issues for you to consider. Be sure to consult school Web pages, request catalogs, and review the MSAR to find out what approach is used at the schools you're interested in. Another resource is the AAMC Curriculum Directory, available from the same place you order the MSAR. Do your research! You should know how the schools you're interested in differ in each of the ways discussed. Weigh the pros and cons of each factor and decide which is most appropriate for your learning style. Remember, each medical school will ask you to articulate why you have chosen it.

Teaching Hospitals

Just as important as the basic science curriculum that a medical school offers are its affiliated teaching hospitals. You'll be doing your clinical rotations predominantly in those hospitals and clinics that are designated as teaching hospitals of that school. Your first clinical experiences will be shaped, in large part, by the type of hospitals to which you are exposed. For example, if a medical school is primarily associated with city hospitals, you'll probably be exposed to a disproportionate amount of trauma and emergency medicine. Likewise, if Veteran Administration hospitals predominate, you may encounter many cases of emphysema, heart disease, and post-traumatic stress disorder. What you experience during your clinical rotations may greatly influence your choice of specialty.

Location

Location is another important consideration in deciding where to apply to medical school. Most premedical students, however, are so concerned about whether or not they'll be accepted by any school that they fail to consider if they'll be happy spending four years in that locale. Applicants tend to evaluate the medical schools lists based on reputation and prestige, rather than location and lifestyle. Don't make this mistake. The bottom line is that you should choose a school where you'll be happy and comfortable for four years. Medical school has enough stresses with the long hours and hard work. Don't complicate matters by choosing a school in a place where day-to-day living will be a chore.

Take the following location-related factors into account when making your choice:

Safety

Many medical centers are located in inner cities with associated high rates of crime. It's obviously an added stress to be in an area in which you feel unsafe. Some medical centers will provide escorts and other security services. Keep this in mind when you're visiting schools and inquire about safety issues. If you're really concerned, you can call the local police station and ask for crime statistics.

Housing

Remember that in addition to tuition, you'll also have to pay for housing, food, and transportation. Unfortunately, due to the location of some schools, nearby housing is either unsafe or unaffordable. In some inner-city schools, the majority of the student body resides in dormitories. These dorms are often expensive and have inadequate kitchen facilities. Nonetheless, they may be the best alternatives given the medical school's location.

In contrast, students who decide to attend equally good programs that are based in small towns or communities may be pleasantly surprised to find inexpensive housing near the school. Crime will not be as big a problem in these areas.

Transportation

This is obviously important as it pertains to housing and community shops. If there isn't housing near the medical center or its affiliated hospitals, then you'll need to have a car. If you don't, it is important that there be adequate public transportation, whether it be a bus line or subway system.

Proximity to Family and Friends

If there are special people in your life with whom you enjoy spending time, it may be important for you to live nearby. Medical school does not afford you much free time, and the time it takes to travel can easily make frequent or lengthy visits difficult.

Affiliation with an Undergraduate Institution

It's of great benefit to you if your medical school is part of a larger institution. Typically, the undergraduate institution allows the graduate students to enjoy the same privileges as the undergrads. This will include gym facilities, movies, libraries, clubs, and other organizations. In addition, if the institution has strong athletic teams, then graduate students have access to tickets and can enjoy this diversion from class work.

Student Body

Some schools are known for having a competitive atmosphere, in which students feel little camaraderie with one another. At other schools, a sense of "We're all in it together" prevails. Think about how much the attitude of other students matters to you. You can probably get a sense of a school's "flavor" by visiting schools or asking your premed advisor.

You may also want to find out about schools' gender and ethnic balances. While many schools strive to create a diverse student body, some are more diligent in their efforts than others. Check our school profiles in the appendix as well as your MSAR for the particulars.

Public versus Private Schools

For most students, the best chance for admission is at a public medical school located in their home state. This is because public medical schools give strong preference in admission to their own residents. In addition, some private schools give at least a little admissions preference to residents of the state in which they are located. As a result, according to AAMC statistics, 67.9 percent of the students who entered medical school in 1998 enrolled in schools in their home state. For this reason, you should take a close look at schools located in your home state as you consider schools to which you will apply.

While a few private schools give some preference to in-state applicants, most do not. Since the majority of applicants apply to at least some private schools the result is that most private schools receive large numbers of applications, sometimes over 10,000, for an entering class size of less than 200 students. Don't let these high numbers discourage you, though, because they are the result of multiple applications. In 1998, the average applicant applied to 11.7 schools. In other words, many of the same people apply to the same schools.

Unless you are an exceptionally strong candidate, your chances of gaining admission to a public school located outside your home state is relatively small, since most public schools give preference to in-state applicants, (some are prohibited from admitting nonresidents), the competition for admission to these schools as a nonresident is very keen. On the other hand, a few public schools will admit a reasonable number of nonresidents. In 1998, 16 public schools enrolled at least 15 percent nonresidents, and 10 enrolled 20 percent or more. If you are a very strong applicant and have an interest in a particular public school you should consult that school's admissions office for advice. The individual school entries in the MSAR describe the school's residency preferences and list the number of applicants and matriculants by residency status, this is an excellent place to start looking for schools that might consider you.

Early Decision Program (EDP)

A little more than half of the medical schools in the United States offer early decision programs. For an EDP, you file only one application to the one medical school you wish to attend. Most schools accept these special applications around mid-June. You are prohibited from applying to any other schools until the school has rendered a decision. If you're accepted, then you must attend. Most schools notify candidates by October 1.

Early decision programs are appropriate only for very competitive applicants who have a strong preference for one particular school. These applicants benefit in that they save considerable money on applications, interviews, and travel. In addition, they know where they're going to med school by October.

If you apply early decision but are not accepted, you'll be behind your peers in the application process. It's not a decision -- or a possible consequence -- to be taken lightly. You should definitely sit down with your premed advisor and decide if this option is appropriate for you.

Different But Equal: Osteopathic Physician

Doctor of Osteopathy degrees are virtually indistinguishable in practice from medical doctor degrees. D.O.'s work alongside M.D.'s or in their own practices. Like allopathic medical school, the osteopathic course of study spans four years: two years of basic education and two years of clinical rotations. After the degree is obtained, D.O.'s also complete residency. Osteopathic medicine more typically focuses on the whole person, leading D.O's to practice more often in primary care fields, such as internal medicine, family practice, and pediatrics. They are licensed to prescribe medicine, and they can admit patients to hospitals.

The difference between allopathic and osteopathic practice lies in focus and reputation. Osteopaths believe that a problem in one body part will cause distress in another. In addition, according to osteopathic medicine, the body can regulate and heal itself if conditions allow for it to do so. The biggest obstacle to this healing process is physical or emotional stress. To osteopaths, musculoskeletal health is key to preventing and overcoming illness and disease. By treating the musculoskeletal system, the disease cycle can be interrupted. Osteopathic medicine focuses on relaxation of muscles, tendons, and connective tissue.

Although osteopaths are highly regarded, especially as the United States focuses on primary health care needs, a D.O. degree may make it slightly more difficult to get a highly competitive residency. It is also more competitive to get into osteopathic schools: Fewer than one in five applicants are accepted.

The College Information Booklet gives a brief description of each of the 18 osteopathic medical colleges, including admissions criteria, minimum entrance requirements, supplementary application materials required, class size or enrollment, application deadlines, and tuition. A single copy costs $2.00 and may be ordered by sending a check or money order (including 20 percent for postage and handling) to:

AACOM
5550 Friendship Boulevard, Suite 310
Chevy Chase, MD 20815-7231.

Copyright © 1999 by Kaplan Educational Centers

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