let’s talk a little pre-med heresy
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Let’s Talk a Little Pre-Med Heresy . Keith Bradley, MD CEO/CMO National Alliance of Research Associates Programs (NARAP). Why Listen to this Guy?. West Point Notre Dame St. Clare’s Hospital (Hell’s Kitchen) Tulane University School of Medicine Medical College of Pennsylvania – EM - PowerPoint PPT PresentationTRANSCRIPT
Let’s Talk a Little Pre-Med Heresy
Keith Bradley, MDCEO/CMO
National Alliance of Research Associates Programs (NARAP)
Why Listen to this Guy?• West Point• Notre Dame• St. Clare’s Hospital (Hell’s Kitchen)• Tulane University School of Medicine• Medical College of Pennsylvania – EM• Norwalk Hospital• Lincoln Med and Mental Health Center (S. Bronx)• Bridgeport Hospital / Yale Emergency Medicine• St. Vincent’s Medical Center
Why Listen to this Guy?
• > 30 years as an academic emergency physician– hundreds of medical students and residents
• 7 years as a Health Professions Adviser– hundreds of pre-health professional students
• Research Associates (RA) Programs x 20 years– thousands of RAs
Agenda
• Help you see the process of preparing for a career in the health professions from a different perspective
• Recruit you – Line RA as a college undergrad– Chief RA as a college graduate
Heresies
• “Pre- Med”
• Why you go to medical school ?
• Research is very important, but …
• Significant clinical experience not optional
• Post-Bac is the preferable option
“Pre-Med”
• No “Pre- anything”
• Career begins with “I think I might want to be a ____.”– you want to be in control of how long or short
• Career Building ≠ just getting into medical school– medical school is a means not an end
Why Do You Go to Medical School?
• Do you want to go to medical school to become a physician?
• Go to medical school to become a resident;finish a residency to become a physician
• Only a physician can practice medicine• Trade School ≈ a medieval craft
– medical student = apprentice– resident = journeyman/woman
– physician = master craftsman/woman
Getting a Residency = Immediate Goal
• PG training for 3, 5, 7 years … to “forever”
• Competitive Residencies: A RODEO
– Anesthesiology
– Radiology
– Dermatology
– Emergency Medicine
– Orthopedics, Ophthalmology, Otolaryngology
Getting a Residency = Immediate Goal
• PG training for 3, 5, 7 years … to “forever”
• Competitive Residencies: A RODEO
• The Residency Dilemma
Residency Dilemma – 30% by ‘15AAMC Statement on the Physician Workforce
↓ Supply• aging work force
– retiring, dying, quitting early• working fewer hours … thank goodness
↑ Demand• more health care available• “Baby Boomers” getting older
Residency Dilemma – 30% by ‘15AAMC Statement on the Physician Workforce
Problem: 85,000 doctor shortfall by 2020
Solution: 30% increase in AAMC MS 1 slots by 2015
Residency Dilemma – 30% by ‘15Benchmark Year = 2002
• 16,000 MD graduates– last med school expansion in 1970’s
for physician shortage– end of federal money for med schools in 1980’s
for physician oversupply
• 24,000 PGY 1 positions– 15% USIMG and 15% FMG
Residency Dilemma – 30% by ‘15AAMC Statement on the Physician Workforce
Problem: 85,000 doctor shortfall by 2020
Solution: 30% increase in AAMC MS 1 slots by 2015
Issue: ask wrong question, get wrong answer
Only licensed residency grads practice medicine, not “doctors”
Residency Dilemma - Do the Math30% by ‘15
• ↑ 2002 AAMC slots by 30% ≈ 5,000 → 21K
• Osteopathic ≈ 1/5 of med school grads → 4 K
• Off-Shore ≈ 2.5 K
24 K – 27.5 K = - 3.5 K
… and no additional physicians!
Residency Dilemma - Consequences
• Competition for all residency programs
• Earlier decision on specialty of medicine
• Medical school > competitive, < collaborative
• Off-Shore option has very great risk
Selecting PGY1s
• MS1s MS4s are “smart enough”– able to compete on MCATs →– pass USMLE →– pass Specialty Boards = fully qualified physician
master craftsman/woman
Selecting PGY1s
• MS1s MS4s are “smart enough”
• How many times can you cut the cream?
• More important “other” criteria– hardest workers– nice, interesting, fun to teach– bring something extra to the table?
Research Is Very Important, But …
Bench
• traditional
• more available
• discernment
>>> research career
Clinical
• new
• less available
• career-building!
>>> clinical career
Significant clinical experience not optional• Why?
– discernment– qualification– development
• Shadowing is not significant– short time, little commitment, passive, available
• Working with patients is significant– long time, huge commitment, active– usually need “two letters” (e.g., MD, DO, RN, PA, PT)– except …
Getting Clinical Experience
RA Programs• Research Associates (RAs) enroll patients and
their visitors in clinical studies in the ED
Getting Clinical Experience
RA Programs• Research Associates (RAs) enroll patients and
their visitors in clinical studies in the ED– SOAP as a physician– Study Protocol as a RA
• One, 4-hour shift per week• Clinical + Research
National Alliance of Research Associates Programs
NARAP• growing consortium of hospitals around the
country
NARAP Member Institutions
CT Hartford Hospital/UConn
Lawrence & Memorial
St. Vincent’s
DC Georgetown
MA UMass
MO St. Louis UniversityNJ Hackensack U.
Medical Center
NY University of Rochester
NV University of Nevada
PA Jefferson
TX Seton / U Texas, Austin
VT UVM
WA Pullman Regional
National Alliance of Research Associates Programs
NARAP• growing consortium of hospitals around the country • utilizing the RA model • produce large scale, clinical studies over short time
frames with minimal cost• Tobacco Cessation study:
- > 19,000 participants, thousands of RAs- 4th largest prospective, interventional study ever in U.S.
Post-Bac is the Preferable Option
Guiding Concepts
• College ≠ getting into medical school
• MCATs takes 400 hours of prep for success
• Career-building, not just admissions
• Residency is the immediate goal
2nd semester, Junior Year
Best Semester of Your Life … Academically
• Upper level major courses
• Best electives
• Cost of Attendance ≈ $___ K per semester
• No second chance
• Ramping up
MCATA “Useless” Test, Except …
• material you will never use again
• format you will never endure again
• purpose you should never face again
MCATWhy spend 400 hours getting ready for MCATs?
• Get into medical school!
• Become an expert test-taker – USMLE – Specialty Boards
MCAT 400 Hour Prep Timeline
If ... Graduation --> Medical School
Activity No later than
matriculate August after graduation
interview 1st semester, Sr year AMCAS
1 July, after Jr year MCAT mid–
May, after Jr year
MCAT prep 2nd semester, Jr year
MCAT 400 Hour Prep Timeline
Medical School after GraduationIssues• January to mid-May ≈ 20 weeks
assume study 5 d/wk = 4 hours of study per day• Out of “best academic semester of your life,”
spend 4 hours/day cramming for a test that is only useful if you– get a competitive score for medical school admissions– learn to be an expert test-taker
MCAT 400 Hour Prep Timeline
Medical School after GraduationConsequences
• Not “the best academic semester of your life”• Not ramping up
• Not really do 400 hours prep → Oops on MCAT
→ forced post-bac year(s)
MCAT 400 Hour Prep Timeline
If ... Planned Post-Bac Year
Activity No later than
matriculate August after PB year
interview fall semester, PB year
AMCAS 1 July of PB year
MCAT September, Sr year
MCAT prep summer, Between Jr – Sr years
MCAT 400 Hour Prep Timeline
Planned Post-Bac Year
• MCAT prep from mid-May to mid-September
• ≈ 20 weeks, 5 days / week → 4 hours per day
MCAT 400 Hour Prep Timeline
Planned Post-Bac YearAdvantages• 2nd semester, Junior =“best semester of your life”
– better grades, better ramping up• 1 “bad” summer
– has to be done sometime!– still time for work, maybe even a little fun
• Oops on MCAT,time to take again and stay on schedule
MCAT 400 Hour Prep Timeline
Planned Post-Bac YearAdvantages• Post-bac year ≠ “year-off,” = YEAR-ON
• Apply with
– optimal grades
– MCATs
– accomplishments from YEAR ON
MCAT 400 Hour Prep Timeline
If ... Planned Post-Bac YearAdvantages• Post-bac year ≠ “year-off,” = YEAR-ON
• Apply with
– optimal grades
– MCATs
– accomplishments from a YEAR ON
Post-Bac Year On
• Do what you may never have the chance to do again
• Career-Build = Clinical Research → Residency• Take 1st year of med school before med school
– be an MS1 with time → more clinical research!• Make money
– knock down undergraduate debt• Have fun!
Post-Bac Year OnNARAP Chief Research Associate
• Middle managers of RA Programs at NARAP affiliates
Post-Bac Year On
Post-Bac Year OnNARAP Chief Research Associate
• Middle managers of RA Programs at NARAP affiliates• Involved in all aspects of clinical research from initial
concept through publication• Networking with top clinical researchers at
residency programs• Residency application:
– published author in a clinical journal– start/help manage a RA program to get their research
done
NARAP RA and Chief RA
www.theNARAP.org