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Thinking about Med School? Perspectives of a Waterloo

GradRobert MorelandJan 2010

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Waterloo Grad (2009)

BSc Biomedical Science, minor biology

BA Joint Honours Psychology and Economics, minor management studies

First Year Medical Student at Schulich Medical School

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Professional Computer Programmer

Medical Imaging Researcher

Interviewed at four of the medical schools in Ontario, accepted at two, waitlisted at one

Normal human being

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The advantages and disadvantages of becoming a doctor

The process to become a doctor in Canada

Medical school application process in Ontario

Tactics for Improving your application

What it’s like to be a medical student

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Why Become a Doctor?PROS

Unique ability to help people

Doctor-Patient Relationship

Remuneration (after residency)

Leadership responsibility

Flexibility (potentially)

Intellectual challenge

Huge demand

Ability to have an impact

Unique research opportunities

Unique position in society

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Why Not Become a Doctor?CONS

Extremely High Cost

Time spent training (school + residency + fellowship)

Extended Work Hours/Usual Hours

High Level of Responsibility

“Compassion fatigue”/Stress/Burnout

Non-medical obligations

Difficulty finding balance between career and family

Constant Uncertainty

Constant Skill Upgrading

Bad Outcomes will occur

Often unable to assist

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Just a Few Possibilities in the World of Health Care

Program Years of Study Type of Degree

Dentistry 8+years D.D.M.

Medicine 10 + years M.D.

Nursing 4 + years Undergraduate

Midwifery 4 years Undergraduate

Physiotherapy 2 years Masters

Dietician 1 year Masters/Internship

Social Work 4 years Undergraduate

Occupational Therapy

2 years Masters

Physician Assistant

2 years Undergraduate*(*Apply after 2nd year)

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Forget everything you have ever seen on television about medicine

Read as much as you can about the field

Talk/Shadow actual doctors

Volunteer in Health Care

Seek help from your career centre

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Step 1) ◦ Get into a recognized and progress along an

university undergraduate degree program - Usually a honours degree program

◦ (takes 3-4 Years)

Students may also take additional graduate training prior to applying into medical school

(takes an additional 2-7 Years)

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Step 2) ◦ Apply and get accepted into a recognized medical

school program

Most students start applying to medical school in the fall of their 4th year

Interviews are held in Feb/Mar of the following Winter

Notices of acceptance begin in mid May, and continue through the summer

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Step 3) ◦ Complete medical school◦ (takes 3 or more usually 4 Years)

Medical school is divided into two distinct phases:

◦ First 1.5-2 years are called preclerkship and are spent primarily in lecture based learning, small group problem solving, and laboratory work related to medical science

◦ Second 1.5-2 years are spent in clerkship where medical students rotate around the hospital directly involved in patient care. This is the beginning of clinical training

Near the end of clerkship, students take electives, often in different hospitals/clinics across the country, to gain experience and be noticed by specialists in areas that interest them

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Step 4) ◦ Apply under the Canadian Resident Matching

Service (CaRMS) and get into a recognized residency program

◦ (2-6+ Years)

This is the point at which one decides on what type of doctor you want to be (i.e. what specialization you will follow) and attempt to be accepted into the corresponding training program

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CaRMS matching is similar to the medical school admissions process - It’s competitive, exhausting, and requires considerable work. Results of the matching are also legally binding

You may not actually get the specialization you want and this is a risk in entering the medical school system. However most people do match into a desired field

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For many residency programs the experience is probably the most intense period of work/learning imaginable

Extended work weeks (50-80+ hour weeks) with rotating on call shifts (1 in 3 or 4) is common

Residents advance over time increasing their degree of responsibility and autonomy as they gain experience and skill

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Step 5) Optional◦ Complete a Fellowship for further specialized

training◦ (1-2 Years)

Fellowships are become increasingly common in medicine as technology advances it takes us longer to learn the highly advanced skills required to most effective

Graduate degrees are also often needed to ultimately work at academic centres

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Total Time 8 – 15(or more) Years

And then there is still setting up one’s practice and paying off considerable loans

“Becoming a doctor is not a sprint, it is a marathon. Get a helmet and enjoy the ride”

Dr. Chan

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Questions so far?

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Every school is different, and the various regulations and requirements change frequently and often surprisingly

Never the less there are several generally recognized objectives in order to become a competitive applicant

Currently about 1 in 6 people who apply in a given year will be accepted

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1. High Grade Point Average (GPA) in a qualified program

2. High and Balanced Medical College Admission Test Score (MCAT)

3. High Quality Essay/Personal Statement

4. Strong Letters of References

5. Significant and relevant Extracurricular/Volunteer activities

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There are two parts to this requirement:

•The applicant must be taking a qualified program

•The applicant must achieve a high GPA

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Key Point:In Canada virtually all honours academic programs

are considered equal when applying medical school

This is an often ignored point and results in students taking overly difficult programs/courses to impress that however actually detract, rather than enhance, a person’s application

It also means students are free to take the program that best suits their interests and talents

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Caveats:◦ There some prerequisites required by some (but not

all) medical schools before an application can be considered

Regardless of program students must take these courses, which generally cover a mix of humanities and science

◦ The MCAT exam requires an understand of basic general/organic chemistry, physics, and biology. Taking associated courses is one way, but not the only way, to master this material

◦ Schools do expect consistency and appropriate progression during one’s degree

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The second part of this object is obtaining a high enough GPA to be competitive

Key Point:GPA is not the same thing as overall average. Instead

it is far less forgiving of low grades and thus a high GPA indicates not only good performance, but also consistently good performance

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Failure to understand how to calculate GPA and what affects it is probably the single commonest deficit in knowledge in most people applying

Key Point:◦ Low GPA, often due to failure to understand how

GPA is computed, is the single biggest reason people are unable to get interviews at medical school

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How to Calculate GPA

OMSAS 2010 DataMost schools (virtually all) fall under category 3Overall: aim for 85+ in each course

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Person takes 5 courses and gets the following results:

AFM 131 Management 85BIOL 130 Intro Cell Biology 85CHEM 120 Chem Prop of Matter 92ECON 101 Intro to Microeconomics 87 GER 101Elementary German I 86

(3.9+3.9+4.0+3.9+3.9)/5= 3.92

This is a high competitive GPA for the term

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Person takes 5 courses and gets the following results:

AFM 131 Management 83BIOL 130 Intro Cell Biology 84CHEM 120 Chem Prop of Matter 89ECON 101 Intro to Microeconomics 84 GER 101Elementary German I 82

(3.7+3.7+3.9+3.7+3.7)/5= 3.74

Traditionally a not a competitive score at most of the schools in Ontario. Yet in terms of average it is almost the same as example 1.

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Person takes 5 courses and gets the following results:

AFM 131 Management 99BIOL 130 Intro Cell Biology 100CHEM 120 Chem Prop of Matter 98ECON 101 Intro to Microeconomics 97GER 101Elementary German I 76

(4.0+4.0+4.0+4.0+3.3)/5= 3.8

Traditionally an only weakly competitive score at most of the schools in Ontario, despite the very high average (94%).

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• Every Ontario school uses the same conversion table, but they calculate GPA score differently. Many give you a break in certain ways:

• Western: best two (best 5.0 counted each year)

• Ottawa: weighted 3 year• NOSM & Mac: cumulative • Queen’s: most recent two (includes

summers)• UofT: can drop 1 full-year course every year

(if you’ve done a full course load every year)

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Since GPA measures consistently as well as average it is advisable to aim for a 85% or higher in every class you take.

If achieved this would make a candidate GPA wise highly competitive at every school in Ontario

Unfortunately this sometimes introduces conflicts between learning and getting into medical school

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Since achieving a high GPA is often a function of interest in the material, it is advisable to be in a program that interests you highly

Many (but not all) schools do not count courses in the summer. If you must take a course you will do poorly in, consider taking it then.

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Sometimes dropping a course is advisable to protect your overall GPA***

Since many schools punish you in some fashion for dropping a course, some students take an extra course easy course in the fall to provide flexibility

*** Beware of the effect of course dropping with respect to Toronto’s policies.

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The MCAT is a four part test designed to test various skills relevant to the field of medicine:

◦ Verbal Reasoning (VR)◦ Physical Sciences (PR)◦ Writing Section (WS)◦ Biological Science (BS)

All parts of the test are written in a set sequence on a single day. There are many offerings of this test spread out over the year

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On the MCAT BS, VR, and PS are scored on a z normalized scale with values ranging between (worst)1-15(best).

The WS section is scored on a letter scale (worst)J to T(best)

Some schools use strict MCAT cut offs (Western, Queens) and some use it as a part of the scoring (Mac, Western, Toronto )

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The MCAT is principally a thinking test rather than a science test

There is virtually no memorization style questions. They are testing logic and reading comprehension

One half of the test (VR and WS) are entirely non-science. These section traditionally are the main non-GPA barriers in Ontario to interviews

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Key Point:Do practise tests. Do them under practise conditions

and take them seriously

Study early and do not ignore material you are weaker on (surprisingly happens a lot). You can study and improve VR and WS scores.

Key Point:If at all possible, give yourself enough time to repeat

the test if necessary to achieve a desired score

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There is considerable debate about the types of volunteer experience that premeds to engage

Volunteer work is not just another checkbox that needs to be filled in on your application

The question to consider is why adcoms are interested in volunteer experience in the first place

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Medical schools want people passionate about medicine in their programs

Key Point

People that are truly passionate about something do not wait to start doing it

Therefore if you are interested in medicine you will on your own already start volunteering in a medically related area – not because you have to, but because you want to

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So this is a way to start your medical training right now. Find your passion and go with it!

Possible areas:◦ Medically related research◦ Hospital/clinic volunteer◦ Community outreach◦ Environmental issues◦ And the list goes on and on

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Once again, do what you like! No “perfect formula” for Extra-Curriculars Try lots of different things◦ You can discover what you enjoy and want to

concentrate on Keep track of:◦ What you did◦ And for whom (‘Verifiers’)

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Three schools have specific supplement materials they wish you to complete for your application

1.Toronto: Personal Statement

2.NOSM: Mini-essay response to several topics

3.Mac: Short essay responses to five questions

All of these materials are incredibly important and often ignored

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You will have spent 1000s of hours working on your GPA, 100s of hours on your MCAT prep, 100s more on your volunteer/Extra curricular activities.

Your written responses will be worth a similar wait pre interview to your GPA

Key point:Take the time to do the essays/personal statements right

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Personal statements are difficult because you are under pressure to distinguish yourself and they force you to articulate your reasons for medicine

Take the time to develop a proper theme for your work

Tell a story where you can. Do not speak in generalities when an example is possible.

Always get your materials proof read by someone skilled in English grammar

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Key point:

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This framework recognizes the 7 primary skills a successful physician should have

It permeates most aspects of the application process, including critically the interview themselves and often aspects of personal statements and essay question responses

You need to be aware of the roles and what aspects of your experience demonstrate you proficiency in these areas

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This is a url to a master document where they are all described

◦ http://meds.queensu.ca/medicine/obgyn/pdf/CanMEDS2005.booklet.pdf

No one will be perfect in all areas of the CaRMS roles but prepared applicants will have experience in many, and understand them all