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Life Before Med School
Kendra Campbell -- The pre-med curriculum has been at the forefront of academic medicine discussions for years now, and many people have written about proposed changes to the current system. An article that recently appeared in the journal, Academic Medicine, discussed how the primary purpose of pre-medical education is to provide students with a broad-based education that prepares them for medical school and for becoming a physician. The author purports, however, that we’ve not really succeeded in this endeavor. Instead, the pre-med curriculum prepares students for the med school admissions test, and doesn’t always succeed in creating a well-rounded student, armed with everything that is needed to become a competent, caring physician.
In addition to the pre-med curriculum, many people have been discussing the other experiences necessary for preparing for med school, such as shadowing physicians and doing volunteer work. A few days ago, I received an email from a pre-med student asking about ways to “fluff” their resume with additional activities that might make them a better candidate for acceptance into med school. This really got me thinking about how the current pre-med experience is set up.
The “traditional” route into med school in the U.S. involves graduating from high school at around 18, spending about 4 years in undergrad to obtain a bachelors degree, and then applying to med school after graduation. During undergrad, students are supposed to take all of their required pre-med courses, and also gain experience in medicine.
I’ve recently been wondering if this “traditional” path might be flawed in one important way. If a student continues straight through school, with no breaks, they will eventually graduate from medical school, finish their residency, and make it to the “real world” where they can practice medicine and make a reasonable living. So, by the time they enter the work force, they’ve had little or no actual work experience. It’s possible that they had a part-time job, or even a few full-time jobs, but the majority of “traditional” students have never lived without student loans or parental financial support. Many of them may have never lived away (or far) from home.
There are plenty of “non-traditional” students, myself included. But the current system isn’t set up to encourage this path. I’ve thought a lot about the path I took to enter medicine. Do I think I made the right decision? Absolutely. I can’t emphasize enough how having experiences outside of school, and outside of medicine, have made me better prepared for handling med school, and I think eventually for becoming a competent, caring physician. I also know many other “non-traditional” students who feel exactly as I do. They believe that their path to becoming a doctor has better prepared them, and that they have an advantage over “traditional” students who never left school long enough to experience the world.
So, the question arises, “why do we encourage the current route to becoming a doctor?” What are the “traditional” students losing along the way, and can they ever make up for that lost time? What do you think it means to have a life before med school?
May 6, 2008 in Kendra Campbell | Permalink
Comments
Hi Kendra-
I couldn't agree with you more! I am on the path to med school at the ripe old age of 34!!! Everytime i have second thoughts about putting myself through the pre-med curriculum at this point in my life, I also get reminded by friends and family that I actually have an avantage by being a non-trad! For one thing, I did the whole Office Space thing, worked for some top companies in the industry I was in Sales/Marketing, lived in the city, partied my butt off with friends, traveled, and genuinely lived life. From that, I have gained so much knowledge about the real world that many traditional students may never experience. Not to fault a traditional student by any means, I commend them for their dedication and discipline that I don't know if I would have had at age 21/22! However, I do definitely feel that while i may be starting my dream of becoming physician later than many, I also do beleive I have some unique life experiences too bring to the table that can only help serve my patients down the road. I think having this perspective and insight also can allow the non-trad's to see what may not be working so well with the current system and help to change the way conventional medicine is practiced!
Anyway, thanks for the great blog and good luck to you!!!
Posted by: Cory | May 6, 2008 4:03:53 PM
Um, the system IS changing. Some schools DO recognize that students need some life-experience before committing themselves to medicine. The traditional route doesn't work that well anymore. I know my med school class is full of non-trad students: married w/kids, single parents, artists, teachers, former business owners etc. Of course there are some of the traditional ones there too, but almost everyone took at LEAST a year off. It is pretty impossible to get into a really good school unless you do. Granted some of us were told to not even bother by some admissions officials, but here I am in a much much better school than those that rejected me. So don't get so worked up about it.
Posted by: Sheila | May 6, 2008 6:04:10 PM
I totally agree. I am a first year medical student who took 3 years off after undergrad. There is a huge difference in stress level, professionalism, and maturity between those who took time off and those who did not. I think for the sake of the profession time off in the work force should be a requirement!
Posted by: Julia | May 6, 2008 6:09:01 PM
Bravo! I didn't figure out what I wanted to do "when I grew up" until after age 30. It is tough to follow an independent path. Fortunately, my top choice schools are okay with non-traditional students. I actually have a better history of volunteering and shadowing because I have had more time to volunteer than someone half my age who is following the traditional path. I have already proved over my life that I'm interested in helping others. Given the length of training that some specialties require, youth is still important, but there is plenty of room for those of us who like to take the road less traveled.
Posted by: Cory | May 6, 2008 8:29:57 PM
Very interesting post
Posted by: cord blood bank | May 7, 2008 7:22:53 AM
As a traditional student entering med school next year, I agree that taking a year off or a couple is beneficial and sometimes the only route for some people.
HOWEVER, this is not something that can be generalized!!!
For me, my life has been filled with volunteer and clinical experiences. I know that this is what I want. I think it would be an increidlby SELFISH to know what I want to do (be a DOCTOR) but to take a couple of years off so that I can "live life"
The thing is, I am 21 and what I've learned is that you cannot plan life. You don't know what will happen, aka getting sick (i have seen a lot of twenty year olds in hospitals), finances, family deaths, marriage, kids etc.
Therefore, I think for some people taking time off is THEIR ONLY option or they just don't really know what they want to do with their life but for those who KNOW and who have TAKEN THE TIME to figure this out you CANNOT GENERALIZE that taking time off is good.
EVERY INDIVIDUAL is so particular that each person has to make the right decision for themselves.
Posted by: MS 1 next year | May 7, 2008 9:09:12 AM
In Ireland it is totally different. The vast majority of medical students here have come straight from school and into medicine at the age of 17/18/19. I'm 20 and am just finishing third year in medicine and, to be honest, I think it's brilliant that I'm going to able to finish medicine so young. It'll give me so much time to decide what specialty I want to do and to train in that specialty. And it will allow me to all that before I settle down and have a family. What a lot of people do here is a take a year out and go travelling, maybe doing some work in other countries or doing some volunteering, after the intern year when they have some money in their pockets! It has been recognised that there is a need for postgraduate places in medicine too and so new postgraduate courses have opened or are about to open in some of the universities here- the requirement for this is simply to have an undergradutate degree at 2:1 or higher and then selection is made on the basis of your score on the GAMSAT. Currently to get into the undergraduate course, all that matters is your points on the Leaving Certificate exams in 6th year in school, although there is talk of incorporating a GAMSAT score into this as well. So there's no interviews and no application forms to fluff up!! Brilliant really I think!
Posted by: Melissa | May 7, 2008 9:30:56 AM
The system is even worse over here in the U.K where we have to decide really at the age of 17 to really 'go for it' and put in an application for medicine, with the necessary stellar grades and medical experience. Now most 17 year olds I know are still discovering themselves, the concept of independence, alcohol, house parties, so they types of people who are motivated/encouraged to apply from a narrow spectrum- middle-class, probably from a medical background, pushy parents, or in my case insane idealism/denial. I don't know, I spent the majority of my teenage years, up until 16, rebelling determined to go to art school, and then did a semi U-turn towards medicine two weeks before I started my A-Levels (equivalent to APs I think). But then I am more used to most at short start and stops in my life, but yes, my point is that this 'Channel tunnel' training scheme, focused on exams, competition, relatively quick reward system encourages a almost militaristic approach, and narrows the range of personal experience that a person can achieve.
But I guess it also depends on what your goals are- if you just want the medical degree to enter into a prestigious career, then the current systems great for you. However, if you really want to be a good doctor, know yourself, how the human body really works, and the many different sides to life, then this narrow tunnel often seems claustrophobic.
Posted by: E | May 7, 2008 11:02:41 AM
As another non-trad. student who started at 31, I have to say I don't regret my journey getting into med school. Do I wish I'd gotten into med school in Canada? Of course. And while I entertain thoughts about what it might have been like to start as a youngster, I have to say that the personal journey I've been on that has led me here has been worth it. I'm a very different person now that I was when I first started applying, and I like this person better than that one.
But as much as people say, "medical schools are realizing things need to change...," it's all wishfull thinking tripe. Medical school admission criteria haven't changed very much at all. And I suspect that admissions committees had no idea what to do with me, a professional musician with a biology degree, who showed no intention of giving up his art while in med school.
If you want to get into medical school, you're still going to have to jump through the hoops, and present yourself as the stereotypical applicant.
Posted by: Beach Bum | May 7, 2008 12:19:41 PM
Love this! It makes a great point, and sorry to all you "traditional students"...most of them lack maturity and are somewhat one sided. Ask them what they want out of life or what they are passionate about...the answer="I want to be a doctor." How dull and boring. Anything else. "No. I never thought about it!" Wow, that says a lot about one's life experiences.
Posted by: Sayeh | May 7, 2008 1:21:59 PM
I have completed 3rd year medicine in New Zealand. Here we have a similar system as in Ireland. We go to univeristy straight from school at age 17/18/19 and complete a one year general 'health sciences course'. The health sciences course is targeted for students wanting to do medicine, dentistry, pharmacy and physiotherapy and if you do not get a place in any of those courses it can easily be transferred to almost any science degree. This first year health sciences course is extremely competetive and you have to sit UMAT (a test designed to assess personality traits such as empathy and logic). Entry into medicine is based entirely on your grades and UMAT score.
However in NZ people are starting to favour graduate entry programs and more and more graduate student places are being set aside for 'mature' students. However the benefits of this are unclear to me as often, 95% of the graduates did the health sciences course.... didnt make it, took 2 extra years to complete a degree and applied again. So they are often only a year or two older than us 'traditional entry' students.
I have decided that in order to set myself apart from other students I need more on my CV as I am never going to be in the top 2% (distinction students) and the rest of us all get the same marks (pass). So I have taken a year off after 3rd year med and am now 4 months into an honours year that my university offers. It involves doing self motivated research and lab work for a year and writing a thesis. Completely unstructured compared to med school and I hope it gives me some invaluable experiences. So far its working.
Posted by: Yoska | May 7, 2008 2:40:03 PM
I think it's actually much harder to get through medical school as a nontraditional student, particularly if you have a family. Medical school and residency require that you sacrifice so much of your life in order to just get through, and it's much more difficult to do this if you're used to having a certain amount of balance in your life. I also have a number of friends in med school who are women in their 30s and now really struggling to balance the demands of med school and residency with wanting to have children or to spend more time with their children. Many of us wish we had thought about these issues more before deciding to go to medical school.
Posted by: R. | May 13, 2008 3:10:42 PM
I am 22 and just recently changed my major from international business to human physiology, like most business students i sat in class wondering why i was there. Then after much thought i really tried to figure out not just what i was good at, but what was my passion. I've been in sales my whole life and while i can make a decent living at it i don't enjoy it. Then i realized that i love the human body and medicine as a whole and look forward to going into surgery. I agree that for most kids fresh out of high school don't really know why they're doing much of anything in college. Even though i know that since i am starting so late in school and will be in med school until i'm 30 because of it, i wouldn't change my life for anything. Knowing that a good Doctor will be in med-school for the better part of a decade, especially if you want to have a specialty, its good to make sure you know why your there. Not just because mommy and daddy tell you to get a good education. I am and will be paying for all schooling and have been living on my own for the past 4 years. I feel real world experience is essential to have the drive, initiative, and motivation to get through such a rigorous program and do it with a smile on your face.
Posted by: Brandon | May 13, 2008 3:15:09 PM
Sayeh, I couldn't disagree more. I know nontraditional students who are immature, and traditional ones who are very mature.
I think you all will find that the final year of med school and residency is a great equalizer. Once training is finished, we end up with similar competence, levels of experience, maturity, etc.
There is no one path. Each finds the best for themself, so don't bash those that take the traditional path.
Another point is that in many cases, government subsidizes much of the education. It is of greater benefit to society, one could argue, to invest in someone who can contribute 30-40 years of patient care after graduation vs. someone who will retire in only 20 years.
Posted by: | May 13, 2008 3:15:35 PM
Brandon,
That tired, "traditional" argument that the med school slots should all go to the youngest students based on expected productive years just proves your immature perspective. By your logic, you'll be counseling patients in the future that their life is over after 30 and they should just finish dying already and get outta the way. What have you done so far to prove your presumed value to society?!
I'm an elder student in my med school class. It wouldn't be hard to show that the taxes I've ALREADY paid and the contributions I've ALREADY made to society in my first career EARNED my spot in class. All you have is a willingness to sign an IOU for services to be delivered later.
Posted by: Senior | May 13, 2008 3:52:22 PM
My school has already moved toward accepting "non-traditional" applicants. 70% of my class took time off between college and medical school, and it's very clear that they were selecting for balanced applicants both in academic and non-medical respects. However, having had such diverse interests and rich experiences in the years leading up to medical school has made it really difficult for me to accept that medicine should now be the only thing in my life. I feel really suffocated by the training and miss the pre-med days when I felt like there was more to my identity than "medical student." I wish we could incorporate a little balance into the medical training itself, because really what is the point of accepting such great well-rounded people if all you intend to do is beat all the individuality out of them and force them into the medical student mold?
Posted by: AM | May 13, 2008 4:38:09 PM
First of all, with a looming physician shortage, I think its completely legitimate to consider how many years an applicant will be able to practice. A large amount of resources are expended educating a medical student and I think it's necessary to evaluate applicants based on how much service they will provide to patients throughout their career. Would you be comfortable offering admission to a student who had no intention of ever practicing as a physician? Then why should you consider whether they will practice for 40 years or just 10?
Obviously, the length of potential service time should be weighed against the quality of service provided. If non-trads are able to practice more effectively than traditional students, then they, in turn, should be offered advantages in the admissions process. That they are offered an advantage is clearly the case, consider that the head of the AAMC has repeatedly said that he believs non-traditional students make better doctors and that med schools should strive to admit them. However, I think you'd be hard-pressed to find any study proving non-trads actually made better physicians, nor do I think that any such causal relationship exists.
But, let's be honest here: the opinions presented on this page are just the authors' biases. I doubt there's any real difference in the quality of care or relationships which non-trads vs. traditional students provide to patients. A lot of this is just sour-grapes about perceived discrimination against older applicants.
Posted by: Brian | May 13, 2008 4:48:52 PM
How about these fast-track baby docs programs? I have kids in my class who are 20 years old. I can't imagine they will be prepared to care for people on a human level at age 22 with an MD! They can barely do a breast exam without giggling. One kid in my class is 19!
Posted by: Zelda | May 14, 2008 5:14:12 AM
The whole premise of this discussion is quite interesting. I believe that the current system is somewhat flawed but to spend years after college working or volunteering may not necessarily prepare you for med school. I agree with the person who said that each person needs to find their own path. Baby boomers may be more experienced in handling situations in a mature manner and there are lots of young adults who have experienced life far differently than their peers (i.e. the partying and craziness). Either group would do a good job and one definitely has more years of service ahead than the other.
Personally, I just want to be sure that practicing medicine is what I desire do with my life not just because I've always admired docs since i was a kid. It doesn't help that I'm passing my science classes with Bs and got my first C in Microbiology this past Spring. If you have any thoughts on how to decide if med is what you want please post!
Thanks
Posted by: CO | May 14, 2008 6:55:33 AM
I'm not sure, Kendra, that you are completely correct anymore in your assumption that traditional students are more easily accepted. I am going through the application and admissions process right now (I am a 21-year old Indian-origin graduating Biomedical Engineer, so I would gather I am pretty traditional in your definition) and I've noticed that all of the medical schools I've applied to have responded very negatively to my age and major.
For most of these medical school, the average age of accepted students is 25 or so. Additionally, my advisors and the medical school's advisors have all told me that "You have an amazing application, but if you don't get in, it would be because of your age and inexperience." My age, of course, I cannot deny; however, I feel that assuming all younger students do not have sufficient experience and are immature is in itself a naive thought.
I feel that my experience as a Biomedical Engineer (BMEN) has trained me very well for life as a physician. I am sure that many people will argue that I am not well rounded; but even through Biomedical Engineering, I have maintained my hobby of playing piano (I am working on a minor in Piano), have taken extensive English classes out of pure interest, and have volunteered in so many hospitals and summer camps that I can't even count them on both hands. Additionally, my experience as a BMEN student itself has added a lot towards becoming a physician: the extensive anatomy/physiology cadaver labs, one-year research projects (mine was in a medical field), one-year engineering-volunteer projects, plus the regular pre-med curriculum.
So after all of this "non-experience," should I be penalized for knowing what I've wanted to do for a long time? Am I supposed to wander around doing jobs that I don't want just to fulfill some other requirement that I need "worldly experience"? I agree with you that some traditional students may not be ready for medical school, but making such a generalization is very unfair. My 28-year old friend got into medical school last year, and he admits that he's the biggest goof-off ever and feels that I would make an excellent doctor compared to him, but I suppose I should work a few years to prove that point?
Overall, Kendra, I disagree with your point and in fact am slightly offended by it.
-Karthik
Posted by: Karthik | May 14, 2008 7:47:35 AM
Thanks, Kendra for a thought-provoking and interesting post. I am in two minds about this issue. Currently I am a final year (6th year) medicial student in South Africa. On the one hand, when I think back to how I was in my first two years, it would probably have been to my advantage to be more mature/experienced; on the other hand, I am really impatient to finish studying, and start WORKING - I can't imagine having to study any longer/finish later than I already am.
I actually took a year out after school and in that year decided to study medicine. If I had gone straight into medicine from high school I would probably have had a lot of doubts, and wondered about what the other options would have been like. Having explored all the options in my "year out" I could make a relatively informed decision, and enter medical school with gusto.
For me it was the right decision to take that year out but I know many people in my class (my clinical partner, for example) who have always known that they want to study medicine, and now do it with passion and diligence. And for them, it was the right decision too.
I think that if you are not sure about what to do after high school, or feel pushed into a certain direction by society/parents/school's expectations of you, then taking a year/two out is the best possible thing you can do; if you have always had a passion for medicine and know it's what you want to do then there's no better thing to do than to go the "traditional" route.
Each to his own! Thanks again for a great post.
Posted by: Linda | May 14, 2008 10:01:00 AM
Coming from an undergrad medical school I feel that although many of us start off more immature and less worldly, eventually we all end up at the same point on graduation day. I think it's just age. 20yrs and 25yrs of age is a significant difference, but after 25 I think any difference in age is less significant in influencing how well we will turn out as doctors.
While we're on the issue of young, immature doctors, I'm sure that at the same time, there are many young, inexperienced people in positions of responsibility and leadership which demand emotional maturity, an ability to handle stress etc etc, much like a doctor. With the appropriate training, I'm sure that the younger traditional students will do as well as the older non-trads.
I also find it funny that you think that a medical career is one's final stepping stone. Don't forget there are many doctors out there who go on to become prominent administrators, researchers, politicians and businessmen, just as such individuals have made mid-career changes to become doctors. Just as your past experiences will serve you well as a doctor, life skills learnt in medicine would do very well in other professions.
Overall, I disagree with your opinion that non-trads are necessarily better-prepared for becoming a doctor. I think that as a non-trad, you are more self-assured, and perhaps more emotionally mature, but I think that medical education constantly throws people into new and unfamiliar situations, and it is here that everyone grows up and is molded into a competent doctor. You may think that as a non-trad you are more prepared for med school, but I believe that whether or not you are prepared for med school is less important than whether or not you are prepared to practise.
Posted by: HW | May 14, 2008 10:27:34 AM
The medical degree course is 5 years long, and allows the student to become more mature, a process that is teamed with increasing age. The preparation for the job, is surely the university's responsibility and one in which many have acted upon by introducing clinical integration as early as second year. This is, I believe, the best way to learn as you are still a student, able to make mistakes and to learn from them, without any negative effects. This is the most relevant work experience for a future doctor. If a person is not sure on the medical career path, then spending more time to think about it may be beneficial. I feel though that the length of the degree allows for life lessons as well as learning the profession, so once graduated, they are as competent as any F1 can ever be.
Posted by: LH | May 14, 2008 11:11:18 AM
I started med school at 37. Was I limited in the application process b/c of my age? Absolutely. Do I regret it? No, I found a great school that actually appreciates non-traditional students and the diversity of my classmates continually astounds me.
Generally speaking (and this is general as every student is different), the tradional students excel at the pre-clinical years and the non-traditionals excel
at the clinical years. It has nothing to do with intelligence or ambition. The simple fact is that the traditionals are closer to the undergrad years and more of the pre-clinical material is a review while the non-traditionals excel in areas of interpersonal skills/professionalism. Everyone is equal with regards to a lack of personal experience in suturing etc. but the non-traditionals have a great comfort level talking with patients and a different work ethic from a prior history of past employment. I found that patients responded to me differently and opened up sooner and faster than with much younger peers.
There is no right or wrong path. Everyone has to make the individual decision of WHEN is the best time for them to enter medicine. I will be a better MD because I chose to do other things first. Ironically, I think that statistically my career duration will be equal to the average today as many people who go straight through often have a change of heart or career down the line.
Posted by: Lou | May 14, 2008 3:41:03 PM
I will graduate medical school next year, when I'm 25. How exactly does being older when you enter medicine make you a better doctor?
I went to one of those 7-yr accelerated undergrad/ MD programs and I can say that I've had no handicap due to my age. I used the time I saved to go abroad and "live in the real world." I've worked part-time and full-time, traveled, and partied (although not as much as my friends who went into business or law). I have friends in my program who skipped grades and did not take time off. They will be doctors at 22 and 23.
It seems counterintuitive that taking significant time off will give you a better work ethic or make you more compassionate with patients. Those who really want to become doctors work hard from the beginning, manage their time well, and make some sacrifices along the way... all to get out there and start practicing! On the other hand, older applicants may not have the determination and drive to go straight through. Also, some older students have family/ work responsibilities that detract from the time they can spend on med school.
While I am living on loans and have yet to pay taxes, I feel that my compassion for patients would be the same no matter what my age. And, my patients open up to me very well -- perhaps they find my naivete and youthful passion endearing. Although some people may take longer to realize their calling in life, those who have known all along they wanted medicine are not at a loss. But, I have to hand it to you if you able to make such a life changing decision at a that age.
Posted by: Stargazer | May 14, 2008 7:25:56 PM
