MCW

Making the final decision

Amanda Xi

As some of you may have already guessed, after finally stepping out of the waitlist limbo, I had a question to answer: which medical school was I going to call home for the next four years?

After obtaining my first acceptance from Wayne, I decided that it was probably where I would end up, regardless of whether or not I got off of the other waitlists. The factors that led me to this conclusion were primarily:
  1. solid history of pumping out medical doctors [Wayne has been doing it since the 19th century…]
  2. location [I wanted to be close to home, or at least reside in the midwest to ensure I had my support network]
  3. cost [let’s be honest here, the economy sucks and we can’t say that we know if physician salaries will continue to be as “cushy” as they are now]
In the end, even though I loved MCW [and my best friend was conveniently moving to Milwaukee!], I could not justify the cost of tuition [~$44k — making it about $15k more per year] and moving expenses when Wayne’s program would most likely get me where I wanted to be for $60k less of debt. This same cost argument was applied to OUWB at the time, but with the added fact that OUWB didn’t have a reputation at all. At that point, I had already thrown NYMC out the window completely — the lure of being close to the city didn’t make up for the fact that it was kind of in the middle of nowhere [oh, and that scary cab driver that picked up another guy to make double the $$$ and didn’t have a GPS didn’t really turn me on to Valhalla… thank god I made it safely to NYMC the night before the interview!].
Come May 15th, I was sitting pretty comfortably on the idea that I was attending Wayne State University School of Medicine and would soon call the streets of Detroit my second home. I even changed my Facebook profile information to reflect the decision!
Around that time, I was still checking up on the School-Specific Threads on SDN and noticed that someone had been recently accepted off the OUWB waitlist with a generous scholarship. A mixture of emotions swept over me — I felt like I had been passed over [despite my heartfelt update letter] and the news reminded me of how much I longed to be part of OUWB’s history. At that point, a friend of mine had already been accepted to the school and I often felt pangs of jealousy — it didn’t seem fair that the school that I loved didn’t love me back.
One of the lessons I learned from this whole process is to never, ever expect anything. All of my expectations were thrown out the window by the end — the schools I thought I would definitely get an interview from, sent me rejections relatively quickly. The schools that I did receive interviews from ended up being much better fits than I had suspected when I submitted the primary and secondary applications.
A week after the May 15th [well, 16th since the 15th was on a Sunday] deadline, as I walked into my apartment after work, I received a call from a 248 number that I did not recognize. I answered to Michelle’s distinctive voice and an acceptance to OUWB’s School of Medicine. In retrospect, I wish I had been a bit more enthusiastic when I answered the phone, but after 8+ hours of work, I was ready for my nap.
As I mentioned earlier, at the time I received the OUWB acceptance, I was 99% sure I would attend Wayne.
That is, until the generous scholarship offer.
After I hung up the phone, reality settled in. My heart had been at OUWB since the interview day and Wayne had not blown me out of the water. The scholarship had leveled the playing field on cost between the two schools. My only reservation was that I had no history to compare the two schools.
When I retell this story to people, I always say that it took me a long time to decide — but my significant other insists that it took me all of 2 hours. While I believe that on some level I had always known what I wanted, it was not apparent during the week that I had to make my decision. In the end, I needed some way to compare the schools on paper and not just in my mind — here is what I came up with:
  • Class size/community/culture: Wayne is known for having one of the largest medical school class sizes in the nation — although 300 students/class does not sound like much when a lot of students come from high schools where the class size was double this, for a medical school, this is huge. Furthermore, I distinctly remember during the tour that the classroom where exams are taken was a bit overwhelming. OUWB’s inaugural class size of 50 is pretty tiny, but also gave me the piece of mind that we would all get to know one another. Moreover, the community and culture at Wayne was automatically going to be different because there were so many “streamers” — students who just stayed home and watched streamed lectures. Although the idea of mandatory attendance brought me back to high school, I realized that this was the only way that a community could really be established. Groups will inevitably form, but I would personally like to graduate knowing every single student in my class.
  • Curriculum: Traditional vs. Integrated — in importance, I’d say that this was pretty much tied with class size. After this many years of school, I have come to realize that I usually need help seeing the bigger picture. This, in addition to the fact that many “established” medical schools are also moving toward an integrated curriculum, OUWB really beat Wayne out of the water on this. Furthermore, I was relatively impressed with the TBL [team-based learning] exercise during the interview day and believe that it’ll help in the long run with learning effective teamwork.
  • Grading: Tiered, with z-scores vs. H/P/F — [keep in mind that at the time I was under the impression that Wayne would keep the tiered grading scale — I have seen rumors of a move away from tiered grading to be effective this fall] while having tiered grading didn’t bother me, the z-score part did. I do get curious as to how I’m doing relative to my peers, but in the end, this is medical school. The graduation rate is in the high-90% at most schools and it is that way for a reason. We were all accepted because a committee thought we were capable of becoming competent physicians. Yes, doing well is important, but I didn’t want a system that contributed to a competitive atmosphere. This goes back to the culture thing — I didn’t want to feel uncomfortable with my peers, knowing that some of them are trying to do whatever it takes to get the highest z-score. Thus, OUWB’s purely H/P/F system was definitely a plus.
  • Location: Having grown up in comfortable suburbia my whole life, the idea of being plopped in one of the most dangerous cities in the country was a bit irksome. In fact, it bothered me quite a bit. Not to say that I don’t know how to take care of myself, but let’s be realistic here — I’m a female, and wanted the comfort of knowing that I could study in the library until late at night and safely walk back to my car. This being said, I heard that mid-town is relatively safe, and that Wayne does a good job with ensuring that students are kept out of harm’s way, but since I was given the option not to have to worry, it became pretty apparent that this was a factor.
  • Clinical rotations: Wayne has some great sites for clinical rotations, but I always knew that Beaumont would be a top choice for rotations. Since Wayne students will no longer be able to rotate there because of OUWB… this definitely put OUWB ahead.
  • Cost: OUWB is comparable with the scholarship [I did not get a full-ride]. Enough said.
  • Other: The final factor was where I felt there was a suitable fit… and OUWB came out way ahead on this one. Something about the faculty and staff’s warmth and investment in the students [oh hey, student-centered approach!] really made the school stand out.
There you have it!
Is there anything else about the process that you’d like to hear about? Let me know by commenting!

Double header: ethics of physician shadowing & the waitlist limbo

Amanda Xi

800+ page views?! Thanks again for visiting!

Today’s blog topics: ethics of [pre-medical student] physician shadowing and the waitlist limbo.

Ethics of [Pre-Medical Student] Physician Shadowing
Somehow an SDN thread on physician satisfaction with the profession led to a MEDLINE search for physician satisfaction, which then led to an article in JAMA that then resulted in stumbling upon a commentary entitled, “Shining a Light on Shadowing” by Elizabeth A. Kitsis, MD, MBE [where MBE is a Master in Business and Engineering, apparently].

Basically, the piece cited four concerns about shadowing [italics are quoted from the commentary]:

  1. a physician’s fiduciary obligation: “How is a patient’s welfare served by having a college student present during an appointment with his or her physician?”
  2. privacy, confidentiality, HIPAA: “In addition to their fiduciary obligations, physicians have other duties to their patients that are breached by college student shadowing, including maintaining privacy, maintaining confidentiality…“
  3. patient consent/coercion: “Physician shadowing by college students also may involved subtle coercion of the patient. To maintain his or her rapport with the physician, a patient may feel compelled to allow students into the examination room if his or her physician makes the request.“
  4. student misrepresentation: “It is possible that manipulation or deception may be used (unconsciously or consciously) to gain entry for a college student into a patient examination room… are college students simply introduced as ‘members of the team’ or generic ‘students,’ which may incorrectly lead patients to assume they are medical students?“

While I understand the validity of these concerns, I find it incredulous that this could be posted in this day and age when physician shadowing [or something similar] is just about a must for entrance into medical schools. Not to say that the author isn’t aware of this [she does mention its importance in the application process]. Happily, there were a couple of responses from other practicing physicians that did a great job countering each of these concerns [though, sadly, Kitsis. rebukes them with the same “what if” scenarios…]

My personal rebuttal:

  1. a physician’s fiduciary obligation: I agree that this obligation may be in question when asked how the patient benefits from a college student’s presence, but I’d argue that a large proportion of students who shadow physicians end up pursuing medicine, and thus, the benefit may not be apparent for that single patient, but will be in the long run. For the most part, I believe that many pre-medical students who shadow physicians do not use the experience as a way to discover career paths, but as a confirmation of their choice.
  2. privacy, confidentiality, HIPAA: This is definitely a big one, but in all my shadowing experiences, I have always signed and agreed to the rules designated by HIPAA, making my presence similar to other healthcare professionals [though, admittedly, I believe that medical schools do delve into the issues that surround HIPAA, so I may revisit the topic later to discuss if I had any revelations after learning more that would make me see this issue differently]. Furthermore, we are all patients ourselves and should understand how important patient-doctor confidentiality is.
  3. patient consent/coercion: While I agree that a physician may subconsciously have a bit more weight in convincing a patient to allow a student to shadow, in today’s day and age, many people are a lot more vocal about their concerns. Admittedly, I do not have a good rebuttal to this one.
  4. student misrepresentation: In pretty much all of my shadowing experience I have had the physician introduce me vaguely as a “student” — while I understand that there is a fine line between what can be deemed ethical in this case, I do believe that this specific case does not necessarily cross it. The term is up for further dissection if the patient wishes [I have been asked what I am studying in school, so the possibility that I am not a medical student has crossed patients’ minds] and I feel that especially because the student is doing absolutely nothing except being a fly on the wall, there is no harm done. Though, I do believe that pre-medical students should be introduced as such in all cases.

My personal experience with shadowing has been extremely positive and helped confirm my almost-lifelong dream of becoming a physician. While I had been searching for shadowing opportunities earlier on, I did not secure an opportunity until right before I submitted my application. Although I was able to include my first shadowing experience in my AMCAS, I did not formally mention my additional experience anywhere [though, one of them did work its way into one of my secondary essays].

I shadowed a cardiac interventionalist, pediatrician and internal medicine physician. Although I cannot say I am particularly enamored with primary care, the opportunity to see primary care physicians in action made the  challenges I had read online, real. It truly is one thing to nod and agree with the patient load and frustrations that primary care physicians have to face, and it’s another to watch an infant’s mother refuse vaccinations or an obese patient refusing to change her diet despite being plagued with a variety of cardiovascular-related ailments. While the cardiac catheterization procedures were interesting, I cannot say that they really sparked my interest [I was just really cold in the OR and really happy that I had a lot of lead on to keep me somewhat insulated].

This all being said, I’d like to propose some “shadowing etiquette” tips:

  • Dress and act professionally — patient impressions are important, especially if you aren’t a doctor yet
  • Make sure you’ve signed a HIPAA statement and have discussed its meaning with the physician you are shadowing — might as well address this ethical issue
  • Ask the physician beforehand if you can be introduced as a pre-medical student to reduce ambiguity
  • Stay quiet while with the patient — while you may suspect that the patient has all the classic signs of strep throat, you aren’t a doctor… yet
Let me know if I missed anything, or if you have a physician shadowing experience that one of these issues arose during.
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The Waitlist Limbo
As some of you may already know, I was waitlisted at 3 schools [OUWB, NYMC, MCW]. Keep in mind that my application was late in the cycle, so one of my interviews [MCW] was for a spot on the waitlist [more details on how this works later].
Unfortunately, the only school that outright accepted me [Wayne] did so in early May, so I was in waitlist limbo from March until May. Undoubtedly, the kid on 11 waitlists on SDN who has been on those lists since October had it a lot worse than I did… but 2 months of just waiting around trying to figure out a back-up plan for the fall was pretty traumatic. Especially since most of us pre-meds are neurotic and crazy… after sprinkling in the “unknown future” factor, it really magnifies the personality.
Honestly, I was not myself after I received word about my first two waitlist decisions. As some of you may already know or will soon know, after investing that much of yourself into this process, and realizing that there is a high chance that you will be unsuccessful the first time, it tends to be hard to find the energy to keep going. I know that had I been unsuccessful, I definitely would have needed to take a serious vacation before starting from square one.
This all being said, here are some important things to keep in mind while chilling in waitlist limbo:

  • A waitlist is not a rejection. I promise you, people get off the waitlist and make it to medical school. Many times, a waitlist could just be because you were late in the cycle and there are no seats left in the class [such as MCW].
  • Be proactive. Don’t be crazy and call the admissions office 3 times a day asking if there has been waitlist movement or if your application is with the committee or if you will be accepted. Do call and check in every once in a while [if the school permits — just ask if you are unsure] so that they become familiar with your name when it comes up.
  • May 15 is a very special day — but probably not for you. While this date is the deadline for multiple acceptances [people holding more than one must rescind all of their acceptances except one, but may remain on waitlists], chances are the admissions team needs to re-evaluate [especially if we’re talking about an unranked waitlist] or prepare for making acceptance calls. Not to say that no one gets off the list on that date, but a lot of people don’t hear anything until a day or more later. I received my OUWB call a couple of days following the deadline.
  • Update letters/letters of intent. I sent in one update letter to OUWB [and look where it got me!]. I do not suggest sending in anything “fluffy” — as in, don’t make an excuse to write them a letter [two more hours in a clinical setting probably won’t boost your application significantly…]. Send in meaningful updates — I personally had an international conference presentation submission accepted as well as received an award, so I made sure to include those in my letter. My letter was not a letter of intent. It is ridiculously important not to lie in these things — if you would not rescind your application from every other school once this school accepts you, then don’t say that they are your top choice. However, I did mention that OUWB was one of my top choices [which it was]. I do not believe that letters of intent make a huge difference, but sometimes they could tip the scales in your favor. 
If you have any questions about the above, let me know! I’d love to make this blog a relatively comprehensive resource.
Finally, some schools will do a couple waitlist-only interview days such as MCW. A good rule to follow with these is that if you do not yet have an acceptance, go for it since every interview gives you a better chance of getting in eventually. Since I did not yet hear any good news, I booked myself a plane ticket and hotel room and headed to MCW for their last waitlist-only interview day. The way that MCW’s waitlist-only interviews work is that you can receive two post-interview decisions: waitlist or rejection. Since their waitlist is tiered [and probably ranked… but they’ll at least release your tier] and they generally fill a quarter of their class from the waitlist, you have a good chance of being accepted. Furthermore, you can be placed higher than someone who interviewed earlier in the cycle [non-waitlist-interview], and thus end up in a better position. 
I really loved MCW when I visited and I saw myself going to the school — I believe that this was pretty apparent during my interview and felt like both the professor and student interviews went well. Apparently, my feeling was correct because when the tiers were released, I had been placed in the top one. I received the acceptance call in early June.
I’ll talk more about my decision to attend OUWB over my 2 other acceptances later!

Hitting the interview trail

Amanda Xi

Thanks to Justin for prompting an entry discussing my experience with medical school interviews!

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[Warning: This post is long and somewhat all over the place… I just wrote whatever came to mind so it isn’t as nicely organized as some of my other posts are. Also, I have inserted some “Applicant tips” throughout the post and there’s a list of resources at the end. If you find you have more questions, please feel free to comment!]
First off, I want to make it clear that having been born and raised in the Midwest combined with two years in the-middle-of-nowhere-Western-Massachusetts, I realized that I love the culture and people of the area. While I can understand the lure of the West Coast [*cough* Mike] and the attraction of the East Coast/NYC, there’s just something about how much sweeter people tend to be in the Midwest. I love being able to smile at random people that I walk by and not receive an incredulous stare afterwards. I love suburbia’s quaint comfort. I love the fact that I can go find a middle of nowhere or a Starbucks without having to deal with ridiculous city traffic. And honestly, I really cannot see myself living an area where snow doesn’t generally fall — snow truly makes winter magical.
Being a Michigan resident, I applied to all of the in-state schools as well as to a number in the surrounding areas (Chicago, Wisconsin, Minnesota, NY). For kicks, I threw in a couple of California ones, but seeing that they barely have enough room for their own residents, I didn’t have much invested in those applications [read: all pretty quick rejections post-submission].
I was complete at a total of 19 schools and received 4 interviews: NYMC, OUWB, Wayne State, and MCW [waitlist-only]. One of the great things about interviewing at schools in your area is the low cost of travel/lodging and I personally find driving to be a good time to reflect and relax [that is, when there isn’t a ton of traffic…].
On to the actual interview days — each of the schools had a different style of interview day. NYMC was a half-day, starting with breakfast, some free time, an hour-long interview with a faculty member, a tour of campus and finally lunch with a couple of students. OUWB was a full-day, starting with breakfast, a tour, an interview with faculty/admissions member on Oakland’s campus, lunch with faculty, a bus ride to Beaumont in Royal Oak, snacks, another tour and another interview with a physician/faculty from Beaumont. Wayne State was just an interview and optional tour [with lunch]. And finally, MCW was also a half-day [but it started later than the other schools], with lunch, a tour, an interview with a faculty member and an interview with a student. All of the schools [with the exception of Wayne] had some sort of informational presentation about the school, the curriculum and financial aid.
[Excuse me if I fudged the description of any of these interview days — I’m trying to recall events from 6ish months ago…regardless, if you went on any of these interview days and noted that something was off, please let me know so I can correct it!]
Honestly, I had a lot of doubts about whether I would ever receive interviews — the reassurances of my friends and family only went so far since none of them had gone through the process. Because of this, I did not prepare for my interviews as well as I could have. A list of resources I wish I would have used more of can be found at the end of this entry.
I did rely pretty heavily on the SDN School-Specific Discussions to get an idea of what the interview day was like [one of the perks of being later in the cycle is that there’s a greater chance someone posted something about how the interviews are structured]. Luckily, [or possibly, logically… in retrospect, I am starting to believe that medical school admissions committees know more about you that you know about yourself] all of my interviews were “laid-back” ones. Not to say you could literally relax in a comfortable chair and talk for hours on end about how incredible you are since you saved babies in Nicaragua and started a free-clinic… but they were definitely more conversational than “interview-y.” This being said, one of the most important questions applicants should know the answer to is, “Why medicine at X institution?“
Most of us had a good answer in our personal statements for “Why medicine” but there really can be a disconnect between what is written and how it is expressed in-person. A lot of things can look great on paper, but not truly mean anything. I feel like a lot of applicants tend to “fluff” what they did in their applications, but then get screwed at the interview because the padding becomes extremely apparent to the interviewer.
Applicant tip: don’t try to make something into what it’s not — if you weren’t moved or touched by a volunteer experience, it’s going to be really hard to convince someone else that you were.
Another thing I did prior to every interview was write down specific things from the institution’s website that I liked/disliked. If the website is… lacking, then try to turn to other sources of information [in this era, I’d hope that all applicants realize the power of Google] or other students who have interviewed at that specific school. The likes can be integrated into your interview responses and the dislikes can be turned into questions for the end of the interview.
Applicant tip: learn as much as possible about each school and don’t be hesitant to use the information during the actual interview. In fact, DEFINITELY use that information…
You will always, always, always be asked whether you have any questions for the interviewer. I cannot stress this enough — but make sure you’re prepared! Even if you have to resort to generic ones [e.g. what made you choose X school? what kept you here for so many years? etc, etc], don’t ever walk out without asking at least one.
Applicant tip: ASK QUESTIONS at the end of the interview.
Thank you letters can also be important, so make sure to write down things that your interviewer said so that you might try to tailor the letter to them. Not everyone sees the value in them, but I have heard far too many times that one or two people will actually be offended if you don’t send them some sort of acknowledgement for taking time out of their busy day to chat with you.
Applicant tip: Thank you letters are almost a standard — make sure to try to include something unique from your interview so that it boggles their memory and helps them remember you better. Also, make send them promptly afterwards.
Some of my favorite interview questions include:
  • Have you ever done something stupid?
  • Define maturity.
  • What is your greatest weakness?
  • What would you do if you could not do medicine?
  • Tell me about yourself.
  • What are you currently reading?
  • Do you have any hobbies?
  • Why do you want to go to school in Detroit!? [ohhh, Wayne…]
I did not receive any ethics questions, but I did hear a couple of applicants during my OUWB interview day had gotten one or two from the Beaumont interview. I cannot really speak for how to prepare for those [since I didn’t…] but I know a couple of my friends read a couple of medical ethics books prior to interviewing. There is never a “right” answer to ethics questions — the most important thing about them is that you show a sound train of reasoning to the interviewer. Guide them from point A to point B and continue until you get to the final destination.
Applicant tip: don’t be afraid to take a moment to formulate your answer or to ask the interviewer to repeat or rephrase the question.
The night before the interview is always an anxiety-provoking, nerve-wracking one, but just focus on breathing. I personally had a wardrobe crisis the night before my first interview [OUWB] and had to make a late-night trip to Meijer… but I still made it to the interview, and must have impressed someone!
If you find that you can’t sleep, I found that literally just thinking “breathe in, breathe out…” over and over again and focusing on the airflow entering and escaping your airways calmed me down enough to fall into slumber. Definitely try to your best way to stay calm in stressful situations.
One way to save money when interviewing away from home is to use a school’s student host program. Some people find that it’s worth the extra money to stay at a hotel and have amenities that you don’t have to pack away into a tiny carry-on bag, but I personally thought both of my host experiences were really helpful for the interview. I was able to get a feel for what the current students were like [read: would I even get along with people here?!] and get all of my burning questions about medical school life answered. I found that especially for NYMC, the student hosts helped bump the school higher on my list just because of the experiences they shared with me. Plus, it was nice to see what a day in the life of a current student was like — you can see if they are frazzled or absolutely in love with where they’re at. In the end, you have to make your own decision on the matter, but I’m a firm believer that it’s worth the sometimes uncomfortable sleeping arrangements [either way you’re gonna have adrenaline coursing through you during the interview!].
Applicant tip: if you can stand it [and when it’s available], use the student host program to get a gauge of the school, where students live, how happy they are and to get all of your burning questions about medical school life answered from a real-life human being. There’s so much you can learn from how a person acts and responds to a question that the SDN forums just can’t convey.
Applicant tip: before the interview, review your AMCAS and secondary essays. No, REALLY. You’d be surprised how much you forget in a couple of weeks…
Applicant tip: trust yourself — as long as you know why you want to be a doctor and why you even applied to the school you’re interviewing at in the first place, then you will get yourself through the interview. However, don’t come across as arrogant. Oh, and smile, please.
Resources for Interviewing (SDN forum links are for 2011-2012 application cycle):
Another post on waitlists and acceptances and such to come… eventually!