The Importance of Away Rotations in Medical School

The Importance of Away Rotations in Medical School

By Jessica Freedman, MD, MedEdits

If you are a rising 4th year medical student, you should be seeking out away elective rotations in your desired specialty. Many students worry that doing away electives at a program they would like to attend could do more damage than good. However, unless you have a poor performance, even someone who is perceived as slightly above average as a visiting student might be ranked higher than a student with similar stats and has not worked in the department. When I was the associate residency director, I always preferred to rank highly a student who was a "known entity" and had a predictable performance rather than a student whom I didn't know.

What can you do to ensure that you are perceived in the best light during your away rotations?

1) Show up early and stay late.

2) Work harder than you have on any other rotation. Do not plan to have much free time during this rotation.

3) Read about your cases.

4) Be professional and confident (but not over-confident).

5) Be independent and a help to the residents and attending on your team; you want to be perceived as a true team player.

6) Treat everyone well -- your fellow students, residents, nurses, staff and, of course, your attending(s).

7) Go to every conference and be sure to introduce yourself to the program director if s/he is not the attending on service.

I am now working with clients for the 2014/2015 match season. Many students need supplemental guidance or advising while in medical school and throughout the residency application process. If you would like to work with us this year, I encourage you to contact me soon. As a private medical educational advisor, I work one on one with students and play the same role as I did when I worked in a formal academic setting at Mount Sinai in New York City.

Visit www.MedEdits.com to schedule your session.

THE RESIDENCY INTERVIEW: WHO SCREENS MY ERAS APPLICATION?

Typically only one to three people per program are responsible for screening residency applications, and how they do it is important to understand. Since some programs may have up to 500 (or even 1,000) applications for only 100 interview slots, for example, it becomes the responsibility of those reviewing applications to decide who will be invited.I can tell you from experience that making these decisions is a daunting task. To decrease the work load, many program directors apply filters to applications to decrease the number of applications that must be reviewed to a reasonable quantity. What kinds of “filters” are used? There are many. Some filters may be applied so program directors only review applications who have a certain United States Medical Licensing Exam (USMLE) step 1 score as a threshold, others may use a filter that only views applicants who have graduated within five years, while others may use no filters and manually review every application submitted. Some programs then assign “points” for everything: research, USMLE scores, and letters of recommendation; you are invited for an interview only when your “score” meets a minimum number. More often, however, a great deal of subjectivity goes into the decision to invite an applicant for an interview, whatever the grading system. Often, the screener’s personal interests and outlook play a part in the review of your application–especially if you are a “borderline” applicant. For example, if reviewer A always had to struggle with standardized tests yet managed to succeed while reviewer B always had board scores in the top 5th percentile, reviewer A is much more likely than reviewer B to screen in an application with lower-than-average board scores.

This blog entry is an excerpt from The Residency Interview (CHAPTER 1: THE INTERVIEW PROCESS).  Click her to read more.

MEDICAL SCHOOL INTERVIEW MYTHS

Some pitfalls of the medical school interview are obvious: Don’t ramble, don’t say “um” too much, don’t be rude to people, don’t chew gum and don’t greet your interviewer like this: “Hey Dave. It is great to meet you. I read everything I could find about you on the internet.” But what pitfalls might not be so obvious?

Not being prepared

You studied for the MCAT. You composed multiple drafts of your personal statement. So, why is it that you think walking in cold to your first medical school interview is acceptable? I find that many outstanding medical school applicants who have an impressive list of accomplishments are often not able to clearly articulate their motivations and paths to pursue a career in medicine. All great performances require practice, and speaking about yourself and essentially marketing your candidacy is not easy. So, practice, practice, practice. Most undergraduate career centers offer mock interviews. Or you can grab a friend, teacher, parent or relative who has more experience than you do in this arena. Practicing also builds confidence, which helps your performance.

Overpracticing

On the opposite side of the coin, practicing too much can also hurt you. Why? First of all, you don’t want your answers to sound rehearsed or canned. Ideally, you want your medical school interview to be conversational so if you are fixated on what you have rehearsed, a conversation pattern for which you didn’t prepare can make you overly anxious. In the same way, over-rehearsed applicants often stumble when they receive a question they weren’t anticipating. This is also an issue for the fortunate applicant who has multiple interviewers. Try to keep your answers fresh, which can be challenging after being asked “Why do you want to be a doctor” for the 17th time.

Getting psyched out before the interview

“Everyone there already had at least 5 acceptances.” “I was the only one at the interview from a non-Ivy League school. I have no chance.” Sometimes the interactions between candidates as they wait for their interviewer or a presentation about the school can be harmful. Obviously, you don’t want to seem like a social outcast and sit alone in a corner of the conference room while the other applicants are chatting. But at the same time, you don’t want these casual conversations to cause you unnecessary anxiety before you enter your interviewer’s office. Though it’s tough, try to stay away from, “So, where else have you interviewed/been accepted” type of topics. And, if such questions do arise, answer vaguely or change the topic without being rude. If you were invited for an interview, you are just as qualified as everyone else sitting in that room with you, and each interview is an opportunity for acceptance.

Adhering to strict rules

“I heard I should speak only for a maximum of three minutes per answer.” “I heard that I need to ask my interviewer at least three questions to seem interested in the school.” Many myths are out there about what you “must do” or “not do” on interviews. Remember that your interviewers are not robots; they are individuals. The vast majority of interviews are not scripted so the rhythm and flow of an interview will depend on many factors, including your interviewer’s style, level of experience and even his or her mood that day. It is important to enter each interview with an open mind as to how the interview might progress. For example, some less-experienced interviewers may feel uncomfortable having a fluid conversation whereas the more experienced medical educator might purposefully get off topic and start a conversation about something in your background that you didn’t expect.

Telling them what they want to hear

It is important to research your school before your interview so you have a clear idea of its mission and values. You also want to try and tailor your answers so you fit these ideals as best you can. But the applicant who says something that is not sincere or that is inconsistent with her background has fallen right into a major pitfall. For example, the school that values community service is seeking students who have a demonstrated commitment in this area but also wants students who have other interests. When an applicant who has no background in community service says that she hopes to become involved in helping the underserved during medical school, her assertion seems patently false. Be true to yourself and make sure that everything you say is consistent with your background and experiences.

Trying too hard to “stand out” or “be distinctive.”

Applicants are always concerned about standing out from the crowd. “What can I say that will make me different than everyone else?” “What can I do that will be unique?” First of all, you cannot change who you are on your medical school interview day. Most interviews are somewhat biographical so your experiences are what they are. I find that when applicants try too hard to be “different,” they often undermine their own success. Medical schools are not evaluating you on your distinctiveness, per se; they are trying to assess your motivation for a career in medicine, intelligence, communication skills and level of compassion, among other qualities. Sure, candidates who have accomplished something truly unusual are evaluated differently, but these candidates are the exception. Ironically, applicants who exude confidence, enthusiasm and authenticity and who are “comfortable in their own skin” are often the individuals who stand out. So, be yourself. A seasoned interviewer can sniff out insincerity. Trying to be someone or something that you are not will inevitably negatively impact your performance and your interviewer’s evaluation.

Ultimately, every interview dynamic is affected by the rapport between the interviewer and applicant, the interviewer’s approach and the applicant’s comfort level in speaking about himself, his motivations and his ideals. Be aware of the common pitfalls and be able to express who you are, why you want to pursue a career in medicine and how you got there.

By Dr. Jessica Freedman, www.mededits.com

Author: The Medical School Interview and The MedEdits Guide to Medical School Admissions

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THE MULTIPLE MINI INTERVIEW (MMI): DO EXTROVERTS HAVE AN ADVANTAGE?

A study about personality type and performance on  the multiple mini interview (MMI) found that extroverts do well in this format and that exhibiting extroversion and agreeableness boosts the likelihood of getting an offer. This finding, by researchers at the University of California, Davis, School of Medicine, is no surprise, though it’s great to have data to support the similar sentiments that Dr. Freedman expressed in a letter to the editor in the New York Times.

I find that medical school interviewees are often focused on giving “the right answer,” which is not really what the MMI interviewer is seeking. MMI interviewers instead are concerned with understanding your thought process, gaining insight into how you navigate a problem and work with others, and with getting a sense of your values and ideals. This is why extroverts, who are good at talking, discussing, and listening, and enjoy being around new groups of people, tend to perform better than introverts, who tend to be more reflective and comfortable with small groups of people whom they know well. For many extroverts, the MMI format is ideal. For introverts, however, it can be incredibly anxiety provoking and may hurt their chances of acceptance.

Perhaps MMI interviewers should take into account that introverts might have different interview styles and approaches and should be evaluated accordingly. Introverts prefer to be alone and like to “act” only after they have had time to reflect – they often don’t “move quickly enough.” Not great for an MMI interview. Is it time to evaluate applicants differently depending on whether they are introverts or extroverts?

Regardless of your personality type, everyone does better on medical school interviews if they practice with us. Let us hear from you if you are interested in our medical school mock interview services.  Contact MedEdits Medical Admissions at www.mededits.com

LETTER OF INTENT FOR MEDICAL SCHOOL

At this point in the application season, I receive many inquiries about how to write a letter of intent for medical school. If you are waitlisted at your top-choice school or waiting for the post-interview decision at a medical school you know you will attend if accepted, it is time to get writing! Even for medical schools that don’t release admissions decisions until March, you want to send your letter of intent well before then.

Below is an outline of what information you should include in your letter of intent to your top-choice medical school.

1) Communicate that if you are accepted to the medical school you will attend—but don’t write this if you don’t mean it.

2) Write about the specific reasons you are interested in the medical school. Try to reach beyond the obvious on the home page of the medical school’s website and seek out opportunities that relate to your own interests and accomplishments. For example, if you have a demonstrated interest in global health, find out about the medical school’s global health programs and point out that this school will allow you to develop your already established interest.

3) Express why you are a good fit for the medical school. You can often accomplish this via item #2 if you compose this part of your letter effectively.

If you need help with your letter of intent, please contact us. Read sample letters of intent in The MedEdits Guide to Medical School Admissions. We are also starting to work with clients who are applying to medical school in 2013/2014. If you are interested in working with us, please contact us soon because we will get booked once the next medical school admissions season is underway.

Visit: www.mededits.com to schedule your FREE 15 minute consultation.

MEDICAL SCHOOL ADMISSION: INCREASING YOUR CHANCES IN THE WINTER MONTHS.

I encourage applicants to think of the medical school admissions process as fluid. Assuming you are not accepted to your top choice school right off the bat, it is important to provide medical schools with more evidence that you are an excellent candidate. What can you do to convince a top choice medical school that it should interview or accept you?

1) Send an update letter. Include academic updates, such as first semester grades and information about any recent accomplishments. You should also express your specific interest in the school to which you are applying.
2) Send a letter of intent. If you are waitlisted or have already interviewed but have not heard from your top-choice school, send a letter of intent. Include the information outlined above, and also explicitly state that the school is your #1 choice and, if accepted, you will attend.
3) Send additional letters of reference. It is always wise to send new letters of reference from individuals who support your candidacy.
4) Recruit an advocate. Your premed advisor, professor, or mentor can call the admissions office of a school in which you are interested to offer support for your candidacy.

Remember, submission of your application often is just the beginning of the medical school admissions process.You must embrace a proactive role throughout the application cycle until you have been accepted to the medical school that you will attend.

WE’RE JUST NOT THAT INTO YOU: WHY MEDICAL SCHOOL APPLICANTS GET REJECTED

Published in the January/February edition of PreMedLife

Every year medical school applicants feel confused and in the dark about why they have been rejected by medical schools. They do not understand what they did wrong or what they need to do differently when they reapply. Whether you are a premedical student trying to make sure to “do everything right” or a medical school applicant who has not yet been accepted to medical school, it may help to learn what applicants who are not accepted to medical school often have in common. Many of these problems are easy to avoid while others take a little more time and effort to remedy. Here are six problems I have observed:

1) Applying to a narrow range of medical schools. Everyone has told you that you are a great applicant and you should have no concerns. Premed advisors, friends, and family may advise you to reach high and that you don’t need to apply to more than 10 to 15 medical schools. I advise most students to be wary of this advice. While I always encourage medical school applicants to “aim high” and to have dream schools in mind, being realistic is also important. The competition for medical school admissions is fierce; fewer than half of 42,742 applicants matriculated in 2010/2011. So unless you have outstanding grades,MCAT® scores, letters of reference, experiences, written application materials, and a great interview experience, it is extremely important to cast a wide net and to apply broadly to a large range of medical schools. Sometimes applicants (or their advisors) overestimate their competitiveness and apply to mostly top-tier medical schools. These applicants are then surprised when they are not accepted to any of them. The bottom line is that, even if you are a top-notch applicant, you must consider adding to your list medical schools that are not ultra-selective.

2) Lacking clinical experience. You are applying to medical school, right? Then you must be able to demonstrate to the admissions committee that your experience fits this career decision. Many medical school applicants are interested in science and, while research is important, it cannot substitute for clinical exposure. Some medical school applicants submit applications with an impressive list of accomplishments and experiences but don’t demonstrate any clinical exposure, which comes in many forms: You can shadow your own family physician, volunteer in a free clinic or a hospital, or participate in a formal premedical program that includes time spent with physicians. It is very tough to convince an admissions committee via your written documents or during interviews that you want to pursue a career in medicine if you have never spent time in a clinical arena.

3) Submitting poorly composed written documents. Regardless of your candidacy’s strengths, composing persuasive application materials is essential for success. Whether you are competitive applicant seeking acceptance to the most prestigious medical schools in the country or a “borderline” applicant with lower than average grades, experiences, or MCAT® scores, your experience descriptions and personal statement must convince the people reviewing your application that you are worthy of an interview and an acceptance. This is especially important during the first stage of the medical school admissions process when the admissions committee decides whether or not to extend an interview invitation. The committee bases this decision on the objective material you present such as your academic profile, but your written materials, including your application and letters of reference, make a difference. You don’t have control over the content of your LORs, but you do have complete control of what you write in your application materials. Written documents that clearly and articulately express the evolution of your interest in medicine with introspection and thought are more likely to motivate the admissions committee to click the “interview” box when deciding your fate.

4) Having a lackluster academic profile. You have done “okay” in college and on your MCAT®, but is your performance strong enough to gain admission to medical school? Many medical school admissions committees “screen” applications; if your grades or MCAT® don’t reach a certain threshold, you are automatically rejected and your application isn’t reviewed. Other medical schools use a school-specific “formula” that takes into account your grades and MCAT® score and determines whether or not your application will be reviewed if you earn a minimum score. The general rule of thumb is that you must have an overall undergraduate grade point average (UGPA) of 3.5 with a strong performance in the sciences and a minimum MCAT® score of 30 to gain admission to medical school, but this rule has variations. For example, if your UGPA is lower than a 3.5, your MCAT® is a 31 and you have outstanding LORs, documents, and interview skills (see below) you can still gain admission to medical school. Medical schools also consider the rigor of your academic course load, undergraduate institution competitiveness, outside pressures (such as financial difficulties), and upward grade trend when evaluating how you performed. Many students perform poorly as a freshman in college and as they adjust to college life their grades steadily increase as they improve their study and time management skills; admissions committees consider this.

The evaluation of applicants is also subject to various nuances. For example, the student who attends a competitive undergraduate institution and pursued a difficult major, with a UGPA of 3.4 and an MCAT® 36 might be viewed more favorably than the student who attended a less competitive college, pursued a less rigorous major and had a 4.0 but earned a 31 on the MCAT®. In other words, to some extent admissions committees consider the competitiveness of your undergraduate institution and course load. At the same time, you need to realize that applicants’ MCAT® performances are the only measures admissions committees have for comparing “apples to apples.” This is why an exceptional MCAT® performance is important regardless of where you attend college.

5) Submitting a late application. You are an outstanding applicant but submitted a late application. Though this problem is easy to “fix,” you should understand why it’s important to rectify it. Every year the American Medical College Application Service® (AMCAS®) starts accepting medical school applications on or around June 1st  And submitting your primary application as close to this opening date as possible is essential. Why? AMCAS® must review and verify your application, which can take up to six weeks (or more if there is a problem), and medical schools will review your application only after you are “verified” and they have received all supplemental application materials, such as letters of reference, Medical College Admissions Test (MCAT®) scores, and secondary applications and essays.

By submitting an early application you will be considered within a smaller pool of applicants early in the season. In contrast, applicants who wait until deadlines to submit their application materials are typically considered within a much larger pool of applicants. In addition, because early applicants have been invited for some of a school’s finite number of interviews, those who apply late are competing with a large number of applicants  for fewer interview slots. Similarly, for medical schools with rolling admissions, interviewing late in the admissions season is less than ideal since in March or April, for example, most initial acceptance offers have been extended. This means that even if you are a competitive applicant, the medical school may not have any more interviews or acceptances to extend. This is why many great applicants who submit late applications, receive “hold”, ‘reject,” or “wait list” decisions rather than acceptances.

If you are rejected by medical school and decide that your academic record needs to be enhanced, you have many options. If grades are the issue, consider taking upper division classes at a four year university after graduation. Postgraduate special master’s programs specifically designed for students who want to attend medical school are also a good alternative; a searchable database of such programs is available from the Association of American Medical Colleges: http://services.aamc.org/postbac. Other possibilities are to pursue a master’s in public or global health or in a specific scientific discipline in which you are interested. These are all great options if you need to improve your academic profile. If your MCAT® is the concern, you must critically evaluate what you need to do to improve so you can target your studying.

6) Demonstrating poor interview skills. Once an applicant reaches the interview stage, the interview is the most important determinant of success. Typically, interviewees with great interpersonal skills and emotional intelligence are naturally better interviewees than applicants who are more introverted. Applicants who are very nervous, not articulate, or who aren’t comfortable  peaking about themselves can under-perform during the interview. Even though some US medical schools are adopting the multiple mini interview (MMI) format, most medical schools still conduct one-on-one interviews. Contrary to what most medical school applicants believe when they start this process, medical school interviews are typically relaxed dialogues; the interviewer is trying to get to know each applicant, assess if he or she has the qualities and characteristics the school is seeking in medical students, and if he is a good fit for the school. While a certain degree of subjectivity influences every interview experience, applicants can perform well if they practice speaking about themselves before the interview and if they clearly express their motivations and experiences that influenced their decision to practice medicine.

I have seen applicants fail to be accepted to medical school again and again for one or more of these “Top Six” reasons. Nonetheless, how a school weighs each of these factors, among others, is determined by each applicant’s unique profile and situation and the criteria and admissions process of that particular school. Always remember that each medical school considers every candidate individually and there are many things you can do to improve your chance of success.

Reference: Association of American Medical Colleges Facts: https://www.aamc.org/data/facts/

Photo courtesy of Sean MacEntee Flickr

JESSICA FREEDMAN, M.D., is president of MedEdits Medical Admissions (www.MedEdits.com) and author of the MedEdits Guide to Medical Admissions and The Medical School Interview. Follow Dr. Freedman and MedEdits on Facebook and Twitter.
This article appeared in the January/February 2012 issue of PreMedLife magazine.

Bloomberg Markets turns to MedEdits and Dr. Freedman for advice in October's edition (page 106). http://www.bloomberg.com/news/2013-09-10/devry-lures-medical-school-rejects-as-taxpayers-fund-debt.html

MEDICAL SCHOOL ADMISSIONS CONSULTING AND STORYTELLING

Storytelling is at the core of the profession of medicine – it is often the first exchange between doctor and patient as they begin their relationship. Similarly, when you tell your story during medical school and residency admissions processes, your future professor/colleague will be listening. Like the patient’s chart, your application will tell your story, but it will come to life only when you arrive on campus and meet people in the admissions or program office and interview with faculty members.

Interviewers often will ask you, “tell me about yourself” or “why medicine?” – this is your cue to tell your story. The better you know your story, the better you will tell it.  A great answer can convey how insightful you are, how thoughtful, how reflective. Are you familiar with yourself on a deep level? Have you reflected on your decision to pursue medicine and discussed it with a few trusted friends or family? Have you journaled about it, even your concerns? Every good story has a beginning and an end, one or more problems or dilemmas, and high and low points. To captivate your interviewer with how you arrived at this moment of pursuing medicine or residency, you need to go back a ways – to the beginning wherever that is for you – and be open to sharing some personal information that led to your decision. Think about your favorite work of fiction or non-fiction, or your favorite movie. Now go a step further and figure out why it resonates with you. Take cues from that story and craft your own.

Students often worry that whatever their story, the interviewer has “heard it before.” Not true. Just as every patient has a story uniquely his own, so too does the applicant. Before your interview, spend some time thinking about what your story really is. If you prepare for this question and then answer it honestly and engagingly, your story will be compelling.

By Laurie Brown Tansey, MA
Senior Consultant, MedEdits Medical Admissions

MEDICAL SCHOOL SECONDARY ESSAYS

I heard I should complete all of my secondary essays within 24 hours of receiving them.
I heard the secondaries don’t matter.
I heard the secondaries are the most important part of the application.

Needless to say, there are many myths about secondary essays floating around. Alot of them, like those above, are not true. Every piece of your application is important and the most important part is largely dependent on the perspective of the person reviewing your documents. This is why I encourage my clients to put equal effort and thought into everything they submit. Don’t rush your writing; inevitably, this leads to sloppy work and weak documents.

Read my previous posts on secondary essays.

I would also like to congratulate our 2013 medical school applicants who have already received interviews at medical schools.

GETTING INTO RESIDENCY: WHAT ARE THE MOST IMPORTANT FACTORS?

Read my article on the Student Doctor Network about what factors aremost important for getting into residency. Click Here to read the article.

HOW DO I APPROACH SECONDARY ESSAYS?

A client wrote me today and asked: “Dr. Freedman, I am confused about my secondary essays. What should I write about?”

I encourage clients to read secondary essay prompts carefully. Many applicants don’t answer the actual question that is being asked. It is important to say something fresh that isn’t stated elsewhere in your application. Don’t drone on and try to be as succinct as possible. Think of the person reading your application — they have already read through your entries, personal statement, letters of reference and now they are reading your secondaries. This is a tiring process especially when the reviewer may have a huge stack of applications to review in one sitting.

Regarding optional essays, don’t feel that you must complete these. If you have nothing new to add and have done a thorough job representing yourself in the rest of your application, it is OK to leave this space empty. The thing that made me crazy when I screened medical school applications was reading something in a secondary essay that I had already read elsewhere.

Also be sure to proofread your secondary essays. More than once I read a secondary essay when an applicant referenced the wrong medical school rather than the school for which the secondary essay was intended. These applications were screened out because this spoke volumes about the applicant.

MedEdits provides comprehensive assistance for medical school applicants.

Visit: www.MedEdits.com

JULY MEDICAL SCHOOL INTERVIEWS

It may only be July 30th, but MedEdits clients already have medical school interview invitations!!! We congratulate our students and see this as a good sign of things to come!

However, it is still very early in the medical school admissions process so don’t worry if you aren’t at the interview stage yet! We can help you get there.

If you need help preparing for your medical school interview, click here.

Also be sure to read our book, The Medical School Interview.

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