Planning a Life in Medicine: Discover If a Medical Career Is Right for You and Learn How to Make It Happen

Princeton Review Publishing, L.L.C.

2315 Broadway

New York, NY 10024

E-mail: [email protected]

© 2005 by Princeton Review Publishing, L.L.C.

The Princeton Review is not affiliated with Princeton University.

All rights reserved under International and Pan-American Copyright Conventions. Published in the United States by Random House, Inc., New York, and simultaneously in Canada by Random House of Canada Limited, Toronto.

eISBN: 978-0-307-94500-6

Editorial Director: Robert Franek

Production Editor: Christine LaRubio

Production Manager: Scott Harris

Editor: Erik Olson

v3.1

This book is dedicated to my best friend and inspiration,

Beatrice Lyyli Smart, my mother.

J.S.

CONTENTS

Cover

Title Page

Copyright

Dedication

Introduction

Chapter 1: The Inward Spiral and Other Tools for Life

Chapter 2: Real-Life Medicine and Top Trends in Health Care

Chapter 3: Approaching Admissions

Chapter 4: Unassailable Undergraduate GPA: Study Skills and the Premedical Timeline

Chapter 5: Exemplary Extracurricular Activities

Chapter 6: Acing the MCAT

Chapter 7: Lyrical Letters of Recommendation

Chapter 8: Researching Medical Schools, Applications, and Financial Considerations

Chapter 9: Rock the Interview

Chapter 10: Long-Term and Nontraditional Paths

Appendix 1: Hyperlearning’s Basic Study System for Premedical Students

Appendix 2: Directory of Allopathic and Osteopathic Medical Schools in North America

Appendix 3: Medically Related Summer Opportunities

Appendix 4: Web Resources

About the Authors

INTRODUCTION

THE PATH OF HEART

Life is a journey, not a destination. You can choose a worthy and challenging goal, but real life happens to you in the long stretches of living between the realization of your noble plans; it happens in the hourly effort you make, the daily direction you take, and how you treat yourself and others in the process. Troy Gardner, a philosopher and friend of mine, likes to say: How you live your seconds, is how you live your days, is how you live your life. That about sums it up.

If you believe your path is in medicine, you are committing to a lifelong climb. The ascent into the field is steep and demanding, requiring spirit, motivation, commitment, and a lot of stamina. Once you’ve made it through the first gate, you’ll find another always ahead. Arrival at full medical practice requires at least a ten-year journey from the beginning of your premedical years. Yet the most significant thing about that destination: it marks a new beginning in your journey. You will face a long tradition of rules and proper conduct, one that pushes you to think of and act with great responsibility for the well-being of others. The medical terrain is often rocky and constantly changing, requiring you to be open-minded, confident, and talented in a number of areas.

But what heights you will reach! Your ability to help other human beings, to deeply impact their lives, will grow powerfully on your journey, both as your experience grows and as awesome and surprising new scientific advances move from the lab to the bedside at ever higher rates each year for the rest of your life. You will see a constantly expanding and partly unmapped future ahead, shaped by avalanches of new medical information that you will carefully navigate, for the benefit of the growing number of people who depend on you.

During your premedical education and initial medical training over the next ten years, you will be challenged ethically, emotionally, intellectually, and physically. You will have to work hard, think quickly, plan ahead, use skills and reasoning, and sometimes, make miracles happen. And yet, when they come, these miracles are at the heart of everything you will do as a doctor. Every year, medicine develops increasingly powerful therapies and treatments. As a physician, you will have the opportunity to deeply touch and, at times, save the lives of your patients. You will be an intimate part of many difficult, wonderful, and life-changing experiences. You will see children being born, a heart beating inside of a living body, people living with terminal illnesses, and people dying. Are you ready to take this journey? Is there a place for you in medicine? As Dr. Steve Nelson says, you must accept that you will never reach a point where your medical training ends, where you can say that you made it. Medical school is not about making you a doctor as much as it is about developing lifelong habits of learning and hard work, which are much more important at the start of internship than any knowledge you learned from a book. Medical school is the start of a wonderful, rewarding, lifelong journey that will consume your life, demand your passion, make you want to quit at times, expose you to both the wonders and horrors that all people are capable of, and if you are willing, it will give you a greater purpose than any other occupation ever could.

Becoming a physician is, in many ways, the ultimate professional challenge in our society. By choosing to be a premedical student, you are entering the realm of the most demanding, life-changing, and for many, inspiring profession on the planet. So you are wise to approach this challenge by reading this book—it shows thoughtfulness and foresight on your part. The good news is that it is not a challenge reserved only for natural climbers, and it is not a solo effort. There will be guides and coaches aplenty who will make your life tremendously easier if you allow them to do so. Becoming a physician is about learning the skills and scaling the peaks necessary to climb with the team. If you love science and medicine, enjoy working with people, can humbly take direction and correction, and are capable of planning ahead, you can become a doctor. The most important thing is that you be willing to persist in finding your place over the long term.

You must be willing to reflect, work hard, make plans and back-up plans, and apply to medical school more than once, if necessary. You will face several years of difficult preparation to get through the first big gate, your acceptance to medical school. But if you have persistence, confidence in yourself, and the abilities listed above, you will eventually succeed. We have written this book not only to aid your success, but also to help you find a path to medical success that you love, one that you are happy to walk every day, one that has the kind of ideals you aspire to embody. Not simply a path, but your path of heart.

The path of heart is the path that will excite, ennoble, and inspire you throughout your lifetime. Students on this path are both passionate and aware of how little they really know in the great field of medicine. They aren’t solely focused on being accepted to medical school. Instead, they maintain perspective and balance while approaching the many challenges that must be overcome on the way to becoming a doctor. They delight in learning and persist in studying, even when the path grows steep. They take the time to form relationships with other people in the field and to strengthen their friendships, though they may have to make sacrifices to do so, and they choose quality over quantity, particularly in the early years of their training. If it takes more than one admission cycle to get into medical school, they aren’t distraught. They stay on the path, continuing to do the little things every day of their journey that will make them a better candidate and ultimately, a better physician.

The alternative to following the path of heart is to take shortcuts, to cheat, to give only the minimum necessary requirements, to lose your perspective and your spirit, to take on more than you can capably do, to succumb to excessive perfectionism and constant stress. The result will be disappointment, self-abuse, cynicism, negativity, or depression. Without a deep desire to do what you are doing and the respect for yourself to do it with dignity, feeling, and honor, it will be difficult to succeed in the long years ahead. Those who manage to simply muscle, luck, or cheat their way into medical school (and there indeed are some who do every year) end up bummed out in wonderland, unable to enjoy the amazing opportunity they have been given.

The path of heart is focused and self-aware. It minimizes competitiveness and hurry. It perseveres, and is always seeking balance. It is engaged, not isolated. It sees the long term but works in the short term. It is patient, reflective, and compassionate. If you seek to improve yourself with every passing day, if you believe in what you are doing, and have the courage to pursue your dreams, then you will find your path of heart.

WHO SHOULD READ THIS BOOK

If you have picked up this book, you are probably considering a career in medicine. In fact, you probably already know that you want to be a doctor. Maybe you are a high school student preparing for college, curious about what it takes to get into medical school. Maybe you are a premedical student, somewhere in the medical school admissions process. Or maybe you have recently graduated from college, or have been in the work force and are now considering a career change, exploring medicine for the first time. No matter who you are or what you are doing right now, this book can help you envision your journey and scout out your own personal, successful path to medical school.

Perhaps the ideal reader is a mature high school senior or college freshman or sophomore, just setting out on their premedical journey and resolving to reconnoiter and prioritize the terrain ahead. Yet at the same time, within the two covers of this book we provide advice (Chapter 10) for another group very dear to our hearts, one that can really benefit from good counseling: older and nontraditional students. The truth is, no matter where you are on your path to becoming a physician, you will find some valuable life insights here that have come from almost a decade of our collective experience (John and Steve’s) at Hyperlearning/The Princeton Review in California, assisting thousands of premedical students through a major rite of passage: getting accepted to medical school.

Looking out over the soaring mountains and breathtaking vistas of the medical field, you may be tempted to set out immediately, forging a trail with machete and headlamp, forgoing maps or compass. Yet if you want to climb far, preparation, pacing, and professional assistance are all essential to your success.

We encourage you to make notes in the margins as you read this book. Skim where familiar, but try not to skip. Be an active reader: write questions, make lists, and come back and think about them again. If you have already brought home Planning a Life in Medicine, you’ve signed us on as members of your premedical advising team. We take that job seriously, so let’s begin thinking about what you need to do.

As you read this book, imagine yourself the step of the journey we describe. Picture in your mind’s eye every challenging thing you must do to become a physician and try to imagine the interesting rewards and experiences that will come after you have been admitted to medical school. Let those visualizations motivate you to make the daily sacrifices today that will take you ever higher up the mountain. See the path ahead through your pre-clinical years, to your clinical rotations, to your boards, to your internship, to your residency, all the way to becoming a practicing, passionate physician. If that is your path, you can learn to climb it well, stopping frequently to smell the roses and enjoy the increasingly amazing view. Remember that getting into medical school is not an endpoint, but rather the first phase in a lifelong journey. The journey begins every day you put another foot forward. Look up. Believe in yourself. Put your heart into the climb, and nothing can stop you.

Res Firma, Mitescere Nescit

That which is built on a strong foundation, cannot be torn down.

Video Assignments in the Path of Heart:

Some days you might crave inspiration as you travel your path. At the end of each section of this book, we have compiled an important set of movies to treat yourself with after you finish various projects in the months ahead. Consider any one of them a reward for a job well done, like completing each section of this book! Take the time to reward yourself regularly throughout your journey.

The first movie on each list has a medical theme, the second two are sports or achievement related. Three movies, times 15 sections, gives 45 great movies to excite and inspire you. Most are dramatizations, but a few, like MD and Survivor MD are true life stories that you should see. All are great for keeping you motivated, so be sure to watch as many of these as you can throughout your premedical career.

Video Assignments for the Introduction:

MD: The Making of a Doctor, Breaking Away, and American Flyers

CHAPTER 1

THE INWARD SPIRAL AND

OTHER TOOLS FOR LIFE

Pursuing a career in medicine takes maturity, courage, commitment, and foresight. The journey is long and arduous, and there are many obstacles along the way. As a medical student, intern, resident, and doctor, in addition to great rewards, you will face a slew of unique difficulties that will occasionally test you and your commitment to the field. What tools and skills will you need to succeed? Who will be your sources of support? How can you best prepare for a lifetime of learning and challenge?

INVESTIGATING MEDICINE TEN TOP BOOKS

The Youngest Science: Notes of A Medicine Watcher, Lewis Thomas, MD, © 1983

Becoming a Physician, Jennifer Danek, © 1997

A Piece of My Mind: A Collection of Essays from JAMA, Roxanne K. Young (Ed.), © 2000

American Medical Association Family Medical Guide, 3rd Ed, © 1994

How We Die, Sherwin Nuland, MD, © 1995

Becoming a Doctor: A Journey of Initiation in Medical School, Melvin Konner, MD, © 1988

The House of God, Samuel Shem, MD, © 1981

Intern Blues, Robert Marion, © 2001

A Not Entirely Benign Procedure, Perri Klass, © 1994

The most important qualities come from within. To get into medical school, you must begin with drive, determination, and a sincere desire to become a doctor. Once you have made a commitment to become a doctor, you will need some good maps of the terrain, like the ones this book provides, to manage the many tests you’ll encounter in your undergraduate years. But you will also need to seek the help of an extended team, such as a few dependable premed climbing buddies, professors, advisors, and mentors, and other books and resources that speak to your heart.

Listed in this chapter are certain study skills and personal tools that will help you on the climb and to deal well with the occasional defeat that happens in this difficult, rarefied terrain, so that you can quickly pick yourself up, dust off, and try again. You will need to recover from falls quickly and fully, without self-pity, anxiety, jealousy, or any other psychological traps. You will learn to maintain a dancer’s balance and to pick paths that aren’t too far outside your abilities, so that your mistakes will be small and easily remedied. You’ll also need stamina throughout the ascent. Staying in motion, with brief rests as needed also helps; there’s nothing like keeping active to keep your attention on the course ahead. Most importantly, you will need to find a strong sense of purpose in your preparation, education, and career. Why is it important for you, particularly, to succeed at this quest? A greater purpose will help you stay focused on present challenges while maintaining an awareness of the bigger picture. When you know in your heart why medicine is right for you, and what unique contribution you intend to bring to the profession, nothing can stop you from achieving success. It is a very exciting and transforming journey that you are about to begin.

THE INWARD SPIRAL

Let’s begin with one of the most basic tools necessary for any extended journey. The inward spiral is a process of observation and reflection that each of us uses, either consciously or unconsciously, either well or poorly, as we negotiate a complex world. We want you to use it consciously, to use it well, and to use it as frequently and precisely as you need to get the job done. It involves two parallel processes, both understanding your world and understanding yourself, at first in broad, general terms, and later in very deep and specific ways. Inward spiral thinking begins by giving yourself time, place, and permission to generate a long list of ideas and possibilities for your future, and then slowly narrowing your focus to a few options that you recognize to be strong fits with your own particular skills, sensibilities, goals, emotions, and intellect. What is health care really like? Who are you and who do you want to be? How long will it take you to become who you want to be? Is medicine really for you? If so, what will be your unique path into medical school and your passionate and personal contribution as a doctor? The inward spiral is a tool that can help you answer these questions as you learn about medicine, understand yourself, and start the journey down your path of heart.

Specifically, we’ll consider four tightening cycles: exploring options, narrowing down, reconnaissance, and picking a path. As you read each, envision yourself in that process. You can spend too little time on any cycle (a common mistake) or too much on one because you are scared to move to the next stage. But the biggest mistake is to ignore the cycles altogether. Ask yourself whether you’ve completed each of these processes at the level your own well-lived life demands. Remember, you are only a premedical student once. Wake up to the special nature of your time and place on this planet. You are very unlikely to get another chance to take the journey you are on today. It is sometimes said that true freedom is knowing all your options, so get to know them well before you choose.

CYCLE ONE: EXPLORATION

The more you know about the rough layout of the terrain, the better you can plan for your particular climb. Being a doctor sounds great, but how well do you understand the field? As a premed, you will become an authority of sorts on a range of medical issues with your family and friends. It is your responsibility now to set aside regular time to research medicine and to learn about the various general and specialty practices available within health care.

Medical schools are not just looking for accomplished students, but rather students who have also made a strong, specific, heart-felt commitment to helping others in their extracurricular affairs. While understanding medicine is not a formal requirement of admission to any medical school, throughout the admissions process you will be tested in many small ways on your basic knowledge of and dedication to the field. Do you have a first-hand understanding of a physician’s job? If not, you need a plan to help you get that experience, starting now.

Evaluating Medical Specialties: THREE GOOD BOOKS

Life After Medical School: 32 Doctors Describe Their Careers, Leonard Laster, MD, © 1996

Our Medical Future: Breakthroughs in Health & Longevity by 2000 & Beyond, J. Fisher, MD, © 1993

How to Choose a Medical Specialty, 4th Ed, Anita Taylor, © 2003

More importantly, learning more about medicine will help you define your goals and enable you to envision your future as a physician. When you are cramming for a biology final or preparing for the MCAT, good grades and high scores aren’t sufficient motivation for you to succeed. What are the real, deeper reasons you are doing what you are doing? If you can’t answer this question yet, then you need to find your vision.

Countless resources are available at your local university. Schedule a fixed amount of time each week or month to take advantage of them. When you realize how little time you actually have available in your busy premedical schedule to research medicine, spending three hours to discover something truly valuable to you becomes a fascinating challenge, one that competes daily with all your other responsibilities, whether you are aware of this or not. Begin by visiting the health sciences library at the nearest university. Ask for instruction in how to use the reference resources, and learn how to locate various books, periodicals, and articles about medicine.

If your are not already skilled in the use of reference materials and research facilities (many students aren’t, even after spending years and tens of thousands of dollars on tuition), most college and university libraries offer free classes on a frequent basis. Sit in on a class. Get to know the reference librarians, and bring them interesting questions to be answered. For example, what skills do admissions officers think premedical students are the most lacking in? See Academic Medicine. Where can you find the annual salaries of various types of physicians? See Journal of Medical Economics.

In the beginning, you may want to flip through general medical reference books, writing down the names of fields that catch your eye. Does something sound interesting that you don’t know anything about? Jot it down and keep exploring. You can discuss curious words and phrases with an expert (medical librarian, physician, professor) later and learn a tremendous amount of information in one conversation. Skim the major newspaper indices to see which articles on medical practice or research sound interesting to you. Browse CD-ROMs, electronic databases (Medline, Digital Library, National Library of Medicine Gateway), and the Internet (Google is your friend!).

Persist in reading about topics until you have reached some tentative understanding. If you keep a Medical Explorations Journal, you can occasionally return to old topics to look for more ideas. The second time you look at old notes, your long-term understanding of them will be greatly improved. As you research, notice your reaction to the material. What are you most exited about? Diagnostic advances? New tools or therapies? New areas of patient care? Research programs? Ways to make medicine more efficient and accountable in society? Who are the healers that seem particularly heroic to you? Are you more interested in the inner lives of patients or the details of their treatment? Or both?

Ideally, if most of the medical fields are really still a mystery to you, choose a consistent time that you will devote to research and reflection every week. For example, you may want to go to the library for several consecutive Friday afternoons over the course of a couple of months. Respect this cycle enough to give it plenty of time, and don’t expect immediate results.

Also, don’t unnecessarily limit yourself at this point. Though it will be tempting to make immediate judgments about the kind of medicine you would like to practice, the less you do this now, the more opportunities you will see as you go forward. Do not let your inner critic object to anything in the medical profession before you have really considered it.

Here is a valuable exercise for the exploration cycle of the inward spiral: make a crude concept map of the health care industry, starting with the types of physicians you know about. Who are the other major forces and players in the health care sector, besides physicians? See what you can come up with from memory, and add to it as you start your research. See how many different specialties you can mentally name and define, to yourself and to your friends. Which are specialties and which are actually subspecialties? What is the difference? What are the most popular specialties, and the least popular? Which are specialties that are considered primary care medicine? What percentage of doctors work in primary care? What percentage work in specialties? What percentage of MD’s work in research, administration, pathology, and other areas with less or even no live patient contact? What other types of allied health professionals practice patient care? A research librarian will help you with such questions, and finding the answers is like learning the geography of a complex and multifaceted new world, one that you will soon inhabit. Knowing the landscape will help you decide the best place for you within it.

Medical Specialties

Here are some of the more common medical specialties. (This is a partial list.) Several of these, such as cardiology, gastroenterology, hematology-oncology, infectious disease, endocrinology, nephrology, and pulmonology are actually subspecialties, accessible only after doing residencies in specialties like internal medicine or pediatrics, followed by the subspecialty fellowship.

Anesthesiology: relief of pain and administration of medication to relieve pain during surgery

Cardiology: diagnosis and non-surgical treatment of disorders of the heart

Dermatology: disorders of the skin

Emergency Medicine: diagnosis and treatment of sudden illness and traumatic injury

Endocrinology: problems with hormones

Family Practice: primary care doctors who diagnose and treat common problems in children and adults

Gastroenterology: diagnosis and treatment of problems of the gastrointestinal system, including the stomach, small intestine, large intestine, gall bladder, and bile duct

Genetics: diagnosis of inherited (genetic) disorders

Gerontology: diagnosis and treatment of ailments of senior citizens

Hematology: blood forming organs and disorders

Immunology: specializes in the reaction of the immune system

Infectious Disease: focus on diseases caused by infectious agents

Internal Medicine: primary care of adults

Nephrology: kidney disorders

Neurology: diagnosis and non-surgical treatment of problems of the nervous system, including the brain, spinal cord, and nerves

Neurosurgery: surgical treatment of disorders of the nervous system

Obstetrics/Gynecology: specializes in the female reproductive system and delivery of babies

Oncology: non-surgical treatment of people with cancer

Ophthalmology: surgical and non-surgical treatment of eye diseases and disorders

Orthopedic Surgery: surgical treatment of disorders or fractures of the skeletal system

Otolaryngology: Ear, Nose, and Throat doctor (or ENT for short)

Pathology: studies the causes of disease and death

Pediatrics: primary care doctors specifically for children

Plastic Surgery: surgeons who treat malformations or injuries that affect the appearance of an individual

Psychiatry: prevention, diagnosis, and treatment of mental disorders and substance abuse

Public Health/Preventive Medicine: specializes in disease prevention and health promotion at the population/community level

Pulmonology: disorders of the lungs and breathing physiology

Radiology: specializes in techniques (such as x-ray and MRI) that allow the visualization of structures inside the body

Surgery: specializes in surgical procedures

CYCLE TWO: NARROW DOWN

Once you have assembled many pages of notes about medicine (could you make such an important life decision without really doing this?), you’ll start to notice that you are rediscovering a lot of the same basic material. Once you’ve made your concept map detailed enough, your search will begin to repeat itself. That is a signal that you’ve reached a good stopping point. It’s time to take a closer look at the information you have compiled.

Eight Good Narrative Exposures to Different Medical Specialties:

My Own Country: A Doctor’s Story of a Town and Its People in the Age of AIDS, Abraham Verghese, MD, © 1994 (Family Practice)

Emergency Doctor, Edward Ziegler and Lewis Goldfrank, MD, 1987 (Emergency Medicine)

Life on the Frontlines of Brain Surgery and Neurological Medicine, David Noonan, © 1989 (Neurology/Neurosurgery)

The Transformed Cell, Steven Rosenberg, and John M. Barry, © 1992 (Experimental Oncology)

Medical Detectives, Berton Roueche, MD, © 1991 (Public Health)

Virus Hunters of the CDC, Joseph McCormick, Susan Fisher-Hoch, Leslie Alan Horvitz © 1996 (Epidemiology)

Maternity Ward, Susan Stanley, © 1992 (Obstetrics/Gynecology)

Unnatural Death: Confessions of A Medical Examiner, Michael Baden and Judith Hennessee, © 1989 (Pathology)

Gifted Hands, Ben Carson, MD, © 1990 (Surgery)

Begin to evaluate your options in the field. Make a list of every medical specialty you have researched that was mildly interesting to you. At this point, the list should be long. Much, much later in your journey, at the end of your fourth year of medical school, you will need to choose a single field (or two in a combination program) to which you can dedicate all your considerable skill and passion. For now, narrow your vision down to as many as you can easily keep in memory over time. In 1956, Harvard psychologist George Miller said this was seven different items, plus or minus two. More recent studies suggest our working memory is actually lower, perhaps only four or five unique items. Try to compare and contrast the specialties you commit to memory as you learn more about them and yourself over your premedical journey.

It’s easy to stop your search early, concluding that only surgery or only neurology would make you happy. Don’t give in to that temptation now, even if others do. Stretch yourself to learn as much as you can about a number of future possibilities, and if one area feels particularly right, that feeling won’t go away if it is genuine. The point is, you can’t really know that now. There are just too many things you have to discover before