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Student overheard on interview tour: Boy, I really put one over on Perkins. I told him I wanted to be a Primary Care doctor…and he bought it. I’m sure to get in now.

What do we look for in medical students? No matter what, we want our physicians to be smart. The selection process is designed to weed out “not-smart” people. Unfortunately, we can only measure smart in a couple of different ways (grades and MCAT scores), ways that tend to benefit the wealthy  (60% of medical students are from the upper quintile of income) and non-minority folks (14% of medical students are from underrepresented minorities compared to almost 25% of the population).

Is there  another criteria we should  use for selecting medical students? Altruism in medicine is best described in the words of this medical student:

So, for me, I see it as always putting yourself behind the person that you’re with. So the patient comes first, no matter what. If it means spending extra time past normal office hours to stay, if it means going out of your way for somebody, if it means sacrificing something for yourself, I think that’s what it is. First and foremost, you’re taking care of the patient.

Can we assess this in a medical school application? Unfortunately, not very well and not in a reproducible manner. We tend to put value on things we can quantify, so an MCAT equivalent of 37 (99th percentile) would attract the attention of the admissions committee much quicker than a prolonged experience at a soup kitchen. As one of my fellow admissions committee members said, “You can’t assay for the Give A Crap gene,” but you sure want your doctors to have it. The MCAT predicts how well the student will perform on tests but has no bearing on how good of a physician they will be. The soup kitchen experience may take away some grade and MCAT points, but give me that doctor-to-be every time.

Another marker is not the number of experiences but the intensity and commitment shown. The best people I have interviewed have been folks who have decided on medicine after several years of Teach For America or similar life experience. These folks tend to be better able to communicate with patients and, not coincidentally, tend to seek careers in primary care.

The best way to assess this, so they say, is through the interview process. As an interviewer, I will look at the student’s activities and query them regarding each of the things listed. Although not focused on primary care, I try to focus on whether or not the person has the GAC  gene. To be honest, if in my opinion they don’t, I am not certain enough on my ability to assess to sabotage the application. If they do, I try to recruit them into our school. If not, I try to sell them on the other allopathic medical school in the state.

 

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Medical school interview season is starting and I am trying to put together the tough questions I might ask these young, future doctors-to-be. The problem is how to determine kindness, compassion, empathy within a 30 minute timeframe. Interviewers tend to develop shortcuts and favorite questions to get at these important characteristics. Prospective interviewers, this year I suggest the Zombie Apocalypse Preparedness (ZAP) scoring scale:

The scale is on a -1  0 +1  scoring system as either too little or too much preparedness might be indicative of a problem. It covers the following domains:
1) Awareness of the potential of the Zombie Apocalypse
2) Mechanism available for immediate action
3) Plan for self removal from Zombie threat
4) Mechanism for meeting up with other intact humans to resume propagation of human race
5) Methods for determining Zombie composition to deter future Apocalypses
So, if you are interviewing for medical school, consider yourself forewarned.

When I applied to medical school, I was 21 years old and had done well enough in school that I knew I would get in “unless I blew the interview.” No one knew what blowing the interview entailed, but my pre-med friends and I had been immersed in chemistry, physics, and biology for the previous 3 years. We didn’t think the interviewer would ask us to draw out a biochemical pathway. This left us with limited background for conversations with folks who either taught or practiced at the medical school and, we presumed, wanted vague assurances that we would be good doctors. Now, thirty five years later and a veteran of over 1000 interviews, I know that “blowing the interview” is difficult, partly because we expect little in the way of life-lessons learned from a 21-year-old who has been immersed in making very high grades for the past 6 years.

I told you all of that to tell you this: what I expect from applicants to medical school is compassion. Compassion can be assessed in several ways, including prior to the interview. The first pass is through actions. Going out to the home to work with wayward children on a regular basis reassures us that you are not just looking to medicine for an easy salary. The second is in answer to the questions “Why do you want to be a doctor?” Please say “I know it sounds corny but I want to help people,” and say it with conviction.

For me, the third measure of compassion is in answer to a question about health system reform.The question is “Have you been following the changes in health care?” The response needs to be “yes” because “no” would imply denial  that you are applying to a professional school that leads to the practice of medicine. It is the next question that gives many applicants pause: “What do you think of the changes brought about by the new law?”

You have likely been exposed to physicians at some point in the pre-med process. These physicians have likely expressed a variety of opinions regarding the changes, ranging from “too socialist” to “not socialist enough.” After I ask this question I can see the wheels turning in the applicant’s head as he or she asks, “Which way does  Perkins fall?”

If you are a reader of my writing, you can likely tell where I stand. That, actually, is not important.Where your need to stand is principally for the patient in his or her access to healthcare for an illness. I am willing to entertain the 21-year-old version of “Personal responsibility is necessary,” although I suspect you have had many advantages that my patients have not had. On the other hand,, if you say to me “I think people should have to earn everything we give them” I am going to flash back to this video and suggest that serious illness might make it difficult to “earn” access to health care. If you start talking to me about “income redistribution,” I will think of patients who due to their underlying illness never were able to generate income.

In short, make compassion the lodestar of your medical moral compass. The rest you will get over time.

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