Category Archives: Medical School

The Three-Year MD Program

The three-year medical school program is a fairly new development in medical education. And while there are many benefits to pursing these accelerated programs, but they’re not for everyone. In this blog, we will take an in-depth look at three-year MD program requirements and formats, as well as which schools currently offer this alternative, in order to determine which students it serves best.

What are Three-Year MD Programs?

Three-year MD programs satisfy a demand for shorter medical school programs. They save the student a year of tuition and living expenses (as well as a year with no income), and the student is often guaranteed a spot in a specialized residency. The education and training to become a doctor can often take up to a decade, and so taking a year off of this process is very alluring to some students.

According to the Washington Post, “Some medical school administrators and policymakers see three-year programs as a way to produce physicians, particularly primary-care doctors, faster as the new health-care law funnels millions of previously uninsured patients into the medical system.” And given that specialists are now making double the income of primary care doctors, primary care physicians are at a particular shortage.

With four-year medical programs, the last year is focused on electives and the process of securing a residency position. But there is some debate as to the value of this final year. According to Ezekial Emanuel and Victor Fuchs, writing in the Journal of American Medicine Association, “Years of [medical school] training have been added without evidence that they enhance clinical skills or the quality of care. This waste adds to the financial burden of young physicians and increases health care costs. The average length of medical training could be reduced by about 30% without compromising physician competence or quality of care.”

Which Schools Currently Offer 3-Year MD Programs?

At present, there are very few opportunities to pursue a 3-year MD program. Of all the options, NYU offers the broadest program. Most others are limited to primary care or family medicine, and some carry an obligation to practice within the state.

Students must choose their residency of interest prior to application to the 3YMD Pathway. For the Class of 2018, there are 34 positions, across 20 residency programs. Students can apply at the time of acceptance or in February of their freshman year. The Three-Year Pathway program starts six weeks before the Four-Year Pathway program, and students work in a summer fellowship between their first and second year. Students can transfer to Four-Year MD pathway, if necessary, due to residency change or otherwise. The graphic below gives a detailed summary of the timeline differences between the 3-Year and 4-Year MD Pathway programs.

Three-Year MD Pathway

Screen Shot 2016-02-24 at 12.14.10 PM

Four-Year MD Pathway

Screen Shot 2016-02-24 at 12.15.28 PM

 

FMAT’s goal is to prepare primary care physicians more efficiently with lower cost. This program culminates in the M.D. degree and leads to a standard three-year family medicine residency at one of three Texas Tech programs, in Lubbock, Amarillo, or the Permian Basin. FMAT is limited to 16 students per year in each class. Students may apply for the FMAT program when they apply for admission or during the fall semester of the MS1 year. Tech School of Medicine provides scholarship support to FMAT students for at least one year of medical school. Students may choose to return to the regular four-year program at any time. However, any FMAT scholarship support will revert to loan status and must be repaid.

  • UC-Davis, School of Medicine: ACE-PC

This program is only for students committed to careers in primary care. ACE-PC students start working in Kaiser Permanente primary care clinics within the first few weeks of starting the program and continue in these clinics for three years. Unique curricular content includes population management, chronic disease management, quality improvement, patient safety, team-based care and preventive health skills with special emphasis on diverse and underserved populations. ACE-PC is limited to six students and classes begin in June. Students can apply for the program during the secondary application, and may choose to return to the four-year program at any time.

This program is only for students interested in practicing Family Medicine who have a strong desire to remain in Georgia. Students apply during the Spring of Year 1 and may opt to return to the four-year program at any time. The curriculum is very similar to their four-year MD program, but is compressed into 131 weeks of instructional time and offers more educational contact opportunities between students and the Family Medicine faculty.

Columbia’s accelerated program is only open to students who have already earned a PhD in biological sciences and intend to pursue biomedical research as a physician scientist. To this end, applicants are restricted to studying cognitive specialties, such as internal medicine, pediatrics, neurology, psychiatry, or pathology. You can apply for this program when you receive the secondary in the regular medical school application process. The program is divided into preclinical courses (18 Months), major clinical year (12 Months), and subinternship and electives (6 Months). Students begin in August of their first year and finish in May of their third year, working over the summers.

PCSP students must commit to complete a residency in family medicine or general internal medicine, and practice primary care medicine for a minimum of five years upon completion of residency. If a student does not fulfill these requirements, they will be asked to return the scholarship award (one year of medical school tuition). There are about 12 positions available in this program each year. Students complete all courses and learning modules required in the first two years of preclinical education in 18 months, as well as several courses during the summer months. Students participate in a sub-internship at the hospital where they will continue their clinical training after graduation. In addition to saving the student from paying for the fourth year of medical school, this program includes a scholarship for the third year of medical school.

In Conclusion…

Accelerated three-year medical school programs are often geared towards careers in primary care, but have the opportunity to expand to more specialties (as at NYU) as they experience increasing success. The shortened programs are extremely academically rigorous, and if students are not meeting academic benchmarks, they are transferred back to the four-year program.

Three-year medical programs mark a specialized pathway of study for those students who are already committed to the type of doctor they wish to become and who are willing to work at an advanced pace to opt out of a year of medical school. Nevertheless it is important to weigh the pros and cons of these programs in order to determine whether or not they might be right for you. Pros of the three-year program include lower costs, practicing medicine a year earlier, and knowing where your residency will take place from the start. Cons include less time off for vacation and test prep, committing to one specialty before gaining experience in medical school, and losing out on a fourth year of consolidated learning.

In the New England Journal of Medicine, Dr. Stanley Goldfarb and Dr. Gail Morrison argue that the fourth year of medical school is a valuable year that should be enhanced with more intense clinical training in outpatient and inpatient settings, as well as increased advising and mentoring, creating a better transition to residency.

“There may be exceptional students capable of accelerated learning and small programs that create unusual opportunities for such students, but we believe that for the typical student seeking an M.D. degree, the duration of medical school should not be shortened.”

Graduate medical study offers many options, and Collegiate Gateway has extensive experience in understanding and weighing the pros and cons of medical training opportunities. Feel free to contact us to find out more!

Pass/Fail, and Other Trends in Med School Grading

In recent years, there have been vast changes in the way medical students are evaluated and graded. Most notably, many medical schools have replaced their letter or tiered grading system (honors, high pass, etc.) with a much simpler one: pass or fail. According to a recent AAMC initiative, the number of schools using a pass/fail system in the pre-clerkship increased to 87 in 2014 from 71 the previous year. A school’s grading policies have far-reaching implications on its academic culture and community, informing everything from stress levels and competitiveness to the methods by which students are evaluated. As such, it is important that prospective medical students take grading policies into careful consideration as they evaluate different opportunities. 

Rationale for Pass/Fail Grading for Pre-Clerkship Years

This change can be largely attributed to a greater concern for medical student’s overall well-being. One study in Academic Medicine found that the class of University of Virginia (UVA) medical students who were graded pass/fail showed a significant increase in satisfaction as compared to their counterparts who were evaluated using a standard letter grading system. An even broader study surveyed students from seven different medical schools, and found that students evaluated using grading schemes with three or more categories had higher levels of stress and emotional exhaustion, and were more likely to experience burnout than those who were graded pass/fail. Many schools also find that a this system fosters a greater sense of collaboration and cooperation among students, while diminishing competitiveness.

The benefits of this pass/fail grading scheme extend beyond the students themselves, as it may also be helpful to schools as they seek to attract the best and brightest to their institution. In fact, a survey at UVA Medical School found that 81% of the entering class cited the pass/fail grading system as somewhat to very important in their decision to accept the offer of admission.

Examples of Pass/Fail Medical Schools

Schools that employ pass/fail grading during the pre-clerkship years include  Case Western School of Medicine, Albert Einstein College of Medicine and Rochester School of Medicine.

Even within the standard pass/fail grading system, however, there are small differences that distinguish one school from another. Students at Harvard Medical School, for example, are given grades of “satisfactory” or “unsatisfactory” during their pre-clerkship years, but students of exceptional merit can receive a Letter of Excellence that is added to their permanent file.

Many students are wary of pass/fail schools that may still track grades and establish ranking orders behind the scenes. However, schools such as Yale School of Medicine explicitly state that “there are no grades and there is no class ranking.”

Concerns (and Rebuttals)  

As expected, there are some concerns associated with a pass/fail grading scheme. Some worry that a non-tiered grading system may negatively impact students’ residency placement, scores on medical licensing exams (USMLE Step 1 and 2) or overall academic performance. If students are placed into only two categories, is there less incentive and, therefore, less motivation for them to work hard?

These concerns, however, have largely been refuted. The study cited above, involving UVA students, found that a change from a letter grading scale to a pass/fail system did not result in a decline in students’ academic performance or USMLE Step 1/2 scores. Furthermore, there was no negative affect on residency placement, as demonstrated by the quality of residency programs to which students were matched.

Alternatives to Pass/Fail for Pre-Clerkship Years

Despite the hype about pass/fail grading, there are still a significant number of schools (~81 according to AAMC) that evaluate their students using greater than two categories during the pre-clinical years. Pittsburgh School of Medicine, for example, employs a three-tiered grading structure: Honors/Satisfactory/Unsatisfactory for the first two years. The University of Maryland School of Medicine employs a letter grading approach: Honors, A, B, C, D, F.

Different Grading Approaches for Different Years

 Schools often employ different grading schemes depending on course types or year of medical school. The pass/fail system discussed above largely applies to the pre-clerkship years of medical school, when students are learning and reviewing the sciences before entering clinics. The majority of schools recently surveyed by AAMC also use the simple pass/fail system for grading students in electives. However, many schools utilize an entirely different grading scheme when evaluating students in their later years of medical school. In fact, the majority of schools surveyed by AAMC use a four-tiered grading system: honors, high pass, pass, and fail for required clerkships and fourth year electives and sub-internships.

Evaluation Components

In the same way grading frameworks are changing, so are the actual methods used to evaluate students. Schools not only assess their students using standard written exams, but now also use a variety of novel evaluation techniques. Although Yale does not give grades for the first two years, it still employs unique forms of evaluation such as direct questioning during seminars and laboratories to deem acceptable performance or not. Feinberg School of Medicine at Northwestern provides feedback to students using conventional methods such as examinations, as well as skills assessments, and narrative evaluations. Moreover, as of 2012, students at Northwestern build an electronic portfolio that is continuously reviewed with their mentors to ensure they are meeting the school’s required competencies.

Schools such as Perelman School of Medicine at UPenn utilize particularly innovative assessment methods, including simulations and standardized patients. Made possible by recent advances in technology, these assessments involve a patient simulator in a realistic hospital environment. Standardized patients, however, are trained individuals or in some cases, actual patients who help to create real-life medical scenarios.

Academic Honors

Often, these evaluation techniques are used to identify students for academic honors. Boston University School of Medicine awards Latin honors (e.g. summa cum laude) based on a number of factors: performance in courses, scores on medical licensing exams, and other more subjective criteria, such as “extreme initiative and talent.” Other types of academic recognition include membership in the medical honors society Alpha Omega Alpha, as well as distinction in research, and various clerkship and departmental awards.

Every medical school differs slightly in its approach to grading, and it is imperative to thoroughly research schools of interest in order to properly understand these nuances. For more information on medical school grading or any other part of the medical school application process, contact Collegiate Gateway – as always, we’re happy to help.

 

The MCAT2015 has Arrived!

 

The Association of American Medical Colleges, or AAMC, officially launched a new version of the MCAT, called the MCAT2015 on April 17, 2015. Approximately 8,200 individuals took this new version of the exam. The test has been changed for the first time since 1991, and AAMC is calling it “a better test for tomorrow’s doctors.” It was designed “to help better prepare tomorrow’s doctors for the rapidly advancing and transforming health care system.”

New Structure of the MCAT2015

The MCAT has changed in several major ways. Most notably, it has doubled in length. The MCAT2015 consists of 230 questions over 6 hours and 15 minutes, whereas the previous version consisted of 144 questions over 3 hours and 20 minutes. But despite the greater overall length, students taking the newer exam actually have more time to complete each question.

Screen Shot 2014-11-04 at 8.03.17 PM

The MCAT2015 includes both new topic areas and different types of questions. The first three sections are organized around “big ideas” in the sciences. According to the AAMC, these sections “reflect current research about the most effective ways for students to learn and use science, emphasizing deep knowledge of the most important scientific concepts over knowledge simply of many discrete facts.”

Here is a sample question from the MCAT2015 from the section, “Chemical & Physical Foundations of Biological Systems.” It focuses on using scientific theories and models to solve a specific problem.

The radius of the aorta is about 1.0 cm and blood passes through it at a velocity of 30 cm/s. A typical capillary has a radius of about 4 10-4 cm with blood passing through at a velocity of 5 10-2 cm/s. Using this data, what is approximate number of capillaries in a human body?

  1. 1   104
  2. 2   107
  3. 4   109
  4. 7   1012

The new sections will also test additional skills, including research design, graphical analysis and data interpretation. Kaplan claims that the “passages will be restructured to test all of the natural sciences within biological systems,” giving the test a more medical focus by showing the application of the sciences to medicine.

The new section, “Psychological, Social, and Behavioral Foundations of Behavior,” comprises 25% of the test, and recognizes the role of social science in treating patients effectively. Catherine Lucey, a member of the MCAT review committee and vice dean of the UC San Francisco School of Medicine, observes:

“One hundred years ago, all you really needed to know was the science. We were all looking for the magic bullet that would cure disease. Now we have problems like obesity and diabetes that require doctors to form therapeutic alliances with patients and convince them to change their lifestyle.”

Ripal Shah, an MCAT test prep tutor for Advantage Testing, agrees that training in the social sciences is beneficial for a career in medicine, because “many studies have shown that communication skills are often the most indicative of patient satisfaction and medication compliance.”

The following visual, from Kaplan Test Prep, illustrates the structural and content changes between the two tests.

Screen Shot 2014-11-04 at 8.03.52 PM

The US News blog, “Medical School Admissions Doctor,” estimates that the vast amount of information covered on the MCAT2015 requires significantly more than standard medical school prerequisites:

  • One year of biology, chemistry, organic chemistry, and physics
  • One semester of biochemistry, psychology, and sociology,
  • A year of humanities (recommended)

Score Scale

Each of the four sections will be scored individually, from 118 to 132, with a midpoint of 125. Scores are combined to create a total score ranging from 472 to 528, with a midpoint of 500. The new score reports will provide details on your test performance. “The AAMC envisions a score report that will bring together MCAT scores, percentile ranks, confidence bands, and score profiles in a way that highlights applicants’ strengths and weaknesses.” The MCAT Score Report Prototype released by the AAMC illustrates each of these aspects of scoring on a sample score report.

Screen Shot 2014-11-04 at 8.04.36 PM

Percentile ranks are included so examinees can compare their performance to others who took the new exam. Confidence bands show the ranges of scores an examinee could expect on another MCAT attempt. Score profiles provide information about applicants’ strengths and weaknesses across the four sections of the exam.

Applying to medical school is a long and challenging process. Not to mention competitive: just under 50,000 students applied to medical school in 2014, with an average MCAT score of 28.6 and GPA of 3.55. Of those accepted, the mean MCAT score was 31.4, with a 3.69 GPA.

For more information or guidance regarding the MCAT, or any other aspect of the admissions process, contact Collegiate Gateway – we’re always happy to help.

 

Applying to Med School: The Importance of Secondary Applications

If you are applying to medical school for the Class of 2020, chances are you have completed your AMCAS Personal Statement, and are in the final stages of perfecting a powerful discussion of why you want to become a physician. Take a breath… and then begin to prepare for individual medical school’s secondary applications! The purpose of secondary, or supplemental, applications is to further differentiate among candidates, and to determine whether you’d be a good fit for the particular medical school.

Who Receives Secondaries

Most schools, such as Harvard Medical School, the Alpert Medical School of Brown University and the University of Michigan Medical School, send all of their applicants a secondary. Others review the primary AMCAS application holistically, and are selective in determining who receives supplemental applications. For example, Vanderbilt University School of Medicine has three independent evaluators review the AMCAS application for academic accomplishment, motivation, personal qualities, leadership skills and educational background, and offers secondaries to only about one-third of its applicants.

The Timing of Secondaries

Try to submit your primary AMCAS application as close as possible to June 2nd, the day that the 2015 AMCAS application submission begins, and certainly by the end of June. The sooner you submit, the sooner your application will be reviewed.

You can expect to receive secondaries from late June through December. You may even receive secondaries before your AMCAS application is verified. If you submit your primary AMCAS application in June, you will likely be completing your secondaries in July and August. Secondary applications are time sensitive, in that the faster you return them to the institution, the stronger your enthusiasm for that school comes across. A quality secondary application submitted within one to two weeks will increase your likelihood of getting an interview.

Secondary Essay Prompts

Once you submit your primary AMCAS, you can begin preparing for secondaries, which typically include a variety of essays on assigned topics, such as the following:

  • Define a physician.
  • Tell us about your diverse talents, experiences, opinions, and backgrounds. What would you bring to the medical school community?
  • Why do you feel that you are a good fit for our particular medical school?
  • If you are not attending college during the upcoming academic year, what are your plans?
  • Describe the personal accomplishment that makes you most proud. Why is this important to you?
  • Please describe a challenge you faced and how you addressed it.
  • Is there any additional information you would like to share?

Start brainstorming, outlining and drafting the above essays so that you can respond quickly. Here are some tips for writing the most effective secondaries:

  • Provide new information. Remember that the admissions committees have already seen your transcript, primary AMCAS personal statement and activity essays.
  • Be specific. Make a compelling case for why you are a good fit for each medical school. Research the school’s academic programs and approach to clinical practice. Does the school require research or a thesis? Be specific about the resources at the medical school that you will take advantage of, and the unique strengths you will bring.
  • Answer the prompt. Though it is sometimes effective to recycle other essays (see below), always make sure you’re answering the question fully and directly.
  • Connect your past, present and future. How have your past experiences influenced the person you are today? How do your future goals link with your talents, accomplishments and values?
  • Take advantage of overlaps. Evaluate the various secondary essay prompts of your medical schools to see if there are any commonalities. Adapt essays for additional medical schools, but only if appropriate.
  • Proofread and edit. Carve out enough time in your schedule to edit several drafts for each essay. It takes time to ensure that your essays represent you strongly and authentically, and are well-written.

Applying to medical school is a challenging process, and the secondaries are no exception. For more information and guidance, contact Collegiate Gateway – we’re always happy to help.

Trends in Residency Matching for 2015

 

matchday7

Earlier this month, hopeful and anxious medical school students gathered at Match Day ceremonies across the country. Match Day, an annual rite of passage for budding physicians, is the day students learn which U.S. residency programs at which they will train for the next three to seven years.

This year was record setting in several respects and, as usual, Collegiate Gateway is here to bring you the most important trends and developments.

More people, more positions

The National Resident Matching Program (NRMP) recently announced that 2015 is the largest Main Residency Match in NRMP history. This year included 41,334 total registrants, the largest number on record. This growth in the number of U.S. seniors is attributable to rising medical school enrollments and the development of new medical schools across the country. In keeping, more than 30,000 total positions were offered in 2015, another record high.

MRM-2015-Largest-in-History-Infographic-with-photos

Good News for US Graduates

Of this year’s 18,025 U.S. allopathic seniors participating in the match, 16,932 were matched to first-year positions, achieving an overall match rate of 93.9 percent. Of those, 51.6 percent matched to their first choice for training. In addition, 2,949 osteopathic students and graduates submitted program preferences, an increase of more than 200. Their match rate rose to 79.3 percent – another record high.

Osteopathic medicine is very similar to the traditional allopathic approach, but with a greater emphasis on hands-on physical diagnosis techniques, as well as a more personal, holistic approach. In the past, there had been distinct accreditations for allopathic (MD) and osteopathic (DO) residency programs. However, in February 2014, the accrediting agencies decided on a single system for residencies and fellowships to begin in 2015 and be fully implemented by 2020. Keep an eye out for our upcoming blog that will delve deeper into the similarities and differences between MD and DO training.

According to a recent report in Slate, the outlook is also good for those who have not, unfortunately, been matched:

“Although failure to match is chastening, U.S. graduates have an excellent chance at finding a program the next year. In the meantime, many of them get a master’s degree, or they teach or work in a laboratory to strengthen their applications. If they decide not to pursue a residency, it’s almost always by choice. Despite the pressure of Match Day, life is pretty forgiving to U.S. medical school graduates.”

Another option for unmatched applicants is the Supplemental Offer and Acceptance Program (SOAP), during which unfilled positions are made available to unmatched applicants. In fact, there were 1,193 unfilled positions offered during the 2015 SOAP.

For Internationals, Challenges Remain

In keeping with previous years, however, graduates of foreign medical schools have a more difficult time matching. This year, 12,380 doctors attempted to match from medical schools outside the United States. Only 6,301 were successful, yielding an approximately 50 percent acceptance rate. Though low compared to the numbers for U.S. medical school graduates, 50 percent is actually a somewhat inflated statistic; these students often apply for programs such as family medicine that generally have difficulty filling their many available positions.

Couples matching

The NRMP allows those with spouses, partners, and significant others, to participate in the Match as a couple: any two candidates can link their preference lists together in the hopes of being paired to the same or nearby programs. An all-time high of 1,035 couples participated in the Match – 110 more than last year – with a 94.8 percent match rate.

Trends in Specialties

Over the next decade, the AAMC predicts that the US will face a shortage of as many as 90,000 doctors. As such, efforts to expand residency positions are common, with particularly high growth in several key areas. Notably, nearly 60% of all new positions were attributable to primary care, an area particularly in need of new doctors.

 

Specialty                     Total positions             New positions           % Filled

Internal Medicine 6,770 246 98.9
Family Medicine 3,195 86 95.1
Pediatrics 2,668 28 99.5

 Some of the most competitive specialty areas included the following, which filled 100% of available first-year positions:

  • Dermatology
  • Medicine-Psychiatry
  • Obstetrics and Gynecology
  • Orthopedic Surgery
  • Pediatrics-Primary Care
  • Physical Medicine/Rehabilitation
  • Thoracic Surgery

Additionally, General Surgery, Neurological Surgery, Otolaryngology, Plastic Surgery, and Radiation Oncology had fewer than 5 unfilled positions remaining after the matching algorithm was processed. Watch for our upcoming blog on the differences between various specialty residency programs.

The road to becoming a doctor is a long and complex one. For more information on the residency match process, or any other part of the process, contact Collegiate Gateway – as always, we’re happy to help.

Trends in Medical School Curricula

As our healthcare systems continuously evolve, medical education must follow accordingly. Although each medical school continues to offer its own unique curriculum, curricula as a whole are following several overriding trends. These changes, outlined below, are intended to strengthen the academic experience of students, while creating more versatile and well-rounded physicians.

Starting clinical work earlier

Many schools have begun to phase out the traditional structure of medical education: two years of pre-clinical, basic science work followed by two years of clinical work. By starting clinical training earlier on in their education, students are able to utilize and expand their hands-on doctoring skills right from the start. This helps students hone their clinical skills, and enables them to apply knowledge from the classroom to relevant real-world situations.

However, med schools are approaching this change in very different ways. On one end of the spectrum, schools such as Duke and Vanderbilt have moved to an extremely accelerated curriculum with only one year of the core basic sciences, followed by core clinical clerkships beginning in year two. Similarly, Harvard has announced that in August of 2015 they will launch a new curriculum, Pathways, that also condenses the basic sciences to the first year.

On the other hand, Mount Sinai has maintained the structure of starting formalized clinical clerkships in the third year, but during year one, med students are partnered with patients to begin a longitudinal clinical experience. Several other medical schools, including Weill and Perelman, have struck a middle ground: students learn the core basic sciences for one and half years, with core clinical clerkships beginning in January of year two.

More flexibility

By finishing core clinical work earlier, students are granted greater flexibility in the third and fourth years, allowing for research opportunities and an abundance of elective choices. At Duke School of Medicine, students dedicate a full year to a scholarly research experience. During this year, students may pursue research or a dual degree, while also completing electives, some standard coursework, and studying for the Step 1 Exam. Similarly, Weill Cornell students are required to select an Area of Concentration (AOC) midway through their third year; these range from global health to neuroinflammation. Students choose their AOC based on personal interest, and then work to obtain in-depth knowledge, skills, and a scholarly project within that particular area.

More interdisciplinary coursework

Physicians must develop a diverse skill set to successfully navigate an increasingly complex healthcare environment. As a result, several schools have carefully crafted their curricula to include courses and themes that span beyond the basic and clinical sciences. This fosters a more interdisciplinary approach, with an emphasis on topics such as health policy, ethics, and population health. In fact, Albert Einstein College of Medicine incorporates a theme of population health into already existing courses and clerkships.

To cater to students with more interdisciplinary interests, many schools offer dual degrees, including an MD/PhD, MD/MPH, and MD/MBA. Certain schools also offer dual degrees in areas such as health policy, clinical investigation and bioethics.

Shortening the duration of a medical education

Partly as a result of the earlier clinical training, several med schools, such as NYU, have begun to offer a pilot “three-year pathway” program. The 3-year program is very similar to the core 4-year MD program, except that 3-year MD students start rotations in their chosen specialty six weeks earlier and spend their first summer pursuing a research fellowship in that same department. These students declare their specialty when they apply, and are guaranteed residencies in an NYU-affiliated hospital. This way, students don’t have to worry about matching into residency programs that may still be wary of the 3-year medical degree.

There is ongoing debate as to whether or not shortening the medical school education is beneficial. In a New England Journal of Medicine perspective piece, Drs. Goldfarb and Morrison state “Given the growing complexity of medicine, it seems counterproductive to compress the curriculum into 3 years, reducing both preclinical and clinical experiences.” Yet, in another Perspective piece, the authors claimed that a shorter medical school education could alleviate the physician shortage by producing physicians at a faster rate, and substantially reduce student debt. Dr. Steven Abramson, vice dean for education, faculty and academic affairs at NYU School of Medicine, predicts: “You’re going to see this kind of three-year pathway become very prominent across the country.”

Emphasis on problem-based learning

Medical education is also increasingly incorporating problem-based learning (PBL) into the pre-clinical years. This technique utilizes clinical cases to stimulate discussion among a small group of students, thereby creating a real-life, collaborative and active learning environment. For example, at Feinberg School of Medicine, each PBL is comprised of 6 to 9 students and a faculty facilitator. The overall PBL process “mimics the manner in which a practicing physician obtains data from a patient.” This enables students to further develop skills essential to becoming a successful physician, such as teamwork and communication.

Most schools have established an effective mix of PBL and standard lecture-based teaching. The Integrated Pathways Curriculum at SUNY Downstate, for example, offers reduced lecture time in favor of a greater emphasis on small-group learning such as PBL. 

For more information on medical education or any other part of the medical school application process, contact Collegiate Gateway – as always, we’re happy to help.

What an MD/MPH Can Do for Your Career

In our constantly evolving healthcare environment, physicians with interdisciplinary skill sets are becoming increasingly valuable. Those graduating with dual degrees such as an MD/MPH are uniquely poised to tackle some of healthcare’s most pressing challenges, which include disparities in access to care, high costs, and controversial reform.

USC-Keck-Medical-School-Quad

USC’s School of Medicine

How Can an MPH Help You as a Physician?

MD/MPH programs lie at the intersection of patient-based medicine and public health. According to the UNC School of Medicine, the MPH provides a broader social context and a focus on improving quality of care. Those pursuing this degree are often seeking a role beyond patient care, which could include policy-making, disease prevention, health education, or health research.

According to Dr. Judith Green McKenzie MD-MPH, Professor of Emergency Medicine at the University of Pennsylvania Perelman School of Medicine, the value of the MPH lies in its ability to expand a physician’s perspective:

“The physician is not only able to take care of one patient at a time but can also use the knowledge gained from the data available to implement changes that would affect the patient population as a whole. This is important towards preventive measures. The impact is not just local (one patient) but global (many patients).” 

Potential Career Paths

There is a broad array of career paths associated with the MPH degree that span public policy, private industry, research and community outreach. According to Brown’s PLME program (Program in Liberal Medical Education), these include the following:

  • International work
  • Environmental health, such as regulation of toxic elements in water
  • Behavioral health: diversity across populations; ethnic/racial group behaviors
  • Health promotion and disease intervention
  • Health management
  • Community outreach and serving the underserved
  • Working with the CDC: regulation of health policy and health education
  • Public policy: federal and state government
  • Special population groups, such as aging and gerontology, maternal and child health
  • Private industry, including epidemiology, pharmaceuticals, health education
  • Research
LSH-Poster-Boards-Mosquitoes

London School of Hygiene and Tropical Medicine Research Poster Board Presentation

Practitioners with a combined training in medicine and public health can treat individual patients while at the same time contributing to public health discourse. Dr. Christina Tan, MD-MPH, Assistant Commissioner for Epidemiology, Environmental and Occupational Health for New Jersey, serves as the top epidemiologist for the state. Last fall, she had the responsibility for assessing the readiness of New Jersey to handle the possibility of Ebola. With regard to her training, she says:

“The MPH program helped solidify and enhance my understanding of epidemiology and public health policy, as it’s important to have an understanding of the historical, legal, and scientific context of public health practice (which is very different from clinical work).”

Differences in MD-MPH Programs

It is essential for prospective students to compare programs in order to find the right one for their specific interests and goals. According to the Association of American Medical Colleges (AAMC), more than 80 medical schools sponsor activities to help students pursue an MPH.  These range in structure from the fully integrated program offered by the University of Pennsylvania Perelman School of Medicine, which houses both the MD and MPH programs within one professional school, to the combined MD-MPH program offered by Yale University School of Medicine and Yale School of Public Health, to Duke University School of Medicine’s partnership with the University of North Carolina’s Gillings School of Global Public Health. These programs differ greatly in their curriculum, concentrations, length and cost

Concentrations

Make sure to check out whether the program includes concentrations that match your interests!  For example, whereas Boston University’s curricular program is flexible, offering concentrations ranging from environmental health to health policy and management, New York University’s MD/MPH degree strongly emphasizes a global health perspective.

NYU-International-Health-Program

Many MD/MPH programs offer standard concentrations such as public health, global health, maternal and child health, and epidemiology.  But if you are interested in less conventional specialty areas, do some research to find appropriate programs. For example, the Harvard T.H. Chan School of Public Health offers Law and Public Health, Columbia University’s Mailman School of Public Health offers Biostatistics and BU offers the interdisciplinary concentration of Health Law, Bioethics and Human Rights. Tufts University’s School of Medicine Public Health Program takes a different approach, offering a generalist MPH degree without any concentrations.

Location

You may want to consider the state in which you ultimately want to practice, so that you can begin to make contacts with nearby related organizations. Or perhaps the location has value for other reasons, such as wanting to stay close to home or in a particular region of the country.  For example, New York has 10 MD-MPH programs, including SUNY Downstate, Einstein, Columbia, Mount Sinai, NYU and University of Rochester. On the other hand, some states such as Alabama, Oklahoma and Wisconsin, have only one MD-MPH program, part of the state system.

Length of Program

Combined MD-MPH programs last either four or five years. The typical model for 5-year programs is to complete the MPH between the 3rd and 4th years of the MD program, as at Boston University, Columbia and Harvard. Several schools offer a 4-year option through a more condensed approach that includes the three summers between academic years. At SUNY Downstate, you can complete coursework over three summers; at the Keck School of Medicine at USC, you use three summers to complete a 150-hour practicum. The University of Miami Miller School of Medicine has a fully integrated program that culminates with a capstone field experience of 300 contact hours. In choosing where to pursue your MD/MPH, therefore, it is important to consider your willingness to interrupt your medical training, as well as your ability to balance the demands of an accelerated program.

Cost

The cost of adding this additional degree may also be an influential factor, yet financial assistance opportunities and discounted tuition are quite common. At Feinberg School of Medicine, the cost of an MPH is simply a surcharge on top of the standard medical school tuition. Other schools, such as Tulane, offer their MD/MPH students both merit-based and research-based scholarships.

When to Attend

The experience of undertaking a Masters in Public Health varies greatly, depending on how you time your work experience. You could undertake a dual MD-MPH, or you could receive your MD degree and subsequently obtain an MPH immediately or after working. Yet another option is to “intercalate” a Master of Science degree in the UK in the midst of your MD program. The London School of Hygiene and Tropical Medicine offers an outstanding one-year MSc program that students can take between their third and fourth years of medical school. Thirteen MSc courses are available, such as Global Mental Health, Nutrition for Global Health and Public Health in Development Countries.

LSH-Library

London School of Hygiene Library

Dr. Tan elaborated in an email about the pros and cons of attending an MPH program before or after work experience: “Because I got my MPH about 10 years after my MD degree (and after working at governmental public health agencies), I wanted to use the MPH as a way to “fill-in-the-blanks” regarding what I was already doing in my work.”

TIMING

PROS

CONS

PRE-WORK
  • Acquire skills for a public health job
  • Build a network of contacts
  • Add an analytical component to your MD curriculum
  • You may not yet know your field of concentration
  • You will need to obtain required fieldwork experience while at university
POST-WORK
  • You will be aware of your knowledge deficits from your actual work experience
  • You will be a stronger candidate due to your real-world experience
  • It may be difficult to return to a classroom environment after work
  • You may find it challenging to forego income at a later stage in life

 

When to Apply

MD/MPH programs can also differ in a number of other ways, including when you would actually apply. At some schools, such as SUNY Downstate and USC, prospective students apply for the dual degree as they are applying for medical school admission. Others, such as NYU, encourage you to apply once you have already matriculated.  Still others, such as UMDNJ-Robert Wood Johnson Medical School and UMDNJ-School of Public Health, offer the opportunity to add the MPH degree after extending acceptance letters for the MD degree.  In addition, there is always the option to apply years after receiving your MD degree and practicing medicine.

Is the MD/MPH Right for You?

To successfully navigate our complex healthcare environment, the AAMC cites the natural and essential overlap between medicine and public health. But despite the prevalence of MD/MPH programs, not every medical school offers one, and not every student interested in public health will pursue one. Additionally, today’s aspiring physicians will likely receive some public health education regardless of whether or not they are involved in an MD/MPH program. Many medical schools – often in addition to offering an MD/MPH –  have now integrated public health concepts into their standard curriculum. Recent policy initiatives such as the Affordable Care Act, with its emphasis on preventive care and population health, further underscore the need to effectively integrate these two disciplines.

Depending on your personal interests and professional goals, an MD/MPH might very well be the right path for you. It is not only a decision about whether or not to pursue this dual degree, but also a matter of which institution provides the best fit. Check out the resources offered by the American Medical Student Association (AMSA) MD-MPH resource guide and the Association of Schools of Public Health.

Choosing to pursue an MD/MPH is a complicated process that varies greatly for different individuals. For more guidance, contact Collegiate Gateway – we’re always happy to help.

Applying to Med School: the Rise of the Multiple Mini Interview

The interview is an essential component of the medical school admission process. It enables the admissions committee to evaluate applicants based on qualities that cannot be conveyed through a paper application. An analysis by the AAMC reports that medical schools typically use the interview to assess applicants’ non-academic characteristics and skills, including compassion and empathy, personal maturity, and professionalism.

The Traditional Interview (And Its Drawbacks)

The majority of US medical schools continue to utilize a traditional interview format: students are interviewed one-on-one by a member of the school’s faculty, admissions committee, or student body. These traditional interviews can vary considerably in terms of length, structure, content, and scoring. Some schools conduct just one interview, while others conduct two or three. At certain schools, the interviewer has limited to no information about the applicant, while others allow the interviewer to have complete access to the interviewee’s application.

The reliability and validity of the traditional medical school interview has long been in question. The results of a 1996 study demonstrated significant variability among interviewers’ ratings and only moderate validity in interviewers’ ratings of an applicant’s true level of performance. The study also discussed the potential for error due to the fact that certain interviewers are more strict or lenient than others.

The Multiple Mini-Interview (And Its Advantages)

Recently, several US schools have transitioned to a novel type of interview: the Multiple Mini-Interview (MMI), which originated in Canada and Australia. The rationale behind the MMI is twofold: to address some of the weaknesses of the traditional interview format and to better assess an applicant’s potential for success in medical school and beyond.

An MMI typically consists of 6 to 10 stations through which applicants rotate, each with a different scenario, question, or topic. At each station, the student has a few minutes to read the question and prepare, and then spends 6-8 minutes discussing the issue with the interviewer and answering questions.

The stations comprising the MMI are intended to assess various applicant characteristics including communication and problem solving skills, as well as ethics and judgment. There are many different types of MMI scenarios, which may involve a patient actor, a writing task, an ethical dilemma, a healthcare policy question, or a standard interview question. Some schools that have recently switched to using MMI are Albany Medical College, Duke School of Medicine, NYU School of Medicine, and SUNY Upstate.

During an MMI, the same interviewer is assigned to evaluate all prospective students at a particular individual station, which reduces some of the inherent variability in traditional interviews. As all interviewees are asked to respond to the same set of prompts, the overall process achieves a greater level of standardization.

A post by the AAMC cites the following reason for more schools moving toward an MMI format: “Because students interact with multiple interviewers in multiple assessments over the course of the MMI, opinions of a single interviewer are not over-emphasized.” According to NYU Admissions MMI FAQ, the overall process is fairer considering “applicants who do poorly on one station have the opportunity to perform better on another.”

Preparing for an MMI

With such a wide array of potential topics, applicants often find MMI preparation quite daunting.  As a student does not know the questions in advance, an AAMC post states “the best way to prepare is to practice expressing yourself articulately and logically in a timed environment.” It may also be valuable to familiarize yourself with some broad, yet relevant topics such as bioethics, current events, and healthcare policy issues.

Takeaways

Both the MMI and traditional interview enable medical schools to assess certain applicant qualities. Yet the MMI differs from the traditional interview in significant ways and in doing so, aims to address several concerns surrounding the traditional interview structure. By interacting with several different interviewers over a variety of scenarios, applicants are judged more holistically and consistently in MMI interviews.

If you have any questions about the medical school application process, contact Collegiate Gateway—we’re always happy to help!

 

 

 

What Is an MD/MPH? And Why Get One?

In our constantly evolving healthcare environment, physicians with interdisciplinary skill sets are becoming increasingly valuable. Those graduating with dual degrees such as an MD/MPH are uniquely situated to tackle some of healthcare’s most pressing challenges, which include disparities in access to care, high costs, and controversial reform.  MD/MPH programs lie at the intersection of medicine and public health, as they combine an individual patient-based approach with a wider population health perspective.

Those who pursue an MD/MPH do so for a multitude of reasons. Many utilize this additional skill set to enhance their standard, day-to-day clinical practice. According to the UNC School of Medicine, the MPH provides a broader social context, an emphasis on preventative medicine, and a focus on improving quality of care. Those pursuing this degree may also be looking for a role beyond patient care, which could include policy-making, disease prevention, health education, or health research.

Differences in Programs

It is essential to consider your professional goals when choosing where and how to complete your dual degree, as one may be a better fit for your particular interests. For example, NYU’s MD/MPH degree strongly emphasizes a global health perspective, whereas BU’s program is more flexible, offering concentrations ranging from environmental health to health policy and management. The Association of American Medical Colleges (AAMC) notes that “over 80 medical schools sponsor activities to help their medical students pursue a master’s degree in public health.” As such, it is essential for prospective students to compare various programs in order to find the right one for their specific interests and goals.

When to Apply

MD/MPH programs can also differ in a number of other ways – including when you would actually apply. At some schools, prospective students apply for the dual degree as they are applying for medical school admission, while others encourage you to apply once you have already matriculated.  Still others, such as UMDNJ-Robert Wood Johnson Medical School and UMDNJ-School of Public Healh, offer the opportunity to add the MPH degree after extending acceptance letters for the MD degree.

Length of Program

If truly integrated, the two degrees can be achieved in four years, as is the case at the University of Miami. Yet, the majority of MD/MPH students require a fifth year to obtain this additional degree. Harvard’s combined degree program requires a leave of absence from the medical school between the third and fourth years. Thus in choosing where to pursue your MD/MPH, it is important to consider your willingness to interrupt your medical training, as well as your ability to balance the demands of an accelerated program.

Cost

Now for the all-important question: how much is this going to cost you?  This additional degree will likely come at an extra cost, yet financial assistance opportunities and discounted tuition are quite common. At Feinberg School of Medicine, the cost of an MPH is simply a surcharge on top of the standard medical school tuition. Other schools, such as Tulane offer their MD/MPH students both merit-based and research-based scholarships.

Is the MD/MPH Right for You?

To successfully navigate our complex healthcare environment, the AAMC cites the natural and essential overlap between medicine and public health. But despite the prevalence of MD/MPH programs, not every medical school offers one, and not every student interested in public health will pursue one. Today’s aspiring physicians will likely receive some public health education regardless of whether they are involved in an MD/MPH program or not. Many medical schools­­—often in addition to offering an MD/MPH­­—have now integrated public health concepts into their standard curriculum. Recent policy initiatives such as the Affordable Care Act, with its emphasis on preventive care and population health, further underscore the need to effectively integrate these two disciplines.

Depending on your personal interests and professional goals, an MD/MPH might very well be the right path for you. It is not only a decision about whether or not to pursue this dual degree, but also a matter of which program is the best fit.

And if you have any questions or are in need of guidance, contact Collegiate Gateway—we’re always happy to help!

The MCAT2015 is Coming – Will You Be Ready?

The Association of American Medical Colleges, or AAMC, will officially launch a new version of the MCAT, called the MCAT2015, next spring, with the first exam scheduled for April 17th, 2015. The test has been changed for the first time since 1991, and AAMC is calling it “a better test for tomorrow’s doctors.” It was designed “to help better prepare tomorrow’s doctors for the rapidly advancing and transforming health care system.”

New Structure of the MCAT2015

The MCAT2015 is changing in a major way. Most notably, it’s going to almost double in length. The MCAT2015  will include 230 questions over 6 hours and 15 minutes versus the current 144 questions in 3 hours and 20 minute. Because of this, the new test will require a lot more stamina and focus of its test takers.

Screen Shot 2014-11-04 at 8.03.17 PM

The MCAT2015 will also include different types of questions.  The first three sections are organized around “big ideas” in the sciences. According to the AAMC, these sections “reflect current research about the most effective ways for students to learn and use science, emphasizing deep knowledge of the most important scientific concepts over knowledge simply of many discrete facts.”

Here is a sample question from the MCAT2015 from the section, “Chemical & Physical Foundations of Biological Systems.” It focuses on reasoning about scientific theories and models.

 The radius of the aorta is about 1.0 cm and blood passes through it at a velocity of 30 cm/s. A typical capillary has a radius of about 4 10-4 cm with blood passing through at a velocity of 5 10-2 cm/s. Using this data, what is approximate number of capillaries in a human body?

A.    1   104

B.    2   107

C.    4    109

D.    7   1012

The new sections will also test additional skills, including research design, graphical analysis and data interpretation. Kaplan claims that the “passages will be restructured to test all of the natural sciences within biological systems,” giving the test a more medical focus by showing the application of the sciences to medicine.

The following visual, from Kaplan Test Prep, illustrates the structural and content changes between the two tests.

 Screen Shot 2014-11-04 at 8.03.52 PM 

The US News blog, “Medical School Admissions Doctor,” is estimating that the vast amount of information covered on the MCAT2015 requires “a year of biology, a semester of biochemistry, a year of chemistry, a year of physics, a year of organic chemistry, a semester of psychology, a semester of sociology, and a recommended year of humanities – several requirements above the standard medical school prerequisites.”

Score Scale

Each of the four sections will be scored individually, from a low of 118 to a high of 132, with a midpoint of 125. Scores are combined to create a total score ranging from 472 to 528, with a midpoint of 500. The new score reports will provide details on your test performance. “The AAMC envisions a score report that will bring together MCAT scores, percentile ranks, confidence bands, and score profiles in a way that highlights applicants’ strengths and weaknesses.” The MCAT Score Report Prototype released by the AAMC illustrates each of these aspects of scoring on a sample score report.

Screen Shot 2014-11-04 at 8.04.36 PM

Percentile ranks are included so examinees can compare their performance to others who took the new exam. Confidence bands show the ranges of scores an examinee could expect on another MCAT attempt. Score profiles provide information about applicants’ strengths and weaknesses across the four sections of the exam.

Should You Take the Old, or Wait for the New?

Some students are wondering if they should hurry to take the MCAT before the change. “The Medical School Admissions Doctor” reminds potential applicants that the current MCAT still requires a solid college-level background. The blog recommends that students who “can get two semesters each of biology, chemistry, physics, and organic chemistry all done before January 2015” might benefit from taking the current MCAT before it is removed from testing options after January.

Just because the MCAT2015 will propose new challenges, doesn’t mean you should rush to take the current exam before you’re ready. Bonnie Miller, senior dean associate for health sciences at Vanderbilt University advises her students to wait before taking the MCAT. “Honestly, I think you’re better off taking an exam that you’ve had a while to prepare for,” she says. Since most medical schools accept scores from two to three years ago, many students will be able to keep their options open when it comes to choosing what scores to use.

No matter which test you take or when, be prepared!   And if you have any questions, contact Collegiate Gateway – we’re always happy to help.