Early patient exposure and the option to pursue research or an additional degree during the program’s third year, make Duke University Med School a unique choice for applicants [Show summary]
Dr. Linton Yee, Associate Dean for Admissions at Duke University School of Medicine discusses the program’s integrative learning approach that offers students hands-on training from day one.
Interested in doing research during your time at medical school? Duke University School of Medicine might be the program for you. [Show notes]
How would you like to take the entire didactic portion of medical school in the first year of medical school and spend your third year doing research or pursuing another degree? That’s what students at Duke School of Medicine can do. We’re going to hear from Duke School of Medicine’s Associate Dean of Admissions right now.
Welcome to the 432nd episode of Admissions Straight Talk. Thanks for tuning in.
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Our guest today is Dr. Linton Yee, Associate Dean for Admissions at Duke University School of Medicine. Dr. Yee earned his bachelor’s and MD at the University of Hawaii. He then did his residency in Pediatrics at Harbor-UCLA Medical Center and a fellowship in Pediatric Emergency Medicine at Children’s Hospital in Los Angeles. From 1996 to 2007. He practiced and taught Pediatric Emergency Medicine in Hawaii and California, before taking a position at Duke University as an Associate Professor in the Department of Pediatrics’ Division of Emergency Medicine, and a pediatric emergency room physician. He’s also Duke Medical’s Associate Dean for Admissions, and it’s in that capacity that I have invited him back to Admissions Straight Talk for a show devoted to Duke Medical.
Dr. Yee, can you give an overview of Duke Medical’s highly distinctive curriculum? [2:11]
We’ve had this curriculum in place for a number of years, and the goal is to produce leaders in medicine and also to help the applicant and the student, eventually, understand the link between clinical medicine and research, and how both of these things help to promote, advance, and improve medical practice. Our curriculum is changing right now, and we’re putting in new elements in what we call ”patient first.” I think all the applicants and med students out there have to understand that the patient is the center of your universe and everything you do has to be done to improve their well-being. So we’re shifting a lot of our thinking now, and actually using the immersion of the med students into the first year, from day one so you’re seeing patients from day one. We’re then integrating a lot of the biomedical concepts with that. So you’ll have early clinical exposure, and you’ll have a lot of the foundations within that first year. That first year is still your basic science year, but with a lot of clinical elements integrated in.
The second year is still your clinical year and then the third year is where we actually have you do research or get an advanced degree. That’s where you get a chance to choose your own direction and get to pursue your passions. If you think about it, there are very limited opportunities for you to do that within med schools in the United States. So this is really a chance to do what you want to do and to utilize everything that you’ve done in the past to pursue what you’re passionate about and that’s kind of how things are set up over here.
If you’re having all of your early clinical exposure and also doing the entire didactic portion in your first year (which many medical schools take two years to do) how do you fit it all in? [4:02]
We try to integrate everything well and I think you’re able to process all of that information if you can link everything together. If you can link concepts like for example, “What’s cardiac output? Heart rate times stroke volume.” But then you see someone has tachycardia, their stroke volume is diminished so how do you adjust this and how do you compensate for all these sorts of things in terms of using a basic formula like that? So I think by integrating all these elements early on, you can see how everything works together. Back when I was in med school, that was part of the frustration. You would just sit there in class and read about things, but you would never actually see it. Here, you get a chance to actually see things actually working together and then you have a chance to learn that better and you process it better. So it becomes, in essence, much easier for you to retain that sort of information and integrate it to other concepts.
How has Duke Medical adapted the med school experience in light of COVID restrictions? And what do you think is going to stick around and become permanent as a result of those adaptations? [5:39]
COVID led to some significant changes. All the students had to be pulled off their clinical rotations. The way they did it last year is they made all the didactic parts happen when all the students were still limited in their ability to go in the clinical routes and then they were able to come back into the clinical realm after things got a little bit better. That’s how that happened but I think now we’re still trying to go back to the way things were. Everyone has to mask up, the students can’t see the COVID positive patients right now. Unfortunately with COVID, almost everybody’s testing positive now, as opposed to when everyone was testing negative a handful of months ago. So this is almost reminiscent right now of what it was in the late summer, early fall, at least for us.
Your secondary application is one of the more thorough and demanding applications. What are you trying to glean from this very comprehensive secondary? [7:15]
There’s a number of different elements behind this. I mean, the simplest one is that it’s a self-screen. If you’re willing to put the time into this, if you’re interested in Duke that much you’ll fill out the essay. But I think, probably, the more important part is all our applicants really have to reflect and understand why they’re going into medicine. The way the questions are structured, it’s to really get you to examine your reasons for this, because this is going to be the greatest undertaking you’ve ever done. You have to be prepared for this and, hopefully, truly understand why you’re embarking on this lifelong journey of service to others and committing yourself to doing your job in the highest fashion possible.
It’s primarily to get the students to understand, because we feel that if the student understands why they’re going into medicine, it makes them a better applicant. It’s not necessarily just for us, per se, at Duke, it’s for them to be a better applicant at every school. You’ve got to know what you’re getting into and why. You have to be going into this for the right reasons, and your vision has to be clear, in terms of how you see yourself working for others in the future.
You mentioned earlier that Duke is having a very healthy increase in completed secondary applications, can you tell us more? [10:35]
We did our first podcast three years ago (at roughly the same point in the application cycle) and at the time, there were 4,330 applications from AMCAS. Right now, there are 6,267 applications. But the even more important part here is at that time, we had 1,100 completed Duke secondaries. Now, we’re at 2,155 and this is only 20 days into our cycle.
That’s amazing. Given that, it looks like it’s going to be a pretty intensely competitive year at Duke. What process does an application go through when it’s marked completed? When you have a completed secondary, what happens to it? Does it go into a black hole? [11:34]
It’s a holistic review, we look through everything. So there’s no cutoffs and we’re going to go through the entire application. What we primarily do though is we focus on the essays and the experiences. That’s going to be the key determinant there. Again, you’ve got to put something valuable into the essays and you have to have relevant experiences – clinical research, community involvement, investment in others are the key components of your application that we’re going to be looking for.
When an application is reviewed, is it reviewed by three people? Do you discuss the applications as a committee? What’s the process? [12:39]
So initially it’s reviewed by one person and then after that, it’s reviewed at another level, and then after that, another level. There are a number of people who are going to go through every one of those applications.
So even an application that, let’s say, the first person looks at and says, “No way this person is getting in,” even that application is going to get reviewed by somebody else? [13:01]
That’s correct. Yes. The way we have our website structured for the applications, you have to click on it to say that you’ve reviewed it so we know when it’s been done.
And let’s say it’s reviewed by three people, how many have to say they want to interview the candidate for them to be invited for an interview? [13:24]
Everyone would have to be in agreement to interview.
What can someone invited to interview at Duke Medical expect from the interview day/week, given that everything is virtual? [13:43]
Last year was virtual, and fortunately, our team here is fantastic. It took like six months of preparation to get it down, but we actually were able to get everything so it worked in an efficient manner. So the way it’s structured is we can only do 10 people a day, just because we had to rotate people through rooms. I think now we’re probably going to be able to do 11 people per day.
Then on that Sunday evening of the interview week, we always have all the people interviewing for that week get together and you’re grouped within your interview day so you have the opportunity to meet the other people that you’re interviewing with. Then during that Sunday evening, our students pretty much run that evening so they’ll discuss what it’s like to live in Durham, what the Duke curriculum has to offer, and answer any questions that the applicants have. Also, we used to have the research and leadership elements into the actual interview day, but we found that that was kind of distracting the applicants from the actual interview process. So we shifted them over to that Sunday, so now when the interviewees come for their actual interview, you’re only there for your MMI stations. The Sunday’s got everything together and we try and keep it down to like just a couple hours, so it’s not lasting the entire evening.
Then when they’re actually here for the interview, they need to check in around 12:30ish just to make sure the connections are good and everything, and then hopefully we’ll have them out of here roughly around 3:15ish or so.
How do the virtual MMIs work? [15:41]
We have five stations in which there’s a scenario. It’s fairly similar to what we had been doing before, when we were in-person, and then we have the team station, which we had to change since we can’t use what we had used before. Now it’s more things that are two dimensional — without giving up out much more information — it’s things that both of the applicants can do via Zoom. Again, our team here was really creative in figuring out how to do that. Then we still have the two traditional interview stations (one-on-one), which we had had in the past. And then a new station in which the applicants would need to observe the interaction of two medical students and assess what’s going on and then offer a solution and observations as to how they might remedy that situation.
We hope that at some point in time COVID will be in the rear view mirror and travel restrictions will ease. At that point in time, do you see Duke Medical returning to in-person interviews or some in-person, some virtual? What do you see happening? [16:59]
That’s an excellent question, and I think a lot of schools are facing that as well. On the plus side for the applicants, interviewing virtually has no cost – the impact on your finances is limited, you don’t have to worry about airports and weather, you don’t have to worry about getting to the airport with traffic, you don’t have to pay to stay overnight at a hotel or those sort of things. But on the flip side, I think a lot of schools miss the interaction with the applicants and being able to have students talk with the applicants and get a chance to show what the facilities look like and actually talk to the applicants about what it’s like to live in your city.
There’s two different pluses and minuses there, but I don’t think we can go to a hybrid model because it would be hard to differentiate whether there is an advantage or disadvantage to doing it in-person versus virtual. Are students being evaluated within the same manner if they’re doing it virtually versus in-person? It would need to be one or the other and I think most schools would probably end up going back to in-person. This year almost everybody opted to go virtually, just to make things consistent.
What are some of the common mistakes you see applicants making either on the secondary or in their interview? [18:49]
Excellent question. A lot of times they talk more about themselves rather than what they learned from other people and what they’ve gained from their interaction with other people. For instance, we have the disappointment question, and a lot of times people will write that they got a B minus in class or didn’t do as well on the MCAT as they thought they would, but I would think that there’s maybe more that they could have talked about.
We like to look for patient interactions. I may have talked about this three years ago, but some of the better essays have been, for instance, like in hospice, what the student actually learned from the patient that they were paired with about going through the latter stages of life and exiting gracefully and how they got a chance to really appreciate the power of the human spirit. That’s the type of experience we would prefer to read about and see that the applicant has a really good understanding of why they’re in medicine and how to deal with people and communication skills and developing relationships.
We have the advocacy one as well, because as physicians they’re going to need to stand up for people who don’t have a voice. I think we realized this long ago, because we’ve had that essay in there for so long, that it’s really important for them to tell us what they did and how they did it. For example, one of the plastic surgery residents who is here now, I think he’s in his fifth or sixth year, and he wrote one of the best advocacy essays within the last 10 years in my opinion. He wrote about how he stood up for someone who was being bullied and picked on by this popular person and so he put himself at risk by intervening and stopping it. Everybody respected him enough that they stopped doing that. The way he wrote it was very eloquent and well put.
And you look at what he’s done today, he’s just a fantastic resident and person and he’s going to do and already doing great things. It’s that sort of stuff that we want to see in essays because just following that one resident longitudinally, we can see what he’s turned out to be.
That’s, again, why the essays are put there, so that people can actually reflect upon these things. Now, I think you could write about your B minus and maybe you didn’t get into med school or that sort of thing, but it would make a really good essay if you told us, “Well, I realized I had these sort of things I needed to work on and I took all that advice to heart and really made a concerted effort to improve upon all those things and then this is what I’ve gained from that setback.” There are ways of improving on just a simple concept of not getting a good grade.
Does Duke consider letters of intent and update letters? If it does, at what phase of the process? I’m not hearing it yet, but I know that in a month or two I’m going to start getting calls saying, “I haven’t heard from any of the schools. Should I assume I’m rejected? Should I send in a letter of update?” If I’m talking to a Duke applicant, what would you say? [22:44]
The update letters are okay. The letters of intent, I’ve been kind of skeptical about because having done this for so long, I’ve seen people who said, “I’m coming to Duke a hundred percent,” et cetera, et cetera, and they ended up going somewhere else. It’s not just one person, with those, that’s fine, but when it comes down to April 30th is really what I care about, are you committing here or not? Updates are always helpful, especially if a paper has been published or you’ve done something else that’s been significant.
How do you look at candidates who have faced mental health issues in the past? [23:49]
Great question. I think a lot of candidates have been more open about discussing this as well. We put a high emphasis on student well-being, and I think by addressing this in the essays, it actually would help the application because you’re showing that you understand what you did and you actually sought out help. I think a lot of times people aren’t seeking out help, and then it just becomes worse, but this shows that you sought help and you were able to recover from it. So it’s kind of like grit, resilience, being able to take your problem and face it and move on from it. Mental health, the emotional aspect, is really important in terms of our student body, so if people have faced that problem and then have grown from it and recovered from it, I think it’s totally fine.
A different kind of issue that sometimes really concerns applicants is what if they had an academic infraction or even misdemeanors on a criminal record or some kind of criminal record. Does that automatically sink their application at Duke? [24:48]
No, not necessarily, but it would be again, what you learned from it. For instance, some people would be cited for, a lot of times it’s the alcohol issue, but if you see repetitive offenses for it, then it’s like, “Well, did you learn from the first time?” But then you see someone who had an alcohol issue, but then they did something with drunk driving and helping reduce alcohol abuse on campus, that’s a very different concept.
Then the academic issues, again, it’s what you gained from it and how you explain it. I think a lot of times, I guess some passages that they got cited for incorrectly, and I’m not all that familiar with the undergraduate system as to how they find these, but it’s, again, what you gain from that and did you recognize that you made an error and did you make amends for that error and have you grown and matured from that?
Would you advise applicants who have not submitted their primary application by late August to use the next year to strengthen their application and apply in 2022 or do they still have a shot for this cycle? [26:19]
I would think that they still have an opportunity to be interviewed here. You’ve got to get things in earlier, rather than later. If you’re submitting your secondary on November 15th, we may only have — I’m speculating — maybe like 25 interview spots open on November 15th. In that case, you would’ve had to do something super spectacular to have gotten one of those versus if you submitted on August 15th and we still have a few hundred. So get everything in as early as possible.
When should applicants who have submitted their secondaries and not heard from you assume that they’re not going to be invited to interview? The site says qualified applicants are invited to interview starting late August and all the way into early January, but I assume that the numbers may trail off at the end of that period. [27:04]
Right. But there are always some last minute cancellations so I would say that if you’re not interviewed by our last day, especially if we’re using the virtual world, then you probably wouldn’t be invited. But in theory, if somebody cancels on the last day, we can call someone to take that interview spot because we’re not involving you with the plane fare and all that sort of thing. I would say that if you don’t hear from us by the last day we’re scheduled to interview, then you probably wouldn’t be interviewed, but if it’s the day before, then you could still be contacted.
On a forward looking note, what advice would you give medical school wannabes planning to apply to Duke in 2022, for a 2023 matriculation? In other words, they’re not applying this cycle, they’re applying the next cycle, or maybe even the cycle after. [28:22]
A lot of what we talked about in the previous episode – broaden your horizons, become invested in your community, get as much clinical experience as possible, make an impact beyond yourselves. That’s probably the most important part there. Show that you can work with people, that you like people, that you can develop relationships, and always remember there’s a unique story behind each patient and it’s your goal, as a student, to work out that story and become invested in it and show that person that you truly care about what they do and who they are.
It’s the beauty of working with people and understanding people and getting to know people. It’s, again, relationships, communication, bonding with the people that you’re taking care of. I think your patients will become invested in what you have to say to them if they know that you’re committed a hundred percent to making sure that whatever conditions they’re facing, you’re going to try and remedy.
Is there anything you want to add about Duke Medical? [30:27]
We’ve always tried to improve the well-being of all people that we take care of, and we’ve tried to address increasing access to care and fix inequities within the system. We’re trying to make patient care better, and we’re always going to need to improve upon that, but I think Duke has really made tremendous strides in making this happen on a regular basis. I think for the applicants and for med students, just take things day by day.
This is a long haul that you’re going through here, and if you’re a med student, just make it so that you’re a better med student day by day and eventually, after 365 days, you’ll see in one year, “Well, I am a better med student than I was when I first started.” It’s probably the same for the applicants, just make a simple task that each day you’re going to become a better med school applicant. Just do something, but each day you’re going to do something to make your application better. And it can only help the people that you’re working with and the people that you’re going to be taking care of.
Listeners can learn more about Duke Medical School at https://medschool.duke.edu/.
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