Everything Applicants Need to Know About the Dell Medical School Experience

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What makes Dell Medical School unique? [Show summary]

Joel Daboub, Director of Admissions and Records for Dell Medical School at UT Austin, explores the school’s unique curriculum and what applicants need to know about Dell Medical’s approach to admissions.

Find out about Dell’s one-of-a-kind approach to medical education, and what adcom members are seeking in applicants. [Show notes]

Today’s guest is Joel Daboub, Director of Admissions and Records for Dell Medical School at UT Austin. He earned his MBA at the University of North Texas and worked at UNT’s Health Science Center as Assistant Dean of Admissions from 2004 to 2015. He then joined the brand-new medical school at UT Austin, the Dell Medical School, which we’re going to learn about right now.

Can you give an overview of the Dell Medical MD program? [1:30]

I’ll point to our curriculum and describe that first because that’s one of the most unique aspects of Dell Medical School. As a brand-new medical school, one of the things that we had an opportunity to do was to rethink medical education. What are the challenges that physicians face today that may not necessarily be addressed with a traditional medical education? And in particular, how do we reinvent healthcare? What skills do clinicians need today to not only take care of their patients, but also manage the healthcare system? And I say “we” euphemistically. The greater minds in medical education looked at curriculums from across the country and across other countries as well to see what skills physicians need to develop. How could we design a curriculum to meet that?

The first thing that many students recognize is that our basic science curriculum is only 12 months long. Historically, in a Flexner-like model, that would be at a two-year length of basic science education. That allows us to then use the second year for clinical education. Historically, that would be your third year. Having our students go through that training in that sequence, that opens up the third year to a lot of marvelous opportunities, especially since we’re part of the University of Texas, and there are so many great training programs at the university that can be beneficial for future leaders. Making that third year available for a dual degree or research activity really gives our students an opportunity to expand their skills in that third year that you historically would not necessarily get in medical training.

Particularly if you’re going on to manage or work in management in a hospital setting, you may choose to do the MBA program, for instance. We have a brand-new health policy degree opening up with the LBJ School for that year. We have a health transformation degree that’s just brand-new in our school for that year that’s actually created by Elizabeth Teisberg, who was one of the co-authors of the book about healthcare transformation that’s really changed how we think about managing healthcare. That third year really expands the opportunity for our students to gain additional skills that one would not necessarily get in medical training but we believe are necessary if you’re going to be at the table, making decisions about how healthcare is going to change. We are starting to think also about not just the process of using fee-payer models to run healthcare, but about how healthcare outcomes are more important drivers than procedural-based or frequency of activity.

And then the fourth year is much more traditional. That is when our students begin to navigate the residency selection or search process. They may do away rotations along with additional clinical training as they continue to grow as clinicians and prepare for their first year as interns. We do have them go through two acting internships during that year. This is a level of clinical training that is a much higher expectation than a traditional level of training a trainee would experience as a student.

What are some of those differences? [4:35]

The expectation is the level of clinical management that the person should be at is the same level that a first-year intern would be. The expectation is, when they actually end up on their residency, they are not surprised or shocked by the responsibility that they have. They should have developed those skills already and have the basic five skill sets that residencies expect them to have when they come in. But that’s, I think, what makes us the most unique. (If one can be “most unique.” I just heard my mother’s voice in my head, who said, “You’re either unique or you’re not unique.”)

But that distinction, that 12-month curriculum undergraduate medical curriculum, the 12 months of basic science is pretty unique. Again, using a qualifier. But I think also of note about that curriculum is that one would think that if you reduce the amount of time, you would increase the amount of class time in that year. In truth, we actually have fewer contact hours in lecture because we do most of our training in small group learning models. The expectation is that when you’re in lecture, that is the application of knowledge. The acquisition of knowledge is actually going to occur outside of the lecture classroom, and it’s going to be in your small group learning module where you will acquire that information. Lecture is much more about how well you understood it. How does it interrelate? How does it interdigitate with information that you should already have as it relates to this clinical problem? It’s a flipped classroom kind of model.

Dell Medical compresses the traditional two-year didactic portion of medical school into one year. How have your graduates done with residency placement and on the USMLE exams? [6:10]

That was one of the big questions when we started. Can you adequately prepare your trainees? Everybody thinks about the USMLE, but really the point is, do you have the basic science foundational knowledge to go into clinical management, which is in the clerkships? Initial indications when they went from their first year to second year were that many of our clinical sites, which were already teaching medical students at their site, so they had experience, felt like our students were not only prepared but seemed to be better prepared for that experience. Everybody kind of held their breath. “What’s going to happen with step one?” And our dean famously said he really doesn’t care that much about step one. In fact, he was an advocate for the exam to become pass/fail. It has now become pass/fail.

But we had to step back a little bit and enjoy the fact that our students did so exceptionally well on that exam, almost a standard deviation above the national average on their average. They did extremely well. Everybody would like to take credit for that, but really the credit goes to them. They worked very hard.

As far as being able to capture the competencies they needed in order to do well in that exam, they did with that 12-month allotted time. But more importantly, what happens in the second year is they start to see the clinical manifestations of that basic science or the constructs they should be learning from the basic science. And so when they see the disease process, and then they go back and take step one, what’s happening is that they’re saying, “Oh, well I know what this is.” And so instead of trying to narrow down five choices, they’re now narrowing down two choices because they’re able to quickly identify what the disease process is. And that’s part of the exam. It’s a second order, third order question exam, where you first have to know what they’re describing is the disease process before you can talk about the basic science or biochemical activity that’s occurring. But that seemed to have worked very well as far as their training.

Everybody got the residency of their choice, and there are some exceptional programs that they’ve gone to. We always want them to stay closer to home, but they tend to cast a wider net. But we have a number of our students who have stayed in Austin, which is really important for our community, that they continue their training here. But we have students who have gone from coast to coast in their training as well.

Another distinctive part of the program is the third year. I had the pleasure of interviewing Zack Timmons who, for his third year project, founded the Good Apple. What are some of the other things that students have done in their third year? [8:51]

It can run the gamut. Of course, the dual degree is one option. The number who choose that is almost half, a little bit more on the dual degree side this last year. And that’s because there are many more dual degree options as well. It doesn’t necessarily mean that they can’t help one of their peers in their project and do that, but they’re not going to do a full-time project like some of their peers will. An example that comes to mind in our first year: One of our students, who was an Austin native and very interested in her community, and in particular her geriatric community, began to develop a program within the subsidized housing program to connect the elderly with resources. These are individuals who live in subsidized housing but don’t necessarily have any connection with resources. She discovered that there was a lot of commonality in their needs and they actually, if connected to each other, developed a stronger support group. She worked with the housing authority of Austin to develop that program. That program, I believe, is still ongoing as a result of her work.

That’s one of the key things about Zack’s program as well. One of the drivers, or one of the asks of them, is to develop something that’s sustainable over time. You can go out and get a grant, and you can go intervene or do some kind of intervention in the community, but when the grant ceases to exist, that intervention ceases to exist. How do you develop sustainable activities that directly affect the health of our community? Those are some types of examples that they’re working on.

Let’s turn to admissions at Dell Medical. Does Dell Medical screen secondaries? Are non-Texas residents admitted to Dell Medical? [10:58]

We have a statute in Texas that no medical school can admit more than 10% of their class as non-Texas residents. In Texas, we’re very fortunate that the state still subsidizes medical education to a high degree. The expectation is, and the recognition from state leadership is, that we have a shortage of physicians and Texas has grown much faster than we ever expected it to grow. We do need to grow more healthcare providers as well. We’re fortunate in that regard that it’s still relatively well-subsidized. Still, medical education is a cost burden, but it’s not what one would think when looking at other private or other states. It’s still a good deal. And part of that expectation is that we train Texans to become those physicians, so that’s why we have a 10% cap on out-of-state. Now for a small class like ours, we only have 50 students. That’s five students. That’s not a big population.

What we do for screening in the first part of our process is, we actually screen applicants to invite to submit a secondary. We really didn’t think it was fair to open up the secondary application to everybody and then not review every single secondary that came in. We wanted to be sure that we were giving those students who we felt like had past behavior that aligned with our mission an opportunity to answer the secondary. Some choose to and some choose not to.

The first part of our screening is looking at a balance of cognitive and non-cognitive attributes that we think are relevant to being successful as a Dell Medical student. On the cognitive side, I think students are all very familiar with the measures that people use, but we really don’t just use an average or just a block number. We look at trends, and we look at academic activity. If you started out like I did as a freshman in college, and when they told you class was optional, you believed it was optional, or attendance was optional, and then got more serious as you matured, you can see that upward trend. We also look at students who have had other careers and have come back and done post-baccalaureate work in order to develop the foundational knowledge necessary to be successful in our curriculum. That’s really the test: Have they demonstrated development and those competencies so that when they do come into our accelerated curriculum, they are going to have the foundational knowledge to be successful? Because it does require that you have a certain set of competencies developed already, or else you’re really going to be behind. And it’s not something that you can catch up on.

We look at other indicators of that kind, which include not just taking the minimum prerequisites, but what other advanced courses one might’ve taken. We also look at what other obligations one might have that may have taken away from their academic opportunities. Maybe they had to work or care for siblings or children or a student athlete or were in the military, things of that nature, to see how they’ve developed those competencies over time. That’s the cognitive look.

Then we do a non-cognitive look at attributes that we think are relevant or past behavior that we think are relevant to our mission. We’re particularly interested in seeing individuals who’ve demonstrated, in their past behavior, evidence of leadership and teamwork, innovation and creativity, and engagement in their community. All these things align with what we’re trying to do as our mission of making Austin a model healthy city. We look for a combination of those and try to find a balance before we invite somebody to submit a secondary.

Some students will have a 4.0 and a 98% MCAT but did not receive the secondary. It’s really because you have to have a foot in both houses. You have to have a combination of both the competencies in the basic sciences and these past behaviors that align with what we’re trying to accomplish. There’s multiple steps of review that occur. This particular review is a much wider casting of the net. It’s looking at past behavior, and it’s much broader. We invite about 600 people to 800 people to submit a secondary application. If they submit the secondary, then that then comes down to a much more stringent review solely on the non-cognitive competencies or non-cognitive attributes. That file’s then independently reviewed by two reviewers who have no academic information about the candidate, only past behavior or VITA activity. They use that to make a decision about how well this person aligns with our mission.

We’re very fortunate that there’s a number of students who are seeking this career called medicine. We have the opportunity to really look at students for a couple things. One is the capacity to handle the curriculum, which is a really important foundational set of experiences or skill development that has to be there. But then you also have the opportunity to see who best fits or aligns with what you’re trying to accomplish as a new school. And we believe we have a fairly unique mission, and we are attempting to find those students who, based on their past behavior, are going to continue to exemplify or quite literally exceed our expectations of what they can come up with. Zack’s an example of that.

I can also relate, in our inaugural class, we had three students who had previously been science teachers before they came to medical school, high school science teachers. They’re in an inaugural class of first years at an accelerated basic science curriculum, and the only expectation we had for them was to be successful in that curriculum. But they missed teaching so much that the three of them connected based on their teaching experience, and they decided on their own to develop a STEM outreach program with a local high school, which had no science instruction at all or STEM curriculum. They created this outreach with this local high school, which still lives today. They’ve graduated and that program still lives today with our students. I think that’s a good example of how past behavior can predict future behavior. We saw evidence in their experiences, their interest in engaging and connecting with, in their particular case, young people and teaching science. That then propagated itself into an idea that they started on their own.

How do you build something that’s sustaining? Zack figured out a way to make it self-funding by virtue of those who can pay and those who can’t, really recognizing the partnership they could develop. I wish I could say it wasn’t serendipitous, but with the current climate or conditions that we’re in right now, many more people in our community became food insecure overnight. They really have stepped up their activity to do more than, I think, they even expected this year to do.

What are Dell Medical’s plans in terms of interviewing for this year? [18:39]

We have started our virtual interview day experience. We have a rigorous interview day. It’s unlike most interview experiences, and it’s purposeful and it’s designed. We do a traditional 30-minute interview with a faculty member, five mini-interviews, and then we have a group exercise interview we also conduct. There are about 60 different points of evaluation that occur across the day. It gives us an opportunity really to map back to all of our attributes that we think are relevant in our mission. It also gives a student, an applicant, multiple times to talk about how their experiences might align with what we’re trying to do. It’s not just one interview and that person’s perception. It’s multiple perceptions or experiences that they can post to across the day.

The challenge has been, how do we then turn that virtual? Many of the comments from our colleagues across the country when they were starting to do virtual were, “Keep it as simple as possible.” We thought, well, that’s the one thing our interview day is not. We are utilizing Zoom for the traditional interview, the welcome presentation, and the group exercise. But we’ve also leveraged a technology called VidCruiter to create an analog to the MMI, which we’re now calling the multi-video assessment, which is an asynchronous video MMI activity. That has worked really well. So we have as close to the on-premise experience as we can. We’ve created an MMI experience that’s virtual.

How many “speed dates” do they have with the MMI? How many stations do they have? [20:20]

They have five stations and the timing is very similar to the timing that one would have when they’re going from office to office. The only difference is that they don’t have an interviewer in the room with them. The interviewer will review their interview after, so it’s asynchronous. We do have a workflow model inside of it. As they go through that exercise, they will be prompted which direction they’re going. They’ll get additional followup information.

The technology is what we’ve been using for our secondary for a couple of years. We’ve had a video secondary for a couple years now, and our research shows that there is a significant correlation between our evaluation of their communication ability and the video secondary as the on-premise MMI communication ability. We’ve always known that there’s a correlation there. What we don’t know yet is how well we can discern the things that we’re looking for in the MMI in that asynchronous video format. The feedback from our interviewers so far has been that they have actually liked this because they felt like they could be more objective in their evaluation than necessarily being there in the room. We’ll continue to monitor and then evaluate against previous years to see how well this exercise works.

Is the secondary exclusively the video or is there a written part as well? And I’m guessing that you’re not using the AAMC’s VITA? [21:40]

No, we’re using that same VidCruiter technology that we started using almost three years ago. When we instituted it, we offered the option for students to choose the written or the video secondary with the expectation that maybe 20% would want to do the written exercise and the rest would be okay with the video. We’ve actually had less than 1% actually choose the written secondary. The feedback we get from them is that they truly feel like it’s another opportunity for them, in a different way, to tell their story in their voice. For us, it’s important that we have some other mechanism to get a spontaneous response, as opposed to an edited and edited and re-edited response, which many of the written secondaries are, truly. Some give some new insight, but many give repeated insight that’s on the application. We wanted another mechanism so that we could learn more about the student in their own words. We found that it does give us that opportunity.

Do students know ahead of time what they’re going to be answering, do you have a bank of questions, and they answer whatever they get? [22:55]

They have a bank of questions. But the bank is in three primary domains of activity. The question is reflective of that domain about past behavior. They’re not asked to come up with anything where they would have had to study for or quantify something. The three domains are the same as the pillars that we talked about earlier: innovation and creativity, teamwork/ leadership, and community engagement. We have a wide range of applicants as far as age, but I have not seen a trend where our older students wanted to do the written. In fact, in some cases, especially if they’ve been professionals before, they’re very effective in the video secondary.

Are there any plans to extend the deadline for the secondary, since this whole cycle has been pushed later by COVID? [24:09]

The team has extended the deadline by a month on all of our dates. We’ve pushed everything back a month. We will be interviewing in February as well, which is not traditional for Texas. Texas usually finishes the interviewing in January.

How do you view letters of intent, either from applicants who’ve interviewed and haven’t heard if they’re accepted or are going to be interviewed? Are they encouraged, discouraged, ignored? [24:34]

We will not forward them to the committee. If you want to submit one, we will put it in your file, but it will not be provided as additional content for your application. We think it’s very important that the communication channel that’s through the application is the only method for delivering content to the committee. It’s nice to see and nice to hear, but it doesn’t affect any part of the decision, and that’s to be sure that it’s fair for everyone. If you are allowed to submit additional letters of support outside of the application, then our committee would have to read 10 or 15 letters per candidate. Our question would be, could you not have found three people that could have done this just as well? I think it also minimizes the effect of each of those letters as well. The idea is that it’s consistent throughout. There aren’t mechanisms for some people to get more information that other people don’t know about. Really, it’s to ensure that our committee is looking at the same information for every candidate throughout the entire process.

COVID has affected every corner of our lives, including medical school admissions. One of the most common questions I’m getting now is, “I just took my MCAT. Can I still apply, or should I wait till next year?” or, “I couldn’t take my MCAT earlier because of the COVID, or I was going to do this volunteer initiative or this research initiative, and it was canceled,” or, “I had to take classes online, or I had to do something pass/fail.” How do you respond to those concerns from premeds? [26:03]

For this particular class that’s coming through right now, COVID really hit towards the end of that window, which they’d be reporting their application. They have a whole arc of activity going back several years. It’s not a single snapshot that’s being evaluated. We’re looking at the entirety of their academic record and their experiences. But we also recognize with a review that they have interruptions that have occurred as a result of that, so we’re always curious to see how that impacted them. What did they do when faced with that? We’re looking at evidence of resiliency and creativity and recognizing that maybe they took on new responsibility as well. That’s what we’re trying to look at with an eye to recognizing that it’s impacted everybody’s life.

As far as the deadline we talked about, that’s extended out. And yes, if you have taken the MCAT later, we’re going to be looking at those applications as well. You also mentioned making offers. We are going to start making offers to students at the same time we would have in previous years. However, we are very deliberate in how we make offers. We always want to look at everybody we’ve interviewed. We don’t make a whole lot of offers starting out the gate. We’ll make a few offers as we move along. And we also, in Texas, we have something called the match for undergraduate medical education, so we also make offers to the match and we also make offers off the waitlist. I would not want a student to think that, if they’re being interviewed in January, they have no opportunity to be made an offer, or else why did we ask them to interview in January, for example?

We’re pretty deliberate in that we don’t fill up early. We recognize what our trend line is, and we’ll make a few offers at a time. The class that I’m worried about most actually is not this year’s class, but next year’s class. They are probably having to figure out how to adjust to this new norm in a way that it’s going to impact their application more severely, I think, than this current application cycle, because this is the point in time many of those students would have been engaged in their second year of research, engaged in leadership activities, or been part of organizations, and they would have been advancing into those activities this year. It’s going to be interesting to see how they have adjusted. What have they done to be creative? What have they done to adjust to the new norm?

Dell Medical seems to be very focused on its priorities and its values. Do you see yourself looking for slightly different or additional attributes in applicants because of COVID? [28:58]

I don’t think the effect of COVID is not necessarily on what we’re looking at. We’re looking at, “What did you do as a result of this occurring?” much like we would look at an obstacle that you overcame. This obstacle is a little bit different: Everybody has this one. But what are you doing in light of that? Or how are you being creative? What are you doing to engage? But we’re also recognizing that it’s going to limit, for instance, the opportunity to shadow as a result. We recognize that that’s occurring. But what other things have they done to take that time that they have to try to engage in their community? Did they do contact tracing, which they can do remotely? Did they volunteer in a location where it was safe to volunteer, for example? Or did they start something online? We look at what they’ve done creatively, but also with an eye to the fact that it’s limited a lot of their ability to do so.

Looking forward, what advice would you give premeds thinking ahead and planning to apply next summer for a 2022 matriculation? [30:12]

Some of them are going back to school and some of them are not right now. Some of them are staying at home completely. Some are doing hybrid models. I do know that at the University of Texas, they’re looking at ways to open up some of the labs for people to still get engaged and involved. I would look at what’s happening. What conditions are you in? And what can you do to stay engaged in some way that you can’t do now? Look for those kinds of opportunities. Obviously, being successful in an online curriculum is more challenging. Focus on that, and that shows resilience. But then what are the other opportunities? Does your organization still meet? Do they still have leadership activities that you’re engaged in? Are there things that they’re adjusting to that you’re a part of? You really need to start thinking about what you can do to still be thinking about your interest in healthcare and how it’s currently being impacted by this once-in-a-century pandemic. We’re looking to see what they’re engaging in and how they’re engaging, and again, doing it within the mindset of what they can do and what they can’t do as far as safety is concerned.

What would you have liked me to ask you? What would you like somebody to know about Dell Medical that we haven’t covered, especially from an admissions perspective? [32:11]

One of the things that premeds tend to fixate on is, “What are the minimum requirements? What do I need to do to get in?” And I sometimes want to flip that on its head and say, “Well, what are you trying to accomplish?” Think about why we ask you to do these things like prerequisites, for instance. The prerequisites for medical school are the minimum foundational constructs or knowledge that you need to have for being successful on the MCAT, which is to verify that you’ve retained those constructs, but also where they’re going to start training in your basic science curriculum.

So I would encourage students to not think about just the minimum, but what they can do to prepare themselves for this education. “What kind of courses can I take that will help prepare me for this type of education I’m about to go into?” That includes looking at more advanced courses like physiology and genetics, not just taking biochem and then stopping right there. The challenge is to think about not just, “What should I do?” but, “Why are you asking me to do this? And what can I do to better prepare myself?” Because it’s not about just making one hurdle and the next hurdle. It’s about building a foundation of experiences and knowledge that’s going to help then take it to the next level. That’s what I worry about sometimes: We think too much about, “What’s the minimum? What’s the required GPA?” It’s really about the totality of that experience and the knowledge that you develop as a result of that experience. It’s the question of a GPA of X in what courses, and what trends?

Where can listeners learn more about Dell Medical School at UT Austin? [34:24]

If they want to go to our website at dellmed.utexas.edu and click on “How to Apply,” that will tell you more information about the unique aspects of the Texas admissions process and our application process, plus our criteria.

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