Show Summary
In this episode, Dr. Valerie Ratts, the Associate Dean for Admissions at The Washington University School of Medicine, offers an overview of the unique program. She describes the “Gateway Curriculum” which provides early clinical exposure and flexibility for students to explore different areas of medicine, including research, innovation, advocacy, and education. Dr. Ratts overviews Wash U’s holistic approach to admissions and the multi-step interview process. Listeners will also learn about the school’s robust student success program, with faculty coaches to provide personalized guidance and support throughout medical school.
Show Notes
Welcome to the 595th episode of Admissions Straight Talk. Thanks for tuning in.
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Today’s guest, Dean Valerie Ratts, earned her MD at Johns Hopkins, where she also did her residency in obstetrics and gynecology and a fellowship in reproductive endocrinology. She joined the Washington University faculty in 1994 and currently is Associate Dean for Admissions and a professor of Obstetrics and Gynecology at the Washington University School of Medicine.
Dean Ratts, welcome back to Admissions Straight Talk. [1:56]
Thanks for allowing me to join you today.
My pleasure. Let’s start with the basics. Can you give an overview of the Washington University School of Medicine Program, focusing on its more distinctive elements? [2:03]
Yes, I think the really interesting thing about the curriculum here at Washington University School of Medicine, is what we call it the Gateway Curriculum. It’s about only three years old, and we put in some very novel portions to it, in terms of what a normal medical school curriculum has.
I think the key thing is it’s divided into three phases, phase one, two, three. The first phase is called Gateway to Foundations, it’s 16 months long, and that’s that traditional part of a medical school curriculum where you learn some of the foundational knowledge, the basic sciences, the clinical sciences that you’re going to apply as you take care of patients.
But uniquely during our first phase, we have you enter into the clinical environment very early on so you can get an idea of what it’s like in the clinical environment as you’re learning those basic sciences. One, to sort of keep you very interested, but also so that you have a perspective. The three clinical areas that you rotate through are inpatient, outpatient, and peri-procedural. We want you to understand what it’s like to be a medical student and to be a doctor, but also, we think that uniquely in that period of time, as a very early medical student, you also have a very unique perspective of how the patient views medicine, relationships with other healthcare providers in that area. And we want to use that unique lens to help you be a better doctor when you’re a little bit older down the line. So that’s one of the things I think that’s unique about the beginning of our medical school. Then we have you rotate for 12 months through all the different clinical subspecialties, which is standard part of every medical school. Medicine, surgery, pediatrics, OB-GYN, psychiatry, and neurology.
And then finally, the third phase is called Gateway to Specialization, and this is about the last almost year and a half of medical school, where now you’ve rotated through the different areas of medicine. You have an idea of what you think you like and you can spend the final portion of your medical school career, almost a year and a half, sort of specializing in getting extra knowledge that’ll prepare you for your residency. So I think that’s what really makes our curriculum quite unique.
And then the final thing is that we have what’s called Explore, and EXPLORE is this concept that there are these different areas in medicine besides your specialty. And the areas of medicine that we think we do really well in teaching you about are research, innovation, advocacy, and education. And so you have your specialty, but you also have the areas of medicine that you’re really excited about. And so we give you the ability to learn special skills in those areas of medicine that you can take into your future career.
So is the EXPLORE part of the curriculum part of the third phase? [5:03]
It’s emphasized in the third phase, but we start at the very beginning. There is actually a four-week period in phase one of the curriculum where you pick one of those four areas and you spend four weeks learning about that specific area, the skills that you need in that specific area, and we also have you do a scholarly project. And then as you go through phase two, there are times where you could even come out of phase two and spend additional time in that scholarly area. And then in phase three, again, that’s where you spend most of the time looking at EXPLORE, and that’s where we have our other degrees, our dual degrees where you can actually get an MPH if you are interested in advocacy. You might do a year of research in bioinformatics or bioengineering if you’re interested in science and innovation. And you might even do an MBA, which we have an MBA dual degree program if you’re interested in innovation also. So there’s all sorts of different dual degrees that you can add in phase three that enhance that EXPLORE part of our curriculum
And EXPLORE is something that you would focus on, right? So a specific student might decide to focus on advocacy or innovation, but they’re not really exploring all four areas. [6:17]
That’s a really good question you ask, Linda. In the beginning, in phase one, we do introduce you to all four of these areas because every doctor needs skills in all four of these areas as they go on in practice medicine. So there are times in phase one of the curriculum where we talk about all four of those areas, help you understand what makes you tick, what really excites you. And then you can go through phase two and phase three of the curriculum where you can emphasize one or two of those areas. We don’t track people. We don’t believe in tracking. We really believe that you should really, in medical school get to explore all these different areas and then you begin to sort of narrow down in that phase three and really enhance your knowledge maybe in one or two of those areas, with a scholarly project specifically in one.
When I was preparing for the call, I noticed that flexibility is something that’s touched on a lot. It’s built into the Gateway Curriculum. Can you touch on that or dive a little bit deeper into it? [7:28]
Right, I think medical school is truly a time when we need to give our students the opportunity to see all the different areas that you can consider as you go into the field of medicine. And so flexibility is key in giving you the time you need to explore those areas, and the opportunity to figure out what you need to do to explore those areas.
So phase one is a little more, I don’t want to say rigid, but a little more planned, like here’s all the things that you’re going to do for 16 months. There’s all this, there’s seven foundational modules that we go through. There is that four-week period of time where you can pick an area of medicine and explore and kind of concentrate on that, but that’s pretty straightforward. Then you enter phase two, which is where you rotate through all those, the six areas of medicine. You can take up to eight weeks out of phase two, which is that 12-month period of time, and step out and go and do a project that could last up to eight weeks if you wanted to.
Could you do a non-clinical project? [8:52]
Yes, a non-clinical project, if you wanted to. And we believe that’s very important. Then after phase two, it’s wide open. You can do a dual degree at that point. You have all these different rotations that you can do. We really want to give you the flexibility to figure out what area of specialty and also what area of medicine, as I mentioned, that you really want to practice in in the future, in terms of education, advocacy, science, innovation. We think that we make academic physicians, people who are going to go into academics in the future, and you need the ability, how do we educate, how do we teach, how do we do research, how do we think about innovation in medicine, to move the field of medicine forward. And then advocacy, very important, a very important aspect of our medical school. We are committed to growing and teaching and educating physicians who will give back to their communities in the future.
Speaking of giving, I noticed that the website said that 85% of the med students receive merit and/or need-based scholarships. I assume that most of those are partial scholarships, but that’s a pretty high percentage. Would you like to elaborate on that? [9:55]
So the cost of a medical education is something we would never want to prohibit someone from studying medicine because of, we would never want that to happen. And so we’re committed to making sure that medical education is affordable to our medical students. So this year and the past year, 89% of our students received some type of aid, either merit or need-based aid, and 67% of our students had full tuition.
Now, a significant, about a third of that full tuition were our MSTP students, our MD, PhD students who received full tuition, but overall, 67% of the class received a full tuition award to come to WashU, so we think that’s important. We have, if you look at overall debt when our students graduate from medical school, it’s compared to the national averages, we’re in the fifth percentile. So significantly lower educational debt at the end of medical school here at Washington University.
That says a lot because I’ve talked to some medical school graduates and most, if they don’t get scholarships, are in the $300,000 or more range of debts. [11:26]
Yes. We’re under 100,000. The average medical school debt at our institution at the end of medical school educational debt is under $100,000, which we think is important. We would never want the finances to determine what specialty you choose and what area of medicine, how you’re going to practice, whether you want to practice in a community, assisting in a community in an under-resourced area. We think that is important as we educate our students.
It’s kind of putting your money where your mouth is, that’s for sure.
Let’s turn to the WashU application. What is the secondary like, and does WashU screen before sending out secondaries? [12:09]
So the secondary is a supplemental application, there’s a little bit of demographic information, and there really are two major short answer questions that we have on there. And basically the two questions are, tell us about a time when you’ve failed or been unsuccessful, which I think is important. Most people that come to medical school have failed in something. And I think that when you see someone who overcomes their failure, that shows grit, determination, and resiliency, and that’s something that we really look for. And then the other big short answer question is we ask if there’s anything else that they would like to tell us that they haven’t had a chance to write about. Are there obstacles, challenges, experiences that they wish to tell us about that they’ve had on their way, on their journey to medical school? So we think that that’s very important too. We send everybody a secondary, and that’s part of our process, and then we look at an entire application. We look at everybody’s completed application to WashU medical schools, that’s how we screen.
I love the failure question. I was actually just reading something about personal growth, and if you can’t acknowledge that you’ve had a failure or done it, then you can’t grow. Very simple. You can’t learn, you can’t grow. And I also read something else that a mistake is a mistake if you learn from it, and it’s a failure if you don’t. [13:42]
That’s a great quote, I love that quote. I think you bring up this concept that I, as an admissions dean, I talk about this a lot, this concept. On the way to medical school, everybody has something that was something maybe they’re not so proud of. And I’m a big believer in whether it’s grades, whether it’s an institutional action, you need to be able to talk about that, acknowledge it, and show how you’ve grown from it, and not be afraid of it. You don’t have to perseverate on it, but I think you have to be ready to acknowledge it, talk about it, and show that growth. And that’s something that shows maturity, which is something that we’re looking for in our applicants.
Absolutely, and the ability to overcome and bounce back, as you said, resilience. [14:48]
Absolutely. You will need that when you’re in medical school. Invariably in medical school, there will be times when things aren’t going so well. So, do you have that skill set that you’ve utilized before to overcome what you need to in medical school?
That’s right, great question. What do you hope to glean from the other question that perhaps doesn’t get covered in the primary? [15:13]
So I think that it’s important. We want to know about experiences, obstacles, challenges in one’s life, which may be related to how they grew up, the culture in which they’ve lived, the experiences that have been difficult for them. And that’s an important part of the application for you to talk about those types of things so that we can even ask you about them. There are all sorts of different sorts of experiences and challenges that maybe we don’t know how to ask you about or we’re not allowed to just say, “Tell me,” just have you ask about these things. We want you to talk about them so that we can ask you about them and learn more about them.
What if the applicant feels like their most impactful experience essay from the primary is where they discussed the biggest challenge they had, or cultural challenges or background challenges? Should they explore that incident or that factor from a different angle in the secondary? Should they choose a different? I mean, I realize that this is hard to give an answer for every single individual because every individual’s background experiences are so different. [16:19]
Right. I think that this area, the question that we have is a place that we allow you to expand. That other impactful experience is pretty small little area, and this allows us to expand it. And if there’s other areas that they haven’t been able to mention them in that area of the secondary.
What is the word limit for this or the character limit? [17:17]
It’s 500. It’s pretty big.
Now, the interview experience at WashU is a little different and frankly, rather demanding. Interviewed applicants do both the asynchronous virtual interview, also known as a standardized video interview, and that is completed before the two live Zoom interviews, which I assume are with human beings like you and I are talking now. Can you explain the difference? Why do you want all three? [17:25]
So the standardized video interview is basically a video interview that we do. We have standardized questions that we ask our applicants. There’s basically three verbal questions that we have you give a verbal answer, and one question that we have you give a written answer, and it’s timed.
So what happens? You get all set up, you sit in front of the computer and we say, we push the button to go, and we basically give you questions that are asked on video by our medical students. They’re behavioral and situational judgment questions. You have 90 seconds to prepare your answer, and then the computer comes on and you have 120 seconds to give your answer. And we think that ability to think quickly and organize your thoughts and give a coherent answer in a defined period of time is an important skill for physicians and something that we use. And then we also have a written question so that we can see writing in sort of a timed fashion too.
And so that’s the standardized video interview. We glean good information from that, but I think the really important information that we get on our applicants comes from this live interaction that we have when we do our Zoom interviews.
Is each interview with one individual? Are they professors, students, admissions professionals? [19:16]
So the interviews that you have one-on-one are with our faculty and staff and senior staff. There is a standard interview where the interviewer has your entire application and is able to review it in advance, and has about 30 to 45 minutes to talk to you. It’s a conversation. It’s about understanding your motivations for medicine, the experiences that you’ve had, why WashU would be a good medical school for you. Tell me about your research. Why do I ask about research? Because I think that when someone talks about your research, and it doesn’t have to be in medicine, it just has to be a question, and research is you ask a question, you gather some type of data, and then you get that data, you analyze it and you think about, what are all my other questions?
So as what do doctors do? They have to take complex scientific information, they have to distill it down, and they have to communicate that to patients and patient’s families, so that the patient and the patient’s family can understand and make the choice that’s right for them. So many times, that’s why we ask about research, because it allows us to understand, can you talk to people about research, the science and have a conversation? So I think that’s really important. So that’s the standard interview.
The closed file interview, again, one-on-one with a faculty member or senior staff, is an interview that’s 20 to 30 minutes. And in that interview, all the interviewer knows is your name and pronoun.
And that’s it, honest to God.
Not even a resume? Wow. [21:11]
Nothing else. And so it’s a conversation, it’s a blank slate, and there you go. And you can talk again about your motivations for medicine, the things that you’ve done on your way to medical school, your background, your challenges, experiences, why you want to be a doctor. And so it’s short, but it’s a blank slate, it’s a conversation.
We try really hard. We’re a collaborative school. Faculty and students work with each other. We’re making medicine better and it isn’t about us being mean during the interview. We want to be kind and understanding and have a conversation about making sure that you fit. Right? What are we doing in medical school as admissions officers? We’re looking to see, do you fit into our medical school? And you should be looking at us to say, do we fit you too, right? Is this the right medical school for you? It’s a two-way street, which I think is so very important. So that’s part of our personality here at WashU. I hope that comes through, because it’s important.
One thought that occurred to me is, in terms of the blind or the closed interview, it’s almost like meeting a patient for the first time. You walk into an ER room for the first time. You don’t know the person. [22:30]
No. It’s a skill set. How do you introduce yourself? How do you communicate? Do you not talk over someone? And that’s hard to do sometimes in Zoom, right? We’ve had to develop these skills.
Right. I think it can also be hard to do in person. [23:05]
Oh, sure. And the faculty want the students to talk and to hear their thoughts, right? Yes.
Now the stats for matriculating students at WashU are through the roof. For the 2023 entering class, I think the mean MCAT was 519.5 and the mean GPA was 3.88. WashU received 5,702 applications, interviewed 1,057, and just admitted 124 M1s. Besides stats, what makes an applicant jump off the page for you? [23:27]
The first thing I want to say, when we say stats like that, you gave an average, but the range is wide.
We go all the way down to 505, all the way up to the top and we have people who have GPAs that are just above 3.0, okay, all the way up to 4.0. So there is a wide range, and I think that’s very, very important.
I’m really glad you brought that up. [24:35]
No, it’s very important. We follow the AAMC Holistic Review model. This is a mission driven approach where we think about experiences, attributes, and metrics. So metrics are a piece of the puzzle, but experiences and attributes are just as important if not more important, right?
Someone may have a lower GPA, but at the end of it all, they started out poorly and then they went up. Wow, that’s that grit, resilience, determination coming right through. That’s what we’re looking for. People who learn from their mistakes and are able to overcome, that’s so important. So metrics is a piece of the puzzle, but I think mostly what we’re looking at are your experiences and your attributes in the application.
I really appreciate the fact that you mentioned the range, and that’s really the limitation of focusing on average, because average is not a roof, right? At the same time, I’m sure you as an admissions officer want the confidence the people you admit are going to do well. So if somebody does have a low GPA or a lower than average MCAT, I’m going to guess that they have to show you in some way that they can handle the work. Am I correct? [25:33]
You are, absolutely. You’re taking the words right out of my mouth. Thank you for saying it. That’s exactly how we look at it. We’re looking at, again, we want to make sure people are successful in medical school and that’s very, very important, the work. And there’s always this concept that people, they can grow along the way. So there are people that maybe this medical school at the very beginning might not be the perfect place for them, but ultimately residency, fellowship, and being an attending here. So we’re always thinking about that too. We want people to be successful here. And we bring in people who have lower MCATs and lower GPAs.
And one of the things I hope we do get a chance to talk about is our student success program. We have coaching and all sorts of ways to support students who may have initially some difficulty along the way. So there’s an incredible program here in coaching and mentoring our students. So, we like to put the metrics to the side and when we review applications, we don’t actually, the metrics aren’t up in front and looking at the faculty. In fact, we blind them.
Really? [27:31]
Yes, we take the metrics off the application and look at the application, in terms of the experiences, the letters of recommendation, the answers to the short essay answers, and your personal essay. That’s what we’re looking at when we decide, is this the right person for our medical school?
And what happens if you say, “This person has the grit, has the resilience, has the experiences. I think they’re going to make a physician,” but the numbers are low? [27:53]
We want to interview them, we want to see them in person. So the initial review of a file is, we look without the metrics. We look without the metrics and we decide, we score the application, and then we decide who we wish to interview. And then again, when you come in to interview, again, the metrics are not in front of the interviewers.
It’s closed file so they know absolutely nothing about the metrics. Write everything up. And so the interviewers interview, understand the applicant, their conversation, and write things up. Now, at the end of the day when we have our subcommittee meeting where the interview scores are there, the application rating scores are there, we look at everything in whole, in total, and decide who we think best would meet the mission of our medical school and do well here and be a great physician for the future. So, coming from WashU.
I’ve interviewed a few admissions directors who say that they don’t look at the metrics first, but they usually do come into play much sooner. I think before interviews would be more common, even for those schools that don’t look at them initially. But they’restill fairly few to my knowledge. And I think you’re giving holistic admissions much more meaning when you blind that, at least until the end. Obviously you can weigh it at the end, but you’re giving all those other qualities a much bigger chance to shine forth. [29:19]
That’s true, that’s what we believe.
How do you view update letters or correspondence from wait-listed applicants at any time during the process? [30:03]
So let’s talk about update letters first. We take update letters. This application review process if you think about it, applicants are filling that out in April, May, June, and things go on after that period of time. So if someone writes us an update letter, we take that and we place it in the file so that when it’s in the file and we can look at that, the reviewers, whether the raters or the interviewers, can look at that information. So that is utilized in the process. So we do accept update letters. Now, I wouldn’t be writing an update letter every two weeks. We’re being practical here, right? But an update when there’s something truly significant to update about. That’s obvious but important to recognize. So maybe one or two update letters over a period of this maybe six to nine month period of time, would be appropriate. With appropriate, truly informative, important information. So that’s your update letter.
The next kind of letter that sometimes we get is this, after the end of the interview season when you’re doing that letter of intent. So WashU, we’re always looking for individuals, as I said before, who feel that this is the place where they fit, where they will… Because when you fit, you’ll flourish. And we want our students to flourish here, that they see the opportunities that will be good for them to grow and do the things that they want to do.
So I say at the end of the season, when you’re all done with your interviews, genuinely think about where you would like to go to medical school. And if WashU truly, genuinely, authentically, and that’s important, being authentic is important in this process. It’s professionalism, right? If authentically this is the place that really would fit you in your mind, we like those letters of intent that tell us why, after you’ve gone through this process, why this would be the right place for you. And again, we take those letters and we place them in our application database. So I think that it can be important, especially as we get to the waitlist too. We take a fair number of students from the waitlist and obviously when we make an acceptance from the waitlist, we want that individual to say yes. And so those types of letters can be helpful at that point in the process also.
Right. I like how you said it’s not just that in a letter of intent you say, “My intent is to go to the schools,” that you also give the reasons. [33:09]
The why’s are important in this world.
Very important. I’ve talked to many admissions officers who say they disregard letters of intent, because so many times somebody said, “Oh, you’re my number one choice,” they offer them acceptance, and then they go elsewhere. So they’re very suspicious of the credibility. On the other hand, if you give really solid reasons, then it’s much more meaningful and persuasive. [33:19]
Absolutely.
Let’s go back to the student success program. Can you follow up on that? [33:52]
Right. So I think we’re a medical school, and as you’ve heard me mention, medical school can be tough at times and we recognize that. And if we bring someone into our medical school, we know they’re great and they’re wonderful and they’re amazing, and we’re going to help them get through medical school. So, every student from day one is given a faculty coach, who is a special faculty member. There’s only a few of them. The faculties have to apply to be a coach and they’re given specialty training to help in coaching students in their small groups of students with a coach. And that coach stays with them through the entire time of their medical school from day one till they graduate.
That coach will never assess them. Okay? So they’re never grading them in any way. And we can talk about grades a little bit. We don’t have grades. We have a unique way of how we assess our students in their preparation. So coaches never assess, they’re never part of when they go to apply to residency, those types of things. They’re not writing letters. They’re not doing that type of letter. They’re there really and truly to help mentor them through the process. They know if they’re having difficulty with whatever, okay, here’s where you need to go and get help with this.
We have in our educational program, the students have dashboards. So we have a dashboard of how they’re doing in all the different areas and we assess basically six areas in our students. Patient care, medical knowledge, interpersonal communication skills, professionalism, practice-based learning and improvement, and system-based practice. These are the six areas that as a medical student you’re assessed on. It’s the same types of areas that you’re assessed on as you go through residency. So we start doing this at the very, very beginning. And so we have this dashboard in all these different areas when you’re in the beginning, in the first part of the curriculum, phase one, there’s different areas of your knowledge, how you’re doing clinically.
So there’s this dashboard keeping track of all these different areas and the coach can see those areas and is there to help and saying, “You know, you’re not doing as well in this one particular area,” and anticipate, “I think it would behoove you to go and work on this, or I think you’re going to want to, in phase three you’re thinking about you want to go into this area of medicine. I think you might want to do this rotation.” Those types of things, or “You’ve had some difficulty in the past with standardized tests or maybe some of the tests that you’re taking, the shelf exams that you’re taking. You know what? Let’s anticipate that we maybe need to spend a little bit extra time getting ready for taking step one, or more importantly, step two.” So helping you with the knowledge base that they have to kind of anticipate any issues that you’re going to have and coach you through so you will be successful in medical school, and on into residency in the area of medicine you want to go into.
Now, let’s say somebody’s not doing so well in the area of professionalism for example. Would the coach come and say, “Your scoreboard shows that you’re not doing so well in the area of professionalism,” how specific does the coaching get? Because if you just say, “I think you need to focus on this area and work on it,” well, maybe they do need to work on it, but they also need advice. Are the coaches trained to be more specific in their coaching? [37:05]
Oh, yes. They’re trained to be very specific in recognizing, this is an issue. And also, getting advice even from the other coaches. The coaches actually get together, not with any specifics of what specific names, but here’s an issue that we’re having. How can we address this? This might be something that is, there are multiple students in a particular area or a class or whatever, and so they can approach it sort of in a system-wide fashion.
You have time. You meet with your coach, you meet every week during the phase one of the curriculum.
And that’s individually, right? [38:52]
Individually, every week and also in groups too. Okay, so in groups, your small coaching group of maybe five to eight students. Phase two, you meet one-on-one with your coach and you also meet as a group every clerkship. And then in phase three, you meet on a regular basis also as you’re preparing for residency, your application. So we’re already looking at, what do we need to do to be ready to go? So there’s lots of one-on-one time. The coaches are basically, that is part of being a faculty coach, they are given a specific allotted amount of time designated to, this is my job and this is how I’m going to help my students.
And the coaches also meet together and can talk to each other of learning how to best, what is the best practice for advising? If someone continues to be tardy, what is a good way to fix that? Or is this a common thing that’s happening as a big group, we need to address this as a class, right? Or is it something, is there a systems issue? If someone’s always late to a lecture, is it because there’s something going on clinically that they’re not letting them free in time to be on time for that lecture? So that’s a systems error and to fix a systems error, you have to recognize the systems error.
Let’s go back to the prerequisites. How do you view prerequisites for medical school taken at a community college? [40:34]
We look at prerequisites as competencies. Our prerequisites are one year of biology, one year of chemistry, one year of organic or a semester of organic and a semester of biochemistry, one year of physics, and one year of math, calculus. So either one semester of calculus or end of semester of statistics, so that can be substituted. So, and these are competencies. Okay? So we feel like you need these competencies to be ready and prepared for medical school. So the idea of our prerequisites is we think it’s necessary to have passed that and have that in, the general information and knowledge that you would have from having those classes.
And so we look at community college classes as if you pass, then you pass that competency, that’s how we believe it. Now if you’ve had AP credit, okay, great. One of the things I’d like to see if you’ve passed all those things is okay, and your schedule is wide open, I’d like to see you take some upper level classes and do well, right? To dive more deeply into an area.
That makes a lot of sense, especially if you’re looking at it as competencies. What about shadowing? I know some schools absolutely want to have their applicants have shadowing experience. Some say it’s desirable but not required. Some say it’s a sign of privilege and they don’t want it to be required because not everybody has the relationships with doctors to shadow. What are your thoughts on shadowing? [42:02]
So here’s how I think we at WashU look at shadowing., I think that you need to be able to answer the question, why do I want to be a doctor? So you have to kind of know a little bit of what a doctor does and what’s happening within the healthcare space. I believe that you can understand what’s happening in the healthcare space by watching in a variety of different ways. It doesn’t have to be a one-on-one shadowing experience. It’s nice to maybe get to do that once or twice, but I don’t think you need to have extended periods of time. Once or twice getting to observe, but that could be observing, it could be observing as an EMT, it could be observing being a volunteer in an emergency room as a tech stocking shelves and things like that. If you’re eyes wide open, you can see what’s going on. Scribing, a wonderful way to do that.
I’m also a big believer, something even like hospice. You’re in that healthcare space, you’re working with patients, sitting by patient’s bedsides and helping in that way. Observing the nurses, the technicians, the medical assistants, all of those types of experiences are important. But I think the key thing is when you’re asked the question, why medicine, that you have a coherent answer of, there is some clinical aspect to that. The other thing about that is that if anybody shadows or watches, it isn’t always fun. Doctors do things that are sometimes, or healthcare providers I should say, do things that are difficult at times. And understanding that there are difficult conversations at times and just observing the difficult things that happen, I think that’s important to understand that about medicine. It isn’t always like, we cure everybody. We don’t.
One of the questions I sometimes ask is, “What have you seen as you’ve observed in the clinical space that was good?” And then I always go, I kind of flip and I say, “And what have you seen that’s not so good?” And being authentic and genuine, I think that’s important.
It is. I get together with some old friends regularly, and the leader of this group likes to say, “What is a rose and a thorn in your life?” [45:04]
Oh, I like that. I may steal that from you.
It takes maturity to understand that in medicine. I think it’s so important.
What is the common mistake that you see applicants make in approaching the primary, the secondary, or the interviews at WashU? [45:41]
I think one of the things that I don’t like that I see sometimes on applications is when people have to describe an institutional action. I think that I see them kind of act like the institutional action didn’t happen, and I’m like, be honest about what happened. Describe it completely, again, not overdoing it, but being honest about it and describing how you did learn from that and how you’re never going to do that again, right? So I think that that’s a mistake that I see people make that, I really don’t like that they don’t take responsibility. They don’t show how they learned or they kind of try to brush it off. Obviously you may think it was small and minor and not important, but the institution thought it was big enough and important enough that they said no, that wasn’t right to do that. So I think you have to own things, right? We all do things. We all make mistakes, especially young people who are typically the age group that are applying to medical school. It’s okay, we get that as admissions officers. The key thing is that you learn from that mistake and you’re not going to do that again. That’s really important.
I was talking to a medical school re-applicant recently, a prospective client, and he had a sharp drop in grades I think in his junior year. And I was like, “What happened?” He says, “Life happened, but I don’t want to talk about it on my application.” So I let it go and came back to it a little later in the conversation and I said, “You don’t have to tell me what happened on this call. But I really want you to think about whether you want to tell the admissions officers, because life happens to them also, and if you don’t tell them what happened, then they won’t know what happened. They won’t know if you were in jail, they won’t know if somebody died, if you had a serious mental health problem, if there was an addiction issue. They’re going to have to use their imagination if you don’t tell them. But again, realize, they are human beings and life happens to them also.”
I think that in addition to what we talked about, about the ability to learn from failure or learn from a mistake so it doesn’t just become a perpetuating failure, I might add, self-perpetuating. If you take responsibility, you take ownership, you’re basically transforming that rather sad event into a learning experience. A mistake can be a learning experience or it can be a failure. It’s a failure when you don’t learn from it, to go back from that quote I read. [47:13]
That’s excellent. I agree.
This show is scheduled to air October 1st, that’s a month before WashU’s final day for submitting the AMCAS application for this application cycle. If somebody is debating whether to submit in October or wait until next year, what would you advise them? [49:02]
You’re asking hard questions here. That’s a hard question because that is really, really late in the application cycle and you have to understand that we’re reviewing all these applications and ultimately at the end of the day, those last few spots get really hard to get. If you apply and you feel you’re late but you feel this is a really wonderful application and there have been really great activities and I don’t see myself doing a whole lot more this next year. I would go for it. The downside is cost, it’s money, right?
It’s also time. [50:09]
It’s, and time, right. To do what you have to do, but also there’s a cost to applying to medical school. If you don’t get into medical school, how we look at this is, okay, you go again and then next year you should be first in line. Applications open on June 1st. You want to be at the front of the line, and then that’s really, really important just because we run out of space. Sometimes people retake their MCATs and now their MCAT is really, really great and really high. Well that, it makes you a stronger application. What activity, what have you done? I never would wait. My paper’s going to get published, I wouldn’t wait for that to apply in any way, shape, or form.
So I’m really not answering your question very well. I’m acknowledging that, that’s the truth. It’s tough because I think being that late, you are a little behind, but if you have a really solid application and you have the time to apply and it is expensive, you have to consider that. But if you don’t get in, you’re just going to say, “I’m going to work really hard this whole year.” If you have a late application, you need to assume that you may not get in, and so you’re working really hard this year, you can’t stop. You’re doing your research, you’re doing your scribing, you’re doing your volunteering, you’re engaging in your community, you’re taking some extra classes, you’re doing all those things because you’re going to enhance your application for the next one. Because if you apply and then you apply again, we expect to see improvements in that period of time.
But sometimes people don’t realize that. They have the same application and you’re like, well, nothing’s changed. And even though it was late last year, we don’t necessarily always consider that. We just say, “Is there a difference in the application?” Got to grow, got to keep growing, don’t stop.
Absolutely. When you have a re-applicant, do you compare the applications? [52:14]
Oh, many times, yes. We look at what they’ve done before and how this application is different.
And that’s one of those failure things. You applied to medical school and you didn’t get in, that’s a failure. You don’t have to perseverate on it, but you can acknowledge it. I didn’t get in, maybe I applied a little on the late side. As I reapply, I’ve improved my application. Here’s the things I’ve done and I am ready to be a doctor. I had to think about it, I had to think about it twice, and I think that’s important. People that didn’t get in and decide, nope, I’m doing this again. Again, there’s that grit, resilience, determination coming through again, I’m going to be a doctor.
One of the more frustrating conversations I have with applicants sometimes, especially re-applicants specifically, is the re-applicant who says, “My MCAT was low last time, so I improved my MCAT, but I’m going to submit the same personal statement.” [53:05]
No, no, no, no, absolutely not. You’ve grown, right? You better have grown.
Especially these 20-somethings, they have tremendous growth taking place at that time in their lives. [53:29]
Oh, yeah. There are all these great things that they can do at that time. Right? That’s got to go into why they want to go into medicine and how they’re ready for it.
What would you have liked me to ask you? [53:44]
This is a great interview, there’s a lot of information. What would I have liked to ask? I guess, maybe a little bit about what makes WashU unique as a medical school?
I think it’s the people, and I know a lot of people say stuff like that, but this place has a culture where you’ll hear our dean say, “It starts from the top, that this place is collaborative. We work together.” We have a lot of very smart, hardworking people, and they love what they do, and that churns it and allows them to produce and to work with others, and continue to advance medicine forward, and I think that that trickles down. Faculty love to work with the students. They want to help them, they want to help them grow. Mentorship is so important at this point in a young person’s life. You need mentors for your science, mentors for your academics, and mentors for, how do I do this thing called life in medicine and the specialty I choose? And I think we at WashU really do appreciate that, and that is how our medical school and our community works. So that’s what I’d like to say.
That’s a great note to end on. Where can listeners learn more about Washington University School of Medicine? [55:06]
They can go to mdadmissions.wustl.edu.
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