Interview with Dr. LeeAnna Muzquiz, Associate Dean for Admission at University of Washington School of Medicine [Show Summary]
Our guest today is Dr. LeeAnna Muzquiz, UWSOM Associate Dean of Admissions, UWSOM grad and professor, and citizen of the Confederated Salish & Kootenai Tribes (CSKT) in Montana. She dives deep into the University of Washington School of Medicine program, mission and admissions practices during this packed podcast. Additionally she provides an excellent overview of how the WWAMI regional program shapes admissions at UW. Finally, she offers can’t-miss advice to UW medical school applicants. Listen in!
Get into University of Washington Medical School [Show Notes]
Dr. Muzquiz, can you give an overview of the UW SOM’s curriculum focusing on its more distinctive aspects? [2:17]
The UW School of Medicine did an overhaul of its curriculum and implemented it with the incoming class of 2015. We are all still getting used to it but essentially we changed the way that we helped students get ready for clinical medicine with exposure right out of the gate. There are three phases (rather than the more traditional two years of basic science and two years of clinical exposure). The design is a layered approach – there is a foundation phase, patient care phase, and explore and focus phase, which really reflects the progress of the student and maturation from student to physician. Starting with orientation and immersion during the first two weeks of medical school it is all about exploring what it is to be a doctor, basic exam skills, and also exposure to service learning and health systems. Students come in with whatever their passion is, and we offer all kinds of different ways to tailor their education.
What are threads, themes, and pathways? [5:12]
The overall approach is really to be multi-layered and longitudinal to help med students and physicians develop critical thinking skills. Essentially, how does basic science, pathophysiology, and physiology really relate to patients walking into the hospital? Threads are both scientific and clinical offered throughout each block, including anatomy, physiology, and pathology. For example, in the first block of the curriculum you are studying the molecular and cellular basis of disease, which will include cell physiology, genetics, pathology, and histology and all of those things will be part of expectations to be mastered in that block. That is the thread going through. The next phase would be Invaders and Defenders, looking at the immune system, microbiology, seeing the anatomy of how that works, pharmacology, etc., so much more system oriented. The themes are recurrent throughout. How does this then look in terms of the value-based concepts — diversity, ethics, and population health – when applying to real people? We are teaching students to think much more like physicians need to think at the end of training, but we’re starting that training in the beginning of it. Pathways are extracurricular certifications to meet the needs of students who have additional interests – the Indian Health pathway is what I did. Other pathways include Hispanic Health, Global Health, Underserved Health, and LGBTQ Health, and you receive additional training in those fields.
UW serves the WWAMI states, which include Washington, Wyoming, Alaska, Montana, and Idaho. How does that work? Is there a set number of students that you take from each of the WWAMI states? In total?[11:45]
We are a state institution, with the main campus located in Seattle, but we collaborate with surrounding states since none of them have their own public in-state medical school. There are 270 slots in total each year for medical school, with 160 seats for Washington residents (100 will do the foundation in Seattle proper, and the other 60 in Spokane), Wyoming has 20 seats with the foundation in Laramie WY, Alaska has 20 seats with foundation in Anchorage, Montana has 30 seats with foundation in Bozeman, and Idaho has 40 seats with foundation in Moscow, ID. Within that Seattle cohort 10 of those are MD/PHD students with a separate admissions process but they still go through committee and are included in our class each year. For each of those states the competition is against other same-state applicants. The foundation is approximately 18 months, and after that is the patient care phase (clinical clerkships of about a year), which one can do in any of the five WWAMI states, based on interests and availability.
What is the TRUST program? [17:00]
Targeted Rural and UnderServed Track is what TRUST stands for, and the program recruits students looking to serve that population, often in primary care. You identify at time of admission that you are looking at the TRUST program, and we fill a certain number of slots in each state. With that, if selected, you have opportunities to be connected with rural communities, smaller cities, or in urban cities with underserved populations. That is your home base for the entire medical school curriculum. You spend time before matriculation and meet the community and get to know them. During foundations you reconnect with the TRUST site. There is a break at the one-year mark of the summer where students have the opportunity to do lots of different things with a less blocked structure, like doing a summer research project, and TRUST students work with rural/underserved communities between the first and second years, then do clinical clerkships at the TRUST site as well. Students come away with a TRUST certification, and we like to think and believe that with the exposure to rural and underserved communities they are more likely to go into specialty areas that serve those communities.
Let’s turn to admission at UW, your secondary application is one of the few that is actually posted on the schools website, which is very helpful to applicants. In your secondary you ask for a 250-word-max autobiographical sketch that should not duplicate the AMCAS PS. You also ask:
• How have your experiences prepared you to be a physician?
• What perspectives or experiences do you bring that would enrich the class?
• What obstacles have you experienced and how have you overcome them?
• How have societal inequities in the U.S. affected you or patients you have worked with?
Why these questions? What are you trying to glean? [23:45]
Their story, and we give them the space to expand on their story. I often tell applicants to make the application a story of you. With the primary application you are limited in space and content, and the secondary is an opportunity to tell us more in depth about themselves, and also is a place to provide updates. We like people to reflect and articulate their experiences on how they have contributed to their pursuit of becoming a doctor. What about those experiences helps solidify this decision for you? Reflection is key for us.
We like our process to be as transparent as possible, which is why we publish the questions. We believe in continuous improvement, and we get input from committee members and current students throughout the process and now on the admissions committee, things like, “I wish maybe people coming in would be more prepared in this or that area.” We want the questions to be meaningful, not hoops to go through. We take them very seriously.
For the obstacle question, I am always struck by a person’s ability to overcome great obstacles to get to where they are, but also, we appreciate the things we wouldn’t have necessarily thought of as obstacles. In the grand scheme of things it might not be a big deal, but what is key is, “This is what I learned, and I am a better person now.” Even something as simple as getting a B+ on an exam, it doesn’t haven’t to be a major catastrophe. Everybody’s definition of an obstacle is different. Sometimes we just learn what value you can get out of even the most trivial things.
UW is also piloting the CASPer. Why? What’s the purpose. [28:46]
CASPer is a situational judgement test, and basically it’s an online vignette of scenarios that test takers are asked to write a response to. It’s not being used as decision-making tool for the class entering in 2019, but what we are hoping for is to get at things like an applicant’s professionalism, ethics, communication skills, empathy, and ability to work in teams. Hopefully it will help us in the overall admission process. We plan to evaluate based on the scores of the entering class and what it can tell us about our process and how it might be useful as a supplement.
UW has a total of 8,607 application for the class that entered in 2017. 1,356 from WWAMI and 7251 from out of the region (OOR) . Within WWAMI it accepted roughly 18.6% and from OOR .2%. How do you winnow it down both inside and outside of WWAMI. The big difference comes in at the interview invitation stage. How do you decide whom to interview? [32:26]
I am amazed at the winnowing process, but it is really well thought-out and well designed. We obviously need some way to get from large to small, so we have an initial screen of metrics – we have a threshold of GPA and MCAT that screens out some people automatically. Those applications are never seen by us, and usually that gets us to a manageable couple thousand. Then applications are put in different buckets – WWAMI and OOR. If OOR folks make it through the metrics they are asked to do a mission essay. For OOR we are looking for people with a very strong demonstration of service or who come from disadvantaged backgrounds. Then they are screened again to see if they have the qualities we are looking for to interview. WWAMIs don’t have an additional essay, but if they get through metric screening they are invited to do the secondary. All apps are screened by two people and possibly a third if there is any conflict. A positive screen results in an invitation to interview. There is more winnowing between the primary and secondary as opposed to the secondary and interview.
What can someone invited to interview expect on interview day? [35:54]
Hopefully a warm welcome and many snacks throughout the day! Beyond that, it’s a full day, with a basic introduction, scheduled things like a high level overview of curriculum and overview in general – things like pathways and TRUST and options within the curriculum. They go on a tour led by current students, have a question and answer sessions with faculty members, lunch with students, and a 30-minute panel interview, with three adcom members interviewing one applicant. If applying to one of the regional campuses, your interviews will take place in those states on those campuses. Seattle folks in Seattle, Spokane in Spokane. The interview itself is standardized across all sites. It is structured such that each applicant has an exec committee rep there (who presents the application in the smaller group that does actual voting), and two adcom members that are part of the team, and it is a question/answer format. All the interview information, like the kinds of questions, are on the website. One is a role play, which is to understand how you think on your feet – navigating an ethical or difficult situation. It is not meant to put people on the spot or make people uncomfortable. It is meant to be done in a kind manner, but being physician can be hard, so we want to know how applicants respond to that. We don’t have MMI as part of the interview
How does UW evaluate multiple MCAT scores? [41:51]
The reality is that with multiple MCAT scores and a metric cutoff we are looking at the most recent score, but with our screeners and interviewers looking at an application in general, we use the most recent as the score you have but we do look at the trajectory, timing, and a piece of advice to applicants: have you reflected on what might have been going on with lower scores, and did you improve over time, and if so, how were you able to do that? If you didn’t improve with multiple attempts have you identified the challenges? We are doing the holistic review. While it is a number, what does it mean to you? If it is on the edge or below a threshold we are going to wonder.
How do graduate education and grades fit into your evaluation of a candidate. Let’s say the applicant’s grades as an undergrad were less than stellar and then they got motivated and did a graduate program in public health with a strong science curriculum or an MS in epidemiology or another relevant masters degree, and they did very well. How does the masters GPA or postbac program fit into your evaluation? [44:06]
Again, no applicant is evaluated on a single aspect of their application. This is a really good example of where we really try to look at the overall picture, and the trajectory matters. We recognize that right out of the gate, college isn’t for everybody, maybe you weren’t socially adjusted, or just not prepared. Unfortunately the GPA we look at and that we use for the metric screen is from the first three years of undergrad. When we are looking at the applicant overall that does matter. With struggles early, how you performed in a graduate or postbac program is important and it’s looked on favorably if you performed well. If you go on with your education and have trouble that is going to be questioned as well.
If someone is on the waitlist, is there anything he or she can do to improve their chances of moving from that list to acceptance? [46:29]
Not really. We don’t expect letters of intent and we really don’t factor in any new information. It should be kept in mind that traffic rules have changed, and applicants should be aware of what it means to “plan to enroll” vs “commit to enroll.” Applicants are asked to help navigate class makeup by declaring their intention in the spring. Around April 30 applicants need to say “commit to enroll,” which requires them to withdraw their names from other programs. If you commit to another program and are on our alternate list, you will be removed from our alternate list. Those are things to play close attention to.
And on a forward-looking note, what advice would you give to med school applicants planning to apply to UW in 2019 for a 2020 matriculation? [50:31]
A couple things are making sure you are preparing yourself now for things that need to happen over that time. The one thing I really stress to applicants and anyone who might be interested in applying is it’s your journey, and you need to do it your way. In general there is not any one prescriptive way to being successful in getting into med school. Doing the things that feed your soul are way more important than just checking the boxes. With whatever things you think are important to the application, you are much more likely to be successful if you are doing things that are authentic to you.
Nuts and bolts, make sure your application is your story, it is written well, and that you have other people read it – people that know and don’t know you – to assess whether it flows well, or is the grammar correct. We have to look for things to be critical about, so if you have neglected something, what does that mean if you want to be in a profession that requires detail? Also, you don’t have to submit on the first day, it doesn’t give you a leg up over anyone else. Just don’t apply until all of the things are ready. We often run into a situation where people want to include supplemental information and we just don’t do that. Finally, make sure you spend time researching the programs you are applying to. There are lots of places you can get lots of advice, but make sure you’re applying to places you’d actually go to – where you understand their mission and it speaks to you. It is a very heavy commitment, so you want to make sure you understand that beforehand.
Any question you would have liked me to ask? [54:50]
I can’t emphasize enough that what we do at UW School of Medicine is very mission driven. At a very basic level our mission is to improve the health and wellbeing of the public and communities we serve, the five state region. We do that by being focused in primary care, underserved populations, research, advancing knowledge, and being leaders in academic medicine. It is a broad message, but it’s important for applicants to understand that. We take it very seriously, and our admissions team is committed to seeing that mission all the way through. Please have an understanding of that.
Another thing that is important for people interested in going into medicine is to have a sense of what’s going on in the world. Now, that’s really broad and general, but having some level of consciousness about the social determinants of health, how that impacts communities, what the state of health looks like, these are really important things. If you have a sense of why some people are healthy or less healthy that can take you a long way to finding solutions. We are looking for those types of things in applicants as well.
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