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Show Summary

What are the pre-med competencies? And if you’re pre-med and planning to apply in September 2024, what do they mean to you? That’s the subject of this week’s podcast of Admissions Straight Talk, as Linda Abraham and Dr. Valerie Wherley, an Accepted consultant, dive into pre-med competencies. Dr. Wherley gives an overview of the 17 competencies identified by the AAMC as essential for success in medical school and beyond. She leans into her expertises as an Assistant Dean, medical school program director, and advisor to present practical tips on how to develop these traits and demonstrate them in an application. 

Show Notes

Our guest today is Dr. Valerie Wherley, an Accepted consultant. Dr. Wherley earned her B.S. and M.S. at the University of Maine in kinesiology, and her PhD in higher education and higher education administration from the University of Connecticut. Over the last 20 years, she has served as the Assistant Dean of Student Affairs and Career Development at William Beaumont School of Medicine, Director of Pre-Health Post-Bacc Certificate program at Sacred Heart University, and the Director of Pre-Health Advisement at Sacred Heart University.

In those roles, and before joining Accepted in 2022, she advised thousands of students in the following pre-health tracks: pre-med, pre-PPA, pre-vet, pre-dental, pre-pharmacy, pre-PT, pre-OT, pre-accelerated nursing, and pre-optometry, as well as applicants to master’s programs in exercise science, biomedical sciences, occupational therapy, speech language pathology, athletic training, public health, and applied nutrition.

Today we’re going to focus on med school admissions, and specifically the AAMC’s recently updated pre-med competencies for entering medical students. 

Dr. Wherley, welcome to Admissions Straight Talk. [2:21]

Thank you so much. I’m happy to be here.

I’m delighted to have you joining me. Now, let’s start with the basics. What is a pre-med competency? What’s the goal of them? [2:27]

Sure. Where I thought that we would start is just looking at the word competency. The National Institutes of Health, or the NIH, define competencies as the following: “Competencies are the knowledge, skills, abilities and behaviors that contribute to individual and organizational performance.” So, if we keep that word in mind, that helps inform our conversation.

Pre-med competencies are now a list of 17 standards that have been identified by the AAMC and others, which I can talk about in a minute, as essential for success for entering medical students, and also people who are going to be practicing medicine in the future. So, it’s not just for students in medical education, but our future practitioners.

So that’s the conceptual framework for the competencies. [3:35]

Right.

Let’s discuss a little bit more in depth. Do you want to focus on some particular ones? I’ll let you take the lead here. [3:41]

Sure. I can give an overview. The competencies are grouped in three categories, and then within the categories there are specifics. With those specifics there are sort of a deep dive into the definitions. So, without getting too far into the weeds, let’s look at the categories, and then maybe the specifics.

The three categories are the professional competencies, which has the biggest list now, and then there’s thinking and reasoning competencies, and then science competencies. If I start backwards, the thinking and reasoning competencies, that’s one category, and the science competencies actually did not get updated in the update that we will talk about. It’s the professional competencies that underwent the update.

So, I’ll start with science competencies. There are two specifics within that category. There’s human behavior and living systems, and you can look at the specific definition of both of those. Thinking and reasoning competencies include the following: critical thinking, quantitative reasoning, scientific inquiry, and written communication. If you look at the definition of those, for the most part, that’s a lot what pre-med students are learning in their curriculum. That’s a lot of what students will be learning in biology, chemistry, orgo, psychology, statistics. When we look at the professional competencies, the remainder of the 17 live in those professional competencies, and I predict that we will do a deep dive into those in the rest of this conversation.

There are obviously 12, if I did my math correctly, right? [5:31]

That’s right.

So, that’s more than double the other two combined, right? [5:37]

That’s right.

I think med students in their applications tend to focus on the thinking and reasoning and the science. [5:43]

That’s correct.

So how have the competencies been updated? [5:53]

How they were updated lends ourselves to starting with a bit of background. So, these competencies originally were published in 2011 and the title was different. The first title was called the 15 Core Competencies for Entering Medical Students. So, as I said, there are now 17, so there’s been some shifting in definitions and expectations. So, what happened between 2011 and 2023? When we think about this, let’s think about what’s happened in the world, what’s happened globally, what’s happened in our society and culture. So, we can all agree, a lot has happened. We think about cultural shifts, shifts in society, shifts in access to healthcare. And medical educators, leaders in the AAMC have said, “So much has happened since 2011 to 2023, medical education has changed. The expectations of what we think medical students should come into school with have changed, therefore we need to update these competencies accordingly.”

So, that started the conversation in 2022, and again, these leaders put together a working group and started data collection, focus groups, and interviewed stakeholders in over 100 medical schools and said, “What are you seeing in students that are the most successful? What are some character traits that you see that lead to very successful medical students?” They mined that data, and based on that came up with these updated competencies. And the premed working group included students, which is great, pre-health advisors, faculty members who are on admissions committees, and people from the AAMC. So, it was a really well-informed working group that came up with these new competencies.

Where’s the focus of the change in the competencies? [8:19]

Right. The focus of the change landed solidly in the professional competencies. So, the two categories that I spoke about did not change. People in medical education, and students, and admissions committees members, after this working focus group did their work, and the work took over 10 months worth of time, said, “Some of the character traits that lead to success in medical school and beyond…” I want to emphasize and beyond. “… when we’re actually practicing medicine land in these professional competencies.” And some of these character traits, and I’m going to cite some of the work posted on the AAMC, include, but were not limited to being able to demonstrate qualities such as active listening, having a growth mindset, patient advocacy, and understanding the social determinants of health. That list is actually much longer. I think there are over 20 different characteristics, and so that all landed in these professional competencies, thus the change.

Can you give me a few examples of what’s changed? [9:31]

Yes, absolutely. One of the big ones is this cultural competency aspect in the professional competencies. It used to be called just cultural competency, which was sort of this, I would say, big aspect of professional competency. They really looked at that and mined through that definition, what is happening in our society? The emphasis that schools have on diversity, equity, and inclusion. And they broke it apart. So, now there are two distinct aspects of that, and they have called it cultural awareness and cultural humility, each with its own definitions and expectations. And so, now it’s incumbent upon pre-health advisors, consultants, like myself and students to understand the difference between cultural awareness and cultural humility, how to engage in each and how to demonstrate each on something like an AMCAS primary application.

How do you do it? [10:41]

I knew that was going to be the next question. So, in my work, I assist applicants with both their primary and secondaries. And secondary questions, we are seeing a huge increase in questions about diversity, equity, and inclusion, and rightfully so. Rightfully so, given the climate of today’s culture. So, cultural awareness and cultural humility should not be underestimated in their importance. I am going to look at my notes for this. Cultural awareness, the definition, this is not the AAMC’s definition, so this is a definition I wanted to provide to everybody watching this podcast. It’s recognition of the nuances of one’s own and other cultures.

And in cultural awareness, it is an appreciation and a desire to learn. How does one demonstrate cultural awareness on an application? So, here are some examples that I came up with. Becoming educated on cultural norms other than your own. So, maybe engaging in a webinar or a new class when you’re an undergraduate student. Becoming educated on different cultures, maybe different etiquette. How about getting a certificate in a language other than your own and being engaged in cross-cultural communication skills? So, this is really about educating beyond what you are typically accustomed to. So, that’s cultural awareness.

Cultural humility is very different. A definition of cultural humility that I’ll provide is, entering into a relationship, a professional relationship with another person, with the intention of honoring their beliefs, customs and values. So, this is really where applicants have to show patient-facing or volunteer-facing interaction with somebody different than self. And so, how can you demonstrate this? This is by asking questions and getting to learn and understand about the person’s ethnicity, gender, sexual identity, social needs, socioeconomic status, and language barriers.

I’m wondering how is that still different from cultural awareness? [13:05]

Cultural awareness, in my opinion, is the education of, so being engaged in the classroom, being engaged in a certificate program. I have an applicant right now who is becoming a Spanish medical interpreter, and Spanish is not his first language. It will become his second language. And so, becoming aware of the needs of Spanish-speaking patients, he’s really becoming culturally aware. Cultural humility, in my opinion, is that engagement with people, the face-to-face engagement with people different than oneself.

So cultural awareness is more academic, and the humility is the actual engagement, as you put it. I think that’s a good word. [13:47]

The engagement is the interpersonal connection, and then also the honoring of the differences between yourself and somebody different than yourself, and then the growth that comes from that interpersonal connection.

That’s a very good distinction to keep in mind. Now, some applicants might look at these competencies and say, “They’re nice. Are they window dressing? Are they virtue signaling? Or are they really requirements, like the MCAT?” [14:13]

Right. My suggestion as a consultant is, these are guidelines. These are guidelines and a framework that can be used by students and by pre-health advisors. And they should not be used as a checklist or a box to tick.

Pre-meds love checking boxes. [14:53]

They are very scientifically minded, right? A plus B equals C. Rather they should be used as a guideline to help inform the totality of the preparation of a pre-med or pre-health portfolio that will be submitted on a primary and secondary application. And the totality of that pre-health portfolio is most competitive when it has both a breadth and depth of experiences. And by using this as that framework, looking at those professional competencies and things like scientific inquiry that will help hopefully stretch an applicant beyond their comfort zone, get into that growth mindset, experience new cultures, and become that most competitive applicant.

I think it’s also asking applicants, especially with the professional competencies, to think more deeply about their experiences. Correct me if I’m wrong, but I would caution applicants against just mouthing the phrases, cultural humility, cultural awareness, commitment to learning and growth, growth mindset – that’s not what this is about. [15:50]

Correct.

This is much more about showing. [16:10]

Yes, absolutely. This is about showing and demonstrating. A huge piece of this is self-reflection.

It’s the self-reflection of not only being involved in these experiences and saying, “I volunteered for 200 hours.” That’s the quantitative piece. But what was it about the volunteering? What did you learn from it? What did you see? What did you experience? How did you grow? How are you new? And how are you further informed about medicine or the social determinants of health, or barriers of access to healthcare because of the volunteering experience? It’s not just reporting. It is the self-reflection that can parallel some of these competencies and help to demonstrate these competencies without verbatim repeating copy, paste the words of these competencies.

Exactly. Let’s say you have somebody who’s translating. Translation in and of itself, it’s not just translating words. It is translating in a culturally appropriate way. [17:15]

Absolutely. And it’s the piece of translation, but it’s also understanding where the patient would be without the translation. Would that patient have even been able to access healthcare that day if the translator had not been there? Thinking about the social determinants of health, it’s thinking more broadly about the isolated experience.

When admissions committees are looking at applications, they’re not checking off boxes either. It’s a holistic process. But are they looking for these competencies, the professional ones, as well as the thinking and reasoning and scientific ones? [17:54]

I don’t speak on behalf of all admissions committees, and so I don’t want to give a sweeping yes if it is not true. The AAMC made a statement at the end of the document regarding the pre-med competencies, and so I’d just like to provide a quote. In the conclusion section of the pre-med competency document, it states in part that, “These competencies will guide medical school admissions evaluation of applicants readiness for medical school as part of a holistic review.” So, the suggestion is there, the AAMC’s expectation is, it should be part of a holistic review. Certainly, it is up to each independent admissions committees in terms of the application of such, but I think the suggestion is strongly there.

You’ve touched on some ways in which med students or pre-meds can demonstrate these competencies, and you’ve naturally counseled against the checklist approach. What are other suggestions that you can make for medical school applicants to both mine their experiences for evidence of these traits and to present these traits? Because really, they’re traits and qualities. They’re not just, “I did this and I did that.” [19:10]

Great question. I have a couple of thoughts about this. First of all, I’ll focus my answer to an AMCAS primary application. On an AMCAS primary application, applicants have the opportunity to enter a maximum of 15 experiences. Well, there are 17 pre-med competencies. So, you can see the math doesn’t work out. You just cannot go down the competency list and think that you’re going to enter one item for each one.

You can assume that the scientific and the ones at the end of the list kind of come through the transcript. [20:15]

You could, but it’s not wise.

I agree. [20:24]

So, a wise way to look at this is, one experience can potentially demonstrate multiple competencies. And I wanted to give everybody an example. An example that I thought about is, let’s assume an applicant is a tutor. We have lots of pre-med students who are tutoring orgo and biochem and such, at that. So, I looked at the pre-med competencies and I overlaid it to being an academic tutor. So, being a tutor requires interpersonal skills. That is a professional competency. It requires oral communication, another professional competency. Being a tutor, it could be argued, is a commitment to learning and growth, a third professional competency. And it also is reliability and dependability. You need to show up, you need to be on time, you need to be reliable for those students. So, that’s four professional competencies in one experience of being an academic tutor.

Also, depending on the subject that a student is tutoring, it could demonstrate quantitative reasoning or written communication, and those two competencies land in thinking and reasoning competencies, which is a different category. So, that’s how students or applicants should be approaching this is, “I’ve done this. What am I demonstrating here? What could I say to an admissions committee in an interview? What have I shown as a result of this experience?” So, that’s just an example. The other thing I wanted to say is, the AAMC has some really great resources regarding these new competencies and how they can be demonstrated, and how applicants can do some self-reflection. So, I wanted to point this out, and I am not sponsored by the AAMC. I just think they have some really good free resources for applicants.

One is called Anatomy of an Applicant Guide, and I actually used to use this in a class that I used to teach. And this offers applicants an opportunity to do some self-reflection, competency-by-competency. What have you done? Where are you in the competency? Are you growing in it? Do you still have work to do on it? And I think it’s an excellent tool and resource. And also on the AAMC website is a page entitled Real Stories of Students Demonstrating the Pre-Med Competencies, and they’re little bio pieces of students who have successfully matriculated into medical school, their very honest story. Sometimes they’re first-time applicants, re-applicants, and they will talk about their journey to medical school and how they specifically demonstrated these competencies, and they can give applicants really good creative ideas.

Does journaling help in developing this treasure trove of experiences that you can draw on to demonstrate the competencies? [23:22]

Absolutely. I suggest students journal from day one, either as a first-year student in undergrad, first-year day in their post-bacc program. As soon as I start working with them as a consultant and journaling about every experience, shadowing in particular, when you’re shadowing an MD or a DO and the day gets done, sit down for 10 minutes in a journal, what did you see? What did you learn? What did you hear? And those notes become invaluable at the time that you’re going to submit your primary application, both to help inform your personal statement and to help inform the experience section of your primary application, and what parallels can you draw to these competencies? And the same applies to volunteering, leadership, clinical work, et cetera.

It can also apply to things like team sports, music, the arts, political activism, advocacy. I would say it can apply to anything where you’re learning. I don’t mean learning in the class, I mean experiential learning in this case. Not that you can’t journal about what you learn in class, but I think for the application, it’s the stuff that you’re doing outside the class that they want to hear more about, unless there was some really spectacular experience in class. 

You kind of anticipated my question about cultural awareness and cultural humility, but I also had a question. Can applicants show the scientific inquiry competency without some meaningful participation in research? [24:20]

That’s a very good question. It is true that scientific inquiry, which falls in that thinking and reasoning competency umbrella is typically shown by being involved in research, a semester of research, a full year of research outside funded research at the NIH. You know, something like that. If students have not done research, can they still demonstrate scientific inquiry? I think, absolutely. I have a couple of thoughts, and there may be more than this, but my two thoughts are this. Number one, you can demonstrate scientific inquiry by picking up another academic minor or doing a double major, especially if that academic minor or double major is in a different field of science. So, if you are a bio major and you decide to pick up a chemistry minor, or a chemistry double major, then you have gone above and beyond the regular undergraduate requirements, thereby proving that you are inquisitive, you have a thirst for knowledge, and that you want to learn more in these science-based fields.

It’s even more so if you are a non-science major. If you happen to be an English major or a history major. I’m working with a history major right now who’s a pre-med. And then you pick up a science minor or a science double major, that certainly shows scientific inquiry. Another way is a service-learning project. A service-learning project either affiliated with a class, or a service-learning study abroad project, as long as it is using the scientific theory to solve a problem. And I’m taking that language directly from part of the definition of scientific inquiry from that competency. So, again, that language is using the scientific problem to be inquisitive and to solve a problem. So, if you’ve done a service-learning project, and I’ll just use some examples, to go to a particular area and purify drinking water, or to go to a particular area, do a needs assessment and make access to healthcare more accessible to a particular population, that’s scientific inquiry, that’s demonstration of the process. And so, that is how somebody could demonstrate that competency on a primary application.

I think it would depend a little bit on the schools you’re applying to. Some schools really value research, and then it probably is more important to have the research in your background. And other schools, they want to see this competence. They definitely want to see it, but it doesn’t have to be with lab research. [27:37]

Correct. Absolutely. And that is when you have leeway with projects, and then matching your scientific inquiry process or piece with the school you are applying to becomes a very important part of the overall application process.

You’re 100% right. Now, a real common concern for applicants is being like all other applicants. How can they differentiate themselves in the really crowded competitive med school applicant field in an authentic way, because all medical school admissions officers want authenticity, while still showing the same 17 competencies that every other applicant will be trying to show? [28:25]

Very good question, and it’s a question that I hear often.

In order to answer the question, I am going to quote and give credit to somebody else who answered this question very eloquently, and in how I would parallel the question. So, I’m going to give credit to Dr. Sunny Nakae who is an Associate Dean of Student Affairs at the University of California Riverside School of Medicine. She was interviewed by the AAMC, and she has a lovely article posted on the AAMC. She was asked this question and she answered it, and I am going to significantly paraphrase and add in some of my own thoughts as well, but I absolutely agree with her answer to this question. She suggested applicants will stand out if they focus on the following three things, in addition to the regular stuff. So, applicants will focus on leadership, volunteering, research, the regular stuff, but applicants will stand out if they focus on their personal mission, growth and grit, and self-reflection. 

So in your personal mission, that’s where you can talk about your personal mission in your own personal narrative, your personal statement. And in that personal mission, attempt to be an agent of change. And that’s when applicants will stand out, if you are a change agent in something you have done. So, maybe it’s not, you are only volunteering, but maybe in some area of volunteering you really caused a change. You really swung the pendulum in a different direction. Maybe you started something new at your high school, maybe you really evoked policy change somewhere in your town. But to be a change agent, as Dr. Nakae stated, will help an application stand out above and beyond these 17 competencies that all other applicants are targeting. 

The next she talked about is growth and grit. Growth and grit is pushing yourself outside of your comfort zone. But as we talked about before, Linda, explaining how it helped you grow. So, not just stating it, not just quantifying it, but talking about how you grew, what you learned, and how it further informed your desire to continue to practice medicine, to want to practice medicine. So, growth and grit.

And those are in the competencies, both commitment to growth and resilience. [31:42]

Yeah. And growth and grit can talk about a failure that you’ve had, a really tough time, how you’ve overcome it, what you’ve learned because of it. So, growth and grit is really important. 

And the third thing that Dr. Nakae talked about is self-reflection, truly investing time in the why you want to be a physician. And in this article that I’m citing, she actually says, “If your why you want to be a physician is because I like people, because I like science, it’s time to go back to the drawing board and do a deeper dive because you need to be more heavily informed about why you want to be a physician and why you really want to practice medicine.” And I’ll add my own personal opinion, to be informed about this is to be informed because of your experiences, because of your clinical work, because of your research, because of your volunteering. Those are the things that should help inform your decision to practice medicine.

That’s fantastic insight. By the way, Dr. Nakae was previously a guest on Admissions Straight Talk if anybody wants to listen. She gave fantastic advice. And if anybody asks me what book they should get in terms of pre-med admissions, I always recommend her book Premed Prep: Advice from a Medical School Admissions Dean. 

I sometimes say if somebody tells me, “I want to become a doctor because I want to help people,” I will usually respond and say something like, “Well, my plumber helps me too. Why do you want to help people in this particular way?” [32:45]

Yeah, absolutely. 

What are some common mistakes that you see applicants make, either in the application process or specifically in trying to incorporate the competencies into their application? [34:21]

Well, as we’ve alluded to before, I think specifically with the competencies, it is using this as a checkbox. When applicants say to me, “Well, I’m done with service orientation because I volunteered at a soup kitchen, and I’m done with cultural humility because I had a talk with my rabbi.” That’s not what this is supposed to be about. This is supposed to be longitudinal commitment. This is supposed to be a framework and a guideline. And this is supposed to be a continued plan. So, I think that’s the biggest mistake in these competencies, is to think that this is a one-and-done system. And I certainly think that, again, the most competitive candidates that I have worked with have participated longitudinally in things that are meaningful, maybe things that are really difficult, but they have exhibited commitment and resilience to the process, whatever the process is, whether it’s clinical or volunteering, leadership. And they’ve really showed that growth over time.

And I think the other mistakes, and I alluded to this before too, that applicants sometimes make in terms of the competencies, is just not taking them seriously. [35:50]

Right. I think you’re right. And if I could continue this list of mistakes I see applicants make in addition to the two we’ve identified, it’s potentially focusing or having a lot of work in one particular competency area or domain, and not enough in another area. I’ve worked with applicants who are very research strong, so they love the process of research. They’re heavily published and maybe they’re working at the NIH or some other wonderful organization, and they have zero clinical experience, so they have no work or reflection of direct patient-facing contact. So, that’s a real weakness. I have students that are the other way around, that are very wonderfully clinically knowledgeable, but maybe they’re weaker in the scientific process. So, I think applicants do need to remember this concept of the holistic admissions review process, and admissions committees are looking again in totality at the breadth of the portfolio that’s put forth at the time of application.

What do you wish I would’ve asked you? [37:31]

This was really good. I think this has been a great review of the competencies. The only thing that I would suggest that applicants would maybe want to think about is, when should you start thinking about these competencies?

My answer is, as early as possible. When I was a faculty member and I started having meetings with pre-med students year one, semester one of undergrad, I would roll out these competencies September of students’ freshman year of undergrad. Or I would start talking to my post-bacc students one of the first times I met with them about these competencies. So, it is not too early to start thinking about these. I do understand, they can feel overwhelming. So, if you are a first semester, first year student and you look at 17 competencies, and you’re taking 15 or 17 credits and you’re very new to college, this could feel overwhelming. That’s why creating a plan, either with a consultant or your pre-health advisor or somebody would be really helpful in thinking about how you are going to navigate through these competencies, and creating a plan so four or five years from now, you are well-prepared for that AMCAS primary.

That’s great. Thank you. And I did think of one more question. You talked about longitudinal commitment. If I get into medical school, are residency directors going to be looking for these competencies along with specific skills in whatever area I want to go into? When you were at Beaumont and you were already presumably looking ahead to your graduates going to residency, was this something that was still discussed? [39:08]

We were not talking about these competencies specifically at that point in medical education, for sure. I think that these competencies were probably more assumed and woven into the residency process, but I think by the time that students were going into residency, we were looking for a wider, broader sense of skills, knowledge, and abilities. But these particular competencies, as the title indicates, are certainly for pre-med students entering into medical education.

They’re foundational, basically. [40:13]

I think so, yeah.

Dr. Wherley, I want to thank you so much for joining me today. This has been a fascinating conversation and I think it’s going to be really valuable for listeners, watchers, and readers. Thank you again. [40:17]

Relevant Links:

• Dr. Valerie Wherley Bio  
• Work with Dr Valerie Wherley
• Accepted’s Med School Calculator Quiz
• Premed Competencies Resources 

Related shows:

• A Dean’s Perspective on What Makes Great Physicians, podcast Episode 420 
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• How to Get Accepted to Chicago Medical School, podcast Episode 544
• All You Need to Know about BU School of Medicine, podcast Episode 405
• What Med School Applicants Must Know About Johns Hopkins, podcast Episode 53
• Get Accepted to Dartmouth’s Geisel School of Medicine, podcast Episode 530

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