How this non-traditional medical student transitioned into medicine as a second career [Show summary]
Efrat Bruck is an M4 at Icahn School of Medicine at Mount Sinai, as well as a parent and MCAT video creator for Khan Academy with a nontraditional path to medicine. She shares how the program has given her the flexibility and support to balance these responsibilities and thrive in medical school. Listen to the show >>
A career-switcher’s journey from teacher to medical student [Show notes]
What’s it like to attend Mount Sinai’s Icahn School of Medicine? And how does this M4 juggle the responsibilities of parenting, med school, serving on the Mount Sinai Student Admissions Committee, and being an MCAT video creator for Khan Academy?
Efrat Bruck is a non-traditional medical school student who attended medical school as a mom and had a successful career as a teacher. Now, she’s an M4 at Icahn School of Medicine at Mount Sinai in New York.
Can you tell us a bit about your background outside of medicine? Where did you grow up? What do you like to do for fun? [1:45]
I grew up in Brooklyn, New York in the neighborhood of Borough Park. My parents immigrated to the US about one year before I was born to seek medical treatment for one of my older brothers who has congenital kidney failure, and much of our childhood revolved around his medical situation. I think, by the time I was in high school, he had had three kidney transplants. My dad is a rabbi and a teacher in the community. My mom was mostly a stay-at-home mom, but also taught intermittently, so I come from a family of teachers. I’m one of 10 children. I have seven brothers and two sisters, and I am seventh, part of the younger crew.
After high school, the expectation was to get out there in the real world and become financially independent, so I went to a one-year program that trained me to be a teacher, and then I got a job as a high school teacher. At the age of 18, I started teaching high school and started what would be an almost decade-long career in education that I really, really enjoyed. In my last year of college, I started working at Columbia University Medical Center in a research lab in nephrology. I had a really personal connection to nephrology because of my brother. I think my work at the lab was the springboard that eventually led me to go to medical school.
When did you go to Columbia? [3:20]
To backtrack, I went to college a few years after high school. Maybe three years into teaching, I went to Touro College in Brooklyn, New York. And then in my last semester of college, as part of one of the honors projects, I started working at a lab at Columbia, a lab in nephrology. The principal investigator was Dr. Jonathan Barasch. That was, as I said, the springboard for applying to medical school.
You mentioned that because of your brother’s situation, you were drawn to nephrology. When you went back to college, were you thinking of getting more of an education-oriented degree and staying in that field, and then you decided to make the switch? Is that how it worked? [3:49]
I’ll backtrack a little. I really always wanted to be a doctor from a pretty young age. I love the sciences. I think all of us, when we sort of look back at our school years, there were some classes that felt like a burden and some classes that maybe felt a little more natural, or you looked forward to it. That’s how I felt about the sciences. I always looked forward to those classes, and I didn’t feel that burden of studying, at least when I was a kid. It gets burdensome later on! But as a kid, I really loved it, and I was just fascinated by this link between science and medicine.
I knew science existed and that somehow this translated into medicine, which I knew kept my brother alive all those years. So I was really fascinated from a young age, but as I said, it wasn’t really on the radar for me right after high school to go to college. So when I did go to college, it wasn’t like I thought, “I’m going to go to medical school,” But it was in the back of my mind. I naturally slid into the premed track. I considered doing a degree in education briefly, but ultimately I chose to do my premed track.
What was the hardest part of the med school application process for you? [5:06]
I’m going to say the MCAT, as it probably is for many people. I think it’s the MCAT, but not just the MCAT. It’s also that I was doing so many things at the time. I had two jobs. I was teaching and then I started working. The lab started off as a volunteer thing, but then turned into a job. And at that time I had also gotten married and moved to, not a new city, but a new borough in New York City, which for people from New York is like moving to another planet. I had to take a car to the grocery store. There was a lot of adjusting, and then to throw it all in, I started opening up MCAT books and realized this is not a test you could just study for in a month or two. You really have to put in a lot of effort. And I was a year away from college already. So I think the MCAT was the hardest part in all the stuff I was juggling, and the solution was to take a good hard look at everything and make decisions. I did ultimately leave my job as a high school teacher. It was a really tough decision, but it was the only way to go onto my new path.
Did you do self-study, or a course, or some combination? [6:15]
I started off studying by myself to test the waters. I had some books and there were some topics that I was strong in. When I say strong, I mean, you can open up test questions and get, let’s say, half of them right. There were some subjects that I was really weak in for some reason. So I ramped up my studying. I gave myself maybe six months of part-time study and then did some practice tests. But I wasn’t happy with my scores, so I actually delayed my MCAT and did another round of studying, a full three months of dedicated studying. I actually used the Princeton Review. I took an actual course, and then my practice scores climbed up and I was happy in the end with the result, but it did push my application cycle off by an entire year, getting the MCAT out of the way. But I think, in retrospect, it was the right decision because it’s always better to take a little more time and become more competent.
What do you see as the benefits of your background in teaching and education going into medicine? What is the relevance, as you see it? [7:18]
I’m really glad you asked that question because I think this question is a springboard for a really rich discussion. I’m going to say this about many jobs, not just teaching, but having a job before medical school, there’s so much you can learn from so many of these jobs that are absolutely transferable to medicine. To speak about teaching a little bit, when you’re a teacher, you’re told to teach a certain subject, and you’re given this load of information to sift through and you have to decide, what am I going to teach? And what do you focus on when you review, and what do you ask on a test? You really learn to zoom in on the important information. This is so important for medical school. Every medical student, I’m sure, will agree with me. You’re flooded with information. In my opinion, this is a flaw in medical education, but that’s a discussion for another time. You don’t know what to do with it. You’re like, “What’s important? What do I need to know for the test? How do I process this information and memorize such a large volume of knowledge in such a short amount of time?” I think teaching really, really helped me with that.
The other thing I would say is, definitely with teaching, but I’m sure this applies in other jobs as well, you have to learn to deal with lots of different types of people. In the school that I taught in, for example, there were lots of immigrants, people from all different countries. You’re dealing with students, in my case, adolescents in Brooklyn. Not always so easy. You’re dealing with coworkers, you’re dealing with principals, administrators, and then you’re dealing with parents, which is a whole other beast. You really hone your people skills, communication skills, things like that, which are extremely important for medicine. Because if you’re going to be a doctor, you’re going to deal with people from all walks of life, different from you, culturally, religion, politically, whatever it is. And you have to know how to see eye to eye with people who are different than you.
One of the things I thought you would raise is that physicians are frequently teaching. [9:17]
It was on my list! I was going to get to that. Medical education is built in this way: You have this pyramid with medical students at the bottom, first, second, third, fourth year interns, residents, attendings. And it’s really the responsibility of each tier to teach the level below them. Patients too. That’s a very important one. But even if you’re not interested in medical education in a formal sense, like I am, you have to teach if you’re a doctor. Medical training, teaching patients. On my medicine rotation, for example, in the third year, the person I learned the most from was the fourth year medical student right above me. Sometimes it’s easier to learn from people who are closer in their training to you. That is absolutely true. And I’ve definitely gotten feedback on rotations that I did a good job teaching, and I think it’s because of my background.
What have you loved the most about Mount Sinai’s Icahn School of Medicine? [10:32]
I could probably spend an hour talking to you about the amazing things at Sinai, but there are a couple of key points that I want to mention. The first and probably most obvious thing is it’s a world-renowned institution and they really, really live up to their reputation. When I look back at my undergraduate years and high school and I reflect, and I think all of us probably feel the same way, there are lots of things we do in school that had us like, “I don’t know if this is so necessary.” Homework and assignments. Sometimes you wonder, “Do I really need this? I mean, do I really need to know where every last electron goes in this reaction for organic chemistry?”
We question these things, and to be honest, a lot of it is not perfectly relevant to what we do, but at Sinai the education we get is so carefully crafted. Every homework assignment, every writeup, every lecture is really another step for you to become a great doctor. I can honestly say that there wasn’t a single time in my education where I thought to myself, “Wow, what a waste of time,” even things that are not necessarily relevant to the field that I’m entering. As a doctor, you need to have a broad foundation for lots of areas. I feel like the education is just superb. It’s a little hard, sometimes, to see it when you’re amongst your classmates because they’re all getting the same education, but when you start to venture out to different sites and you’re among other students, I think that the Sinai students really stand out in their remarkable education that they get.
Other than just training us to be great doctors, I think at Sinai they really try to support you in your unique journey, whatever that is. So for me that was that I wanted to raise a family while doing medical school. For my classmates, it’s other things. I have a classmate who is a playwright. There are people involved with startups. There are people involved in all sorts of things where your time is spent not just in medicine. At Sinai they really, really try to understand you and support you on your unique journey. That’s another fantastic thing about Sinai. The way they do this is they have, of course, expectations of us and what kind of students they want us to be, what kind of doctors, but it goes both ways in that we expect them to take our feedback very seriously.
That’s something that’s also great at Sinai. They take student feedback extremely, extremely seriously. Like every other institution, we evaluate our classes, every lecture, every professor, and change is implemented very swiftly. The evaluations don’t just land up in some desk and stay there. “I don’t know what happened to it.” They’re taken very seriously. I’ve seen changes implemented definitely from one year to the next, even one semester, one month to the next, based on students’ feedback. I think that’s how they do it. They really take their students seriously.
What could they improve? [13:31]
I’ll give some background for those of you who are not yet in medical school, but when you’re a third year, which I think is the most intense year of medical school, you have clerkships, which means that you’re on a clinical site. You’re in the hospital setting. Sometimes at your own campus, but sometimes you’re sent out to other sister campuses. Sinai has its goals and objectives for their students and what they want us to accomplish. And sometimes at the various sites, the residents or attendings or people at that site aren’t necessarily that familiar or don’t understand the schools as well. Sometimes there’s a little bit of a mismatch between the goals of the school and the people at the site. I think some communication between the school and those various sites, so that everybody’s on the same page as far as what the goals are for medical students.
You became an MCAT video creator for Khan Academy. Why, and do you have any MCAT tips that you’d like to share? [14:24]
I fell in love with Khan Academy when I was an undergrad, and I discovered that if I had a hard time with a subject, I can just go to Khan Academy and watch videos for free. The videos were amazing. Sal Khan is an outstanding teacher. I found myself not using it just to learn for myself, but using it as a tool to improve my own teaching. I used it a lot in studying for the MCAT. This is before they even had the MCAT platform, or maybe it was very new. And after I took my MCAT, I had this free space. Remember I mentioned that I pushed my application off by a year, so I took the MCAT in January and then was sitting around until the summer, and I had already left teaching. I read about this competition that Khan Academy launched with the Robert Wood Johnson Foundation and the AAMC where they wanted to build an MCAT platform, which I thought was a brilliant idea. Because as you all know, courses and MCAT prep are prohibitively expensive, and everything would be for free.
I felt like this would be a great way to get involved and give back to Khan Academy because it helped me so much and would help level out the playing field for people who are at a more financial disadvantage, which at certain points in my life was definitely the case. I understand what that’s about. So I just entered this competition, and I was chosen as one of the winners. We got a paid trip to San Francisco, which was really nice. We were trained. The training was led by Rishi Desai, who was the Chief Medical Officer at Khan Academy. I think he is the chief medical officer at Osmosis right now, if I’m not mistaken. And then a couple of us were then hired by Khan Academy to make the videos. Like I said, I had the time. It was in between different things going on, so that’s how that happened. I still remember that the video I submitted was about the kidney. Honestly, I don’t think I could give you that lecture. I don’t remember anything, I just know that it was about the kidney because that’s what I knew at the time. I knew about the kidney because of my brother and my research. But it was really a synthesis of my career with launching my new path in medicine.
MCAT tips: I think if I could go back, I would start studying in undergrad after each course because there’s this link you have to make between your course material and the MCAT. MCAT really requires you to synthesize the knowledge and apply it to new scenarios. Don’t start on your first day of bio, but if you’ve finished a bio course, do some bio MCAT questions. You finished chemistry; do some chemistry MCAT questions. Do it in a modular way as you go, and I think that’ll make your studying later much, much easier.
And I would say to use Anki. I wish I had discovered it earlier. If I had Anki in undergrad, boy, my life would’ve been so much easier. I’ll give a really short background to understand what Anki does. So there have been lots of studies done on how people memorize things and remember things. The basic bottom line is a concept called spaced repetition, which is that when you learn a certain fact, there comes a point in time where you know it really well, but then there comes a point in time where you start to forget it, and your memory drops. That point in time is where you should learn it again, and then learn it again. And that interval between your learning gets smaller and smaller and smaller as you go.
What Anki does is it has an algorithm. It’s a flash card application, and it has this algorithm where it asks you a question, and you tell it if you knew the answer, if you didn’t know the answer, or you were in between. Based on your response, it will decide when to shoot that flashcard back at you for optimal memory. That way you’re not wasting time studying those things that you already know. You’re spending more time studying those things that you don’t know. But thrown in there, it has somehow built into this algorithm, research-backed, how much time should be spaced between learning facts. It’s not going to shoot you the same card every day. It took me two to three days to really get the hang of how to use it. It’s so powerful. I used it for one exam and didn’t do it the right way. I didn’t even keep up with my reviews, and I saw a dramatic improvement, even using it wrong. When I did it correctly, I saw an even better improvement. I would say, if you could learn how to use Anki now, do it. It’s really popular now in medical school. We have decks for everything. There’s a good chance you’ll be doing it in medical school anyway, so you may as well get familiar with it now.
Does it have modules for undergrad sciences as well? [19:31]
You either make your own cards, or there are people out there who will create a deck and share it with other people. There’s a deck I used to study for one of my board exams. That person is educating medical students all across America. I don’t know who this person is, but they should get like a Nobel prize or something. I just downloaded it from Reddit, and that’s how I studied for my board exam. So I’m sure on Reddit or SDN or these other platforms, I’m sure people have shared MCAT decks, or you could make your own cards. The process of making cards in itself is also really great for memory.
Let’s go back to being the president of Mount Sinai Parents. How are you managing med school and parenting? What are the biggest challenges, and how are you dealing with them? [20:22]
I have two kids. My older one is four. She was born between the first and second year of medical school. Then the second one was born in my year 3B. She’s two. She just turned two now. Before I answer your question, I just want to put a disclaimer out there that I always tell people, I don’t really recommend it. It’s really difficult. If the stars have aligned for you such that you don’t have to do both at the same time, I think it’ll be better for you. I’d just like to put that out there because I don’t want to sugar coat it and make it sound like it’s a piece of cake. It’s really difficult. Probably one of the hardest things I’ve done. Just putting that out there before I answer your question.
The way I think about it, I feel like there are two components to this. I’ll tell you what they are and then I’ll address each one. I think the first component is the emotional or mental aspect. How do you develop the bandwidth to be able to handle these two full-time endeavors at the same time? Raising kids is a full-time job, and going to med school is a full-time job. So how do you manage it from a psychological standpoint? And then there’s the practical aspect. You can’t be at two places at once, so how do you manage both of these?
I’ll talk about the first because I think it’s a little more important, the emotional or mental aspect. I think the first thing is you have to have a really good vision of what you want your life to look like in a couple of years down the line and really understand what your goals are because that’s really the only thing that’s going to get you through some of those really difficult times. The endless studying, the endless hours of the wards, the baby up at night crying and you’re thinking about what you have to do the next day at 6:00 a.m. But if you have a really clear vision of what your goals are and what your end point is, I think it’s a lot easier to pull through. That would be the first thing, I would say.
The second thing is, it takes a village to raise kids. If you’re going to do it while you’re in medical training, you need an even larger village, and you really need a robust support system that’s going to give you that emotional support, and it’s going to be different for everyone. For me, it’s my husband, who’s been a rock throughout this entire medical training. My parents, my in-laws, and my siblings. For someone else, it might look a little different. Whatever it is, you need a really strong support network because you can’t do it by yourself. I think that addresses the first part, the mental or psychological aspect.
Then the second part, practically, if people are looking for just, “Okay, how do you do the day-to-day?”, I would say, if you’re a parent in medical training, you need multiple layers of childcare. It’s not enough to just have one thing. I’m sure with some jobs, you send your kids to school and they come home and it’s all good, but in medicine you need a couple of layers. For me, for example, we have the daycare. We have a wonderful daycare that’s very close to the house that our kids are in during the day. Every season, we curate a small group of babysitters who are usually local students. I’m choosy with my babysitters, so I pick them out and these are people who I’m really comfortable having around my kids. They help out in the mornings, evenings, weekends, busy times. And then as a third layer, I have my family, which don’t help out on a day-to-day basis, but they do step up during big times. For example, during my step two exam, my mother took my kids for 10 days. My siblings helped out. They step up when you really need help. My family are a sort of village at this point. I would say that’s a practical tip.
I will also throw in there that being a parent in medical school really forced me to learn what it is that I need in my personal gas tank. It’s very different for everyone. I can’t have everything. I’m not going to get eight hours of sleep every night and three cooked meals and get my exercise in. It’s not going to happen. But you can zoom in on those things that are really key for you, and that’s going to get you through. For me, it’s sleep. I have classmates and friends who can get their five hours of sleep and they’re good to go. I’m not a person like that. So I really prioritize sleep. I exercise a few times a week. And then right after that, if you give me 30 minutes a day where I’m not around people and I have time for myself, I’m good to go. A warm-cooked meal every night would be lovely, but it’s not one of those things that’s really essential for my well-being. For every person, you really need to choose. Say, “This is a rough time in my life. Things are busy. What are the key things I need to keep me going?”
Icahn at Sinai touts its flexibility on its website, and it’s known for that. Has the Icahn School at Mount Sinai been helpful to students who are also parents? Was it supportive to you in this regard? [25:34]
I’m glad you asked about that. In short, absolutely. I’ll address the flexibility part first, and then I’ll tie that into how it really worked out for me as a parent. To answer your question, Sinai absolutely lives up to its reputation as far as flexibility goes. I was not on the FlexMed program, so I don’t know if I have all the details 100% down pat, but the basic idea is that you can apply to medical school while you’re still in college. You can be any major. In fact, most FlexMeds are not science majors. You can get an earlyish answer, or an early answer if you’re accepted. The idea is that we want you to use that time doing other things because the premed grind can be really, in some ways, soul-crushing. We don’t necessarily think that that’s the only way to become a great doctor, so we want people to use that time for other endeavors.
You don’t have to take MCAT. They do a summer boot camp where they bring you up to par with some of the sciences. Sinai has published studies comparing the FlexMeds to the traditional medical school applicants, and there are some slight discrepancies in certain areas of performance, but the bottom line is that they do just as well as the traditional students, and in some ways even surpass the traditional students. So it’s definitely a program that has tremendous success. I think, at this point, 50% of the students in the class are FlexMed, which is different than when I first came in. There’s a lot of success with this program.
The other thing we have, over the third and fourth year, is 28 weeks of electives, which I only recently learned is a pretty large amount of time. I have friends in other schools who are lucky if they get 10 or 12 weeks. You have 28 weeks of time where you get to choose how you want to drive your education and then pick which courses you want to take, etc. I think that’s really great because it helps you take ownership over your education. Not just that, but during first, second, and I believe third year as well, we have protected time called flex time. It’s a weekly block of time, it can be an afternoon during third year, or if it’s busier, it’s maybe only once or twice a month. But that’s time that’s really blocked off for students to do things like shadow, get involved with research, or endeavors outside of medicine, where they’re telling us, “Be the person you are. You’re on this unique journey. Protect the time for you to do your own thing.” I have to say that when I was pregnant, I think I used some of that time to nap, but I think it demonstrates the priority that they give us as far as autonomy and flexibility goes.
Another thing I would say is we take all of our exams on our own time, on the weekends, in our own space. The exam opens up on Friday, closes Sunday, and you can pick to take the exam whenever you want, wherever you want. It makes it really easy to go away for weekends and be with family. There are people who, at 7:00 p.m. on Friday, have the exam opened up, and they take the exam, and they’re done with it and have their weekend free. There are people like me who wait until Sunday night until the baby is sleeping at 9:00 p.m. to take the exam. Basically, they’re telling you, there are lots of different paths to becoming a great doctor. There are lots of different ways to do things. You can choose and take control of your education in the way that you want.
To answer your question about how that ties in with parenting, when people say to me, “Oh, how did you do it?” I say the key was time. What Sinai has been doing recently, and this I think is more recent that they’re doing this, for people with families or even other endeavors that just require a lot of time out of medicine, is something called the decelerated year. The decelerated year is where you take your year of medical school, which for most people is third year, because it’s the hardest year, and you split it over two years. Everyone hears that and thinks, “Ah, so smart.” You’re doing it in a proactive manner. You’re not showing up and saying, “Oh, I can’t…” You’re planning everything a year in advance, and you’re setting up your clerkships in a way that you have breaks in the middle at times that you need them.
For example, I took a decelerated third year, and then I also took a decelerated fourth year. So I was able to take a good two months off when my second daughter was born. At times where things were really crazy, there was always a little break at the end. When I was pregnant and really sick on my surgery rotation, those are really long days where you’re there at 5:00 or 6:00 in the morning. I would come home at 8:00 at night, throwing up half the time. On a clerkship like that, because I have that extra time at the end, I was able to push off my shelf exam and not take it exactly at the end of the clerkship because on top of all this clinical stuff, you have to study. It gives you some time to play around and really affords you that flexibility. That was really the key to me both being a parent and doing medical school.
You’ve also served as a student on the Admissions Committee at Mount Sinai. What do you wish you’d known as an applicant that you now know after having been on the committee? What would have helped you deal with the application process? [30:50]
Every school has its own mission statement, goals, and nuances. The schools are different. When you’re applying, it’s a lot of pressure, and it’s intense. All you’re thinking about is, “I just want to get into a school and become a doctor,” but schools are really different. I think it’s worth taking the time to investigate those differences and tailor your application to those differences. Some schools love research, and some schools love global health. For some schools, it’s community service. If you can learn what that school is into, that would really help you, and it’ll also help you on the interview, which is of course an integral part of your application. There are people, for example, who would tell me, “I really thrive in competitive environments that are really structured and I need that pressure.” I’m not sure Sinai would be the best place for you. It’s more about independence and autonomy. I think it’s the trust they put in you, that they really trust you to take ownership of your education, but at the same time, strive for excellence.
How do you see your career evolving? [32:52]
I’m actually applying into anesthesiology, to teach over there. I have a particular interest in medical education, and I don’t know if I know how that will flesh itself out exactly, but I know that I do want to be involved in medical education in some way. I’m a huge fan of a Khan Academy approach, making knowledge available for free and in a very digestible way that appeals to everyone. I think that’s going to be a big part of my career, in addition of course to becoming an excellent clinician. I’m a really hands-on person, which is one of the reasons I chose anesthesiology. Being able to master technical skills and being great at what you do is definitely one of my goals.
What advice do you have for applicants aiming for a 2021 application? [33:50]
Take a good look at your application and try to separate those things that you can change and those things that you can’t. Nobody’s perfect. Maybe you have a C in some science class, it doesn’t look good, but there’s nothing you can do about that. And try to not fret over those things and really work on those things that you can improve. If you’re not happy with your MCAT score, maybe you can take it again. If you feel like your extracurriculars are falling short, get involved in some research and some shadowing. Get some clinical things. Boost the things you have control over.
The other thing I would say is, instead of trying to just check boxes (shadowing, check; volunteering, check; research, check), try to find things that you are really passionate about because you’ll be more authentic about it, and it’ll come across better on your application. We all have to check boxes off in life. It’s just part of life. But as much as you can, try to find things that you’re passionate and driven about, because that will help your application be a lot better.
What would you have liked me to ask you? [35:01]
If I think being a parent would make me a better doctor. I don’t know if, at every point in time, it made me a better student. Time becomes a thing when you’re a parent. I definitely did not have as much time to spend studying, so it was more about learning how to hone my studying skills so I can get the same amount done in a shorter amount of time. But as a doctor, I’m absolutely certain that being a parent will make me a better doctor. It’s amazing the amount of similarities between these two endeavors. There’s a lot of investment upfront, both with parenting and with medicine, where you don’t only see your results right away, and you have to believe in your investment. When that baby is keeping you up at night or acting fussy or not sleeping, or your toddler’s throwing tantrums and you just don’t know what to do with yourself, it’s hard to remember that one day, hopefully this will be a fully grown adult who’ll function by themselves. I feel like medicine, too, there’s a lot of investment upfront and time that you have to put in and energy. In that regard, it teaches you to stay in the fight, have that grit, and make it to the end.
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