A conversation with Dr. Nichole Zehnder, Assistant Dean of Admissions and Student Affairs at the University of Colorado School of Medicine [Show summary]
Dr. Nichole Zehnder, Assistant Dean of Admissions and Student Affairs at the University of Colorado School of Medicine, shares an overview of the school’s unique offerings and admissions process for prospective med school applicants.
Get to know the University of Colorado School of Medicine [Show notes]
Today’s guest, Dr. Nichole Zehnder, earned her MD at the University of Rochester School of Medicine and Dentistry in 2006. She did her residency in internal medicine and is a practicing physician affiliated with the University of Colorado Hospital, and she’s also an Associate Professor of Hospital Medicine at the University of Colorado. More importantly, for purposes of this interview, she is the Assistant Dean of Admissions and Student Affairs at the University of Colorado School of Medicine.
Can you give an overview of the Colorado School of Medicine’s program, focusing on the more distinctive elements? [1:37]
The University of Colorado School of Medicine is a four-year MD/PhD program. We’re LCME accredited and affiliated with AAMC. We offer spots for 10 MSPP students, so 10 MD/PhD students in each of our intern classes, and then 174 MD spots.
I think there’s a few different distinct parts of our curriculum, some of which are just blooming on the horizon, which I’d love to feature here, as well as some things that are already in existence. Some of the more notable parts of our school and our curriculum as it exists right now are our longitudinal interprofessional curriculum. We’re fortunate to be on one of the biggest healthcare campuses in the United States. We have our medical school, our dental school, our PA school, our pharmacy school, and our nursing school all here on our campus. And with that, we think that we should take that geographic advantage and have our learners learn together in a true interprofessional environment. That starts here at CU in the first year, continues all the way through the fourth year or the senior year of medical school. That’s one of our really distinct opportunities that our students can take advantage of. And that’s true for both MD and MD/PhD students.
I think a few other parts of our curriculum really deserve a shout out. One is, we have quite a few developed, longitudinal, integrated clerkships in our clinical year. Our students who will be entering in this year’s intern class, so the 2020 intern class, have the opportunity to, if they want, participate in five different longitudinal integrated clerkship models. Everything from urban underserved care at our Denver Health site to our C-CLIC, which is our rural and community longitudinal integrated clerkship.
The longitudinal clerkship model is a model that’s been done for decades. Here at CU, we’ve been doing it for about the past six or seven years. And that’s done in the clerkship phase of training, so the clinical phase of training, which for some schools is the third year, for some schools it’s earlier. For us right now, it’s in the third year, and I’ll get to that part here in a second. But the students have the opportunity to do the entirety of their clerkship or clinical year at this specific site.
The Colorado School of Medicine has a branch in Colorado Springs, although most of your campus is outside of Denver. What is the advantage of that? Why would a student choose that? [4:09]
Our main campus is located at the Anschutz Medical Campus. That’s in Aurora, which is east of the Denver Metro area. Colorado Springs is about an hour south of the Denver area, and we have 24 of our students do their clinical training down in Colorado Springs.
One might think with Colorado Springs that they may be more interested in mountain medicine or rural medicine, but actually we have students who are interested in all of those things. I think the big focus for Colorado Springs is really about the community. For the community, specifically the ability to engage meaningfully in the community and be able to partner with organizations locally in the Colorado Springs area to provide different types of care and to do quality and patient safety in that community. Many of the students who elect to go to Colorado Springs have some sort of tie to that community prior to entering medical school.
Is there a preference at the Colorado School of Medicine for in-state residents? [5:19]
What I can say is that we have a higher percentage of students from Colorado, if accepted to our school, that ultimately choose to come here. Students from Colorado, if accepted, are more likely to come to our medical school than students who are from out of state. That said, last year we had a record 10,435 applicants for 184 spots.
As you can imagine, the vast majority of our pool is actually from out-of-state. Each year, we end up with a class that’s around 50/50.
We don’t have any legislative mandate in terms of number of slots filled, so it can vary from year to year. Sometimes it’s 55% in-state, sometimes it’s 50%. It does vary a little bit. This actually isn’t a preference from the Admissions Committee; the in-state tuition is much cheaper than the out-of-state tuition.
What is the Mentored Scholarly Activity at Colorado? [6:30]
Some schools, as I’m sure you know, have a research requirement or a senior capstone requirement. We call ours the Mentored Scholarly Activity. Our students though come from a hugely diverse background and set of experiences, and we want them to foster a lifelong curiosity in an area of their choosing. It doesn’t have to be a research project. If they want to have a community engagement project or make a focus in the arts and humanities, they’re able to do so.
They are partnered with a mentor in their first year; and if they don’t know who they want to work with, we help figure out who would be a good partner for them. And then they get the opportunity to work on a project that’s meaningful to them. They most often present some sort of scholarly output at the end and create some work, whether it’s a written work or an app platform or a community program that is able to satisfy that requirement.
It starts in the first year. There are some didactic components, but largely this is experiential learning. The students are out in the lab or in the community doing actual work, and then come back and present their work at the end of their four years.
Let’s turn to the medical school application. What is the Colorado secondary like? [8:00]
Unfortunately, I can’t tell you the actual question, but I think many savvy applicants utilize Google. (I’m not naive enough to think that it’s not out there.) The Colorado secondary is one required question and then optional questions if students are interested in joining one of our tracks or participating in the Colorado Springs branch. The optional questions aren’t part of the admissions decision. We just hold onto those bank posts for later. If a student’s accepted, then we use that data to help figure out their customized curriculum. It doesn’t give an applicant an advantage or doesn’t give them a disadvantage if they are or aren’t interested in a track or the branch.
Colorado requires the CASPer. What does it provide you that the primary and secondaries don’t? [8:47]
What we hope to get out of that is a better glimpse into some of the attributes, the non-cognitive attributes that an applicant is bringing into a medical school. As the applicants know, right now the CASPer is scored as Z score. We get a Z score, its norms compared to test takers at that time. And so we have a sense as to how the applicant did related to the non-cognitive attributes that they were assessing during those video scenarios. And we wouldn’t necessarily get that from an essay or from experiences in a way that’s standardized and validated. We’ll be entering our second year using CASPer.
Does Colorado screen secondaries? In other words, are they sent out automatically assuming that somebody is above a certain GPA and MCAT without any automated screening, or is a human being looking at them before? [9:40]
When I first took this job back in 2014, we were a school that automatically sent secondaries to every applicant who sent us an AMCAS application. I’m a true believer in holistic review, and I don’t think that that’s fair to either the applicant or the school. If there’s a candidate that we wouldn’t consider interviewing, we shouldn’t ask for their money or their time. We do screen, and we have some automated features. So students above certain thresholds automatically get a supplemental application. But every single person who doesn’t meet that threshold gets a human review, and the human decides whether or not that applicant would be someone that we would want to send a secondary application to, and we do that every year.
Is there a GPA threshold also?
There’s not, no.
If the applicant is below the AMCAS threshold for the automated secondary, then a human will review the application and make a decision?
You said that in a previous year you received 10,000 primary applications. How do you winnow it down? What makes an applicant jump off the page for you and be worthy of an interview? [11:19]
This is such a hard question, Linda, and this is one I struggle with specifically because we have so many qualified applicants, and I think the nature of the beast is that there’s something that we’ll miss, quite honestly. That’s hard because of the volume of applicants. But getting to your question about what makes an applicant exceptional, I get asked all the time, what is the right formula, or what’s the magic? What do I need, what are my scores, and what kind of activities do I need to do? And there’s no one right applicant.
What I try and tell our applicants is to be the best version of them that they possibly can be. Most students who are wanting to enter the profession of medicine are kind, altruistic. They’re empathetic. They really want to be of service, and I like to see the applications that really mirror those values. If they feel like they’re devoted to vulnerable populations, to truly do work with vulnerable populations and to do so in a way that’s meaningful and deep and rich over a large amount of time, and when I say large I mean that they’ve done this for a year or more, as opposed to kind of doing these drop-in activities.
If you say that you want to work with homeless populations and this is something you’re passionate about, I want to see evidence that you’ve done that and you’ve done it for a while, and you’ve done it in a way that is meaningful, and that you can reflect on that and know why that experience will make you a better provider in the future.
We don’t have “boxes” to check in our screening rubric. I think there are schools that may say you need to volunteer for this amount of time or you need to shadow for this amount of time. But every applicant comes with their own unique story and their own unique passions. And I would much rather have an applicant who is able to dive deep into their passions and is clear about their values and has the stuff that we need in medicine as opposed to someone who’s checked all the different boxes because that’s what they need to get in.
What is interview day like? [14:44]
Interview day for us starts with a welcome, and I do a quick 15-minute introduction, talking a little bit about the profession of medicine, talking about our institution, explaining the overview of the day, how the day will flow. We then split the group essentially into two halves. We interview 60 applicants on each interview day and that number is fixed at 60. And so half of the group will go on to do a group activity, and the other half will stay in the room that they’re in and get an overview of our curriculum.
The group that’s doing the group activity will do something together. I’ve kindly asked our applicants who have interviewed not to share that, and I think they’ve honored that. We also have the longest-standing honor code in the United States for medical school, so we think that’s something we take pretty seriously, and so I have not seen that activity disseminated broadly. And I appreciate, applicants, if you interviewed with us, thank you for not sharing.
But what we’re really looking to get a sense of is how do our students work in teams. We’re truly a collaborative team environment here. We believe in team science; we believe in team learning. We do a lot of small group learning, and medicine is a team profession now, right? When you’re out there practicing, you’re working with other healthcare colleagues in a way that you have to be able to communicate with them and play nicely in the sandbox and understand mutual goals, and do this all with the patients benefit at the back of your mind that we’re all working together towards that collaborative common goal. We like to see how they do together. It’s short, it’s really fun, and it actually opens up the day in a quick and really just exciting, fun, innovative way.
Then those two groups flip flop. The group that was getting curriculum would then go on and do the group activity. After that, the students then have a small group interview, which is for each applicant they’re partnered with two other applicants, different then they worked with previously.
And then they have a short interview with two of our interviewers. It’s a little bit traditional, but there’s some situational judgment in there, some kind of, “What if you are confronted with this situation, what would you do in this kind of scenario?” So half of the group will be doing that. And then the other half is learning about financial aid, learning about our Colorado Springs branch, learning about more of our infrastructure here in our programming. Then they again flip.
After that, our students get the opportunity to have a panel with our current students. We step out of the room, and the students drive this. I tell our current students to be honest, we’re not perfect, but it’s an incredible place. But it’s okay to talk about things that you would like to see changed because that matters to us as well. They go on a tour with the students and then they finish out the day with individual interviews. That’s one applicant with two interviewers, and that’s more of a traditional interview.
We do not have MMIs. We’ve explored it. I really liked the format that we’re doing now. I think it allows applicants to shine from a variety of different backgrounds, introverts, extroverts. I think it gives us the information that we need, and it’s also comfortable and fun for the applicant.
Do you want the students that you admit to have both research experience and clinical exposure? [18:24]
The answer to that is not necessarily, but what I will say is that most of our students who are accepted actually do have both. That’s the most common thing. I also recognize though that as an undergraduate, particularly if you’re working, you’re working to support yourself or your family, that those are nearly impossible choices and someone may not get the opportunity to do both in depth. And so that wouldn’t necessarily disadvantage a student, but most frequently, we see people who have done both clinical work and research work.
Do you weigh letters of intent? [19:18]
We actually don’t accept any letters of intent at all, or updates. We take the application as we get at when it’s complete with the supplemental and the CASPer. And then we get letters of intent. Even though we don’t consider them, we can kindly thank them or discourage them from sending them. Because the reality is that if we got one from every single applicant in our pool, we would be overwhelmed with just reading these. And the other part of it is, we don’t know what sort of advice that applicants are getting. Some applicants may be getting the instructions, “Oh, follow their directions, don’t submit anything.” And then some applicants, many have connections or may submit those letters, and I don’t feel comfortable giving those applicants necessarily a competitive advantage because they send something in supplemental when someone else may very well want to come here just as bad. And I don’t know if there’s a right way, but this is our philosophy that we’ve adopted. We thank them for it, but it doesn’t go to the Admissions Committee. It’s not part of the decision either to accept them or not accept them or to have them come in off the alternate list.
Let’s say I’m a junior or senior in college right now, or perhaps I’ve taken a gap year and I’m looking forward to the 2021 application cycle. What advice would you have for me? [20:47]
The advice that I would have would be to apply broadly. We know that our students across the United States are applying to more than a dozen medical schools on average. The other thing that I would strongly encourage students to do is to make sure their application is complete and in early. This should go without saying, but there’s thousands of applicants, and I think you do have an advantage getting in early and making sure that it’s complete. There are sometimes students who wait until the very end and then even the next day or the day after they say, “Oh, Dr. Zehnder, I almost made the deadline, but I didn’t quite,” and we don’t consider those applications.
My final other advice that I may have for applicants would be to make sure their letters are truly strong. At least here at University of Colorado, we would much rather have a letter written by somebody who knows you well than somebody who may be a bigger name and actually doesn’t know you well at all. We want to know who you are as a person. We can read the rest of your AMCAS application. They don’t need to reiterate your CV. They don’t need to tell us about your GPA. We get that from the MCAT, but we want to know about fit. Culturally, will you do well here? Are you the kind of person we want to rotate with on our board teams? Are you the kind of person who would do well in our labs. Twenty years from now, are you going to be an alum who we’re proud to say graduated from our institution? And so letters should really reflect those sort of interpersonal qualities.
What would you have liked me to ask you? [22:23]
We’re right now undergoing curriculum reform. We’re doing some really innovative things. The entering class of 2021 should be on the lookout for a newly launched website. But as a sneak-peak, we’re doing what a lot of schools around the country are doing. We’re shortening our preclinical phase so that we can get students into the clinical environment earlier. We’ve made the decision to move USMLE Step 1 until after the clinical year, particularly since the eight schools that did this initially found at least if not better scores, less anxiety around USMLE Step 1. I would want students to know that coming into our curriculum.
The other thing that we’re doing is we’re moving towards an all longitudinally integrated clerkship here for our entire medical student body. We’ll be the first school in the nation who truly is an all LIC model. In the traditional model, when students do their clinical year, they’ll do surgery, then OB/GYN and then maybe pediatrics. The students here really get the opportunity to do patient-centered care; and on any given day, they may be an OB/GYN and the emergency department and rounding on the internal medicine boards in a way that they can facilitate both longitudinal relationships with preceptors, but more importantly with patients.
For instance, if I was the patient and I went into the hospital and I needed my appendix out, my student who I saw in the primary care clinic would be alerted that I was in the emergency room. Then maybe when I went to surgery they would scrub into the surgery, see me in the hospital after, visit me postoperatively, then go to my surgery follow-up. It allows for the student really to get to know the patients in a meaningful way across the year.
The other thing that I would want students to know is how welcoming our culture is here. We truly want every single one of our students to succeed, and they’re like family. Our doors in our Office of Student Life are always open. We’re meeting with students into the evening, sometimes on weekends. We want to celebrate their successes, whether it’s personal or professional, but also get the opportunity to help support them in some of the tougher times of medical school. Medical school is hard, and we don’t follow the philosophy that we’re going to weed you out if you’re not going to succeed. We want to help create an environment that’s going to help you succeed so that you can be the best physician possible.
The USMLE just became pass/fail. Is that going to influence your decision at all? [25:27]
As of right now, the answer is no. I don’t know for sure if that will change in the future. But at least for the intern class of 2021, we’ll keep it there after the clinical year.
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