Physicians

Is Medical School Admission Squashing Creativity?

What does it take to get into medical school today?

High MCAT scores. Pre-requisites galore, coupled with a stellar GPA. Research experience. Clinical experience. Volunteering.

It has become a series of check-boxes, many going through the process gripe. Worse, it’s an exercise in conformity.

Last week at TEDMED, Dr. Jacob Scott shone the spotlight on this system as a root cause of the lack of creativity among people going into medicine.

“You can’t take any risks, or you won’t get in [to medical school] – you won’t get into the club,” he told the audience. But, he continued, that means weeding out creativity. Future doctors are being trained to “memorize certainty,” rather than think imaginatively.

Having gone through the admissions process recently, I could relate to many of Dr. Scott’s sentiments. It’s true: preparing to get into medical school does little to encourage risk-taking. Admission criteria are rigid. And you know if you don’t do what they ask, there is no shortage of others who will.

Want to become a doctor? You can’t slip up, or you’ll fall behind. You can’t rock the boat, or you won’t get admitted.

This critique is not unique to medical education. Scott’s talk reminded me of a speech by former Yale English professor William Deresiewicz to the 2009 plebe class of the United States Military Academy at West Point. Skeptical of modern benchmarks of success, Deresiewicz told the young cadets:

“It’s an endless series of hoops that you have to jump through [to get into college], starting from way back… What I saw around me were great kids who had been trained to be world-class hoop jumpers. Any goal you set them, they could achieve. Any test you gave them, they could pass with flying colors…. I had no doubt that they would continue to jump through hoops and ace tests and go on to Harvard Business School, or Michigan Law School, or Johns Hopkins Medical School, or Goldman Sachs, or McKinsey consulting, or whatever. And this approach would indeed take them far in life.”

Apply that to medical school, and you get a system that selects for people who have known they wanted to be doctors since the first day of college, or even earlier. Often, that translates into students who come from families of physicians. Those who come to discover the beauty of medicine through another path, later in their academic trajectories, find themselves significantly behind – with the gap so large that many are discouraged to try. It’s too late to become a doctor, they think.

And the mandates keep escalating. In 2015, for example, aspiring medical students will have to endure a new MCAT (Medical College Admission Test): about two hours longer, with new sections on psychology, sociology, and ethics in addition to the previous sections testing physics, chemistry, biology, verbal reasoning, and writing.

I do not contest the goal of cultivating well-rounded students. But I would disagree that multiple choice questions are the best way to assess these forms of thinking. I could imagine a situation where actually grappling with ethical situations in real life could keep someone from adequately preparing for the ethical section of the exam.

Not every desirable trait is exposed through filling in bubbles.

To me, the new test means more mandates. More hoops to jump through. More rigidity. More contrived benchmarks of success. More ways to fall behind.

Pointing out flaws in a system is a good first step. But it’s not enough.

The real question is: can we propose a better alternative?

There is no such thing as a perfect admissions system. Every method you can conceive will have benefits and drawbacks.

You select a system by identifying different options, evaluating them, comparing them, and determining not the one stands out as ideal, but the one that is least bad. The one that maximizes what you consider the most important pros, and minimizes your conception of the worst cons.

It’s like what Winston Churchill said about selecting the best form of government: “No one pretends that democracy is perfect or all-wise. Democracy is the worst form of Government except for all those other forms that have been tried from time
to time.”

No doubt, the medical school admissions system has flaws. But can we do any
better?

If not by grades, MCAT scores, and extracurricular activities, how do you identify good future doctors?

The status quo certainly has its advantages.

After his TEDMED talk, I had the pleasure of sitting down with Dr. Scott. “I’m just
blowing the whistle,” he admitted. “I don’t have the solution.”

Still, he had some suggestions. One was setting quotas on undergraduate majors. We could create a class of twenty biology majors, twenty physics majors, twenty English majors, and so on. “Your ways of thinking are strongly defined by your major,” he explained. Thus, to assemble a diverse array of thinkers, recruit a diverse array of majors.

And yet – isn’t a person more than his or her undergraduate major? Isn’t that ignoring all a person’s other traits that would predict a good doctor? Creating a new check-box? Not rewarding holistic learning? I agreed that medical schools need diverse ways of thinking. But, I thought about the distinction between creating a well-rounded class – and a class comprised of well-rounded individuals. I wouldn’t want to neglect the latter.

I said this to Dr. Scott. He nodded and said: “right on.”

Maybe it’s that attitude, right there, that we need.

Discourse, not dogma. Not just criticizing the status quo, but proposing new ideas. Dialogue. An honest evaluation of pros and cons.

A person who says “right on” to opposing ideas. A person who can adjust his or her own ideas in response to new ones.

That’s a creative person. That’s a creative doctor.

Ilana Yurkiewicz is a first year medical student at Harvard Medical School with a developed interest in mass media and science journalism. This piece was originally featured on her Scientific American blog, Unofficial Prognosis.

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Viny Sonimoto
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Viny Sonimoto

My D is a HS Senior. Looking to go into medicine. Has a perfect ACT, almost perfect SAT. Has got a number of AP (12) She has been told that if she wants to maintain a high GPA in college she should not take college credits for the AP courses she has already got a 5 on. In other words, if she repeats the same courses, her GPA is likely to be very high (on the other hand, if she takes a credit and takes a course of higher level of difficulty, her GPA might end up becoming low). And… Read more »

Shannon Wagner
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Shannon Wagner

This blog post is a bit old; however, I do hope to still stimulate some conversation! Yes, indeed, I do think the medical school (or, rather, pre-medical school) curriculum is in need of a reform. While the extensive pre-requisites are diverse in that there are many and produce individuals that manage to volunteer, do research, and nail A’s on a transcript, these numerous checkboxes leave room for not much else. Yet, what most interests me is the rigorous science-based pre-med curriculum that, rather than preparing undergraduate students for the years of medical training ahead (i.e. more science), seems to encourage… Read more »

admissions schools
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patrick
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patrick

As a current aspiring physician as well as a senior in a BSN program, I believe that this diversity is needed. Many of the pre med biology students I have met at my large private university are closed minded. They are in college to keep a high GPA and hit all those check boxes along the way, and that is it. When it comes to getting into medical school, and understanding the content, I know everyone of them will be fine. Where I see the biggest issue is in patient interaction. As a nursing student, my education is focused on… Read more »

PreMed Roadmap
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Very interesting post, thanks for sharing. I happen to believe that the admissions process actually encourages creativity. Sure, you need to have high MCAT scores and great grades in pre-req classes. That can’t really be changed. However, there’s no written rule that you must major in science. Plenty of medical students majored in economics, business, engineering, and humanities, just to name a few. There’s also no rule that you must have a clinical volunteering experience. I personally believe it’s much more important to find something you’re passionate about and commit yourself to that cause for an extended period of time.… Read more »

platon20
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platon20

I find it interesting that everybody is so adamant that doctors education needs to be tweaked because it is lacking in X, yet nobody seems to care about PA and NP education.

Its hilarious how most of the people on this board think that PAs and NPs can and should take over primary care from MDs, yet all we hear on this board is how MD education is subpar, despite the fact that it is over twice as long compared to the midlevels.

DeterminedMD
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DeterminedMD

Welcome to the antiphysician lobby that lives by the adage “hear the lie enough and it will become truth”. And no thanks to colleagues who stupidly fuel it by trying to validate non physician trained paraprofessionals can step in. I still wait for malpractice carriers to catch up with the NP field, especially in some specialties that are allowing NPs to prescribe as liberally as I have witnessed first hand. We’ll see how many continue to practice once the costs finally hit home!

ARCpoint Labs of Louisville
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My opinion is that technology should only aid the learning process. When we are able to focus on the bigger picture because some of the “process” is streamlined we should be producing better physicians.

platon20
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platon20

I disagree with the assertion that the top notch med schools are less likely to have creative people because they have more “boxes” to check.

I graduated from Johns Hopkins with 4 olympic athletes, several world class musicians, and many division I athletes. Other elite med schools have similar classes. You dont find these people studying medicine at Rocky Vista. If there is a lack of “creativity” in the med school applicant pool, it’s at the lesser programs, not the top notch ones.

DeterminedMD
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DeterminedMD

Per Will’s above last rebuttal to me re calculators cause atrophy, yes, in fact I do try to limit my use of calculators to very complicated math. How do you react standing in line waiting for someone to ring up a customer who can’t figure out how much change to give if the register is not working right? Or trying to add a couple of numbers that might be as quick as hunting down the gadget and turning it on and punching in the numbers? Rationalize and intellectualize your validating technology is ” about mechanizing simple things so we have… Read more »

Bill
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Bill

The US health care system has set up a path to becoming a physician remarkably unlike that for advancement in most other industries. I think that our system would be much improved if we adopted the latter type of model. Wouldn’t it be great if one could enter the health care delivery field after earning a bachelor of science degree, work and take classes to develop skils to achieve progression milestones, and eventually become a physician if they reach the necessary level of experience and education? This would open up the door to so many more potentialy qualified candidates, enhance… Read more »

MG
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MG

Granted this only applies to US medicine and admission to medical school. I would be interested to learn more about other countries and their approaches including curriculum in the first 2 years instead of dumping a sea of abstract knowledge on med students.

Kristina
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Kristina

One could just make patterns out of the bubbles. That would be creative.

bulldog
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bulldog

Thank you for your response, Ilyana. If students feel “stifled” or limited by checkboxes, they should take some time off before or after college to explore other interests. From my vantage point, such exploration is only encourage and rewarded by medical school admissions committees. In fact, the past decade might be the first time in American history that medical schools are rewarding such interests. I’d bet that the current crop of accepted students has a much wider array of backgrounds than any generation before it. Furthermore, medical students themselves are exploring more research projects, masters in public health, community service,… Read more »

Ryan Gray, MD
Guest

Great Post. I do find it interesting that you are a student at Harvard, one of the more prestiguous (read lots of checkboxes) medical institutions. We often forget to look up and see what the rest of the world is doing. Because we are in a “system” and think that everything we do is unique to our “system,” we fail to realize that the need to check the box is everywhere in our society. It has nothing to do with medical school admissions. 1st Grade, check – move onto 2nd Grade. 6 months Learners Permit, check – move onto regular… Read more »

Ilana_Yurkiewicz
Guest

Thanks for your comments, everyone. @bulldog: I think you are right that successfuly completing some of the checkboxes does involve creativity. One example that comes to mind is research — being in the lab itself is the checkbox, but some applicants have contributed to scientific discoveries at an impressively young age. It takes a greal deal of creative thought to do something novel in research. I would really like to emphasize that it’s the system itself, not any individual person or classmate, that seems questionable. For example, I have known people who were committed to being doctors later in life,… Read more »