Planning Your Premedical Career: Gardeners and Architects

Posted by Santiago on 7/1/19 12:50 PM

medical school admissions

Competition for coveted medical school seats increases every year and with it the pressure on aspiring physicians to meet the ever-rising expectations of admissions committees. Whether you knew you wanted to become a physician since you could want anything at all or are planning on making a career change into medicine, it can be overwhelming to think about everything you will need to do just to be ready to start writing your application. George R. R. Martin once said there are two kinds of writers: gardeners and architects. Architects like to draw up blueprints, measurements, grand plans before even thinking about laying down a foundation. Gardeners, on the other hand, plant a seed, water it, and watch it grow, tending to the needs of the sprout as they arise. Your medical school application is the story of why you want to (and should) become a physician, so how are you going to go about putting it together? I don't think there is a single, right answer to that question, but I do believe that every premed should strive to find their own balance between master planner and rolling stone. In this two part post, I'll talk about how each mindset might shape your premedical career.

Part 1: The Best Laid Plans

The bare minimum requirements for any medical school application consist of about two years’ worth of coursework (which varies from school to school), ample experience in the clinical setting, and, of course, an MCAT score. It is critical that you set yourself a timeline for hitting these milestones. Whether you are in an undergraduate or post-baccalaureate course, you need to understand the sequence and pace through which you'll complete the required coursework. This is where your academic advisor at your home institution can be an invaluable resource. The quality of academic advising can vary from institution to institution (indeed, from advisor to advisor), but every advisor at your institution should, at the very least, be familiar with the school's course catalog and hurdles faced by their premed students.

Finding that first engaging and participative clinical experience is even more important, not merely because it is expected of you but because it is precisely this kind of experience which will tell you — very quickly — if medicine is right for you. I strongly advise all of my students to seek out clinical volunteering or shadowing before pursuing any other extracurricular activity. Medicine isn't for everyone and your undergraduate education is partly about discovering what kind of life, work inspires and drives you — locking in or ruling out medicine as early as possible can only benefit you. Reach out to a physician you know (even your own) and ask to shadow them or if they can recommend you to another physician who might be more willing. Avoid hospital volunteering positions unless they are explicitly patient-care oriented. Instead, look for volunteering positions in free clinics, community health centers (in my experience, they are always looking for help), or, if you can spare the time, as a medical scribe.

You've laid out your course schedule far in advance and have had some encouraging patient-care experiences...it's time to start thinking about the MCAT. Don't be so eager that you start reading MCAT review books starting your freshman year; similarly, it would be an error to think that there is nothing you can do to prepare for the exam from your first day as a premed. MCAT review books are just that, review books. Without a strong foundation, you'll merely be cramming information into your head instead of absorbing the critical relations between concepts, themes, biological mechanisms and physical principles which the MCAT will ask you to apply. How do you build this foundation? By investing yourself in your coursework! It goes without saying that your GPA is important but if you make the effort to go above and beyond in your coursework to truly understand and internalize the material then your GPA will reflect that. Some students want to start reviewing MCAT flashcards alongside their regular coursework, but I'm here to tell you that your attention is best invested fully in the coursework itself. The MCAT is mainly an application exam, not a knowledge exam, so conceptual understanding, not rote memorization, is where you ought to focus your efforts until it comes time to study for the exam in a dedicated fashion.

One last note about the MCAT: plan to give yourself time. Many students attempt to study for the exam for the first time alongside their regular coursework either because they feel rushed or don't want to sacrifice a full summer to the exam. I can understand that mindset. However, this single eight hour exam will be weighed as heavily as your entire collegiate academic career. Medicine is a marathon and not a sprint — there is always more time to bolster a sparse résumé but your academic metrics are far more time consuming, difficult, and expensive to alter beyond the first attempt. Although not ideal, it's not the end of the world if you need to take the MCAT more than once to be a competitive applicant, but trust me when I tell you that nobody should plan to take that test twice, even if just for the sake of their own sanity. 

Part 2: Gardening

"In the first place, in the physician or surgeon no quality takes rank with imperturbability...Imperturbability means coolness and presence of mind under all circumstances, calmness amid storm, clearness of judgment in moments of grave peril, immobility, impassiveness, or, to use an old and expressive word, phlegm.” - William Osler, Aequanimitas

The path to medicine is long. Things happen; doors open and close; crises come and go; life intervenes. Flexibility and equanimity is just as valuable as thorough planning, if not more so. Aequanimitas, what Osler called imperturbability, is a cultivated trait. One must be prepared to face possibility head on and this includes the possibility that your plans may be stalled or fail completely. A common scenario I see is a student overburdening themselves with courses, commitments, activities, responsibility and unwittingly making undue, unwise compromises under the pressure of progressing as quickly as possible toward their imagined goal. These students have a mindset similar to that of a track runner preparing for hurdles: they see the obstacles in front of them and know they must jump so high and see themselves surrounded by others preparing to do the same. In hurdling, the goal is to clear the track as quickly as possible with the fewest errors; premed is similar in that you should work to clear each hurdle as cleanly as possible, but the race is an illusion in the mind of the competitor. So, the when our overburdened student starts to see a dip in their grades or fail to accomplish anything meaningful in their activities, they become discouraged, damaged even, and begin to flake on their responsibilities, health instead of responding to the problems at hand. Equanimity, or more simply grit, will help you through those tough times but merely weathering the storm is not enough to be a good gardener.

If the student was, instead, a good gardener, they would plant a single seed at a time (starting with academics) and open themselves up to possibility, waiting for the right time and opportunity to diversify their efforts. This is what I mean by flexibility. It's this gardening mindset that helps you build a standout extracurricular résumé. The most impressive applicants will not necessarily have the most activities or hours, but they will have made a significant contribution to, and grown from, every project or organization they have chosen to involve themselves with. If you are filling each of your days with meetings and busy work on top of your academic responsibilities then you will never give yourself the chance reflect on what you do, to internalize the fruits of your labor, to glean the possibilities hiding all around you. It's those moments of leisure and reflection which open us up to ideas which might allow us to have a positive impact on the people and world around us. You need to allow yourself that space. It's good for your health, too!

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Want to read more about the process?  Read on, dear reader, read on!

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