Janie is one of hundreds of premeds and medical students with whom I've worked. She knows applying to medical school is a long and complicated process. In June 2016, she will submit her primary applications to begin med school in fall of 2017.
Hopefully, Janie will receive secondary applications starting in late July. She will celebrate getting "secondaries" because receiving them means schools are interested in her. She'll write many short essays in response to the schools' questions. Her answers will be crafted (or so we hope) to grab admissions committees' attention. With luck, she'll be invited to interviews sometime between August 2016 and late March, 2017.
Admissions offices see scores, grades, recommendations, resumes, and personal statements in primary applications. Hopefully they use all of this information.
Unfortunately, the hundreds of students with whom I've worked have learned that scores and grades are filters that all-too-often screen out people who had to overcome the real world problems millions of patients struggle with daily.
Buy food? Or meds.
Make time to earn needed income? Or take mom to the doctor.
These choices literally shape students' futures and/or the lives and deaths of people they love.
What do scores, grades, recommendations, and carefully crafted essays say about whether Janie is able to deal with difficult patients, or crises, or death? My diverse experience suggests that until recently, they didn't say much....and say little more even now.
The American Medical College Application Service (AMCAS) has realized that Janie's understanding of real world factors that affect disease is as important as her knowledge of biology, chemistry or physics. However, the "new" MCAT which adds fields like demographics, ethics, and sociology to the sciences only evaluates her book knowledge ....and often only the information test prep companies tell her will raise her score.
Janie is understandably focused on keeping her grades and scores high. She also does things (like research), that good candidates "need" to do. As a result, she has little time to get real world exposure to how patients experience disease and disability while living, loving, working and yes, dying. Experience she needs to be effective in an era when patients spend almost all of our time and energy on managing our health outside of the clinical setting; or so these data on in -and-out patient care, the physician workforce, and chronic disease indicate.
Most recommendations for students like Janie focus on their performance in the lab or classroom. These letters usually don't say whether candidates can empathize with the lives of patients who are statistically sicker, older, poorer, less well educated, and less white or Asian than they are.
As a Ph.D. trained geneticist I can say students usually don't work with patients in the lab. Work as a CNA or EMT for example, does provide this experience. Because it pays better than undergraduate lab research, home health or emergency services work can let students start health professions training with less college debt than they carry now while getting far broader real world experience of healthcare than they get doing lab research (invaluable though it can be), or volunteering in the hospital (where they often don't work with patients).
And yet, most candidates have relatively little patient care experience.
Students often don't get this experience because their advisors and friends who applied in previous years tell them that admissions committees strongly prefer research to other work. This is particularly true for candidates from Ivy-type schools. State university students are, in my experience, likelier to work with patients because they have fewer opportunities to do research.
My mentees (many of whom later sat on admissions committees) also report that many medical school admissions committee members haven't practiced in years. In many cases, committee members don't have any healthcare training or experience. As a patient myself, I can't see how someone who doesn't regularly work with patients, do procedures, or diagnose colds is qualified to decide who America's future physicians should be. I also don't see how physicians who spend half of their time on patients can fully connect with students wanting to focus on people, not Petri dishes.
It is therefore likely that today's admissions committees themselves are a barrier to selecting physicians with the empathy we now know is essential in selling patients and their caregivers on behaviors that are emotionally challenging and physically painful.
We can change this by giving patients an overt, full, and equal voice in the admissions process. Helping vet candidates would let thousands of volunteer patient interviewers feel their experience has value.
If students knew patients would decide their futures, they would seek experiences to help them bond with patient interviewers, much as they now do research to connect with today's admissions committee members.
Patient interviewers would ask themselves: "Would I be comfortable with this person as my physician in ten years?" their answers to this question would have value because they account for the real world experience of illness and impairment that shape patients' health more than grades, scores, and committee members' connections to academic recommenders.
Medical school candidates should also be required to have a thousand hours of direct patient contact and one patient recommendation: most have neither of these things today.
Finally, nurses or physician assistants should also sit--and vote--on medical school admissions committees. This would ensure accepted candidates have attitudes and experience these invaluable health professionals feel will support teamwork rather than uncaring behaviors. This indifference may exacerbate medical errors that causes 400,000 deaths and unnecessary suffering for millions every year.
Changing who chooses are future physicians will open opportunities to people more socioeconomically and experientially like tomorrow's patients than many of today's medical students are. This will improve communication, patient welfare and professional longevity for people selected for their emotional intelligence and capacity to deal with diverse patients and difficult workmates rather than their ability to experiment on fruit flies.