A flawed process?

[sisphus]

There are some things bugging me about the medical school application process, and I just wanted to share my thoughts what you think.

I used to be part of a really involved community volunteer group, which coincidentally had a lot of students applying to schools of medicine. During my involvement in this group, I saw many of these people get into medical schools. But they were rarely the people I expected to get in off the bat. Why? While volunteering I got to know some people who demonstrated great character, resilience, and compassion for others. These people would volunteer for more responsibility when others couldn't, go beyond what was expected of them in terms of their volunteer role, would always be available to support others if they were going through hard times, and sacrificed their own time and energy to make the volunteer group and the community it was supporting better. These were people I always knew would have my back if something bad were to happen. In addition to their clear academic ability, their character told me clearly these people would definitely be accepted into schools of medicine and go on to become amazing doctors who would make patients feel well cared for. But they didn't. They were not interviewed or accepted. Needless to say, despite this they have gone on to be fulfilled and accomplished in alternate life paths. This in isolation would sit well with me, as it is a competitive process after all. 

However, what didn't sit well with me was the fact that there were other people who did the bare minimum, fulfilled their responsibilities and no more, and only stayed to volunteer until they achieved some sort of recognition or title. These were not the people who went out of their way to help when there was a crises, such as being short-staffed or staff/community members have difficult personal issues (e.g., addiction). If such an event occured, they quit not long after and moved on to other opportunities. These were not the people that I could depend on, that I felt comfortable asking for their help. However, THESE were the people who eventually got accepted for schools of medicine and are moving on to be doctors.

Why does it matter? Well, if you had to pick a doctor from either group, which one would you prefer to look out for you and take care of you? I would resoundingly pick the former. I want somebody who just doesn't do the bare minimum and calls it a day after fulfilling their responsibilities. I don't want someone looking after my grandma, who just wants to tick off the checkboxes and call it a day. I want somebody who cares, goes out of their way, and is not satisfied with 'just enough'.

I can already see the arguments against this. Burnout, someone who can meet their responsibilities as a doctor only is all that's required, doctors don't need to be saints, that I only saw one aspect of these people, other. 

But when I think about stuff like the Casper test, a test created to look for good character, maturity, sense of ethics, I am surprised to learn that people do well by compiling a thesaurus list of 'empathy' terms that they just word-vomit onto each question prompt in an effort to score well. Is this test really looking for people who would make good doctors, or people who are good at gaming the system? Isn't this just selecting for people who are good at faking compassion and empathy?

When I consider other issues, like the high costs of the MCAT, or the susceptibility of extracurriculars/references to nepotism, or the ridiculous GPA requirements, I wonder if the whole process is just selecting for people who are either privileged (resources, status, connections, etc) or are extremely good at jumping through arbitrary hoops. I've seen rich high school kids whose parents are friends with a doctor get amazing work positions in medicine that others would need complete BScs or MScs, or extensive work experience, for. Undoubtedly, this will only help them gain better experiences to put on their resume. Ultimately, it wouldn't matter how they got it for the admissions people who are skimming through resumes. At the end of the day, is the process truly selecting for people who can recognize and serve the needs of a diverse patient population?

Feel free to refute or support. Happy to hear either.

[anonymouspls]

It makes logical sense that the people most successful within an arbitrary system that selects med students are the ones that can best navigate, or “game” said system. Any admissions process, no matter how you structure it will reflect this. Im not sure if its possible to suggest otherwise unless we just admit everyone and select those with the best personality traits after 4 years before residency? That would be impossible as im sure you can understand.

 

i must say gpa is simply used as nothing more than a cutoff at a lot of schools now, and mcat is as close to an academic equalizer as we’re going to get. Nepotism though still useful wont really help you that much because experience working at a mcdonalds job can get you as many points on your ec as working in a fancy lab or volunteering overseas. Its during residency interviews that nepotism becomes a big problem but thats another topic.

[apple94]

I didn't read your whole post but i understood the sentiment. And ysera's first sentence is exactly what i was thinking. I think it is well known that the process is flawed - to the extent that there is an element of doing what needs to be done (aka "gaming" the system). Why do we need reference letters when they are subjective? Why do we only get 2 sentences to talk about each activity on our ABS when these experiences should be valued for their depth and not quantity? Why do we need CASPER when not everyone types at the same speed? I can keep going on but ultimately you can point out flaws everywhere and find unfairness conveniently depending on your perspective. I'll give credit to admissions in Canada though for having very different requirements among schools (CASPER vs. mcat vs. essays vs. ECs) which gives people the flexibility to still get in based on their own unique strengths.

Also there is another debate to be had about the value of being able to jump through arbitrary hoops (aka competency) versus true character and compassion (but at the expense of competency). The good thing is, based on my own experience, 90% of people who get in are both competent and compassionate.

[Pepperyelk]

Medical school admissions will always be imperfect. People that would have made fantastic physicians will continue to get rejected and people that should never be physicians will continue to get accepted. However, the opposite is true as well, and hopefully, the majority (from my experience), are great candidates. I completely agree though how frusterating it is to watch great people get rejected. What I do find hopeful however, is that medical schools continue to refine their admissions process. They continually try to improve it and seem to keep shifting their focus towards trying to find good candidates rather than just good grades (which seemed to be a lot more important in the past).

Ideally the medical school admissions teams would know each candidate personally, but that's not possible and I think that it would just breed corruption. I also agree that it would be great to be able to see how candidates performed in medical school/as residents but that would be a huge investment and waste of time for people who weren't selected at the end.

Despite our imperfect system the main thing I appreciate about Canadian medical schools is that admission is the main rate limiting step to becoming a doctor. That is, its actually far more difficult to get accepted into medical school because the bar is so high than to make it through medical school and get a residency (I mean in terms of probabilities not hard work). Imagine instead a different system where almost everyone gets accepted but then lets say only 50% graduate or get a residency. Our Canadian system, with its tough admission, seems more cruel at first glance but in reality our system lets you live your life and choose other options (including reapplying) when you are rejected rather than letting everyone in and wasting an incredible amount of time and money for candidates that eventually are not selected. There are other countries where being accepted into medical school is not the rate limiting step and from my opinion that is a much more cruel and stressful system and it requires a much bigger investment.

In the end, I wish medical school admissions could somehow know the amazing people they reject every year. It sucks and its imperfect but they are trying to improve and it's their loss not the persons when they reject those people.

[Coldery]

3 hours ago, sisphus said:

There are some things bugging me about the medical school application process, and I just wanted to share my thoughts what you think.

I used to be part of a really involved community volunteer group, which coincidentally had a lot of students applying to schools of medicine. During my involvement in this group, I saw many of these people get into medical schools. But they were rarely the people I expected to get in off the bat. Why? While volunteering I got to know some people who demonstrated great character, resilience, and compassion for others. These people would volunteer for more responsibility when others couldn't, go beyond what was expected of them in terms of their volunteer role, would always be available to support others if they were going through hard times, and sacrificed their own time and energy to make the volunteer group and the community it was supporting better. These were people I always knew would have my back if something bad were to happen. In addition to their clear academic ability, their character told me clearly these people would definitely be accepted into schools of medicine and go on to become amazing doctors who would make patients feel well cared for. But they didn't. They were not interviewed or accepted. Needless to say, despite this they have gone on to be fulfilled and accomplished in alternate life paths. This in isolation would sit well with me, as it is a competitive process after all. 

However, what didn't sit well with me was the fact that there were other people who did the bare minimum, fulfilled their responsibilities and no more, and only stayed to volunteer until they achieved some sort of recognition or title. These were not the people who went out of their way to help when there was a crises, such as being short-staffed or staff/community members have difficult personal issues (e.g., addiction). If such an event occured, they quit not long after and moved on to other opportunities. These were not the people that I could depend on, that I felt comfortable asking for their help. However, THESE were the people who eventually got accepted for schools of medicine and are moving on to be doctors.

Why does it matter? Well, if you had to pick a doctor from either group, which one would you prefer to look out for you and take care of you? I would resoundingly pick the former. I want somebody who just doesn't do the bare minimum and calls it a day after fulfilling their responsibilities. I don't want someone looking after my grandma, who just wants to tick off the checkboxes and call it a day. I want somebody who cares, goes out of their way, and is not satisfied with 'just enough'.

I can already see the arguments against this. Burnout, someone who can meet their responsibilities as a doctor only is all that's required, doctors don't need to be saints, that I only saw one aspect of these people, other. 

But when I think about stuff like the Casper test, a test created to look for good character, maturity, sense of ethics, I am surprised to learn that people do well by compiling a thesaurus list of 'empathy' terms that they just word-vomit onto each question prompt in an effort to score well. Is this test really looking for people who would make good doctors, or people who are good at gaming the system? Isn't this just selecting for people who are good at faking compassion and empathy?

When I consider other issues, like the high costs of the MCAT, or the susceptibility of extracurriculars/references to nepotism, or the ridiculous GPA requirements, I wonder if the whole process is just selecting for people who are either privileged (resources, status, connections, etc) or are extremely good at jumping through arbitrary hoops. I've seen rich high school kids whose parents are friends with a doctor get amazing work positions in medicine that others would need complete BScs or MScs, or extensive work experience, for. Undoubtedly, this will only help them gain better experiences to put on their resume. Ultimately, it wouldn't matter how they got it for the admissions people who are skimming through resumes. At the end of the day, is the process truly selecting for people who can recognize and serve the needs of a diverse patient population?

Feel free to refute or support. Happy to hear either.

If you talking strictly on the basis of commitment to this single volunteer group, understand too that people have their own lives and obligations. They may have other commitment(s) where they are already demonstrating the effort that you speak of for those that weren't interviewed or accepted.

If you are talking about a situation where they demonstrate an outright lack of care or negligence then that would be different. Otherwise, you'd have to get the full view before coming to a conclusion. 

[canadianguy7]

Coming from a low income background, I was one of those that did the bare minimum for volunteering (I went once a month during certain periods of time, but I wasn't a burden to the program). However, I spent all of my summers working full-time, worked part-time during school, did co-op, etc just to have enough money to finance my living expenses and tuition. Volunteering is a privilege in itself if your parents can help finance your education. I had to bust my ass working 9-5 pm, then study the MCAT from 5-11pm during the summer to compete against other students that had the luxury of not working jobs while volunteering modestly over the summer to study for the MCAT. At the end of the day, I think it was my extensive amount of job experiences that helped me grab some med interviews. Everyone comes from different backgrounds and I am sure the amount of involvement/care that they put into their work is reflected into their application. Ie) If Applicant X only did 50 hours vs. Applicant Y that did 500 hours, I am sure the volunteer coordinator would write a much better and tailored reference letter for Applicant Y...

[CardiacArrhythmia]

Read up Marsha Barber's article written in 2016: https://www.universityaffairs.ca/features/feature-article/medical-school-admissions-process-skewed/. Some of your points do align with her article and how she saw the process unfold for her son. 

I also want to say that every year, med schools get great applicants but unfortunately not everyone can get through. Many factors are outside the applicant's control as well. Despite Canada in great need for primary care, the federal and provincial governments are limiting (and also looking to cut) down on educational and occupational funding for healthcare. The result? A reduction in employment, reduction in residency spots, a CAPPING of MD seats due to limited residency spots...the spiral chain continues further down. 

In regards to "people who you thought would get in and those who you thought wouldn't ended up getting in", I found that people who were often (for a lack of a better word), ARROGANT, were the one's who tend to show more confidence in their interview skills. Once you get to the interview stage, it's all about being confident in who you are and being to portray yourself and again "gaming" the system. Some people are good at lying at interviews and about their experiences with a straight face - this happens in all types of interviews whether it be a job or med school. Would they eventually make a good doctor? Probably not. But in the moment, the interviewer could think he/she makes an amazing physicians. Remember they got through 1 gate, but not the 2nd gate, being residency. I have known an individual who got into med school, being arrogant and lying his way through to an acceptance...but where did he ended up? Being rejected from all the residency positions he applied to.  

Also, I am going to bring up sociological factors here. Socioeconomic status differences provide different levels of thinking often with low SES being more empathetic due to the personal experiences they experience themselves - this could also mean that they are more aware and react more emotionally on what's going on around them. At times, this may or may not be the best for interviews as many distractors can be thrown your way to phase you out. Also, at the interview stage, I commonly believe those from the admission committee from a high SES background will never TRULY and FULLY understand what these people go through. I really do advocate for more diversity in the process - having members of the committee being from a low SES background, on a panel and/or a few MMI stations. I have literally met a few practicing doctors, both younger and older,  who have dismissed cultural factors and made indirect racial comments towards my family for seeking medical care - these physicians were simply culturally incompetent and rude.

Luckily, med admissions is starting to notice the trend in their admissions. Although, we will likely not see a significant change immediately in the doctor population, we are gradually shifting towards a better approach with expected change in the distant future. 

[sisphus]

Hi all, some good and interesting points from different perspectives. I was a little nervous to start this conversation as it might be contentious, but now I am glad to have done so. I will reply to what I can, but I recognize that my logic, knowledge, or experiences are limited and may not necessarily be applicable.

 

I've noticed a few responses that have the same pattern. Yes, the system is imperfect. And there are and will be many flaws that can't all be addressed. These flaws are not limited to medicine or its admissions. However, does that mean that we shouldn't try to address them? It pains me to see that, since the time Queen's Medicine expelled its black students, during 3 generations, we are just barely starting to encourage indigenous, black, and low-SES students to apply in a few select programs in some schools across Canada. These populations and their difficulties have existed for a long time and it's not a current issue.

With support, the majority of people can be trained to be competent at a procedure, and even do it extremely well. However, things like compassion and empathy are harder to train, if at all trainable. Is it ever possible to train somebody to truly understand what it's like for somebody working 2 jobs to support a family, unable to afford and adhere to their medication, living paycheck to paycheck, stressed from waiting every day for the other shop to drop (emergencies, sickness, etc.). I'd argue no, unless that training provides extensive living experience in their shoes. Why is this important? As their doctor, you are providing care that will need to be tailored to their circumstances, otherwise they will not be able to adhere to your treatment plan due to their circumstances getting in the way. No matter how hard they try. When the selection process is unfortunately biased in favour of selecting for those who are well-off, which is apparent when you see most current practicing physicians, this becomes a systemic problem.

Yes, many selection systems naturally select for people who can jump through the predetermined hoops, no matter how arbitrary they may be. But does this truly assess a person's competency or their ability to be competent as a doctor? How well can you jump through a hoop if your leg is lame? Similarly, many people are afflicted with poor situational circumstances that prevent them from displaying so-called competency.

 

Yes, Canada is blessed to have schools that try to recognize and serve their local population (Western with its SWOMEN program), including different eligibility criteria used. There may be a school that caters to each kind of applicant and they will have their niche of opportunity. Unfortunately, due to the sheer level of competition, applicants simply cannot afford to apply to that one school and realistically expect to get in. A successful applicant is usually the one who has the ability and the means to jump through as many hoops as possible and satisfy the criteria of many schools. Through attrition, this means that less fortunate applicants are lost as potential doctors, who may have provided a valuable perspective due to different experiences. 

 

Let me put it to you this way. A black kid grows up a poor neighborhood with a struggling family. Somehow, against all odds, they are convinced that they can be a doctor despite not being able to afford classes or time to study or the means to travel to volunteer. Due to their poor circumstances, they work under the table (illegally) doing odd irregular jobs (A McDonalds position would be lucky) to support their family, and consequently they have a low GPA in university and limited experiences that admissions likes or finds palatable. They can't afford to take the MCAT twice or the Casper. They never learned French. They decide to apply to UofT, which has a program for black students. However, due to the sheer number of people vying for the same spot, they don't get in. And so we lose a potential doctor who could have served their neighborhood and recognize what it's like growing up in their situation.

 

Yes, my perspective is limited and I should not try to assess applicants by their involvement in one activity. They may have really given it all in other domains of their lives and were not able to do the same in mine. However, my point is that Medical Schools are vulnerable to that exact same bias. Many of these schools also view applicants through a similarly limited perspective (though better than mine), which does not fully capture the applicant's potential and activity. 

 

Ultimately, I am heartened to see recent changes like Ottawa's low SES initiative, but I'm concerned that medical schools are not adapting quickly enough to the needs of their communities.