Different Strokes
Medical schools meeting your needs
Paul Jung, M.D.
For those who have successfully endured the arduous medical school application process, it's time to choose a medical school. But what may seem like a simple task really isn't. Don't fall victim to this common adage: "All medical schools are alike-you wind up with a medical degree at graduation."
Sure, many of us think we know which schools are the most prestigious, and it's true that your state medical school(s) will charge the lowest tuition, but there's more to selecting a school than just name and cost. You need to evaluate the unique programs that may differentiate seemingly similar medical schools, because these programs will significantly affect your medical education. In fact, it's important to research the school, period.
A premed once told me, after he had submitted his medical school applications, that Cornell University's Weill Medical College was his first choice. When I asked him why, he confidently replied, "I love Ithaca. It's a beautiful town." When I asked if he applied to any medical schools in New York City, he said, "No, the city's too crowded and dirty." He looked stunned when I explained to him that although Cornell's undergraduate campus is in Ithaca, its medical school is in the Big Apple. Imagine if this student had applied only to Cornell, or worse, had applied early decision (see March 2001 "PremedRx" for a discussion of 'Early D'). This example may seem extreme, but it serves to show how simple mistakes in the medical school selection process can turn out to be catastrophic. You need to approach it carefully.
Every U.S. medical school must successfully comply with demanding accreditation standards set forth by various supervisory boards, and in this sense it is correct to assume that the schools are all similar-they all provide the requisite education for a medical degree, and they all prepare you for residency training. The joke that 50 percent of American doctors graduated in the bottom half of their class is technically true, but this crack ignores the fact that all U.S. medical school graduates are rigorously trained for minimal competence to enter residency regardless of which medical school they attended.
But since medical students learn best in different ways, there is no point for one school to be identical to another. Hence, there are significant differences between medical schools that may affect not only your chance of admission, but also the quality of the education you receive. It is imperative for you to investigate these differences.
Find out how you are going to learn about medicine. Is your school's curriculum created for the 20th or the 21st century? The "Flexner Report," published in 1910 by Abraham Flexner, basically stated that most medical schools at that time poorly trained doctors. This report initiated the blueprint for the modern medical curriculum-i.e., two years of basic sciences and two years of clinical hospital rotations. Unfortunately, as medicine has changed dramatically in the last 90 years, the Flexner curriculum has remained, for the most part, unchanged.
Many medical schools, however, have altered their curricula in the last decade. Some now offer creative programs. Listed below are some of the more common innovations advertised by medical schools. Consider them as you evaluate your schools:
· Problem-based learning. Problem-based learning (also known as case-based or self-directed learning) requires students to research answers to clinical cases and patient vignettes. In so doing, students learn the concepts through independent study and collaborative education. Most medical schools now have some form of problem-based learning within their curriculum, and a few bold medical schools use this technique exclusively throughout their entire curriculum. Those anachronistic medical schools that lack any form of problem-based learning probably have students napping soundly in dingy lecture halls built around 1910.
· Primary care. Primary care is a catch phrase that means different things to different people. Health-care experts still debate its definition, and medical schools have not achieved consensus on this point. But many medical education experts consider the best primary care experience to be a required family practice rotation in the third year of medical school. Some schools now require a continuity clinic, one half-day a week, for all students. Regardless of how individual schools approach primary care, every applicant should carefully investigate and understand exactly what each medical school does to promote it. For a balanced education that offers a sampling of every major specialty, a required third-year family practice rotation should be on your list of must-haves, and you should look for a school that offers primary care experiences throughout its curriculum.
· Early patient contact. Why should medical students be required to wait to master histology before they are allowed to practice communicating with patients? Many medical schools now promote patient contact early in their curriculum. These experiences range from taking simple patient-histories to shadowing physicians. If a modern medical school does not offer early patient contact, it's way behind.
· Computer-based learning. Computer-based learning simply means the use of computers to replace animal physiology experiments, cadaver dissections and patient simulations. Not every school has the financial resources to provide all these advances to every student. Still, you should look for one that at least provides for basic competencies in computer-based learning.
· Systems-based learning. A systems-based learning program teaches the complete physiology and pathology of an individual body system by combining all the traditional basic science disciplines into one module. Instead of biochemistry, histology, pathology and pharmacology, students learn the normal physiology, diseases and treatments of the gastrointestinal, cardiovascular and neurological systems, etc., all at once. This is an effective method of transforming scattered information into an organized system.
· Pass/fail vs. 'A'-'F' grading. Should you use a school's grading system as a criteria in your application and enrollment decisions? Definitely.
Some schools use the traditional letter-grading system for all their courses. Others have completely switched to a pure pass/fail grading system in an attempt to validate the notion that basic medical competencies are either achieved or not achieved. Some schools have enacted a bizarre pass/fail system that rates students with honors, high pass, pass, low pass and fail. The substantive difference between this grading system and the standard 'A'-'F' one is up for debate-as is the question of whether this type of grading system really alleviates letter-grade competition and anxiety. Still other schools give letter grades for some courses and pass/fail for others. And Yale University School of Medicine doesn't even give grades at all. The possible permutations are endless.
The traditional letter-grading system does have an advantage, though. Those who graduate from medical schools lacking a significant reputation or prestige will fare well in residency selection if they have 'A's pasted across their transcripts. Conversely, a transcript strewn with mere 'pass'es won't do much to overcome a school's lack of distinction. But remember that no matter what type of grading system is used, all medical schools rank their students for dean's letters (the mandatory letters required for every student's residency application), even Yale.
For the most complete description of allopathic medical schools, check out the Association of American Medical College's Curriculum Directory and Medical School Admission Requirements. For osteopathic medical schools, refer to the American Association of Colleges of Osteopathic Medicine's Annual Statistical Report and its College Information Booklet. These catalogs describe each medical school in detail, providing information in such areas as curricula, student interests, faculty strengths, tuition and fees.
Always keep in mind that you must research your medical schools. It will help you avoid this troubling scenario: A premed once told me he wanted to attend Johns Hopkins University School of Medicine because he was interested in trauma surgery and, he said, "Hopkins has their shock trauma center." He did not believe me when I explained that the Maryland Institute for Emergency Medical Services, commonly known in Maryland as "Shock Trauma," is part of the University of Maryland Medical Center, not Hopkins. He actually said, "There's no way that Shock Trauma is part of Maryland." Apparently, in his mind, only Johns Hopkins could have a prestigious surgical institute.
Beware of these costly mistakes. Imagine if he actually interviewed at Hopkins and asked about their shock trauma center? Or worse, if he became a Hopkins medical student and expected a rotation at the center? Again, this example may seem silly or obvious, but the lesson to be learned is never to assume anything. Research your medical schools.