Premed Prep

SUNNY NAKAE, Ph.D., M.S.W., is the Senior Associate Dean for Equity, Inclusion, Diversity, and Partnership, and Associate Professor of Medical Education at the California University of Science and Medicine. Prior to joining CUSM she served as Associate Dean for Student Affairs at the University of California, Riverside School of Medicine where she held an adjunct appointment as Associate Professor of Social Medicine, Population and Public Health. She has previously held administrative positions at the University of Utah School of Medicine, Feinberg School of Medicine at Northwestern University, and Loyola University Chicago Stritch School of Medicine.
 

Chapter One
Premed Basics
Be Quick, But Don't Hurry
 
The prevailing advice I give about academic progress in premedical preparation is a quote from the great John Wooden, one of the most successful basketball coaches in NCAA history, “Be quick, but don’t hurry.” This seems contradictory, but in fact it’s not. Go as fast as you can without your speed compromising your performance. If you sacrifice performance for speed it will not pay off. If you are in a hurry, you might make mistakes and not perform your best. This will lead to having to spend extra time addressing deficits, and that does not actually help you in the long run. What is the point of graduating in four years with a 2.9 GPA? You will just end up taking at least a year of post baccalaureate courses to really show you are prepared. Better to be intentional about your pace from day one.

My second most salient piece of advice is this: Your GPA will NOT get you in, but it can keep you out. You absolutely must safeguard your GPA during this process. The GPA is like a token that unlocks consideration for admission. Think of it like a key that determines how much the door is open. A lower GPA does not necessarily mean you’ll be excluded, but it will mean that the number of schools that will consider you will be fewer than if your GPA were higher. 

Notice I said consideration. Schools typically prioritize their candidates by GPA to varying degrees, at least initially. How much consideration you receive is usually preliminarily based on your numbers. Some schools that are holistic have a minimum threshold that you have to meet before holistic review happens. Even schools who consider post baccalaureate applicants may have minimum undergraduate GPAs that all candidates have to meet before they consider your post baccalaureate performance. Admissions practices vary across schools, and as a rule having a solid GPA always helps. 
 
Know the rules        
Before you begin, it is critical that you know this important rule for the American Medical College Application Service[1] (AMCAS), the common application to allopathic (MD-granting) medical schools. Every course you have ever taken for college credit will appear on your AMCAS application. You cannot repeat courses to improve your GPA. If you take a biology course for four credits and you earn a D, and then you repeat that course and earn an A, AMCAS will average in four credits of D and four credits of A into your GPA. Your university most likely will replace the four credits of the D grade with the four credits of the A grade. This makes getting off to a strong start and taking charge of your premed course journey that much more important. 

Withdrawals
Real talk with this important fact - withdrawals are not good, but they are better than F’s or D’s. F’s and D’s do real damage to your academic record and are hard to make up over time. You should enter college knowing the important dates for registration and course management at your school. You should know the last drop date and add date for courses. Know the minimum credits you have to take each semester. Find out whether you can take a class pass/fail and what the deadline is to switch that option to a graded course. Most schools do not allow pass/fail courses for the premedical coursework, but pass/fail courses do NOT affect your AMCAS GPA. If you are not sure if you can do well, you may wish to utilize a pass/fail option in order to preview the class if auditing is not allowed, or if you need the credits for financial aid purposes. If you fail a pass/fail class, your GPA calculation in AMCAS will not be impacted, but it will be noted on the academic summary page. (Your academic standing with your school might be impacted.) Know if you are allowed to audit and if there are fees for auditing. Know when the final allowable withdrawal date is. Be aware of the academic progress, tuition refund, and financial aid policies related to withdrawing or dropping classes. 

If something happens during the semester and you know you will not be able to earn at least a C, consider taking withdrawing and taking the W instead of a very poor grade. This is not to be taken lightly, of course, because a persistent pattern of withdrawals can be concerning for committees. Withdrawals also mean that you likely paid for the class and will have to do so again. Schools do not want to see someone continually withdrawing for fear of not getting perfect grades! But believe me, a W or two on the transcript will not affect your GPA, and you will live to tell the tale. You may still have to explain what happened during your interview, but you will be more likely to reach the interview phase of applying, rather than losing consideration because your GPA has sustained real damage. Let’s talk more about customizing your path and the importance of starting strong.
 
Alejandro
Alejandro entered the university from a public high school in the same city. He was very interested in a career in medicine and had participated in a health careers program at his high school. As the first child in his family to attend college, he sought mentorship and guidance for his journey right away. For his first meeting with me he brought in the premed track handout that the prehealth advising office had given him. According to the schedule he needed to take Biology I with a lab and General Chemistry I with a lab his first semester, then Biology II and General Chemistry II with labs his second semester. This was nine science credits the first semester and eight science credits the second. Twelve credits is full time. Did it make sense for Alejandro to take these courses right away when he had liberal arts requirements, history requirements, writing requirements, etc.? What was he interested in studying as he adjusted to college? We talked about his science background and his high school courses. He did not have any lab classes in high school because his school did not have a science lab. 

Alejandro and I created a schedule that included an introduction to lab techniques class his first semester and an introduction to General Chemistry class his second semester. The rest of the courses were in writing, history, behavioral science, and recreation. Through the introductory classes he became familiar with resources in the College of Arts and Sciences and the pace of science classes in college. He did well and was able to build confidence in his ability to step up to a more rigorous schedule his second year. When it was time for him to take labs in biology, chemistry, organic chemistry, biochemistry and physics, Alejandro was more comfortable in his surroundings and by his third lab he served as a peer instructor. Alejandro graduated with his degree in 5 years, which by the way, is the average time it takes a student in the US to complete a Bachelor’s degree[2]. His grades were not a perfect 4.0, but he was well prepared and confident when he started medical school. He did not have to explain any massive blemishes on his record. 

Customize your path
Map out a path that makes sense for YOU. Do not pressure yourself to finish or “stay on track” if that track is not your own. At most colleges these days, premed is one of the most popular major declarations for incoming first years. Thousands of students begin the journey intending on medicine as a career, but only a fraction of those remain premed at college graduation. So what goes wrong? Let’s start with a little history lesson. 
 
Premed courses and MCAT timing
In 1910 a man named Abraham Flexner was hired by the American Medical Association and the Carnegie Foundation to study medical education in the United States[3]. Before Flexner there were all sorts of types of doctors (apothecaries, bonesetters, botanists, etc.) and many pathways for training. Anyone could hang a sign up that said “doctor” and how they trained was not regulated or verified. Nothing was standardized and although there were legitimate doctors then, there were also many bogus practitioners. The American Medical Association was eager to standardize medicine so that the term doctor was consistently associated with someone who had undergone a standard training pathway. So Flexner declared in his report that a year of specific university courses should be required for entry to medical school. This began the standardization process for allopathic medicine. These course recommendations have largely gone unaltered since then! 

Fast forward to modern times where the Medical College Admissions Test[4] (MCAT) is a required element of the application. When testing was paper and pencil, it was only offered twice a year – April or August. Thousands of tests had to be securely collected and scanned, so it took at least 8 weeks before scores were released. Applicants who took the August test were at a big disadvantage because their scores came out in October (late in the application cycle). So colleges aimed to have their students prepared for the exam in April. Back in 2000, most students applied right out of college, meaning they started during their third year of undergrad with applications and matriculated to medical school after graduating the following spring. Why does this matter? 

Many university premed course tracks will set you up to finish ALL your premed courses by the first semester of your junior year despite it being unnecessary now. Even though the sequencing of the MCAT has changed, some premed course tracks have not. That’s roughly 5 semesters for: 1 year of biology, 1 year of general chemistry, 1 year of organic chemistry, 1 year of physics, plus biochemistry, genetics, and any other classes that schools may require. (The requirements may not be exactly the same for every medical school.) That is a formidable list of tough courses to tackle in a short period of time. The good news is that you do not have to accept a “one size fits all” format. Think about it. One size does not fit all. If we gave everyone a pair of boots that are women’s size 8 and asked them to run a mile, how many people would be out of luck and unable to even make forward progress? 

Please believe me when I say that you can take charge of your classes and construct a schedule that is ideal for you. Speak with your academic or prehealth adviser and ask for options. Be an advocate for yourself and your path. There are many wonderful advisers who will customize your pathway with you, even though it may extend your undergraduate time. Many students worry about the cost of taking another semester or two, but I promise this option is cheaper and more certain than a post baccalaureate program down the road. (It is important to note that not all post baccalaureate options have full financial aid, and getting into programs can be competitive.) 

You can also utilize summers strategically to plan your schedule so your course load stays manageable. If you consider summers you have nine semesters for classes even without a gap year (year one fall/spring/summer, year two fall/spring/summer, year three fall/spring/summer). Taking a different sequence of classes is not to say that you avoid challenge, but you should assess your prior experience and preparation to set yourself up for success. I like to think of it as a runway, how much distance do you need to take off and soar to 30,000 feet? 

The MCAT has been computer based since 2005. It is offered 20+ times a year between January and September[5]. Scores are typically released in 30 days or less. This means you do not have to take the test during your junior year. You have the flexibility to complete an additional semester of courses and take it during the summer before your fourth year. If you do not plan to apply while you’re working on your undergraduate degree, you have even more flexibility as to when you complete your courses and take the MCAT. 

Nearly half of the applicants to medicine do not apply during their junior year and plan to take a gap year. Many students take more than a year between graduating and applying. Students these days are beautifully curious and approach their preparation differently than in generations past. Today I see equal emphasis on the journey and the destination. 

The MCAT typically has a three year shelf life at most schools. If you plan to take time off, consider that your score should not be more than three years old when you apply. (Also be sure to check if there is an expiration on your premed course work. Some schools have a shelf life for courses as well, although that is less common.) Some students plan to apply to medical school, secure a seat and then defer for a year to finish up other activities. While this may be a reasonable plan if you think your MCAT is going to expire, be aware that deferment requests are granted by schools on a case by case basis. Most of the time if there are reasonable justifications schools allow them, but they are not guaranteed. It’s better to plan your test window effectively up front. 
 
 
College success
In my experience succeeding in college is actually not primarily about intellectual capability. (I have a PhD and even at that level it’s the same story!) Brilliance only gets you so far. Succeeding in college is about life skills, navigation, and executive function first. Learning to navigate the college environment takes time. Building skills to manage your performance in the college classroom also takes time. Developing a skill set to manage your academic performance and access the resources you need takes time. Relationships, life stress, and being away from home for the first time are all things that can really affect your performance. Consider this example.
 
Ari
Ari participated in a science scholars program in high school. They had always performed well in their classes and graduated as valedictorian. They declared premed and registered for general biology and general chemistry their first semester. Ari joined several campus organizations and enthusiastically became involved in GlobeMed their freshman year. They struggled to balance academic demands with their social engagements and their performance started to slip. They were cramming to pull off B’s in their classes. During their first finals week fall semester, Ari’s roommate became suicidal and Ari spent the week distracted and concerned. They did not know how to reach out for help and tried to handle the situation alone. The night before their biology final, Ari was in the Emergency Room with their roommate who had attempted suicide. Ari straggled in to take their final unprepared and exhausted. They received a D in biology and a C in chemistry. 

Ari’s grades did not reflect their capacity for science. The grades not even reflect their previous preparation for college science from high school. They felt discouraged about their performance and decided they had already failed at pursuing medicine. The social factors of adjusting to college greatly impacted their performance. They were so ashamed of their poor grades that they did not talk to any friends or mentors about what happened. They changed their major to sociology and thrived academically from that point forward. I met Ari at age 23 when they were seeking post baccalaureate programs because they still wanted to be a doctor. Ari began the journey at that point, a confident, resolute and mature student. Today they are happily practicing medicine, but for every positive outcome there are countless stories of students who never circled back to their dream. 
Getting off to a solid start is important for building self-efficacy in college, and there are other reasons to approach your premed coursework carefully. You will need letters of recommendation from professors who have taught you in the classroom. Many schools require letters from science professors. Getting to know professors requires maturity and engagement during class. During your first and second years you are less likely to have the skills to impress your professors. Building relationships with professors might mean going to office hours or supplemental instruction. It might mean joining a research project or volunteering as a teaching assistant or tutor. Becoming a seasoned student takes time. Grades typically improve over the course of college, so your performance is likely to be better the longer you have been in college. You will also be studying for the MCAT toward the latter half of your college career, so why front load all your science courses? It will be better to have the MCAT material fresh in your mind from your courses. 
 
Choosing a major
 Before we leave this topic I have one more important piece of advice. You can major in anything you want! You do not have to be a science major to prepare for medicine. Advisers may encourage you to major in science or assume you wish to major in science because it is very efficient for the courses you will be required to take. This means that the requirements to complete the major and the premed requirements overlap nicely. But the best and most experienced advisers will guide you to seek a major that reflects your strengths and interests. Major in something about which you are passionate, curious, and excited. Choose more than one major if you wish! You will have more fun and likely perform better in college if you study something that you love learning on a deep level. You will still have to take the required array of premed courses, but you can diversify your undergraduate education any way you’d like. You will need to work with your adviser to ensure that you plan carefully, and you may need to use some of your major’s elective options for science, but it’s doable. One class we admitted in 2017 at the Stritch School of Medicine had over 50 majors represented and it was almost an even split between science and non-science majors. 

Preface
Part I: Getting a Solid Start   
1          Premed Basics: Be Quick, But Don’t Hurry               
2          Advice for First Generation Students           
3          Advice for Minoritized Students       
4          Advice for Undocumented Students               
Part II: The Premed Journey
5          Exploration & Affirmation                            
6          Dump the Checklist Mindset                                                 
7          The Secret to a Competitive Edge     
Part III: Advice for Application Season          
8          The Inside Scoop on Strategy and Maximizing Mission Fit             
9          Understand the Graduate/Professional School Context        
10        Professionalism and People Skills in a Digital Era
Part IV: Support Team Advice
11        Advice for Parents and Friends                       
12        Advice for Advisers
Part V: Gap Years and Reapplying
13        Maximizing a Gap
14        Advice for Reapplicants
15        Finish Lines and Deadlines
Appendix: An Overview of the Journey to Becoming a Physician
Index