19/06/10 Thinking about Med School? Perspectives of a Waterloo Grad Robert Moreland Jan 2010

19/06/10  Waterloo Grad (2009)  BSc Biomedical Science, minor biology  BA Joint Honours Psychology and Economics, minor management studies  First Year Medical Student at Schulich Medical School

19/06/10  Professional Computer Programmer  Medical Imaging Researcher  Interviewed at four of the medical schools in Ontario, accepted at two, waitlisted at one  Normal human being

19/06/10  The advantages and disadvantages of becoming a doctor  The process to become a doctor in Canada  Medical school application process in Ontario  Tactics for Improving your application  What it’s like to be a medical student

19/06/10 Why Become a Doctor? PROS Unique ability to help people Doctor-Patient Relationship Remuneration (after residency) Leadership responsibility Flexibility (potentially) Intellectual challenge Huge demand Ability to have an impact Unique research opportunities Unique position in society

19/06/10 Why Not Become a Doctor? CONS Extremely High Cost Time spent training (school + residency + fellowship) Extended Work Hours/Usual Hours High Level of Responsibility “Compassion fatigue”/Stress/Burnout Non-medical obligations Difficulty finding balance between career and family Constant Uncertainty Constant Skill Upgrading Bad Outcomes will occur Often unable to assist

19/06/10 Just a Few Possibilities in the World of Health Care ProgramYears of StudyType of Degree Dentistry8+yearsD.D.M. Medicine10 + yearsM.D. Nursing4 + yearsUndergraduate Midwifery4 yearsUndergraduate Physiotherapy2 yearsMasters Dietician1 yearMasters/Internship Social Work4 yearsUndergraduate Occupational Therapy 2 yearsMasters Physician Assistant2 yearsUndergraduate* (*Apply after 2nd year)

19/06/10  Forget everything you have ever seen on television about medicine  Read as much as you can about the field  Talk/Shadow actual doctors  Volunteer in Health Care  Seek help from your career centre

19/06/10  Step 1) ◦ Get into a recognized and progress along an university undergraduate degree program - Usually a honours degree program ◦ (takes 3-4 Years)  Students may also take additional graduate training prior to applying into medical school  (takes an additional 2-7 Years)

19/06/10  Step 2) ◦ Apply and get accepted into a recognized medical school program  Most students start applying to medical school in the fall of their 4th year  Interviews are held in Feb/Mar of the following Winter  Notices of acceptance begin in mid May, and continue through the summer

19/06/10  Step 3) ◦ Complete medical school ◦ (takes 3 or more usually 4 Years)  Medical school is divided into two distinct phases: ◦ First years are called preclerkship and are spent primarily in lecture based learning, small group problem solving, and laboratory work related to medical science ◦ Second years are spent in clerkship where medical students rotate around the hospital directly involved in patient care. This is the beginning of clinical training  Near the end of clerkship, students take electives, often in different hospitals/clinics across the country, to gain experience and be noticed by specialists in areas that interest them

19/06/10  Step 4) ◦ Apply under the Canadian Resident Matching Service (CaRMS) and get into a recognized residency program ◦ (2-6+ Years)  This is the point at which one decides on what type of doctor you want to be (i.e. what specialization you will follow) and attempt to be accepted into the corresponding training program

19/06/10  CaRMS matching is similar to the medical school admissions process - It’s competitive, exhausting, and requires considerable work. Results of the matching are also legally binding  You may not actually get the specialization you want and this is a risk in entering the medical school system. However most people do match into a desired field

19/06/10  For many residency programs the experience is probably the most intense period of work/learning imaginable  Extended work weeks ( hour weeks) with rotating on call shifts (1 in 3 or 4) is common  Residents advance over time increasing their degree of responsibility and autonomy as they gain experience and skill

19/06/10  Step 5) Optional ◦ Complete a Fellowship for further specialized training ◦ (1-2 Years)  Fellowships are become increasingly common in medicine as technology advances it takes us longer to learn the highly advanced skills required to most effective  Graduate degrees are also often needed to ultimately work at academic centres

19/06/10 Total Time 8 – 15(or more) Years  And then there is still setting up one’s practice and paying off considerable loans  “Becoming a doctor is not a sprint, it is a marathon. Get a helmet and enjoy the ride”  Dr. Chan

19/06/10 Questions so far?

19/06/10  Every school is different, and the various regulations and requirements change frequently and often surprisingly  Never the less there are several generally recognized objectives in order to become a competitive applicant  Currently about 1 in 6 people who apply in a given year will be accepted

19/06/10

1.High Grade Point Average (GPA) in a qualified program 2.High and Balanced Medical College Admission Test Score (MCAT) 3.High Quality Essay/Personal Statement 4.Strong Letters of References 5.Significant and relevant Extracurricular/Volunteer activities

19/06/10  There are two parts to this requirement: The applicant must be taking a qualified program The applicant must achieve a high GPA

19/06/10  Key Point: In Canada virtually all honours academic programs are considered equal when applying medical school This is an often ignored point and results in students taking overly difficult programs/courses to impress that however actually detract, rather than enhance, a person’s application It also means students are free to take the program that best suits their interests and talents

19/06/10  Caveats: ◦ There some prerequisites required by some (but not all) medical schools before an application can be considered  Regardless of program students must take these courses, which generally cover a mix of humanities and science ◦ The MCAT exam requires an understand of basic general/organic chemistry, physics, and biology. Taking associated courses is one way, but not the only way, to master this material ◦ Schools do expect consistency and appropriate progression during one’s degree

19/06/10  The second part of this object is obtaining a high enough GPA to be competitive  Key Point: GPA is not the same thing as overall average. Instead it is far less forgiving of low grades and thus a high GPA indicates not only good performance, but also consistently good performance

19/06/10  Failure to understand how to calculate GPA and what affects it is probably the single commonest deficit in knowledge in most people applying  Key Point: ◦ Low GPA, often due to failure to understand how GPA is computed, is the single biggest reason people are unable to get interviews at medical school

19/06/10 How to Calculate GPA OMSAS 2010 Data Most schools (virtually all) fall under category 3 Overall: aim for 85+ in each course

19/06/10  Person takes 5 courses and gets the following results: AFM 131 Management 85 BIOL 130 Intro Cell Biology 85 CHEM 120 Chem Prop of Matter 92 ECON 101 Intro to Microeconomics 87 GER 101Elementary German I 86 ( )/5= 3.92 This is a high competitive GPA for the term

19/06/10  Person takes 5 courses and gets the following results: AFM 131 Management 83 BIOL 130 Intro Cell Biology 84 CHEM 120 Chem Prop of Matter 89 ECON 101 Intro to Microeconomics 84 GER 101Elementary German I 82 ( )/5= 3.74 Traditionally a not a competitive score at most of the schools in Ontario. Yet in terms of average it is almost the same as example 1.

19/06/10  Person takes 5 courses and gets the following results: AFM 131 Management 99 BIOL 130 Intro Cell Biology 100 CHEM 120 Chem Prop of Matter 98 ECON 101 Intro to Microeconomics 97 GER 101Elementary German I 76 ( )/5= 3.8 Traditionally an only weakly competitive score at most of the schools in Ontario, despite the very high average (94%).

19/06/10 Every Ontario school uses the same conversion table, but they calculate GPA score differently. Many give you a break in certain ways: Western: best two (best 5.0 counted each year) Ottawa: weighted 3 year NOSM & Mac: cumulative Queen’s: most recent two (includes summers) UofT: can drop 1 full-year course every year (if you’ve done a full course load every year)

19/06/10  Since GPA measures consistently as well as average it is advisable to aim for a 85% or higher in every class you take.  If achieved this would make a candidate GPA wise highly competitive at every school in Ontario  Unfortunately this sometimes introduces conflicts between learning and getting into medical school

19/06/10  Since achieving a high GPA is often a function of interest in the material, it is advisable to be in a program that interests you highly  Many (but not all) schools do not count courses in the summer. If you must take a course you will do poorly in, consider taking it then.

19/06/10  Sometimes dropping a course is advisable to protect your overall GPA***  Since many schools punish you in some fashion for dropping a course, some students take an extra course easy course in the fall to provide flexibility  *** Beware of the effect of course dropping with respect to Toronto’s policies.

19/06/10  The MCAT is a four part test designed to test various skills relevant to the field of medicine: ◦ Verbal Reasoning (VR) ◦ Physical Sciences (PR) ◦ Writing Section (WS) ◦ Biological Science (BS) All parts of the test are written in a set sequence on a single day. There are many offerings of this test spread out over the year

19/06/10  On the MCAT BS, VR, and PS are scored on a z normalized scale with values ranging between (worst)1-15(best).  The WS section is scored on a letter scale (worst)J to T(best)  Some schools use strict MCAT cut offs (Western, Queens) and some use it as a part of the scoring (Mac, Western, Toronto )

19/06/10  The MCAT is principally a thinking test rather than a science test  There is virtually no memorization style questions. They are testing logic and reading comprehension  One half of the test (VR and WS) are entirely non- science. These section traditionally are the main non-GPA barriers in Ontario to interviews

19/06/10  Key Point: Do practise tests. Do them under practise conditions and take them seriously Study early and do not ignore material you are weaker on (surprisingly happens a lot). You can study and improve VR and WS scores.  Key Point: If at all possible, give yourself enough time to repeat the test if necessary to achieve a desired score

19/06/10  There is considerable debate about the types of volunteer experience that premeds to engage  Volunteer work is not just another checkbox that needs to be filled in on your application  The question to consider is why adcoms are interested in volunteer experience in the first place

19/06/10  Medical schools want people passionate about medicine in their programs  Key Point People that are truly passionate about something do not wait to start doing it Therefore if you are interested in medicine you will on your own already start volunteering in a medically related area – not because you have to, but because you want to

19/06/10  So this is a way to start your medical training right now. Find your passion and go with it!  Possible areas: ◦ Medically related research ◦ Hospital/clinic volunteer ◦ Community outreach ◦ Environmental issues ◦ And the list goes on and on

19/06/10  Once again, do what you like!  No “perfect formula” for Extra-Curriculars  Try lots of different things ◦ You can discover what you enjoy and want to concentrate on  Keep track of: ◦ What you did ◦ And for whom (‘Verifiers’)

19/06/10  Three schools have specific supplement materials they wish you to complete for your application 1.Toronto: Personal Statement 2.NOSM: Mini-essay response to several topics 3.Mac: Short essay responses to five questions  All of these materials are incredibly important and often ignored

19/06/10  You will have spent 1000s of hours working on your GPA, 100s of hours on your MCAT prep, 100s more on your volunteer/Extra curricular activities.  Your written responses will be worth a similar wait pre interview to your GPA Key point: Take the time to do the essays/personal statements right

19/06/10  Personal statements are difficult because you are under pressure to distinguish yourself and they force you to articulate your reasons for medicine  Take the time to develop a proper theme for your work  Tell a story where you can. Do not speak in generalities when an example is possible.  Always get your materials proof read by someone skilled in English grammar

19/06/10 Key point:

19/06/10  This framework recognizes the 7 primary skills a successful physician should have  It permeates most aspects of the application process, including critically the interview themselves and often aspects of personal statements and essay question responses  You need to be aware of the roles and what aspects of your experience demonstrate you proficiency in these areas

19/06/10  This is a url to a master document where they are all described ◦  No one will be perfect in all areas of the CaRMS roles but prepared applicants will have experience in many, and understand them all