Advising Students Interested in Medical School: What is the Best Approach?

Matthew Church, Kelly Berg, and Anthony Robinson, University of Louisville

Introduction

Every adviser has encountered students interested in medical school. Some of these students are focused on becoming a physician and care little for anything else. Self-defined as “pre-med,” many of these students eschew courses not related to medical school admission (Engel, 2005). While this kind of motivation is to be lauded and admired, there is a problem: Medical school admission is not guaranteed. Numerous roadblocks arise on the path to medicine. For many of these students, medical school is a lifelong dream that permeates their very self-definition. The possibility of not becoming a physician could crush them. While all college students undergo difficulties related to major selection and career choice, students interested in medical school require a different approach. This article attempts to explore a possible best practice for advising students interested in medical school. Included in this exploration will be the identification of potentially successful approaches.

Preparing Students for Medical School

There are numerous requirements to gain admission into medical school. The American Medical Association (AMA) lists several traits needed to gain admission to and succeed in medical school. According to the AMA, potential physicians need motivation and intelligence, evidence of motivation for medicine, evidence of an interest in service, evidence of leadership, and good communication skills (American Medical Association, 2005). The aforementioned traits are beyond the adviser's control and ones students possess regardless of adviser involvement; however, there are many requirements that the adviser can assist in fostering. Admission to and success in medical school require: a well-rounded college education, including classes related to the study of human beings; good academic performance and high grade-point average (GPA); completion of prerequisites for medical school admission; preparation for and timely completion of the Medical College Admission Test (MCAT); good recommendations; and timely applications to medical schools (American Medical Association, 2005). The adviser can keep track of the student's academic status and completed courses, advise the student which courses to take, and assist the student in setting a schedule/timetable for the MCAT and completing applications to medical schools. While the role of the academic adviser in advising pre-med students appears straightforward, there are many possible approaches to this role. There is not one type of ideal medical student or one typical medical school admissions process (Brieger, 1993). The following lists several important issues to consider when advising students about preparation for medical school.

Expectations

Many students decide to pursue medical school without foreknowledge of the process. This trait is one that should be addressed early when advising students interested in medical school. A simple question of “do you know how medical school is set up?” can serve an immense benefit to the rest of the advising appointment. The response to this question can guide the meeting towards a description of medical school structure or generate a parlance on particular specialties and reasons for pursuing medicine. Asking students if they know how medical school is structured is a requisite to advising any pre-med student. This requires that advisers know medical school procedure and curriculum.

While many students interested in medical school are not informed of the exact process and procedure involving medical school and becoming a physician, other students may question their desire to become a physician. Expectations for future physicians are high, and future physicians are expected to be both managers of health care resources and socially aware healers with a mature personality in addition to medical expertise and clinical skills (Niemi, Vainiomäki, & Murto-Kangas, 2003). With these expectations, it is necessary to both encourage and inform potential medical students. An adviser should always encourage the pursuit of student aspirations to medicine, but temper this encouragement with the provision of information on the difficulty that awaits the student. If the student is uncertain of their decision to pursue medicine, a series of questions from the American Association of Medical Colleges (2006) can help pinpoint their fit: Grades

One common misconception among potential medical students is the belief that perfection is required to gain acceptance to medical school. In fact, a student with a 3.8 GPA stands as good of a chance as one with a 4.0 when factoring in all admissions criteria. Qualities other than GPA and MCAT scores can make the student stand out in his or her application. The American Medical Association (AMA) has called for greater emphasis on more compelling personal characteristics (Albanese, Snow, Skochelak, Huggett & Farrell, 2003). This call includes the trend toward using GPA and MCAT as threshold measures (Albanese et al., 2003). These trends place added emphasis on students pursuing achievements or accomplishments that make them stand out, such as service learning, research, study abroad, athletics, and other activities. Community service or service learning is particularly important since many assume students with service commitments will be more caring about their patients (Elam, Hafferty, Messmer, Blue, Flipse, Lazarus, & Chauvin, 2004). While it is important for students to do well academically and on the MCAT, a grade of B or A- is not the end of the world or a sign to give up on medical school. Even a C+ is not reason to give up, since students can use the application process to explain any weaknesses. These trends not only allow students to further pursue strategies to gain acceptance into medical school, but also allow advisers to help direct their students' energies to other activities.

Majors

Advisers must also make students aware of the variety of majors that are possible for medical school preparation. Many students enter college with the preconceived notion that the only appropriate majors for medical school are those in the natural sciences, particularly biology and chemistry. While these majors are obviously solid choices for medical school preparation, students need to be aware that they are not restricted to these fields of study. Potential medical school students may major in anything that they want as long as they finish the pre-medical prerequisites, which many majors either require or can include. For example, many psychology departments are emphasizing the biological aspects of the field and require their students to take a larger number of natural science courses than previously required. A review of student profile data from the University of Louisville's 2005 class shows that students from a wide variety of academic programs were accepted to medical schools. Of those in the 2005 class who were accepted to medical school, there were three history majors, two agriculture majors, four psychology majors, and a religion major, just to cite a few. The bottom line is that majoring in a natural science is not necessarily a definitive path to medical school acceptance and that medical school admissions officers look for academic diversity.

The Humanities

A recent movement in medical education has called for the inclusion of the humanities in the medical curriculum, and nearly half of American medical schools include the arts in the curriculum (Strickland, Gambala, & Rodenhauser, 2002). This movement is important when combined with the 1991 change to the MCAT, which focused half of the test on verbal and written competence (Engel, 2005). The combination of these two developments make recommending and promoting the humanities easier and more important to students interested in medical school. Since these subjects appear in medical school curricula, pre-med students will be more inclined to take these courses. Engel (2005) noted her shock at the poor writing skills and lack of reading interest on the part of pre-health students. The promotion of the humanities allows students interested in medical school not only to gain familiarity with material found in medical school, but also to improve their writing and enhance the well-roundedness of their education. The promotion and acceptance of humanities entails several institutional benefits. The potential interest of pre-med students in the humanities allows enhanced course offerings in the humanities and the offering of courses that fuse medicine and the humanities, such medical ethics and literature and medicine. This recommendation is not to imply that all students interested in medical school forsake the humanities, but some do, and the linkage of the humanities to medical school allows students to better prepare for medical school. Humanistic study allows students the opportunity to focus on compassion, the story each patient brings to the encounter, and concern for others (Engel, 2005). Promoting the humanities presents opportunity for the adviser to promote a better-rounded curriculum to the student.

General Education

Traditionally, students interested in medical school have had an antagonistic relationship with general education. Pre-health students have been viewed as cynical about liberal education and academically narrow (Simmons, 2005). This traditional predilection for taking only hard science courses does not relate well to one serious fact of medicine: Physicians must help patients make critical decisions about life and death. Patients and society need to have confidence that physicians have not only sound clinical training, but also sufficient educational background to make sound ethical and moral decisions (Simmons, 2005). The wide array of skills developed in liberal education provides the skills and habits needed for such a professional role (Simmons, 2005). The need for a wide variety of skills is entailed in the general education programs at most institutions and can be addressed by structuring the course selection of the particular student.

The key is to link general education to the future aspirations of pre-med students. Suggesting that a student take a psychology course because all medical students do a psychiatry rotation in the third year of medical school is much more appealing to pre-med students than suggesting that they take that same psychology course simply to fulfill a social science requirement. The main strategy for promoting general education is to find ways to link specific requirements to future considerations in medical careers. The need is to help students see the connection between what they are learning and their goals (Glynn, Aultman, & Owens, 2005). While not all requirements lend themselves to a perfect linkage, many do. Writing requirements, public speaking requirements, and social science requirements can be utilized to prepare students for medical school and careers as physicians. Additionally, humanities and theology requirements, dependent upon the school, can help formulate student decision-making skills.

Cultural Competence

At the beginning of the twenty-first century, addressing issues of cultural diversity was evident in all medical school curricula (Koehn and Swick, 2006). The world is changing, and the future holds continued integration and mobility in a globalized world (Friedman, 2005). Future physicians will see numerous patients from various cultures and countries. Due to this development, potential physicians benefit from course work promoting cultural competence. There is need for potential physicians to be knowledgeable of the interplay between patient culture and gender, socioeconomic status, power position, and past history (Koehn and Swick, 2006). Physicians need to be able to gather and critically analyze health-related information and develop a range of multidimensional skills necessary for the range of patient diversity.

The need for transnational and cultural competence in medicine is a great development for academic advising. Building from this need, advisers have a foothold from which to recommend study abroad and service learning trips to pre-med students. Previously, pre-med students may have avoided study abroad and service learning trips due to the preconceived disconnect between these programs and their career goals. Now advisers can readily promote these programs by emphasizing the provision of cultural knowledge necessary for medicine. Using this need, advisers can promote courses previously unpopular with pre-med students. Courses such as anthropology, geography, political science, and history have greater application to the transcultural competence necessary for medicine. The final benefit is that the need for cultural competence can serve as impetus to get more pre-med students to take or continue taking foreign languages. The growing need for cultural competence allows advisers to promote study abroad, cultural/international-focused courses, and languages, all to the ultimate benefit of the pre-med student.

Advising the Individual Student

As Brieger (1993) mentioned, there is no ideal medical student. Each pre-med student has his or her own personality and rationale for pursuing medicine. This inherent uniqueness mandates that the advising approach to pre-med students be tailored to the individual student. Glynn, Aultman, & Owen (2005) noted that students have two goal orientations: performance and learning. A learning goal orientation is held by students who want to get better at a task and are not concerned by mistakes or how they appear (Glynn, Aultman, & Owen 2005). Contrary to learning goal orientation, performance goal orientation involves students being more focused on good grades and looking smart to their peers (Glynn, Aultman, & Owen (2005). If possible, the adviser should try to ascertain which goal orientation the advisee possesses and promote courses accordingly. This does not mean suggesting easy courses to performance goal oriented students, but maybe an incremental upgrade in the difficulty of their non-science courses to build their confidence.

Advisers need to be mindful of the student's orientation in seeking medical school admissions. Students with performance goal orientation need to be approached differently than students focused on a complete body of curricular and co-curricular work to gain admittance. An adviser must find the balance between encouraging academic exploration and reminding students of the need for good grades (Simmons, 2005). Pre-med students favoring liberal education need to be advised differently from those viewing liberal education as anathema to their future endeavors. While it is easy to address specific advisee populations by a uniform approach, all pre-med students are different and unique and must be advised according to their own abilities and interests. Students may also differ in their motivation based on their status as Generation X or Millennials (Borges, Manuel, Elam, & Jones, 2006). The key is to take the steps outlined in the preceding and combine them with individual student characteristics to construct an individual and well-crafted academic advising model for students interested in medical school.

Conclusion

There is no standard type of student interested in medical school. Accordingly, there is no definitive best way to advise students interested in medical school. The role of the adviser is to encourage the pursuit of medical school admissions, but temper it by telling students what is involved in the process of becoming a physician. The suggestions outlined in the preceding serve as a stepping stone to crafting the individual academic plan for students interested in medical school. By employing some or all of these steps, advisers can help pre-med students prepare for medical school, gain knowledge of what is involved in medical school, and overcome resistance to courses not directly related to medical school admission. This can all be done by using potential course options to prepare students for future careers in medicine and linking and structuring requirements to the goal of becoming a physician. As Simmons (2005) noted, there is a need for physicians to have excellent clinical skills and ethical and moral decision-making skills. These suggestions can help the potential physician prepare for medical school, gain appreciation of all academic fields, obtain cultural competence, and acquire an excellent education.

References

Albanese, M., Snow, M., Skochelak, S., Huggett, K., & Farrell, P. (2003). Assessing personal qualities in medical school admissions. Academic Medicine, 78, 313–321.

American Association of Medical Colleges. (2006). Considering a career in medicine: Making the decision. Retrieved September 18, 2006, from http://www.aamc.org/students/considering/decision.htm

American Medical Association. (2005). Preparing for medical school. Retrieved September 18, 2006, from http://www.ama-assn.org/ama/pub/category/2371.html

Borges, N., Manuel, S., Elam, C., & Jones, B. (2006). Comparing Millennial and Generation X medical students at one medical school. Academic Medicine, 81, 571–576.

Brieger, G. (1993). Getting into medical school in the good old days: Good for whom? Annals of Internal Medicine, 119, 1138–1143.

Elam, C., Hafferty, F., Messmer, J., Blue, A., Flipse, A., Lazarus, C., & Chauvin, S. (2004). Reflections of medical student service leaders: Implications for admissions and curriculum. Journal of Experiential Education, 26, 152–166.

Engel, M. (2005). Achieving narrative flow: Pre-medical education as an essential chapter of a physician's story. Journal of Medical Humanities, 26, 39–51.

Glynn, S., Aultman, L., & Owens, A. (2005). Motivation to learn in general education programs. Journal of General Education, 54, 150–170.

Friedman, T. (2005). The world is flat: A brief history of the twenty-first century. New York: Farrar, Straus, & Giroux.

Koehn, P., & Swick, H. (2006). Medical education for a changing world: Moving beyond cultural competence into transnational competence. Academic Medicine, 81, 548–556.

Niemi, P., Vainiomäki, P., & Murto-Kangas, M. (2003). “My future as a physician”—professional representations and their background among first-day medical students. Teaching and Learning in Medicine, 15, 31–39.

Simmons, A. (2005). Beyond the premedical syndrome: Premedical student attitudes towards liberal education and implications for advising. NACADA Journal, 25(1), 64–73.

Strickland, M., Gambala, C., & Rodenhauser, P. (2002). Medical education and the arts: A survey of U.S. medical schools. Teaching and Learning in Medicine, 14, 264–267.

About the Authors

Matthew Church is an academic counselor senior with the College of Arts & Sciences, Center for Advising and Support Services, Freshman and Sophomore Division, at the University of Louisville. He holds a bachelor's degree in history from Bellarmine University and master's degree in history from the University of Louisville. Matthew is currently pursuing a Ph.D. in educational leadership and organizational development with a concentration in postsecondary administration at the University of Louisville. He can be contacted at mschur01@louisville.edu.

Kelly Berg is a fourth-year medical student at the University of Louisville School of Medicine. She is also pursuing a master of science degree in public health at the University of Louisville. Kelly holds a bachelor's degree in biology from Bellarmine University. In the summer of 2004, Kelly was a part of a medical service trip to Guatemala. She can be contacted at kaberg01@louisville.edu.

Anthony Robinson is an academic counselor with the University of Louisville Honors Program. He holds a bachelor's degree in psychology from the University of Louisville. Anthony is currently pursuing a master's degree in higher education administration at the University of Louisville. His master's thesis is a historical survey of anti-intellectualism in the twentieth-century United States. He can be contacted at awrobi01@louisville.edu.


Published in The Mentor on September 20, 2006, by Penn State's Division of Undergraduate Studies
Available online at dus.psu.edu/mentor
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