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Many students would have given up, but Natalie didn't. She had to apply to medical school three times. The first time around, she ignored her premed advisor who told her not to apply yet. Her second time around, she applied and did very well. She got tons of interviews but didn't get in. Then on her third time, she took each obstacle and learned from it, ultimately gaining acceptance to six medical schools.

Hear her journey, how she became successful, what she learned along the way, and her advice to you so you don't make the same mistakes.

Natalie recalls wanting to be a doctor back when she was five years old in kindergarten. Obviously, she always had that interest since she was a child. Part of it too was having an aunt who is a doctor and that she likes people and the idea of helping people.

Fast-forward to college when she was shadowing physicians, she started volunteering in the emergency rooms near her home and the idea appealed to her even more having been able to actually connect with people and having to learn more about the pathology, she got more involved. So the combination of science and service appealed to her.

"I had an interest since I was a child but then I realized why I want to become a physician because of my experiences during college and after college."

Natalie describes her family as having done their best to provide a great environment for her and her two siblings who were very different. One didn't graduate from high school while one is currently in community college. She didn't have much academic guidance from her parents in terms of asking them questions about school since her mother didn't graduate high school and her father being in a different area of expertise. So whenever she had issues on something, she would just do her research and she sought out mentors and asked questions.

Additionally, Natalie had to learn to work in a very stressful environment. When Natalie was in high school, her cousin who lived with her was also in high and he got into trouble that led to some people threatening them. Despite everything that was happening, Natalie knew she had to do well in school and just learn to work under stress.

"With persistence and then with my faith, knowing how to handle difficult times with a positive attitude, that really helped me."

What made her stay down the path is the certainty that this was what she wanted to do and that she was willing to work really hard to get to it, not to mention that didn't see herself doing anything else. In her case, she had to try three times and her motivation came from the idea that it's going to take a lot of work but she eventually be a physician if she did her absolute best and if she sought the resources she needs. She needed to do this so she sought the mentors she needed.

"I would always ask myself, what was missing here, what didn't you do right the first time?"

For her, it was about being willing to put in the work and knowing she was picking the appropriate steps, not just guessing. Moreover, being a person of faith she believes that knowing this was something she was meant to do, she felt confident that it was just a matter of time. So she thought not getting into medical school was not just her time and she was going to learn something very important in the two years she wasn't in medical school. True enough, she learned a lot about her as a person and she was able to support other people going through other issues she gone through before and this gave her motivation too in knowing that her time out of medical school had some purpose to it as well and she thought she'd become a better doctor because of it.

The second time she didn't get in and she was waitlisted at six schools, she thought about what she could learn in the interim. So she worked as a college instructor for adults with learning disabilities. Had she not had that experience, she would not know how to communicate well with patients that had disabilities. As a result, she knows how to speak with them better or why not to look at individuals with autism in the eye. She basically became more aware of different things. Natalie considers this as a success and being one of her best experiences especially having learned so much from it.

"Knowing who I was, knowing that this was what I wanted to do, and looking at each time I didn't get in as something that had purpose to it, something I could do in the interim time that I could take to learn, that motivated me."

Natalie kept in touch with her pre-health advisor when she was an undergrad at Johns Hopkins so she had someone to go to every time she had a question and her advisor gave her any contact she needed to assist her. She basically did the same thing during her postbac, developing great relationships with the people that wrote her letters and any time she had questions, they would also give her advice. Moreover, she applied to different internships and different jobs from where she also got to find mentors. So she tried every possible outlet. She tried whenever she saw interesting research at a nearby hospital or urban institution and she also looked online for reasons that students get into medical school. She would look at who wrote the article, where they come from, and whether this person could answer possible questions. She basically tried the obvious routes and in other cases, she would take the risk and try to get in touch with the person.

Taking a close look at her first application, Natalie thought it wasn't realistically the most competitive GPA with about 3.14 in her sciences. The rest was good but there were a couple of dents on her GPA because she took on too much. Being a Type A personality, Natalie admits of making the mistakes of trying to take too many credits at once, trying to balance really difficult classes with extracurriculars, and trying to study for the MCAT when she was taking a very difficult class.

"Do not put too much on your plate... Know thyself and know how much you're able to balance."

Seeing the mistakes she made and the dent she had made, she had to show to medical schools that she'd be able to handle a large academic course load of challenging classes that's why she did the postbac which was also upon the advice of her other mentor.

Taking the postbac did help her where she got seven interviews. In doing research on which postbacs to go to, she searched online as well as checking the AAMC List of Postbaccalaureate Programs which were categorized according to career changers and academic enhancers where she had to do the latter. She had to show schools that she was able to get A's and some upper level Biology courses relevant for medical school. Natalie found UPenn on the AAMC website and applied to several but thinking it was the one that fit her best, she went to UPenn once she got accepted.

"Rather than reinvent the wheel and apply with no changes, I thought the postbac was the best option."

In the first semester, Natalie was taking three classes and dropped one when she felt she didn't do well on the first midterm and she knew she had to focus on the other two where she got A's on both which were very tough classes, Immunobiology and Neurodegenerative Diseases. By the second semester, she took four classes and did very well in all of them. What basically helped her was not putting too much on her plate. Knowing those four classes were very dense in information and required a lot of work, she knew she shouldn't get involved in too many extracurriculars. So assessing very early on which classes were going to be a problem for her and what she should be doing outside of school, and balancing them helped her.

Another thing that helped her that she learned her learning modalities. Knowing she was heavily visual, she was very tactile and she had to ask a lot of questions. So knowing she wasn't going to pick up very much during lecture but instead pick up more from images, it helped her study a lot better.

In figuring out the best way for her to study, she was just observing herself. She realized what calls her attention a lot are pictures. The way she remembers things are through pictures and once she made that connection and realized she would be more efficient with her time if she applied it to the way she studies and focus less on reading too much text.

She also noticed what people said about her. For example, what drives Natalie's mother crazy is that if she repeats the same thing five times, it won't stick. but if she writes it on a note, she will remember it because she sees the note. She can be attentive when listening to a story but when it comes to instruction, it was different and she had to connect what one was saying to a picture.

The third time Natalie applied and after she interviewed, she prayed and said she was a little scared because she didn't get in the first two times and it was really difficult for her to see the white coat. So took a lot of comfort in praying and meditating. She wrote things down in journals and she had a ton of spiritual experiences. She felt more certainty whenever she addressed her doubts that way. Lastly, knowing herself and not seeing any sign or having any feeling that she was meant to do something else brought her a lot of comfort and more certainty. Nevertheless, there were times that she had to ask herself if it was really a closed door. But there were other situations that made her feel certain that this was what she was meant to do which were more spiritual in nature rather than academic. There were little things along way that were positive reinforcements or signs saying that this is her thing and it's just going to happen in the time you need it to.

When Natalie took the MCAT the first time, she was taking Biochemistry while studying for the MCAT and she was taking time to commute by bus. She was trying to balance a summer condensed biochem course with a condensed MCAT course. That said, she was putting too much on her plate and she was very exhausted to the point she didn't realize her exam was moved to a day earlier. The information was sent to a different email so she only found out about it through word-of-mouth the night before the exam. Then she still had commute.

"Had I not been putting too much on my plate, I think I could have avoided that problem. I could have done much better."

Not only on the MCAT, doing too much at the same time also put a dent on her GPA because she was getting A's on her midterms but she didn't do well on the exam for biochem and she ended up with a C- in the course when she could have gotten an A had she not had to study for the MCAT and commute. She realized she should have done one thing at a time. That was her first mistake of doing too much all at once and not giving herself enough time to rest.

Moreover, her pre-health advisor had advised her not to apply to medical school right away and to wait another year to study for the MCAT and then apply. Succumbing to family pressure who wanted her to apply right away, she did and it backfired. She also met others who were hesitant to take a year off for certain concerns like pressure from family or fear of not recalling what they learned in school. These are reasons that prevent students from taking the time off they need and they cram as well as some financial reasons.

Natalie worked during the time off she had and saved for her applications as well as for mock interviews and for the first months she started school. She points out that although she's starting later, she's starting more comfortably because of it. Plus the fact that she is more prepared and she has more experience relating to patients and more knowledge about herself to help her study better.

"It's tough but try not to worry about it. Look at it this way, it's going to be harder if you don't get in and you don't prepare the best because you're going to have to do it all over again."

Natalie adds that you have to be aware and try to look at full possibilities, what is best for you and what is more likely to happen. To add to that, don't necessarily listen to what other people are telling you especially if they have never been on this path. Natalie's father actually discouraged her from the major she was pursuing when to her it was the one of the best things she ever did. But her father didn't understand that. She was a Writing Seminars major which involved writing screenplays, poetry, fiction and nonfiction. She actually figured learning other skills that she can have that's going to help her in the long run and that would make her stand out and so she thought of becoming a writer. Her father told her it wasn't going to get her much out of college and she told him her ultimate goal was medical school anyway so she can major in anything. Her father told her she had to get straight A's and be a science major and she disagreed with this. Natalie would describe her school as a premed factory being surrounded by physicians all the time as well as science professors and premed students so she knew what she was talking about.

"It doesn't mean you love your parents any less. It just means that they don't always have the answer so do what's best for you."

Natalie got in touch with three admissions committees that interviewed her. One reasons it was easy for her to connect with them is because she sent them thank you notes (some emails, some handwritten). As a result, they were grateful and welcomed her to ask more questions. So she asked for some feedback from them and a couple of them told her that bringing her MCAT score of 29 up to a few more points, she had a much better shot at getting in. They told her she had a strong application but that was the weak spot.

After consulting her mentor, she was advised to do mock interviews. She also noticed some postbac programs provided mock interviews while others didn't.

"I saw that the students that had mock interviews had a much higher success rate."

Natalie says she had the idea what to say during the interview but not having anyone to practice with, she didn't have anyone giving her feedback. This was what she actually noticed was missing. She had the numbers, The MCAT was borderline and she knew people who got in who had 29 and below so she figured the mock interview was the major difference. She worked with adults with learning disabilities so she had that additional experience under her belt and she was volunteering at a hospital so she knew the mock interview was the thing that was missing.

For Natalie, the most difficult part in the interview was getting started and the infamous "Tell me about yourself" question where she had a rough start with it. So she did know walking out of the interview that the first part of it was horrible. She adds that some interviewers have a way of making you feel more comfortable but it doesn't guarantee that they're going to write you a positive review.

"The first minute, even the first fifteen seconds, really determines how the rest of the interview will go."

I actually worked with Natalie in doing the mock interviews and she says that knowing that a professional helped her who is someone who's a doctor and who had gone to medical school and had experience interviewing, she thought that if she can go through interviews with me, she can go through interviews with anyone else who's going to interview her. So she knew she was going to be more prepared and she had thought of every possible question she could think of and she had rehearsed it with an experienced professional so that gave her a lot of comfort.

Additionally, Natalie was practicing four different types of interviews so this made her comfortable too. She had gone through multiple interviews before. At one point, she interviewed at one school that did two one-to-one interviews and an MMI. She thought she has done this before so she took each question as a challenge if she needed to pause and thought about it and she told the interviewer she needed to think about it. These are things she learned from the mock interview, which are little things that prepared her and made her more calm and composed.

Natalie didn't feel as stressed though because she already felt much more articulate because she practiced and having carried with her amazing tips. Walking into her first interview, she was nervous yet calm. Prior to mock interviews, she was nervous at every interview.

"There is that little bit of anxiety because it's your first interview and you want to get into medical school but you're also confident."

Natalie actually received some very difficult questions particularly during some of the MMI's. She explains that what really helped her was this one piece of advice I gave on my book, The Premed Playbook: Guide to the Medical School Interview, which was to read a lot of healthcare magazines. One of the questions asked was about euthanasia and she read an article about that so she was able to give them a very good answer. It was because she followed this advice and she was reading such topics that she was able to get a very-informed answer and give the interviewer her stance on it and sticking to her beliefs about it. There were also other parts where she had trouble answering but she asked for a moment to think instead of just staring blankly. This gave her time to collect her thoughts. Lastly, whenever she didn't know something, she would tell the interviewer she's not sure but she would tell them what she thinks. Knowing that you're not always going to have the answers helped a lot too.

Out of fifteen interview officers, she only went to ten. She had six acceptances and the rest were waitlists. Natalie says that aside from her postbac and her work experience, what made the difference this time was the fact that she had done four mock interviews. She reviewed them each time and she was also staying very well-informed and this helped her give some very articulate and applicable answers to relevant issues. During her third application, she went into the interview more prepared, more articulate, and more knowledgeable.

In narrowing down six acceptances to ultimately decide where to go, Natalie wrote down a very detailed description of what she really liked about each school and what she disliked. She ranked the schools and gave it a score. She was down to three schools which scored 9.1 out of 10. She also looked into financial aid which helped her a lot. She basically kept note of everything. When it came down to her final decision, financial aid played a role but also, she tried to put herself in a hypothetical position.

"If I had gone to this school, will I be thinking what if I had gone to the other one?"

Ultimately, she looked for what's going to make her happy, where she wants to match for residency geography-wise, match lists, and her own ranking of the schools with details of what she liked and disliked. Natalie is going to the University of Michigan - Ann Arbor.

Natalie hopes to work with underserved populations and she's considering getting a Master's in Public Health but she's keeping an open mind knowing she's going to find other things she would like. As to what specialty to get into, she's a curious person so she might make her decision on the third year. She likes working with her hands and she scrubbed into surgeries. She remembers coming out of each one elated. She's also starting school early since Michigan has a program for students interested in health equity so she's doing that and getting a jumpstart in Anatomy and Histology and get connected with mentors.

Finally, Natalie's advice to those battling with self-doubt and had to reapply, is to take the time to prepare the way you need to even if you have to wait a year or two to get your finances in check or academics in check. A year or two years will not put a big dent at all when you look at the grand scheme of things. Look at the available resources out there. Look at AAMC and look at postbacs. They can be expensive but you can take loans and scholarships. Try to see it as an investment.

Natalie adds that there is always room for improvement so don't feel so hopeless. Be real with yourself and ask yourself, what could happen better. Be honest with yourself and be humble as well. In her case, she had to pay a little more for mock interviews but she believes it's a very great investment.

"It's very easy to assume that you did your absolute best and you made no mistakes. Chances are, you made a mistake. Humble yourself, be honest, and address that issue."

Be curious. Seek help from your premed advisors. Don't ignore them. Listen to them. IN some instances, take it with a grain of salt but don't make the mistake she made of ignoring her advisor the first time that she didn't even get any interviews. Don't be discouraged. Take things one step at a time knowing you can get to your final destination. It may take longer but it's possible. Don't let any negativity consume you. Do your absolute best and keep on pushing.

If you have any questions for Natalie, go ahead and ask her at The Hangout Group on Facebook. As you've heard, Natalie talked about having mock interviews with me. As we're releasing this in early July 2017, I'm starting to get filled up with mock interview requests. If you're interested, sign up for a mock interview with me. I did four interviews with Natalie, an open interview, a closed interview, an MMI, and a mix of anything else she needed.

Also check out our brand new Mock Interview Platform and sign up to be notified when this will be launched and when you can sign up to be part of that platform. If you have any questions, shoot me an email at ryan@medicalschoolhq.net.

The Hangout Group on Facebook

The Premed Playbook: Guide to the Medical School Interview

Mock Interview Platform

MedEd Media Network

AAMC List of Postbaccalaureate Programs

Ryan jumped on a Facebook Live and answered your questions live. Check out the great questions that came in. Join us at http://medicalschoolhq.net/group.

Dr. Andrea Tooley shares her journey from premed to current Ophtho resident. She didn't know a lot about the premed journey, but fought to inform herself. Andrea has a YouTube channel called A Doctor in the House. She shares her journey to medicine including chasing down anybody in scrubs and the mistakes she made, the successes she had, and everything in between.

Having always loved science since late middle school, Dr. Toole already thought medicine would be a good career for her by mid high school and considering she never had any exposure to health care growing up and not having any physicians in her family. But she always wanted to have that secure career that offers certainty and being able to interact with people so medicine was what she thought fit her personality. As to why she wanted security, Andrea has always been a planner who has always mapped out her future which she thinks is an innate character.

To test the waters whether medicine was right for her, she has done shadowing with a few people early in high school including a general surgeon and a nephrologist that was set up through her school that had kind of a career day but they could actually go to work with some of these people. Still it was little exposure but it wasn't until eleventh grade when she got her pilot license and she flew airplanes in high school that she met this pilot who told her about the ophthalmology-related nonprofit organization he was involved with. Upon reading about the organization, Andrea finally found her aha moment and thought it was what she wanted to do with her life. From then on, she started reading more about ophthalmology and shadowing more surgeons. But it was when she fell in love with the organization's concept of helping people see and eradicating blindness that she made her big declaration that it was what she wanted to do with her life.

Andrea initially didn't know about ophthalmology but when she started reading about what the organization was doing, she couldn't imagine anything better than giving someone back their vision. And that to her was the essence of what an amazing career would be. International work was also another component Andrea was interested in and so she thought a doctor would be the best job ever.

Andrea's stepfather who flew airplanes encouraged her to try it and she loved it. So she got her license in high school and flew a little in college. Once she got to medical school, she simply found it impractical to fly an airplane. Considering how expensive it is and knowing it wasn't her first priority at that moment, she had to let it go. She hasn't flown in years but she would love to get back to it one day.

Her decision to be a doctor didn't actually play any part into choosing where she wanted to go to college. In hindsight, she wished she had been more strategic about it. With lack of guidance, her dad being an architect and a musician mom, neither of them had any great graduate school-type advice for her. She also went to a tiny school in Indiana so they didn't have any big school-type counseling for choosing a college. She basically didn't think about it, more so, not even knowing how to think about it. As a result, Andrea applied to a bunch of random schools in Florida, New York, and Indiana where she ended up going to Butler University in Indianapolis. She actually got a scholarship that was a full ride to any Indiana school but she got wait listed at Notre Dame and felt devastated leaving her with Butler as her only option thinking she wasn't going to turn down a full ride. But what seemed to be the worst point of her life turned out to be the greatest thing since she enjoyed every minute of it. She found that a smaller liberal arts school fit her personality so much better than a bigger school. Not having any prior introspection into all this, Andrea was thankful everything ended up well for her. But if she had to do it all over again knowing she wanted ophthalmology, she would have chosen a school connected with a medical school with a strong ophthalmology program which would have been the smartest thing to do. What she recommends to students out there interested in a certain specialty is to find a medical school, if you can, in-state. It's always the way to go in terms of financial cause. But be a little strategic about it if you're very interested in one certain specialty.

With Butler not having a connection with any medical school, Andrea recognizes the difficulty of getting involved with research in a medical school or to shadow or get to know the department as an undergrad. What Andrea did instead is to remain involved with the nonprofit organization she was involved with in high school which was out of her own effort and outside of Butler. Nevertheless, Andrea still finds Butler to have a great premed community with wonderful professors who were great mentors to her in terms of academics and leadership but nothing specifically geared towards ophthalmology nor towards a certain medical school.

Andrea describes college as a fun time where you can try out so many new things and push yourself so she was heavily involved on campus at Butler. She overloaded her plate with too many clubs and groups plus her sorority and friends. However, she explains that when you're a premed, you have to say no to this certain event or be able to go on a night out and it wasn't easy for her. So she learned time management and organizational-type skills because she had to or she would have otherwise fallen apart which she in fact did at times.

Moreover, there were a couple of classes they had to take that were really hard which they all struggled through and this is true of any premed. Generally, she found her school to be very supportive, she learned so much, and grew as a person. Luckily, she didn't find herself in a cutthroat community at Butler. One of her best friends was pre-dental. They took the same classes and studied for everything together even when her friend was in dental school while Andrea was in medical school. Her best girl friend was premed so she didn't see any competition within her group even within her bigger study group although Andrea thinks she could have been just oblivious. She believes you find what you're looking for and for her part, she focused on seeing positive things so she may have overlooked, nevertheless, she didn't find the negativity, even in medical school.

Andrea found great benefits of a smaller liberal arts school in as much as there are some aspects that fell short of and a bigger school might have been better. She felt the person designated as their premed advisor was not that well informed but she had great professors and mentors whom she found as her great premed advisors having had a lot of one-on-onetime with them and receiving premed advice from them. She also remembers having a strong premed community of students in spite of a less established faculty-run premed community compared to bigger schools that have stronger, pre-existing premed framework to help students along the way. Andrea had to do a lot of researching on her own and remembers running after people scrubs who are medical students from another school and asking them about everything they know. She would be asking for advice and basically took a lot of things into her own hands.

It's this mentality that Andrea has of going out there and finding information. She adds you have to make it happen for yourself. There are so many people out there who want to help you. You can Google things and find stuff online. Find people in coffee shops or ask friends of friends, basically just try using every resource available to you.

Andrea went straight from undergrad to medical school applying to the Early Decision application at Indiana University. It's a binding acceptance so you're only allowed to apply to one medical school and apply early in the cycle then you find out early in October which is way early for the medical school acceptances. If you're in, good but if you don't get it, technically, you still have time to apply to other schools but it's going to be late in the cycle. She had heard that if you've met all those requirements, as long as you didn't have a felony on your record, then you would probably get in. She thought going to a state school that has a great medical school would be a great financial decision. Knowing she was a decent applicant having met all the requirements for early decision to IU, she felt confident that she would get in.

Again, knowing fairly well that she was interested in ophthalmology, she still didn't consider this in choosing her medical school. She didn't think about the ophthalmology aspect at all. Now she's thinking maybe she should have tried to go to a medical school that was connected with a stronger ophthalmology residency. Although IU has a strong ophthalmology residency program, there are also other state schools that have it. If she had to do it all over again, Andrea says would have been more strategic about choosing her medical school.

Andrea explains that as when she was applying to medical school as an undergrad, you are so far from residency that she didn't even know what internship is. She would have just looked at residency rankings but she's not sure whether she would have looked at specific qualities in a program. She was heavily invested in this nonprofit organization so maybe she would have chosen a program that had a faculty associated with that nonprofit. For example, one of her co-residents wanted to do ocular oncology which she had known she wanted to do since high school. She was very strategic about where she applied to medical school and residency fully knowing she wanted a program that had ocular oncology which not every ophthalmology program has. So Andrea recommends that if you have a niche you're interested in or you've done research in a certain area, look at residency programs that are strong in that one area and then find a medical school associated with that. Ultimately, she recommends going to a school where you think you're going to be happy because your biggest thing is to succeed in medical school. You can pick medical schools with the best associated residency but you don't like the medical school, but maybe you won't even make it to the residency because you hated school and you didn't do well. So much of it is going where you think you're going to succeed. Andrea adds making a financially smart decision is important.

In addition to Andrea's advice, I always say to students, don't go to a great medical school. Go to a medical school that will make you great. Too many students look at the name and the prestige and don't think about what's going to make them happy. Andrea further paints this picture that you can be a superstar anywhere or a crummy resident or medical student at Harvard. It's all up to you.

Andrea was so excited to finally be starting medical school and she was just really intense during medical school. She knew she was getting into ophthalmology and grades were really important to her so she simply was so into it. Although she didn't mean to be, Andrea admits she was a total gunner. And looking back, she just shakes her head in shame.

Andrea has always been pragmatic about everything. Getting into medical school and residency, her thought process was that if she got good grades and worked hard then she will get into medical school and get into residency. She knew ophthalmology was very competitive so she knew she had to get the best grades possible along with research. She wanted to get involved with ophthalmology research really early which she did and she also got involved with the ophthalmology student interest group at her medical school early where she got a lot mentorship from other medical students who had just matched or those applying and she moved up every year. On the other hand, Andrea's research mentor was just out of fellowship and was very helpful.

Additionally, Andrea also remembers some premeds attending the student interest group meetings which is a great thing for any premed to do so you can meet people. She recommends that if they let you go, then definitely go. Their group at IU also started a free eye clinic so they would have premeds come to the clinic to help see patients and get them involved. So if you're near a medical school, contact the school and contact whoever is in charge of the student interest group for whatever specialty you're interested in. It's a great way to get involved.

Having matched into a fellowship now, Andrea felt she was so laser-focused on ophthalmology since she was sixteen until getting into residency and realizing you don't learn a lot about ophthalmology in medical school. She had done a ton of shadowing and clinical experience as well as surgery and thought she had seen a lot as far as medical school went but when she actually started finally doing it in residency, she couldn't find something she thought she would have really fallen in love with or she thought was something she could do everyday for the rest of her life. She didn't feel like she could do cataract surgery everyday for the rest of my life. She also discovered that she doesn't love looking through lenses as much as you should to be an ophthalmologist. So she chose a fellowship in oculoplastic surgery, which is a plastic and reconstructive surgery around the eye that does orbital surgery. You can do combo surgery with neurosurgeons or ENT-type surgeons. She loves the patient population so to her, it felt different than intraocular surgery (cataract surgery). She just fell in love with this and she didn't feel this way about any other subspecialty within ophthalmology.

In terms of choosing her specialty, it's not really that she second-guessed ophthalmology but she also liked little pieces of a lot of specialties. She loves surgery and she loved her general surgery rotation but she didn't like the macroscopic nature of general surgery as she preferred the smaller, microscopic nature of ophthalmology. She also loved neurology and liked the patient and clinic aspects of it but for her there wasn't enough procedural aspect to neurology. She likes talking to people and loves the patient and clinic aspects but she she didn't love being in a hospital and doing an in-patient service. So she liked so many things but nothing really made it difficult for her to choose ophthalmology.

When Andrea was studying for Step 1, she started reading blogs as an escape from what was seemingly a miserable life studying for Step 1. She's also into healthy eating, nutrition, and fitness so she started reading blogs about them. So it started as a fun little escape for her and thinking it was also something she could do, she wanted to share her recipes and her experiences as a medical student. The day after she took Step 1, Andrea started her blog without any goal or intention for it at all except for using it as her little place to document and chronicle her third and fourth years of medical school as well as some kind of a repository of her recipes. This way her family can read them so they can always keep in touch with her. But Andrea ended up getting small readership and found people were more interested in the medical school side of things and cared less about healthy living stuff. Since this was a bit off the genre of her blog, she thought of making a YouTube video instead talking about medical school. So she started making little videos talking about things like what to study or what she wished she had known about medical school or her third year experiences and people liked them.

Andrea describes making these videos is so fun being able to interact with people and connect with premeds. It's fun helping people with whom you were also in their shoes just a few years ago. From there, she started doing more interview-type videos. Although not a priority since residency is number one and learning how to be an amazing ophthalmologist, Andrea doesn't put her 100% into it but she does this when she can which is okay. This brings her joy so she keeps doing it. Check out her videos on her YouTube channel, A Doctor in the House, and her blog at www.AndreaTooley.com.

Andrea explains this is not an easy path for anybody and what she hears most from people is how do they stay motivated and she gets that question all the time. People lose motivation considering this is a long and arduous journey as well as people dealing with self-doubt. Both of those combined, it's hard to stay in a mental state and have that mental fortitude to continue especially these days where everything is getting more competitive and cutthroat. There is so much on the internet and test scores and averages just keep on getting higher and higher and the standards are getting impossibly high. Just to have the strength to keep going and to get through it is such a challenge so Andrea encourages people to surround yourself with a family that helps you and supports you as well as friends that support you and study with you. Lastly, just put one foot in front of the other. Nobody really likes working this hard but just keep doing it and you will get there. You need to enjoy the process along the way but you're not going to enjoy every minute of it. So just find that balance where you're not miserable abut you're still working hard and this for her is what she finds as the biggest challenge.

Looking back, the most memorable part of it for Andrea was matching into ophthalmology residency which to her was a culmination of so many years of having a school and finally getting that phone call from her program director welcoming her into the residency. She also felt the same way getting into medical school and getting that envelope in the mail. She says it's those moments you've worked so hard for that you'll never ever forget that feeling that it was worth it and you did it. Lastly, she just remembers the bits and pieces of the whole thing studying and it's all great. At the end of the day, we all want to be good physicians and help our patients and that makes it so worthwhile.

You don't have to be perfect to get into medical school and know everything to get into medical school. You just need to work hard. Work hard for your dreams and get as much information as you can along the way. You don't need to know it all right now. Just start working towards that path of getting into medical school and one day, you will get there.

Dr. Andrea Tooley's YouTube channel

Andrea's blog www.andreatooley.com

Andrea Tooley's Instagram profile

Early Decision application at Indiana University

Butler University

MedEd Media Network

Allison joins in again to discuss something that came up with one of the students I'm helping. Should your premed advisor tell you that you can't or shouldn't apply?

I was in a phone call with a student I'm working with and he said his premed advisors told him that if he didn't get a 510 on the MCAT, he shouldn't apply to medical school this year. We were talking about applying to Harvard and so I took this in the context of not applying to Harvard. But he corrected me saying the advisors meant not applying to any school for that matter. And so I wanted to bring that conversation into our episode today to discuss the role of the premed advisor.

I went to the University of Florida, a very large state school that typically puts out the most matriculants into medical school every year. My premed advisor told me not to apply to medical school not because of my grades, MCAT score or volunteering or shadowing, but because I was a white male. Needless to say, I didn't utilize their services very much after that.

Allison had a different yet similar experience with her premed advisor going through her undergrad in Canada. She saw her only once because the help she gave her was not helpful. Getting into a medical school in Canada is extremely difficult so premed advisors have this idea that everyone should have some kind of plan B because most people are not going to get in. And most people don't get in. She basically had friends who ended up going to nursing school because they applied to medical school once and couldn't get in, even applying three times to the same school and didn't get in. Plus the fact that there are only about seventeen medical schools in Canada so it's highly competitive. So when Allison went to her advisor and said she wanted to go to medical school, she asked her what her plan B was and that was the only thing she wanted to talk about.

Allison thinks that what her premed advisor should have done was to encourage her to apply to medical school, to tell her honestly that getting to medical school in Canada is extremely competitive and difficult, and to ask her how she can support her  in pursuing what she wanted to do. Adversely, Allison got zero encouragement and it was all plan B. It was a dismay considering she wasn't there to do the job Allison felt she was there to do.

Advise refers to an act offering suggestions about the best course of action to someone. Extending it to an academic advisor, it's about offering the best course of action based on what the student wants to become. It may not necessarily be possible, but they will give you the best advice possible.

In my opinion, the advisors stepped over the lines of what they should be doing which is to offer advice based on what you want and being the person who is the gatekeeper to medical schools.

Basically, your premed advisors are there being the eyes and ears based on your school and your location. They know the teachers, they know everything. Having somebody locally that you can go to and sit in there office and have conversations with is beneficial. So don't avoid them because of what we're saying on this podcast. Rather, pay attention to what they're talking about and the advice they're giving you. And if they're give you some of this information, maybe look elsewhere.

Allison did not get any help from her school. She looked up online as much she could and just worked hard. She ended up looking AMCAS online and trying to look at the individual school she was applying to. She didn't have any premed advisor essentially nor did she go to a school where there was a committee that did a letter. For her, everything was very individualized. Ultimately, she got advice from other people she knew were applying. She didn't know anybody that was already in medical school but she knew somebody that had gone through the process and this was helpful.

I pretty much did the same thing where I had a core group of friends in undergrad and we just put together the information as best we could. I still didn't do it right since I didn't get into medical school the first time I applied as I was missing proper shadowing and clinical experience, which were stuff that I would have known if I had gone to my advisor more but I stopped going to her because of the advice she originally gave me.

The information your advisor gives should help you with your decision to going to medical school. The role of the advisor is to guide you, not stop you. So when you hear an advisor telling you not to apply to medical school if you get lower than 510, ignore that information because it's not based on any data.

A lot of premed offices will keep track of the students they advise and who gets into medical school and who doesn't. They use that data and put it on their website to brag about how 95% of their undergrad premeds  got into medical school. By telling a student not to apply to if you have less than a 510, that obviously helps the premed office with their stats if they're keeping stats which a lot of them do. So this ends up being a marketing technique for the undergrad institution. But just because you got less than a 510 doesn't mean you're not going to get into medical school.

The role of the advisors is not to tell you that you're not going to get into medical school. That's the medical school's job so let the medical school tell you no, not them. Your advisors are there to help you.

The role of the advisor is to give you the best recommendations. They could be brutally honest with you and tell you it's going to be freaking hard and that you're probably not going to get into medical school but if you still feel like you want to apply, here are the best things to do moving forward or here's how you can strengthen your application. Or they have that conversation of having a shot at becoming a physician and getting into medical school but just delaying your application for a year for you to take courses, repeat the MCAT, and get the necessary experience. Sadly, a lot of students are hearing from their advisors that they have no chance of getting into medical school.

Meanwhile, many students listening to this podcast are nontraditional students and many of them have been told they can never get into medical school and yet they're in their postbac, getting great grades, studying for the MCAT and getting great MCAT scores, and they're applying to medical school and getting in.

Here's another email I got from another student I'm working with in the middle of application. He's in the process writing secondary applications and after speaking with the Dean of Admissions at a medical school, he was told his MCAT score of 504 and a cumulative GPA of 3.0 due to his past course work will keep him from hearing from any schools. The dean instead recommended him to apply to Texas which has an academic fresh start program where they erase your previous grades and you get to restart, retake all the prereqs, and retake the MCAT with the intention of scoring a 510.

Based on the student's actual data, his overall GPA is 3.06. It's not very good. Then looking at his overall BCPM GPA , it's 3.58. BCPM is your science which stands for Biology, Chemistry, Physics, and Math. His undergrad GPA is less than a 3 and this was what hurt him. His grad school GPA is 3.86 which is great. MCAT score is 504 is not great but it's okay and it's just one piece.

Allison's advice to this student is to go ahead and apply. The worst case scenario is that he doesn't get in and he can try to repeat the MCAT. But the MCAT score alone should not keep him from applying.

I want to add that a 504 versus a 510 is a decent jump up but there are plenty of students who get into medical school with a 504. Looking at the AAMC Applicants and Matriculants data, Table A-23 shows the grid of MCAT scores and GPAs. Looking at this student's MCAT score and GPA, it's not the best information as there were 65 students accepted out of 329 applicants that matched a 502-505 MCAT score and a 3.00-3.19 at an acceptance rate of 20%. Although not great, one out of five is still pretty good.

This is one of the reasons I hate looking at MCAT scores and GPAs where you're applying to medical school. This applicant has an amazing backstory that will work for him when he applies to medical school. He has a great personal statement and he's going to be able to do very well. He will be one of those students that will get a second look from a school because of that backstory, because he had a strong graduate GPA, because he picked himself up from a prior poor start to medical school. For example, people said Tim Tebow couldn't go pro coming out of college but he did. And his response? "It only takes one." He was drafted and the rest is history. Now, he is a minor league baseball player.

In response to this student's email, I told him to apply. This is one perspective from one dean. There are plenty of other schools out there that will take into account the rest of his story that will overlook his previous undergrad GPA, will look at everything else, and give him a chance.

Allison concurs with me on this further saying that one opinion is just one opinion so what they say is not solid gold and the only thing that matters. So one admissions officer does not speak for all admissions officers in the country. Besides, this should be part of the discussion with your advisor. You're allowed to disagree with your advisor and a good advisor will take that into account and still help.

Some undergrad schools will keep track of data and not help students that have low GPA or MCAT score. It's the same thing with committee letters. They will look at a student and say they didn't meet the MCAT cutoff to be given the committee letter. It's understandable that resources are limited but that's not an excuse for leaving a student out in the dark. That's as good as telling that you're not getting any help and you're not getting into medical school and this definitely negatively impacts your confidence. It tells you're not good enough and you should go have a plan B. That's terrible.

When I first had this conversation with a student last week, I jumped on Facebook Live. Some of the comments there said their advisors are doing this. One student said that's how it is with committee letters and you have to have a 3.5 or they won't help you. Another student said this type of "advice" was what kept him from applying as an undergrad. Now, she's a nontrad student and has taken some time off when she could have gotten into school during the normal time frame.

If you're getting this type of advice, take it with a grain of salt. Seek other opinions, not Student Doctor Network. Go to the Hangout Group or send me an email at ryan@medicalschoolhq.net. Talk to another advisor, if possible, in the same office. Talk to a biology or chemistry teacher or somebody else who may have some information or someone who's been dealing with premed students for a while. The worst thing you can do is take the advice from one person and internalize it and give up on your dreams and this is exactly what you don't want to do. Their goal is not to tell you no. Let the medical schools tell you no.

Allison gives this analogy with lawyers like if you go to a lawyer and you try to win a case, the lawyer is not going to not take your case because they want your cash or even if they know you're going to lose if you're the plaintiff. This makes her think about what incentive premed advisors have. If they were paid to do that kind of work then they would not be saying no to you.

The moral of the story is do not avoid your premed advisor but use them to the best of your ability and to the best of their ability. But if you're getting the type of advice that says you can't get into medical school, those words should not be coming out of your premed advisor's mouth. In that case, seek help elsewhere. Seek other opinions or speak up and tell them you disagree and ask how they're going to help you.

I will soon be reaching out to a premed advisor who gave a talk at the recent Premed Advisor Conference I was at. She got on this tangent of the role of a premed advisor. She used to be the Dean of Admissions at a medical school so she knows. Her perspective is that it's not her job to say no. Her perspective is that you shouldn't be saying no to students. You need to be honest with them but not say no. She also talked about how other advisors insist it's their job to say no.

Lastly, utilize your premed advisor to the best of your ability but those words that you can't or shouldn't or won't should not be coming out of their mouth when it comes to your chances of getting into medical school. Your chances are always greater than zero percent when applying, zero percent if you don't apply. Good luck on your journey and hang in there!

AAMC Applicants and Matriculants data, Table A-23

Medical School HQ Hangout Group

MedEd Media Network

ryan@medicalschoolhq.net

Allison and I tackle several questions from the Hangout, our private Facebook group. We cover everything from motivation to residency status.

As we're recording this, my book The Premed Playbook: Guide to the Medical School Interview is officially released today. I appreciate those who pre-ordered it. To those who haven't pre-ordered yet and wanted to wait and look at it at the bookstores, I'm going to announce something soon.

A story came out about ten undergrad students had their admissions withdrawn by Harvard after it came to light that there was this private Facebook group they were a part of that all of the new acceptances for the Class of 2021 formed this super private and raunchy Facebook group sharing memes of lots of bad stuff. Somebody turned them in. The administration looked at it and whoever turned them in obviously let them see their Facebook account to see what was going on that led to these students having their acceptances withdrawn.

The moral of the story is do not put anything out there on the internet that you wouldn't want your grandma seeing. Allison adds that social media has become a part of life and when you interview for a job, people look at your Facebook, Instagram, and Snapchat accounts. Part of the article was about how many admissions officers now look through someone's social media profile to get more information on them. Be very careful. A lot of people change their name on social media when they apply to a school.

But just don't be a bad human. There is dark humor but the kind of stuff they were joking about were just beyond dark humor. Talk with your friends in person but don't post things that are despicable online. Also, if you're not using your real name on Facebook, you're actually breaking Facebook's Terms of Service and if you had an issue with your account, you will probably never get your account back because you can't verify your name and they won't give you access to your account.

Back to our questions, a student who recently joined the Hangout said she was having problems staying motivated to study for the MCAT while also working full-time.

For Allison, she always enjoyed school and although she doesn't like the MCAT, she has always been a future thinker and always thinking about what she's doing is in service of her future goal. She thinks about her future and the future she's living into and this gives her excitement, drive, and ambition to put herself into what she's doing 150% so she can get to that future and live in that future.

Moreover, I posted something on Instagram about you're not studying for the MCAT. You're training yourself how to be a lifelong learner for your future patients. So don't just think of this  as just studying for this one test. Go in and think about it as preparing yourself for the future and for that patient that you're going to be treating.

Working full time is hard when you're studying for the MCAT but if that's what you need to do, fine. However, you also need to find time to shadow, do clinical experience. You need to stay involved in some way, as much as you can, so you can see what you're working towards. When you're faced down and working full time then you come home and put the kids to bed and then you crack open the MCAT books and that's your life, you forget what it is you're doing and why you're doing it.

When you're struggling with your studying and not improving your scores and you're pulling your hair out, you have to maintain some sort of clinical experience so that you can be around patients and you understand why it is that you're doing it.

Allison agrees with this because when she studied for the MCAT. She did a gap year between college and med school to apply and do the MCAT, she was involved in patient care and was involved in two different internships, one of them being in patient care. That gave her the drive because she got to think about the patient's' experiences and apply them. It helped build that excitement, ambition, and drive to keep her going.

Do this even during medical school. As a premed, you assume that once you're in medical school you stop shadowing but that's not the case at all. You can continue to shadow as a medical student and be involved in whatever specialty or hospital you're interested in. Shadow  even when you're a resident. Shadow for as long as it takes until you get to the specialty or whatever career you're going to do. It's about lifelong learning.

This next question is from a student getting ready to submit their AMCAS application, hasn't taken their MCAT yet and wants to play this game I hear a lot, which is applying to just one school to get verified. Then when they get their MCAT score back, they'll submit the rest of their applications if they like their score.

Allison and I don't think this is not a good idea. Logically, yes, this makes a lot of sense. But the problem with this kind of thinking goes along with the thinking that you're going to apply to schools based on your MCAT score. And I don't agree with that.

Additionally, if we break the timeline, you submit your applications mid-June and taking a June 29th date, your MCAT score isn't coming out until August 1st. You're going to look at your MCAT score and you're okay with a 505 or 507 or whatever it is. Then you're going to look through the MSAR (Medical School Admissions Requirements) website that the AAMC gives you and based on your score, here are the school you want to apply to now then you'll add those schools. The schools will get notified basically immediately that the student has applied to them assuming everything else is done. The school is going to see that as an application and they're going to most likely send a secondary application or request for secondary essays. Most schools will send those automatically.

When you do this, you're delaying your ability to pre-write those secondary essays. From June 29th to August 1st, when you select the schools you're applying to, there's a month there where you could be writing secondary applications, but you don't know what schools you're applying to yet so you're creating this dead space where you're not getting anything done. It's going to be late anyway since that's when your application is complete with that MCAT score on the beginning of August. And it's delaying even a couple more weeks because of those secondary applications.

Moreover, when you pick only one school, you're giving yourself psychologically an out. Then you're okay if you don't do good on the MCAT since you applied to only one school anyway. Whereas, if you applied to 20 schools and it cost you a ton of money so you're going to get a great MCAT score. And if it doesn't work out, you course correct and figure out from there. But don't go in with a Plan B going, "It's okay, I can always cancel my applications."

And if on July 1st, you already know the school you're applying to then you can start writing your secondary applications and essays. Come August 1st, when your score hits, your done. It's then just a matter of the schools looking at your complete application because they're ready for it.

Again, logically, it makes sense, But when you factor in everything else, it doesn't make sense and it's not a game I'd like to play.

Question 1: Does that mean the medical school programs can view the application as soon as it's verified?

The answer is yes and no. At the very beginning of the application cycle, the application services delay sending off the first batch of applications until a set date. After that date, as soon as you're verified, the school gets it.

I forgot the date this year for AACOMAS but for AMCAS, the date is June 30th. So if you apply early and you get verified, your applications are not getting out to the schools until June 30th. After that, they will get it immediately.

Question 2: Should I contact the programs individually if I had more letters of recommendation and more extracurricular activities?

You can't add extracurricular activities at least for the AMCAS, which is fifteen. But if you only put thirteen and you want to add another one later, AMCAS only lets you six or seven different things you can change on an AMCAS application after you submit it. But extracurricular activities are not one of those. But I am not sure for AACOMAS.

Letters of recommendation will get added and the schools will see that so you don't need to contact them individually.

Question: Is shadowing a military physician on base viewed the same as shadowing a regular hospital?

Answer: Yes, a clinic is a clinic no matter where it is. A physician is a physician. Medicine is medicine. Patient care is patient care. The only aspects that I would put on this having been a military physician is it's really hard to shadow a military doctor if you don't have access to the base already. Even when you do have access to the base, it's up to the chief medical officer to decide what their rules are for shadowing. It's like any other hospital setting that shadowing rules are different everywhere. For a military hospital or clinic, it's harder because you would need access to the base as well. Given our heightened level of security these days, access to the base typically isn't given unless it's really needed.

A student I'm working with this application cycle is in the military applying to medical school and she shadows physicians at her base.

This student is from California and still has the option to become a resident of California but currently a resident of Florida. She's applying next year to medical and is asking about changing residency in order to have a better chance of getting in back home in California. Or should she keep her residency status in Florida?

Allison thinks that if you want to go to school to California, you should definitely change your residency back to California. It's very hard to get into California medical schools from out of state. What do you want? There is no safety net anywhere. There is no guarantee. You could move to California and get into a Florida school and now you're an out-of-state resident.

In this same regard, I've talked to a lot of students in the middle of their application cycle on moving. But why are you moving? You're risking being a non-resident everywhere. If you leave one state, depending on the state rules and laws, you are possibly losing the residency of a state that you're moving from and it typically takes a year to get residency to a state you're moving to. So you don't want to screw yourself and be a resident of nowhere.

One student I'm working with this year is moving from Kentucky to Texas and I advised her not to do it and call the schools and state and find out what their rules are. So she called the University of Kentucky. Her parents still live in Kentucky and still have a house in Kentucky. Based on that fact alone, University of Kentucky still considers her an in-state resident even if she's living in Texas. She's a nontrad and out-of-school.

So if you're planning on moving anytime around applications, talk to schools. talk to states. Figure out what the rules are around that because that's important.

I found out today that I'll be speaking at the UC Davis Pre-Health Conference, probably the world's largest premed conference every year. I think they're expecting 4,500 students this year. I will be speaking about nontrads and how nontrads should be able to know their worth as a nontrad, why their stories are important, and how to tell it.

If you're in the area or you can make the trip, it's going to be on October 07, 2017 at UC Davis, California. Sacramento is probably the closest place to fly into if you're flying in. I met some people last year who flew in from other places.

How do you deal with family that doesn't seem to understand that to have a good grade, you have to study? I did my undergrad away from home so it's actually a first that I'm studying the entire summer for the MCAT at home.

So the family keeps bothering them and they're almost two days late into their MCAT studying plan already. They tried explaining to the family and their philosophy is since you're smart, you're going to do well. But the student's philosophy is they can't do well if they don't study. Obviously in medical school, you have to explain to friends and family what life is like and how you're not coming to birthdays and not coming to holidays since you have to study. And this is hard thing.

In medical school in particular, when you're studying all the time and people don't understand why you're not being a good friend and you're not keeping in touch with people or not making it to different events, there becomes this drift or divide where you just feel separated because people don't understand why you have to be studying all the time. That does begin as a premed too since you have to study a lot. Allison think you just do the best you can. At the end of the day, if your family loves you, they will let you be and they don't need to get it. They're not going to medical school, you are. You're the one who needs to study. You're the one who's going to take the MCAT. So if they love you and support you and let you be, great. If they can't, go to a library, go to a book shop and just get space. Don't let your family or friends' concerns and opinions and feelings get in the way of what you are there to do.

Your goal is to become a physician and the sacrifices you have to make include saying no to family and friends. So you have to go to a coffee shop or library just to set that boundary. And they will get it eventually. It's a very long journey and this is not normal for most people to have to spend much time with your nose on a book, studying, and working so if they don't get it that's okay. That's probably the beginning of them not getting it for quite a long time so get used to it. Know that there are other people studying just like you who get it so go to the Hangout Group.

We got the third nomination for Best Podcast in Science and Medicine. This is happening at the end of August in Anaheim, Southern California. I will be doing a meetup then so stay tuned for that. I will put this event on the Hangout. The conference is on August 23-25 so I will definitely be doing a meetup so I can hang out with you if you live in the area.

Again, I will be at UC Davis in Northern California in October for the UC Davis Pre-Health Conference. In November, I will be in Florida for the Premed Fest.

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Win one of 50 copies of my new book, The Premed Playbook: Guide to the Medical School Interview. Text BOOKGIVEAWAY to 44222. Promo runs until June 4, 2017.

Allison is back! The last time I've done a podcast with her was back on the Specialty Stories podcast episode 03 about Neurology. Today, Allison and I discuss our experiences during the first two years of medical school.

Recently, we got a comment on the Facebook Hangout Group asking for more information about medical school, specifically the biggest difference between M1 and M2, which is your first and second year, the schedules, breaks, etc. It's a hard answer because every school is going to be different.

So Allison and I are going to share our personal experiences along with some variability in there as well about what we know from other schools that we applied too or looked at or what we hear nowadays.

Allison describes her first year of medical school as something crazy but she liked it. She always liked school. You're wanting so badly to get to medical school so how can you not be thrilled and excited. So there's a lot of anticipation and excitement when you first start.

I wasn't as excited when I started, well, because as Allison points it out, I haven't been studying for three years and I've been working. Plus, I was scared. And mad actually because it had nothing to do with orthopedics. In fact, the only class I liked in my first two years was Anatomy.

Allison thinks it's all about a change in mindset especially when you're going from working into studying and you've forgotten how to study. Allison took a year off but she also had a very different undergrad experience than a lot of people. She was at McGill, the Harvard of Canada and there was a lot of studying but Allison didn't have a traditional university experience. She wasn't going to parties and drinking. She was literally studying. She studied all the time so she was really well-prepared for that aspect. It was more of the pace that was different because of how much you had to study and how much material you had to shove into your brain at a given time. It was just like med school.

Allison says it was the pure amount of material that was like whoa! And the labs. It's generally what first year is - classes and lab, being in the library or wherever you choose to study.

Allison says she started to feel like people who weren't going through what we were going through couldn't really understand how much pressure we were under and how challenging it was.

It's the same for undergrads too. Non premed students don't understand the pressures that you're going through as a premed, the commitment and time you need to put in to study because you have to get good grades.

Allison recalls going out to eat ribs after we dissected some ribs or talking about poop after dinner and normal people don't do that. So it was just different and that's why a lot of relationships fall apart at the beginning of med school. People you've come into med school dating who are not in medicine and that starts to fray a lot of times since you're now immersed with a group of people you're literally doing everything with. On the other hand, other relationships also start so a lot of people pair off at the beginning of med school. In med school, you become so close to those in your class because you're spending so much time with them studying. First year in medical school is an immersion.

Traditional style of learning is where you take your first year anatomy, histology, the nervous system, physiology, etc. In your second year, you take pathology and pharmacology. You learn everything about healthy first and then everything pathologic and unhealthy on your second year.

In systems-based learning, you study the kidney. You study the anatomy of normal kidney and the physiology of the kidney and the pharmacology of the kidney. Then you study pathology and anything that goes wrong with the kidney. Arguably, it's a better way to learn because everything is integrated.

Pharmacology, specifically, is very challenging because it's memorization and it's not systematized. You learn classes of drugs but if you applied that to a system, like an organ system, it would be probably have been a lot more straightforward and not easy to memorize.

Moreover, you can have problem-based learning in both the traditional and a systems-based curriculum. Problem-based learning is a small group discussion, learning about everything surrounding a particular problem. The faculty creates a patient for you and gives you a huge history then you sit down and discuss it with a facilitator. This is one of the things that I help teach at the University of Colorado. I haven't actually done one yet. I'm on the substitution list for the problem-based curriculum. But we had a little bit of that at New York Medical, specifically around pathology although it was different.

Personally, I would have liked a systems-based, problem-based learning system. Allison adds that in the problem-based system, it gets you thinking clearly clinically right from the get go because they start giving you cases so it's very useful and very helpful.

Nevertheless, Allison knew systems-based learning existed in some schools. But her consideration for choosing her school primarily was geography. Her advice to students is that if you've been accepted to multiple schools, take the time to actually go through and see what their curriculum is because it could affect you depending on the kind of learner you are. Although for most people, they just want to be a medical student anywhere.

Most medical schools nowadays will throw you into seeing patients right away. We went to clinic and each of us had a preceptor assigned to us. Allison had her preceptor in Winchester county who is a primary care physician. She went to his office once a week and she would shadow them. At some point, he would have her see a couple of patients on her own first and then tell them what's going on.

We didn't have many standardized patients. In fact, I tell students at the University of Colorado where I help them with their communication with standardized patients that they're so lucky to be involved with standardized patients so early because it was something we didn't have at New York Med. We didn't have the immediate coaching of talking to standardized patients. We actually didn't do it until the second year. We did the OSCE prep and then the OSCE. That's where you learn the physical examination.

So that's common in almost every school now and it's almost a sales pitch some schools have now where they get students involved right away with patient care and so do most schools these days. When I do mock interview with students, one of the things I ask is why you're interested in this particular school and their usual answer would be early patient care, etc. It' snot unique so don't worry about that one.

Some schools have mandatory lectures and some schools don't. Allison learned in college that sometimes when she would miss class and just teach herself from a textbook that she often learned more. For instance, her general chemistry class lectures were really useless. She would go to them but found them entirely useless and found that the T.A. sessions were much more useful.She started going to lectures in medical school and at some point, she realized she wasn't getting good value from the way she learned. Hearing it and taking notes, she felt it was an inefficient way to learn. Instead, she would have scribes. Scribes are people who take notes on the lectures and they would distribute it and you would pay. Then you would just have the transcript of the lecture so she could use that and read that, take notes on it, and go from the textbook. She found this as a much faster and more efficient way for her to learn. Allison admits she wouldn't go to a lot of classes, especially in second year, she says she rarely ever went to lecture since it just was not a good way for her to learn. Obviously, she went to all of their labs and all small group sessions but she found that she just learned very well on her own.

I, on the other hand, would just hook up with Allison. She's doing well and she knows how to study so I was just doing what she was doing. We were like two peas in a pod as Allison would describe it. We would get up early and go to a place where we can study all day long. In second year, Allison recalls that time when we had to read this large textbook from cover to cover and we would just sit there for hours and hours. We would be studying and taking notes from the textbook. It worked a lot better for her than for me however.

So this is one of the things where I talk about learning styles and needing to adjust study styles and techniques to not only for yourself going from high school to college and then college to medical school, but also between students. Allison and I started dating very early on in medical school and so we studied all the time together. However, I never took into account the fact that I didn't learn the way that Allison learned. I just wanted to hang out with her so we'd go hang out and study. And that reflected in my performance. I should have gone to the lectures. It was an inefficient studying for me because I'm a very auditory style learner.

So there are some people that needed to be in class to get that auditory feedback and that style of learning like me while there are other people like Allison who just learned a lot better in a different way. Therefore, it's very important very early on to figure out what kind of learner you are and how best to study and how best you're going to learn the information.

Specific to New York Med, between first and second year, we had the last break of our life. Allison spent her summer shadowing and that's when she found out she wanted to do Neurology. I, meanwhile, stayed in the city and was helping out a free clinic and got scholarship stipends.

Most schools are still going to have that break between first and second year. Although I have heard there are some schools that are getting rid of that break and are going into an eighteen-month first and second year, basically eighteen months to pack in all of those two years and they start clinical rotations much earlier.

So look into the school you're applying to and see what they have and whether they're going to have a summer break. Allison adds we should put "break" because if you're going into something really competitive like you know you want to do a certain specialty, you're probably going to want to use that "break" to start research and hook up with a mentor, etc. So it's not like you're really using that "break" to have a break but you can use it to go shadowing and keeping busy. In theory, you could use it to hang out but for most people, they use that time.

Second year was basically the same as first year, just different courses and different classes. Another thing that's different is you start getting more in-depth with the physical exam. We had standardized patients, people that you can kind of learn the exam on, which was a really interesting part of second year. We would go to a clinic on one Saturday and we learned the breast exam, the rectal exam, and general exam for women and men. Allison describes it as a very different type of experience which was something very unique.

What Allison liked about second year was feeling much closer to being a doctor, not based on time but once you get to pathology, you start to talk about disease so you're really starting to get into more of learning about actual disease which is what you need to know a lot about when you become a doctor. As opposed to a systems-based class, you would be studying it all along.

Basically, Step 1 is that light at the end of the tunnel. Studying for it was like five to six weeks beforehand. We finished the classes in May and we took the exam at the end of June. We had about five to six weeks of studying essentially all of our first and second year. There specific books to help you with that (soon to be the Board Rounds podcast so watch out for this).

Once you finish Step 1, then you're right into third year and there's no more break. Once you go straight into third year then you're on the wards. You're finally like a real doctor. You finally get to wear your white coat around and wear scrubs all the time. It was an exciting time.

Reminder: Do not advertise you're a doctor or you're a medical student by putting anything in your car because people have gotten their cars broken because people were looking for drugs.

Exams were very frequent like every two weeks. Some schools have exams every week now. You end up becoming a professional test taker. since you take so many exams. Anatomy has four big ones and then a big final. Histology has four big exams too. It ended up being spliced out so you're having exams essentially every week or every two weeks. There are so many tests and they're so frequent.

I would like to have a guest in the future to talk about study skills and how to be more efficient with studying. One of the biggest issues with studying right now for everybody is probably your phone and social media. The data shows that it takes about 20 minutes to get back into the groove and the mindset of where you were before that interruption happened. So if you check your phone every half an hour or you get a text message from your loved one every hour or so, you are wasting so much time. My best advice is to put your phone in airplane mode and study then in every hour or so, pick your head up and take a little break and then get back down.

Sleep when you have a little bit of free time like when you finish exams. We would treat ourselves when we were done with an exam. I would have like a day, usually a weekend, where we would binge-watch episodes of 24 and CSI. Basically, the television was a big thing for us. We were either studying or watching TV.

We also had end-of-the-year party, med school prom, and another party at the end of second year, and another party at the end of fourth year. There were lots of work but there were also lots of fun. But only have some fun once in awhile.

Lastly, don't lose track of friends and family because that's very important. You need to take care of yourself. Eat healthy and make time for exercise.

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Specialty Stories Podcast Episode 03: What is Neurology? A General Neurologist's Story

New York Med

University of Colorado

Jen Briney is host of the Congressional Dish podcast and joins me today to talk about our current healthcare system and where it may be headed.

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Today's guest is very interesting as it's someone who wouldn't normally be here on the podcast but with the changing landscape of our U.S. healthcare system, I thought of bringing an expert in this field. Jen Briney's Congressional Dish podcast is devoted to talking about bills that go through Congress. She has read the Affordable Care Act (ACA), Current TBAC, the new AHCA, and has discussed what's in there or not. She comes on the podcast today to talk about these things so you can come prepared for your medical school interviews. This is going to be a good primer for our healthcare system even if you listen to this in 2018 or 2019, assuming there are no dramatic changes.

Being a Congress-watcher, Jen watches Congressional hearing and reads bills and laws being created so that taxpayers, like her, would know what's going with their money. What led her to become so familiar with healthcare was the government shutdown in 2013 when the Republicans were trying to repeal the Affordable Care Act (ACA). She did not like the system as a whole because it's an insurance system, not a healthcare system. But Jen believes it's better than we had before because rules have been put in on the insurance industry. Currently, the Republicans have control of all of government. They're trying to repeal the Affordable Care Act but instead of repealing it, they're putting together bills very quickly with no hearings and no overall plan.

What Jen does now is she's reading all the different versions. She has read the first one that failed. But now the house just passed another version of the American Health Care Act, which she's reading for her next episode.

Jen explains there are different ways you can give people healthcare. A lot of other countries do "single payer" where you pay taxes and the government pays for healthcare. It's one of those essential government functions.

Conversely, the United States buys health insurance which is supposed to cover the big catastrophes. Before the ACA, these are for profit companies so what they would do is only cover healthy people because it would cost them the least. What health insurance does is you give them $100 a month and as long as you're healthy, they just put that in their pockets. That's profit. But as soon as you get sick, that's when they have to start to pay for stuff and they really don't like this part.

In order to have this system that still had private insurance at the center of it, the Affordable Care Act put rules in place. Before the ACA, there would be lifetime limits. You'd sign up for a plan. You get cancer and then you look in the fine print of your insurance and they would say, "Once we hit $1 million, we're not paying for anything for you ever again." And you would go bankrupt.

Another common practice with health insurance where once someone would get sick, they would just drop their plan. They would no longer cover you because they don't have to. Basically, they were doing all kinds of shady things to make money.

Why Jen thinks the ACA is better is because there are certain rules. For instance, there are now 10 essential health benefits that if you buy health insurance, they have to cover it such as preventive care. Jen shares her experience that when she went to get a physical exam and all the little bills came in, it cost her over $400. Now, that's illegal. Thanks to the Affordable Care Act. They also have to cover things like ambulances, hospital stays, maternity, prescription drugs, etc. There are things now that when you buy insurance, you know you're going to get. It's better than it was was before but it's still based on private insurance.

What you see now is these insurance companies liked the old days where they could profit by making up all the rules. Now the people in Congress working on behalf of the insurance industry are trying to make those rules go away. These are the people writing legislation designed to help the insurance industry to be more profitable. They're eliminating these rules so these essential health benefits are going to be flexible in certain states, if states wanted to, so they won't have to cover those essential health benefits anymore. This is not something that's good for the people, but it's good for the businesses.

Jen mentions the website OpenSecrets.org where you can look and see these people who are voting for this elimination of rules and you can see where they're getting their campaign funding from and in almost every case, you can see the health insurance industry and health professionals. Then you can see these companies get invited to help write these bills to repeal the Affordable Care Act. In fact, these insurance companies were in the room to write the Affordable Care Act, as well as the pharmaceutical companies.  These health insurance companies want to exist so they use their lobbying power to stay in existence and that is the basis of the Affordable Care Act. Jen says a lot of people call it the "poison pill" and no one right now in Congress is talking about the "single payer" system, the tax-funded system that works in so many other countries.

Jen explains why she says these people are working for businesses and not for us is because when you look at what they're doing, that's who benefits. Jen always looks at who benefits financially. With the American Health Care Act of 2017 (AHCA), it's the businesses that benefit from it.

In Episode 48 of the Congressional Dish podcast, Jen read the Obamacare and shares some big takeaways.

First, it puts rules on the private insurance industry. It allows the private insurance industry to remain the main way that people get their healthcare in the United States. As opposed to now, if you wanted to get a government plan, you have to get Medicaid, a program for poor people that gives them their health insurance. The federal government picks up all of the Medicaid funding for the states that accepted it. It basically expanded the program beyond what it used to be. So it allows poor people to get government-funded health insurance. Medicare, on the other hand, is for people over the age of 65 and for the most part, they also get government-sponsored healthcare. Everybody else is in the middle. If you make more than 133% of the poverty line or under the age of 65, you have to get health insurance in order to get healthcare for the most part.

This is the basis of the Affordable Care Act. It's a very complicated system that tries to put rules in the private insurance companies so that they will not go bankrupt but still have to cover people with pre-existing conditions. This is expensive because these as your healthcare provider, these insurance companies would have to pay for those benefits for your entire life and they don't want to do that. Hence, ACA forces them to cover you and it forces healthy people to get health insurance to outweigh those costs. Jen thinks it's a very delicate system with a lot of moving parts that have to work together in order to make this private insurance system work.

However, this is currently being actively dismantled. Jen admits she doesn't know what to study when it comes to ACA because we really don't know how much of this is going to survive.

One way to get health insurance today is the individual market which didn't exist before. For instance, Jen as a podcaster doesn't have a big corporation paying for her health insurance so if she were single and needed health insurance, she would have to go to each individual company and try to figure out what they cover which can be very confusing. Jen basically ended up with a $400 physical since she had no idea what she was buying.

One of the basics of the ACA is that it has created this individual insurance market where people could go on a website and pick a plan from a selection of companies offering it and compare them based on the premium, coverage, percentages - all of which are being explained, which didn't exist before.

Through the ACA, it separated your healthcare from your employer so you could quit your job and still have health insurance. Apparently, there are so many people in this country that are clinging onto jobs they don't like because of their health insurance.

Other ways of getting health insurance include the small group market and the large employers, where most people in the country are still getting their insurance from. Moreover, the ACA also requires that employers buy plans that cover those ten essential benefits and have minimum of what needs to be provided in return for premiums.

Jen ultimately stresses that the Affordable Care Act keeps the private insurance company at the center of our healthcare and try to make it so they can be profitable and yet we get coverage with fewer medical bankruptcies. Jen adds that this did not eliminate medical bankruptcies in the U.S. nor did it cover everybody but it is better than it was before. Basically, it's a stepping stone.

Even if you don't have insurance, you're going to get care anyway, right? You show up to a hospital and you're going to get the care you need. Is this how it works?

Jen thinks it's anecdotal but that's not how it works. Before the ACA, Jen's friend got cancer at 15 years old. She went into remission. They had one awesome summer and then the cancer came back. She was told she was going to need a bone marrow transplant. That's what was submitted to her health insurance company but someone behind the desk decided it was too expensive and said no. Because her parents were not millionaires, she died.

So you can't really separate medical bankruptcy from getting care. If you got hit by a car and you get brought to a hospital, you're going to get the basics so you can get out of there. But what about the follow-up care? What about cancer treatments? You can't get that in emergency rooms.

Jen firmly says this is inaccurate to say that hospitals have to cover you. They do cover the minimums like emergency care but the maintenance and the preventive stuff, that's what keeps you alive long term and that is not covered in the emergency room, especially not on a systemic level when there 325 million people in the U.S.

Jen has observed that there is so much corporate influence in our Congress right now on both sides. You have the Republican party that wants the insurance industry to write the rules. So they get to call the shots and they decide who gets covered and who doesn't because they believe in an economic theory. They believe in it so strongly that Jen is convinced they're not really looking at it from the people's perspective. They want people to have access to healthcare but access is different from "actually" having healthcare. So the Republicans are really working on behalf of businesses in a way that I think clouds their judgment.

As with the Democrats, they're also corporate in a certain way so they're the ones who created the Affordable Care Act. Instead of nationalizing the healthcare industry like it is in so many other countries, they are also creating the system and doing the middle of the road thing. They can keep the private health insurance in control as long as there are rules. But the people who just want to get healthcare as part of being American citizens are vastly outnumbered in our Congress right now.

Unfortunately, there is no side that is saying that access to doctors and getting healthcare is just an essential that everybody needs. Jen thinks there is an ideological battle happening and it seems to her that government should be covering the things that we all need but we don't know when.

The problem with treating healthcare like any other business is you can't opt out of it. It's not a restaurant, you can't choose to not go there and cook at home. You need the doctors when you need them. And the Republican party, specifically, sees healthcare as a business.

Jen adds it's not necessarily a left versus right thing. Instead, is this a business and should it be for profit or should be a part of the government? This is the real battle going on right now and business is winning big time.

Let's say, you got bitten by a dog and you're bleeding. Are you supposed to go to Yelp for doctors and figure out which one is the cheapest? And then go to the cheapest one questioning where this doctor actually got their degree. Jen doesn't think this makes sense on so many levels. When you're sick the only thing you're thinking of is how do you get better. You're afraid for you actual life.

This is why health insurance companies are an amazing profitable business because it's something we all need and will pay anything for. We don't question our doctors and for most of us, doctors are gods.

Again, it's not a business; at least, it's not supposed to be a business. It's not like buying a shirt and choose from different stores. But it matters when it's your health because you only have one body and if you screw it up, game over.

Jen bluntly admits that she is horrified with what the current administration is trying to do by making it all for profit again. It's not a normal business and so a lot of people are going to get hurt by this. With the new American Health Care Act, if it becomes a law, people with pre-existing conditions still have to be covered technically but there are so many loopholes that they've now written into the system.

The The MacArthur Amendment got passed in the house. It's basically a waiver that lets states waive the essential health benefits and states can create the essential health benefits, state by state. This implies that not only will states be able to define the categories of benefits but they also get to decide what's in those categories. For example, a state may decide to only cover three prescription drugs instead of a lot of them which were supposed to be covered or a state may decide they won't cover ambulances anymore.

Moreover, when you get sick, the ACA puts a limit that you only have to pay a certain amount out-of-pocket. Those are all tied tied to the essential health benefits. With the MacArthur Amendment, each state is allowed to determine what essential health benefits mean and it's also going to determine your lifetime and annual limits and what your out-of-pocket expenses are.

Jen thinks this is just going to be much more expensive for customers on so many different levels that people are going to skip care because they can't afford it. Additionally, they say it's designed to reduce premiums. By eliminating the rules on the insurance companies, it's true that premiums might go down because the plans do not cover anything. Jen had one of those. She got her plan for $80 a month but when she went to get a physical, it was $400. Imagine if she actually got sick! That's what they're going back to.

Jen says they promise this is only the first step. The main goal is to allow the private insurance companies to do what they will. This is Jen's biggest concern (and ours too!) because they exist not to provide the best healthcare but to make as much money as they can and divvy it up to their shareholders. This is what for profit corporations do. Jen explains it's not necessarily evil but it is when you do it with healthcare. Again, you're talking about desperate people that will pay anything for their own health. So she doesn't see anything good about it.

To better understand what Jen has just discussed, it's like car insurance. When you're looking for a car insurance from a premium standpoint, you're typically looking for the cheapest thing possible and you're not digging around aspects like towing service, accident coverage, or parts replacement. All you want is the cheapest premium because you're a poor college student.

Allowing patients to choose the cheapest premium without understanding that back-end of what they're actually buying. They're basically betting on the American population to not be smart. Jen thinks it's not even smart because what they do is deceptive and put it in the fine prints. Those are tricky things insurance companies do so you're not aware. They don't want you to be aware because they want to get out of covering you when you actually do get sick.

Jen got a cheaper plan for her car and when her battery died and called her insurance asking for roadside assistance, she found out she's not covered for it anymore. She ended up asking for help from someone. Good thing it wasn't a big deal, but what if it was?

However, the problem with comparing health insurance and car insurance, is that you actually don't need a car. So if you don't want to pay premiums, you may choose not to have a car. But you don't have the option to not have a body. You basically don't have any choice. So even if you compare it to other insurances, it doesn't make sense because you don't have to own a car or a home and even life insurance.

For those who want to know more about these policies, Jen recommends you go straight to the bill. It can be super painful to read legislation but Jen has seen so many conflicting information from sources written by other people. Hence, the best way to truly understand it is to go to Congressional sources and read what they're reading. Jen says it's not that intimidating. She's outlining the stuff on Congressional Dish and she links to all the individual provisions.

Jen uses GovTrack.us to look at the status of bills as well as those that have already been enacted. Jen considers reading the Affordable Care Act was the most miserable experience for her and found it so difficult. It has ten sections. She actually ready the first nine and found out that the tenth edits the first nine. But if you truly want to understand what the system is, you have to go to the bills and the U.S. code and read it. The codes can be confusing to read because of all the numbers or codes written but the laws are written in plain English. So you can go to the sections of the law itself and just read it to understand. It's not as hard as reading bills because you don't have to jump back and forth.

AHCA has passed the House and now it's in the Senate. Jen explains that what happens from here is that it may be changed because the Senators are not happy with it as it is. The people on the committees don't give Jen hope that it's going to be changed in a way that protects people more. There are certain Republican senators that are uncomfortable with people losing their insurance and having it be more expensive. But there's also a group that are ideologically opposed to the idea that the government puts any kind of restraints on private business and they see healthcare as a business. Two of these people, Ted Cruz and Rand Paul, are going to be involved in the shaping of the Senate's version and jen says they just don't believe in government.

The best we can hope for in this Congress is that the whole thing just stops. Jen hopes we can make enough noise that the Senate doesn't vote on it or it fails in the Senate. Timing-wise. Jen heard they want to have this vote in the Senate done by August. This means we have a couple of months to make a fuss in the Senate particularly. The House's rule is done for now (May 2017). So you have to focus from now until August of 2017 unless it's passed sooner.

Jen wants to emphasize to doctors that private insurance is based on a lot of paperwork. There are a lot of receptionists hired to fight with the private insurance industry and a lot of times, the doctors care more about the patient. Jen says what happens to many doctors is they end up having to be insurance experts to help their patients get better and not go bankrupt. So doctors are involved in this and if you like to minimize your cost, minimizing the role of insurance would be good. Insurance companies don't want to pay because that's their business model and you want to get paid. So it's important for doctors to really pay attention to what's going on right now. Having read the bill, Jen encourages doctors in all of their interest to fight it as she thinks there is no good going on here.

Jen's friend has Crohn's disease and she's working on moving to New Zealand so that if this becomes a law, she's out. Jen stresses this is how serious this is for your patients. It sounds extreme but it is extreme! This is what keeps Jen awake at night and she thinks this should keep us awake at night too.

Lastly, Jen mentions how fast this is being crafted. It's not something the Republican have been working on for the last eight years since the Affordable Care Act. This bill they passed in the House was not available to read the night before the vote. It was not on the internet. The Congressional Budget Office does the really in-depth analysis of the financials but they were not done with this until the week of May 22, which is in the future of when this bill was actually passed. They simply just wanted to get something passed and so they passed it. Jen thinks this is so reckless. It's not a carefully crafted bill but something that has been thrown together last minute and the effects be damned.

This is the same as a doctor not evaluating a patient, giving them some antibiotics and if something doesn't work, another doctor will fix them.

Jen outlined the Affordable Care Act on the Congressional Dish podcast episode 048 and linked them to specific provisions. Episode 151 is Jen's next episode where she will be linking to all these provisions she's talking about when she outlines the American Health Care Act. You may also get a free app so you can get the show notes on your phone as you listen.

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Congressional Dish podcast

Congressional Dish Podcast Episode 048: The Affordable Care Act (Obamacare)

OpenSecrets.org

Affordable Care Act

American Health Care Act of 2017 (AHCA)

Medicaid

Medicare

The MacArthur Amendment

GovTrack.us

Sarah is a current 3rd-year medical student and former CTICU nurse who now wants to be a Cardiothoracic Surgeon! Listen to her journey and how others reacted.

The paperback version of The Premed Playbook: Guide to the Medical School Interview will finally be released on June 06, 2017. (Pre-order the book and get almost $100 in giveaways including one-month access to my mock interview platform and lifetime access to my 13-part video series on medical school interview. Simply test PREORDER to 44222 to get instructions on how you can enter to also win one of the 50 copies to be given away. Promo runs until June 04, 2017)

Back to our episode today, Sarah is the second guest on the show that came from a nursing background. She shares with us her transition from being a nurse into a medical student along with her share of challenges. If you're a nurse thinking about making this same transition and worried about how your colleagues are going to react to this, take a listen to learn from Sarah's experience.

Sarah had to deal with a lot of self-doubt in terms of becoming a doctor being 34 years old yet traditionally raised. So she thought being a girl, nursing was her automatic path into medicine. But as she worked and got into critical care, she realized she really wanted to do what surgeons are doing and it was something she knew she could do so she went back to take some classes.

To begin with, her initial interest in health care was mainly influenced by her dad who is an engineer and would always call "Nurse Sarah" to treat his wounds he got from woodworking. Then the show ER came out and seeing that inspired her even more to help people.

Not the best student in high school, Sarah would consider herself as a late bloomer, nor medical school was on her horizon back then. But she wanted to help people and thought being a nursing associate could be her quickest route. Pharmacy was not an option since she loves talking to people and being around them.

Sarah's path to nursing was not smooth and easy as she she had to teach herself math for someone who didn't do well in high school. She had to go through an academic advisor to help guide her along her path as to what classes she needed to take and in what order.

While in nursing school, she found her first open heart surgery which she thought was so cool. Already a year in nursing school, she talked one day with her academic advisor and expressed her interest in going to medical school and was told she had to take things one step at a time.

Then she got a job as a nurse after graduation and did not continue to apply to medical school for a couple of reasons. She got married shortly after and established her personal life more. She also wanted to work a bit to be able to save some money so she could pay up her student loans and then go back to school to get her Biology degree. Additionally, she was not 100% certain that she could still be a doctor. Still, self-doubt kept on creeping in and this basically kept her in nursing for about a year and half before she finally started to move forward.

Sarah thinks her self-doubt must mainly come from her academic performance being a nontraditional student and not having the highest scores in school. She had this picture in her heard that in order for someone to be a doctor, you have to be a 4.0 student and have everything aligned so she thought her background would not be appreciated. Her biggest hindrance was thinking that they only want the best so she wasn't good enough.

Sarah got into critical care, which is a very hard area of nursing to get into. Her manager was just feeding her whatever she wanted in terms of patients she wanted to manage, which was not always the case in nursing. Sarah was lucky enough to have a strong person and a good mentor for her. She also told her about going to medical school and her mentor totally encouraged her and supported her.

Sarah actually found that a lot of physicians she worked with discouraged people from going to medical school which made her a little apprehensive but her mentor really pushed her forward, instilled that faith, and saw things in her that she did't see in herself. So she knew she had to go for it.

Shortly after she spoke with her nurse supervisor about her interest in going to medical school, a new trauma surgeon started and Sarah found out she was a former critical care nurse herself. So she met with her one-on-one and helped her draft her personal statement. She basically saw that her mentor could do it so it became more tangible for her considering that nurses-turned-doctors are hard to find.

Sarah had a similar story with her mentor. As they discussed why doctor and why not nurse practitioner or nurse anesthetist, they simply both agreed that it wasn't the leap they were looking for. They wanted to be the ones to make the full decision and be the shapers of the plan and care for the patients.

She definitely hates the term "mid-level providers" most hospitals use but the reason those were not the avenue for her is having worked at several different locations from a community hospital to academic centers throughout different states and Sarah saw how varied their roles were from hospital to hospital, practice to practice, state to state. In one place, for instance, their nurses couldn't even interpret if an NG tube was placed properly on an x-ray.  In short, the autonomy varied based on practice, based upon hospital and state, which was something Sarah did not like.

Another reason she wanted to take the medical school path is that as a nurse, you take orders from doctors and nurse practitioners and while you can question them but in the end if you don't agree with something, it's going to be hard to stomach that. Sarah says they have a bit more of a sixth sense sitting at the bedside all day that can't be conveyed to any other way to certain people. Not having that authority and the ability to do those things and to be told you can't do it since it's not within your scope of practice was not something she was looking for.

At every single interview she was on, this question of why she didn't just become an NP or PA always came up. Sarah recommends to nurses going into medicine that they need to prep on this question for the interview. You need to know why you didn't and it needs to be a good reason. Sarah adds there needs to be self-discovery, introspection, and maturity that comes with your decision to be able to articulate that clearly to those interviewing you for them to understand and look inside of your rationale fro choosing it. They want to know you're doing it for the right reasons and that you've looked into other avenues.

Fifty percent of Sarah's reason for going into medical school is not being able to get enough of learning the pathophysiology of things because she feels she has only scratched the surface in medicine and now entering her third year, it has taught her to levels she would have imagined. That knowledge and passion to learn more and the why of things, although they have always been a big component for her, they were not enough. She wants to used that knowledge to formulate more holistic plans for her patients and be able to provide plans of care that she's fully behind and that she believes. She basically wants that autonomy to do so and use that knowledge she got. Knowledge is therefore a huge component of why she entered medical school but now the entire protion of the pie.

I definitely agree with Sarah 100% because what's missing from just the knowledge part of it which is all focused on you, is that patient care. How are you going to turn that knowledge into something that benefits the patient?

That said, Sarah adds you can always go into other areas if you simply want to learn something. There are now online courses that are being taught at these Ivy league schools that you can access for free. But the reason that separates doctors and nurses from other people is the drive to apply it directly into hands-on patient care. Having this answer in your heart when you're answering this question is definitely the right way to approach it.

Sarah has quite a remarkable approach in how she deals with even her negative interactions saying she always had something to take away from it, even when in the heat of the moment. It's about taking that negative energy and turning it into a positive light which is also what you should go for in life in general. Sarah explains you're always bound to come across conflicts and that's something that's going to always happen in your career so you need to be able to convey that to the people interviewing you because they need to know you can work with people and that you're willing to also listen when there are conflicts and try to figure out a resolution together. Things like this make interesting stories and the interviewers will push for those so you have to be able to take your positive spin on it and think about how you appropriately solved the problem.

About a year and a half into nursing, Sarah met with an academic advisor at a four-year institution and he laid it out for her the timeline for applying to medical school. Sarah proudly says it was the right first step.

As a nurse, there are different avenues and the one Sarah used was what they call registry. They had a more flexible scheduling and didn't have to schedule 36 hours a week. She didn't have to do certain times and worked every single weekend for at least 24 hours and would sometimes pick up an eight-hour shift. It can be hard being in four-year institutions since they have traditional school hours and not everything is available online so Sarah had to get creative, nursing being the perfect avenue for that because of the different hours you can pick up.

Nursing is super flexible but you also have to focus on keeping those grades up because ultimately, if you only care about the money aspect, you might have to give up some of those great scores and that might hinder you in getting into school.

As to why she didn't choose to go to a community college that may give a more flexible schedule, Sarah explains that what medical schools won't tell you is that they may take different weights for an A from a top 10 school versus an A from a very small community college. So she saw it as a way for her to prove to them that she went to a good school and did very well there.

There are other ways to go about this like taking part-time classes. For full-time nurses, it's only three days a week. You can also get student loans to help offset your living expenses, this is something she took advantage of. There are financial avenues to help support you during getting your advanced degrees.

As to the idea that medical schools looked four-year institutions and community colleges differently, she obtained this information from meeting with different admissions advisors as well as from doctors that served on admission committees. Sarah is a big proponent of networking and meeting as many people as possible in getting information. It basically took her three years to get to her bachelor's degree so over those years she gained different alliances with people and was able to get those information from conversations with them off-the-cuff. So it wasn't something they advertised but it's being thrown around on the internet and on different websites.

I agree with it to some extent. A lot of students will look at two different four-year institutions and will look at one that they're maybe not excited to go to thinking it's going to be a bigger hit on their medical school application or it's going to be looked at more favorably. A lot of the discussions I've had with students are around those types of scenarios. Once you're up to a four-year school, unless you're talking Harvard versus some four-year Podunk university in Alabama, but across the board, there's so little variability for most students to worry about it.

Sarah adds that as long as you perform well on the MCAT or have a great background that augments that, medical schools look at you as a holistic candidate. And she agrees that most four-year institutions are going to be okay.

Thinking she was just going to be fine considering she's used to handling stress being an ICU nurse and having went to school, Sarah still found medical school to be stressful and she acknowledges the need for a good, strong support group around you. Indeed, she describes the analogy of drinking through a fire hose couldn't be more perfect and she didn't totally had a grasp of what it meant until she started medical school.

The hardest thing for her was not only the sheer, vast amount of information she had to face, but also, the anti-social portion of it which she had to adjust to having to stay for longer hours in the library.

Her nursing background has helped her in starting medical school such as the life lessons she learned, ways she talked to people, and how to handle stress inn general considering the stressful nature of job nurses have. She also has taken on mentorships towards her fellow classmates and was able to help tutor some of them especially in Pharmacology. Because of nursing, she knows the names of the drugs and the dosages and their indications which are no longer new to her.

Within a couple of weeks within her university, they already started seeing patients in clinics and their attending surgeon commented she was light-years ahead of the other students and is already acting like she's an attending as far as her comfort level. She basically already knows how to handle difficult situations such as if a patient yells at you and be able to roll with the punches instead of being freaked out. However, there were times when she wanted to handle certain portions of patient care which were not within her scope as a medical student (that nurses do) and this was quite difficult for her being used to the all-over patient management.

Moreover, Sarah is fairly aware that working with residents and attendings, she should not come off as overly confident and know-it-all so she had to balance it out since they are the ones grading your and they're the ones teaching you so you have to be humble. At the same time, you have to learn how to speak up and recommend different things in a way that's coming off as abrasive.

Sarah actually had to deal with this problem having a lot of negative feedback from other nurses. She had to insist that she still is a nurse and she continues to advocate for the nurses because she is still part of the team. She is not leaving not because nursing is not good enough, but it's not just the road for her. Sarah explains this is something you will experience as a nurse working and trying to go to medical school so you have to be very careful with who you tell this to and who you surround yourself with otherwise it's going to be an issue.

As an actual practicing physician, nurses speak highly of physicians that were nurses before. Apparently, the harder part is when you're actually making the transition because they don't fully understand why you're making that change.

Sarah found the application process to be a lot longer than she anticipated. She took the MCAT twice and she wanted to make sure she performed at a level she wanted to because she did not want to be hindered with the kind of schools that would pick her. She describes it as a very arduous process and it took more time than she thought.

Sarah advises that if you're thinking of family planning or dating somebody and you're giving them the realistic expectations as far as how long this process would take, always consider that it could take another year or two before you can actually land in medical school. Sarah didn't have previous knowledge of rolling admissions and that you only get accepted during these times and the whole application process itself takes an x amount of time. So you have to do your homework on that before you apply.

Sarah iterates that you have to write your personal statement 10+ times over before you get it right and you have to get so many eyes on it. The personal statement being a critical portion of the application, you have to get yourself across. You have to talk about what sets you apart and Sarah believes being a nurse is very favorable and so you need to draw upon that in your application process.

In choosing which schools to apply to, Sarah looked up MSAR in terms of demographics. She was looking for schools that favored diversity and those that looked at nontraditional students more. She didn't want anything that felt toxic or she didn't feel at ease when you're interviewing there. She wanted to feel like they were looking for the right candidate and they were invested in her already that's why they gave her the interview. Sarah can happily say that the school she is in now is the perfect fit.

Sarah recommends that if you're in academics as a nurse and they have a medical school, network away with that because that is what really helped her out. She actually met their Chief of Surgery who worked with her as a heart transplant surgeon and got into the whole process and she was able to bring her concerns to the table. She adds that in order to get a feel for the school, you have to actually go there and reach out to the admissions advisor while starting to take courses to reach out for guidance especially the school you're interested in attending.

I want to add that one of the biggest mistakes students make when looking at schools is they look at those stats but those are averages. Half of the students that are admitted are below that average while the other half are above. So it's only one small piece of how you should be looking at a school.

For Sarah, interactions are the most rewarding part for her. She recalls during a rotation at a surgery clinic and met an older couple. The surgeon introduced her as the future heart surgeon and the woman looked at her and talked about she was so proud of her considering not too women actually enter this field and it was something she would have wanted to do when she was younger. Sarah didn't realize how special this is sometimes and when someone says something like this, it touches her because it means she has an impact on them and makes her realize how far she had come on this journey.

Sarah leaves us with an inspiring advice to not ever let yourself doubt yourself. You're going to be old one day anyway so don't worry about the time and the things that you have to sacrifice to go into it because in the end, everything you do is going to mean so much more than any of those momentary stresses. Sarah actually sat down with a 60-year-old taking a calculus class who told her she's going to be old one day but she wants to be old doing what she loves and having no regrets. Don't let time or any of those other stressors get in between you and your goal. You can do it. It's never impossible. Just put your blinders on and go forward.

Text PREORDER to 44222 and get instructions on how to win a copy of The Premed Playbook: Guide to the Medical School Interview as well as remind you on how to preorder the book at Barnes and Noble and the free giveaways you can get with that.

Next week on The Premed Years Podcast, I will be talking with someone who is very well-informed with healthcare, the policies and bills being pushed through. She has a podcast all about reading the bills going through Congress. I'm bringing her on the show to help you get a better understanding of what's going on in this world in the healthcare world here in the U.S. to help you prepare better in your interviews.

The Premed Playbook: Guide to the Medical School Interview (Pre-order the book and get almost $100 in giveaways. Simply test PREORDER to 44222 to get instructions on how to go about it.)

MSAR (for MD schools)

College Information Book (for DO schools)

First off, the preorder for the paperback version of my book, The Premed Playbook: Guide to the Medical School Interview is now available. It releases on June 06, 2017. To celebrate that launch, If you preorder it from Barnes and Noble, I'm giving away $100-worth of free gifts including:

Brand new mock interview platform:  Only available right now to those who pre-order the book, this tool will allow you to practice your interview skills anytime you want as well as share these videos and recordings of you interviews with mentors, advisors, friends and family. The regular price for this is $47 a month but you get a free month for pre-ordering the book.

Video series: These are 13 video courses on the medical school interview which are normally sold at $47.

To get access to these free gifts, preorder the book on Barnes and Noble before June 6, 2017. To find out more, text PREORDER to 44222.

Tying this all back into our episode today, I'm sharing with you 5 common medical school interview questions and how you can answer them to help you prepare for the entire interview process.

I will soon be interviewing a student who went through the medical school interview process last year and had 5-7 interviews. She is a great students obviously as she got several interviews. She got a great story but she didn't tell her story properly during the interviews. As a result, she didn't get in anywhere.

Then she worked with me and we did four mock interviews together. She reapplied and didn't really change anything else in her application and then she got 5-6 acceptances to great MD schools. She really turned it around because she prepared for the interview.

Being prepared for these five questions today will help you get started in the right direction in terms of preparing for the interview.

99.9% of the time, I start my interviews with tell me about yourself. When I'm interviewing a student, I almost always start with that. It's actually more of a statement than a question but why is it such an important answer for you to give?

This is basically your opportunity to take charge of the conversation. The whole goal of this interview process is to not have it be an interview. You want it to be a conversation between you and that interviewer. Pretend like you're sitting down in a coffee shop with your future or current colleague and just have a conversation.

The most common mistake students make is they recite their resume and give information the interviewer doesn't really care about or that can be read on your application. This is your time to take the reins and direct the conversation wherever you want to go.

This is essentially your opportunity to discuss some interesting things about you. If you're think you're not interesting then you're wrong. You are unique because you are telling all your experiences through the lens of your own life. You are unique and you just have to talk about yourself.

Answer this statement by diving into fun things about you such as where you grew up, about your family, brothers and sisters and growing up with them and the fun adventures you've been on with them. Dive in a little bit deeper. The goal here is to give enough details and as you're having this conversation, you are being a human. And those are the kinds of people they're going to want for the medical school class - somebody who's going to be able to communicate and be interesting.

Instead of talking about where you graduated, what you majored in, and you want to help people that's why you want to be a doctor, which they've already heard a thousand times, talk about things like your spaghetti recipe or milking cows at four o'clock in the morning. That's fun, interesting, and different.

One of the students I worked with got accepted into ten medical schools. She was a former actress and we prepared her story all around being an actress and the feedback she gave me after 11 interviews (she got ten acceptances) was that all they wanted to do was talk about her acting. Of course because it's different!

Don't underestimate your difference no matter what it is, even if you're a traditional student and you've gone to high school and college, and you've always wanted to be premed. There's something in there, a fun story, a hobby, something you can talk about and take hold of.

This is where a lot of students fall flat on the face. Wanting science and wanting to help people are not good reasons to discuss during the interview as to why you want to be a doctor.

Instead, discuss your initial motivations such as family illnesses, personal illness, child prodigy, etc. Whatever it is, be able to talk about experiences you've had that motivates you to become a doctor. These experiences are typically best shown through direct patient interactions.

For example, talk about working with Mrs. Smith or Mr. Jones and being there by their side as they're going through a procedure. Those stories you can tell along with the connections, emotions, and the impact that you can discuss that you had or they had on you or you had on them, those are the stories that the interviewer wants to hear.

Wanting to help people is not limited to being a doctor. I once took an Uber and asked the driver how he was doing and he said he's having a great time helping people. This is the perfect example of somebody that is loving their job helping people. So don't tell me that you want to be a physician because you want to help people because there are a billion and one things out there, including being an Uber driver, where you can help people.

Obviously, you need to have a combination of helping people and loving science to want to be a doctor because you have to survive prereqs with your science courses and do clinical experiences and be around patients. But it all comes down to those interactions that you've had with patients and the impacts you have seen physicians make on patients to really drive home the point about wanting to be a physician. Usually, this is also the way to write your personal statement too. The most one being what your initial motivations are for entering medicine followed by some experiences.

This is one question that a lot of students trip over. My top tip is to answer the question the interviewer gives you. When they ask for the one thing, give them one thing and not three or five or ten things. Trying to squeeze stuff in because you think it's going to make you look better may only do otherwise.

So how do you answer this? Well, you have to be able to honestly answer that. It can be as simple as being highly organized or leadership skills, listening skills, good time management. Whatever it is, be able to tell a story that supports your claim. Unfortunately, a lot of students say what they think the interviewer wants to hear but they don't actually believe in what they're saying.

So make sure you're able to back it up with a story. Tell them what that looks like and the impact your strength has. The same goes for weakness. Talk about what your weakness looks like. The more you can answer questions with stories from your life, the better your interview is going to go. Stories are more memorable. They're conversational and they're impactful.

Hard one, isn't it? So you tell them that you're motivated and determined so you're going to make a doctor and that you really love medicine. Of course, this is what you want to do. Hopefully, 99.9% of the applicants know that this is what they want to do. Knowing that you want to be a doctor is not a reason to accept you. And being self-motivated or determined or passionate in itself is not going to be a good reason either.

Hence, this is your opportunity to sell yourself and sell your skills. Be able to hit home that you're a leader because of xyz. You're passionate as illustrated by xyz. You have great time-management skills based on xyz. You are a a great team player because of your experiences with this organization.

Again, use stories to associate them with your skills and traits that you have that you think are going to make you a great classmate. How are you going to take you skills and traits and experiences and bring them to the class? As much as you can say that you want to bring this skill to the class and help you classmates in this way and be a great team player, then the interviewer would be picturing you as part of the class. Therefore, translate your skills and tell a story. How do you add to the class because they're building a community of students.

A lot of students talk about they have friends that go to that school and they love it. But this is not the way to answer this. Find out specific details of the school like specific programs you're interested in be it related to diversity or outreach. Whatever that may be, find out the specifics about the school. Look up their mission and vision statements and find out if anything resonates with you. Look for the minute details in each of these things in trying to figure out why you're applying to each of these schools. In fact, you should already know this considering you applied for this school to begin with.

Don't talk about the great ability to help the underserved as most urban academic medical centers are going to help the underserved population and this is not unique. Try not to have anything generic that you can pull out of your statement and put it into any other school. So be very specific such as the curriculum, class size, location and support structure in that area.

This is just one part of the medical school interview process. To know more, we have a lot more podcast episodes tackling that or better yet, pre-order The Premed Playbook: Guide to the Medical School Interview. Text PREORDER to 44222 and get instructions on what to do next so you can get access to my mock interview platform and video course all on the medical school school interview.

The Premed Playbook: Guide to the Medical School Interview

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OldPreMeds Podcast

The MCAT Podcast

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