Medical Milestones

Kay Singer

A student who didn't want to go to medical school once admitted to me that her father had completed the common medical-school application, signed her name to it, and submitted it. Another told me that it was "culturally unacceptable" for her to delay her application to medical school for a year to strengthen her credentials. Still another revealed to me his intent to fail organic chemistry in order to sabotage any chance he might have of acceptance to medical school. He believed that, only then, would he be allowed to follow his own plans for his future instead of his parents' plan that he become a physician.

Administrators are often concerned about the "baggage" today's college students bring with them when they step on campus as freshmen. Along with the extra-long twin-bed sheets, computers, MP3 players, and worn teddy bears, freshmen bring with them parental expectations. Almost always the parents are well-meaning. Often their expectations provide a positive framework on which the student builds a college experience. However, sometimes the expectations are misplaced, particularly if the parents' goals are not the same as the student's. And in some instances, those expectations and the parental behavior they engender are actually disabling for the student.

One of the challenges I faced as the health-professions adviser at Duke was to convince students that there is no single path to pursuing a career in medicine. It is here that my advice often comes into direct conflict with that of parents. Many parents would like a road map for their student to follow that guarantees success in the application process. Many would like to accompany him or her on the trip, serving as navigator and taking over when he or she is tired of driving or distracted along the way. And many object when their student expresses reservations about becoming a physician or when she mentions the possibility of taking a year or two before entering medical school to work, volunteer in a service setting, engage in research, or pursue a career in the arts.

The fact is, there is no road map—and for very good reasons. Medical school admissions committees seek to put together a class in which everyone brings a set of uncommon experiences. During my tenure, I made certain that students had the information they needed to become strong applicants; however, they never received from me a checklist of what they needed to do to prepare for medicine. That would encourage a "check-list mentality"—shadow a doctor? Check. Conduct research? Check. The result would be a group of cookie-cutter applicants, or what one former medical school admissions dean disparagingly called "perfect pre-meds." Instead, I encouraged students to pursue their own passions and to commit themselves deeply to their academic work, independent scholarship, and activities that are meaningful to them—in other words, to distinguish themselves. I encouraged them to pursue what most interests them and then ask, "Are my interests consonant with a career as a physician?" rather than to decide they want to be a physician and then pursue activities that would "look good" on their applications.

I also encouraged students to make certain (as best they can) that medicine is the right path for them—even if it takes more than three or four years of college to do that. Many of our strongest applicants are those who took at least a year or two after college to explore areas related or unrelated to medicine. Others have delayed an application because they needed to overcome a weak academic record during their freshman or sophomore years at Duke. Many of those individuals enrolled in post-baccalaureate programs to take additional courses and strengthen their applications, and many of them are now practicing physicians. It warms my heart.

When I first started advising in 1991, the majority of our applicant pool was made up of seniors who were planning to go directly to medical school after graduating. That changed in 1997 when, for the first time, alumni applicants outnumbered seniors. Now, delaying a medical school application in order to pursue other interests for a time has become commonplace. The result is that the people entering medical school are more mature. After spending a year or more in the "real world," they are also more outward looking.

There is a conflict in medicine today. Medical schools state their intention to train humane physicians who will treat the patient, not the disease. They seek individuals who are broadly educated and have taken humanities and social-science courses in addition to science courses. But physicians are rewarded economically for spending less time with patients. Performing procedures is clearly valued over discussing preventive care with patients. The faster you can do a procedure, the more procedures you can do, and, therefore, the more income you will generate for yourself—and for the health-care organization for which you work.

Duke applicants to medical school are remarkable individuals. It is no wonder that they are extraordinarily well regarded by admissions officials. For years I have told them that medicine is all about being in a room with a relative stranger and getting him or her to open up to you and talk about very personal matters. It is my hope that they will never lose sight of that fact, even in the face of pressures to the contrary.

Singer Ph.D. '77 retired in January after fifteen years as director of Duke's Health Professions Advising Center.