Growing Up Around Medicine My name is Joyce Ho and I just finished my second year at the Stanford School of Medicine. I am currently taking a year off to do the inaugural Stanford-NBC News Global Health Media Fellowship. Stanford School of Medicine is known for accepting only a small percentage (around 3%) of its applicants, and while I am not involved with admissions in any way,  I feel I can offer some insight into the application process based off of my own experiences. I can’t point to any single reason for my acceptance into Stanford. What makes a person an appealing med school candidate stems from the overall narrative of their life. Every med school student is different, each with his or her own talents and history. However, there is one factor common to them all: passion. Where did I find my passion? Well, to a large extent, I grew up around medicine. When I was 5, my brother was born. He had a condition called cerebral palsy. Ever since I was little, my family and I would go to the hospital with my brother. We’d go to surgeries and doctor’s checkups, and little by little the doctors improved my brother’s health. Seeing the effect the doctors and other health professionals had on my family, I decided I wanted to do something similar, to help people out. Were it not for all those hours spent among doctors and nurses, watching them make the broken whole again, I might have pursued a different career.

How I got involved in high school For high school, I attended Castilleja, which is right down the street from Stanford. During the summers I volunteered at the recreational center at Lucile Packard Children’s Hospital and the Asian Liver Center at Stanford. Both were great introductions to what I could do to help patients and raise awareness of health disparities in my community.

An overview of college research and activities One of the great things about attending a big research university like Stanford is the abundance of opportunities for hands-on experience in current scientific studies. If you’re willing to take the initiative and talk to your professors about doing research, you’ll be surprised at their willingness to get undergraduate student involved. In fact, right after my freshman year I had the opportunity to work at a liver stem cell lab during the summer. After that I spent 2 years conducting research at a neurosurgery lab, which is also where I did my honor’s thesis. Your colleges want you to get involved, but you have to be willing to seek out these opportunities.

During my undergraduate years I also became interested in global health issues. I participated in a great program called Unite For Sight, which allowed me to spend a month in Ghana doing volunteer work. I was right in the villages helping with pre- and post-operative care. Even with my then limited medical knowledge I was able to help out and gain valuable experience. Later, I got to go to India with the Stanford Emergency Medicine department. India was starting it’s first consolidated 911-style emergency medical response program. They were flying in Stanford professors to teach the skills course. I got to work with a group of other Stanford students to design a leadership curriculum for their first class of paramedics. We taught the course twice in Hyderabad, and the course is now integrated into the paramedic training across several Indian states. After returning to Stanford, I founded the Stanford Service in Global Health Journal to promote on-campus discussions of global health. Support for the project was overwhelming, and the whole experience taught me a lot about leadership, journalism, and obtaining funding through grants. The journal has since grown to be a place for students and faculty to share their service experiences abroad, publish photo essays, contribute opinion editorials about current pertinent global health topics, and find new volunteer opportunities to participate in. My interest in global health has continued into medical school, as I am exploring the intersection between global health and media this year.

My life in perspective I was fortunate to be able to experiment with several facets of medicine before applying to med school. Throughout my life I’ve steadily worked toward gaining medical experience. However, I didn’t invent an AIDS vaccine; I didn’t found a billion dollar company; and I didn’t single-handedly cure an epidemic. To succeed and get into med school there are three things you need: passion, a bit of luck, and a willingness to work. If you explore what you like to do within medicine, discover and follow your passions, and end the day with something to show for your work, then all of the time and care you have devoted will come through in your application.

A common question every undergraduate asks himself is: what should I do with the limited amount of free time I have outside of class? Well, there’s no perfect formula for picking the right activities. Keep in mind that works for some people may not be the right fit for others; it really depends on what you are passionate about. Here are a few general rules that should help guide you along.

1. Explore Your Interests

It is never too early to start thinking about your future. In an ideal world, you can start thinking about what you want to do early on in life so you can start working towards that goal. Realistically, however, people need to have different experiences in order to feel inspired to pursue a career path. If you think you are interested in medicine, I would suggest talking to or shadowing physicians, medical students, or other healthcare professionals. Learn as much as you can about the field and if you can get a taste of what the field is like, then you will have a better idea of whether this job is a good fit for you. I was interested in medicine at a pretty young age, so I started volunteering at a children’s hospital after my sophomore year in high school. I also worked with the Asian Liver Center to spread hepatitis B awareness. Participating in activities like these are small steps in the long run, but are very important steps towards finding out if you want to begin the long journey of becoming a physician.

2. Figure Out Your ‘Hook’ And Develop It

The admissions committees go through an incredibly vast amount of applications – your application is one bundle of paper among thousands. This is the reason why you need a “hook”, something interesting or compelling about you. Getting the admissions people to remember you is half the battle. Even more important is figuring out your hook early on so you can develop and shape it through your activities. During my undergraduate year, I realized that my passion for global health and community health issues is what defines me as a med school candidate. Because of my interests, I participated in two different health programs abroad, one in India and one in Ghana, and created a global health journal to spark discussion in this field at the Stanford community. Through my participation in these activities I got to explore my passions and demonstrate my initiative all at the same time.

3. Don’t Be Afraid To Take A Risk

You won’t get anything done if you’re too afraid to pursue opportunities as they arise. Yes, most people have at least some underlying anxiety when it comes to getting through the applications and interviews required for a lot of the different programs available during college. It is by mastering this fear and taking advantage of every opportunity that you will succeed. I got the amazing opportunity to spend six months helping to develop a leadership curriculum for paramedics in India. I also got the chance to spend five weeks teaching this very class in Hyderabad, India. If I hadn’t responded to an email they were spamming to all the dorm lists, I would have missed out on an opportunity to make an impact on the world and to demonstrate leadership ability.

4. Have Something To Show For What You’ve Done

If you spend a significant amount of time on an activity, make sure you have something to represent your efforts at the end. No matter what activities you do, you should try to have some sort of result that you can be proud of and show off to the admissions committees. You as a student can easily work in a lab for years as a tech, but ask your mentor if you can take ownership of projects. Try to author an abstract, present at a conference, or best yet, produce an original manuscript. Another example: if you work hard at a community service activity, make contacts with individuals who can vouch for your work and serve as references for you. Apply for funding to continue the project or get the newspaper to write an article about your project. Awards and positions are like citations. The admissions committee mostly knows you through what you put on paper, and these “citations” will further support how amazing you are. An activity is worthwhile if you’re passionate about it, you’re good at it, and if you have something to show for all your effort.

5. Don’t Forget To Have Fun And Relax

Some people think you have to spend every moment either studying, volunteering, or conducting research. This is not the truth at all. Yes, you’ll have to work really hard to get into a good med school. But part of that process should involve making friends and having a good time. Otherwise, you’ll never acquire the social skills necessary for being a good doctor. Med schools aren’t looking for lifeless science robots who can name every muscle in the body but don’t know how to listen to and understand a patient. When you go into your admissions interview, they will try to get a feel for your intangibles. Basically, they’ll want to see that you’re a normal, functioning human being with the social skills needed to become a physician.

The path which will bring you from a high school student to a doctor is not always the most obvious path. It is generally pretty similar for everyone, but there are some deviations that you can make, and being prepared for them can help take your education along the best possible path.

Early Education

The path to becoming a doctor really begins in High School.  Its essential to get good grades, and to get good grades consistently. You need to demonstrate, beginning in high school, that you’re intelligent, creative, and hard-working. There aren’t many better ways to show this to educational institutions than by getting good grades and test scores.

After high school you’ll attend university. During your time as an undergrad, you’ll have to take pre-med requirements, which are basically science classes that prepare you for the MCAT and Medical school. Just as in high school, it is essential to get good grades as an undergrad, as medicine tends to be very hierarchical, and where you go to medical school will be very influential in your residency and fellowship placement, and ultimately where you will be able to work.

On to Medical School

Toward the end of your time as an undergrad, you’ll take the MCAT. The score that you receive on this test is a very important part of your Medical school application. Then you go on to Medical school, where your medical education truly begins. The beginning of medical school isn’t actually quantitatively very different from undergraduate. The main difference is just that instead of studying languages, history, and economics, you’ll only study medicine.

In the third year of medical school, you begin your clinical rotations, which are actually very different from anything you will have experienced up to that point.

The Transition to Clinicals

Clinicals are very different from the first two years of medical school, but they are somewhat similar to what you’ll experience as a resident. You basically do one rotation in each specialty, where you spend four weeks learning all about one specialty while trying to survive and impress your clinical director. Then after four weeks you go on to the next specialty and start over, and repeat the process 24 times.

Straight through or time off?

One of the other options is to consider taking some time off and doing something different during part of your education. One possibility which some people do is taking a year off the path after high school to work or travel. Personally, I took a bit of a different path, by taking time after my third year of medical school to do a clinical research year.

Understanding the Match

After medical school, there is a process called the match through which students are paired with Residency programs. Basically all medical students go and interview with a number of medical schools. Then the schools and the applicants rank their preferences, and a computer algorithm sorts out who will go to which residency.

Once you’re matched to your residency, you can celebrate and relax – until the residency begins.

Any school, program, residency, or fellowship that you apply to will receive countless applications similar to yours. Many people will have attended the same prestigious institution, received the same great grades, and aced the same exams. To be accepted to an elite institution, its necessary to go the extra mile and do something that really makes you unique, and then use your application to draw attention to whatever that is.

My Background

Personally, I come from somewhat of a unique background. My parents immigrated to a small town in Rhode Island from Hong Kong when I was a kid. Growing up, my parents worked in Laundromats and Chinese restaurants. I was the only Asian kid in my high school, possibly the only Asian kid in town, and the first person in my family to apply to college.

So when I applied to Brown, I drew out that aspect of the application, the part that made me different from the other students, as a lot of them also had good grades and test scores. But I highlighted this aspect, how I had come from very little and still managed to do well in school, and when combined with the other facets of my application, it was sufficient enough to earn me a spot in the eight year medical program.

Creating Uniqueness

Of course, not everyone can tell a story about their background similar to mine, but consider what makes your story unique. What have you done that other people haven’t? Perhaps you excel at a sport, or you’ve started a new club at your university, or you play in a band. Whatever you can do that not many other people can do should be highlighted in your application.

Additionally, it helps to be proactive about the application process. This is often overlooked by applicants, but make sure that you consciously get involved in activities that can help your application. So look for activities that can help you develop skills and build relationships which can then be highlighted on your application.

You want to draw out the aspects that will make the admissions council stop and think twice about you, rather than just looking at you as a set of test scores and grade point averages.

After four years of medical school, the next piece of a medical education is residency. Being accepted to a residency involves attending a good med school, achieving excellent results, and then finally a match process.

A Brand-Name Medical School is Key

The first part of getting matched to a top residency is getting great scores and grades as an undergraduate so that you can attend a top Med School. Medicine tends to be very hierarchical, and it very much relies on pedigree and brand names. And nationwide, there are certain brand names that people recognize. If you attend a Med School that is well known, like UCLA, USC, or Brown, then you’ll be likely to see very good results in the match.

But then there are some other schools, that don’t really have the brand name. And its important to realize that when you’re applying to residency, the brand name of the medical school that you went to has a huge impact on where you’re matched to for residency.

Tests and Evaluations

To become a doctor, you have to pass the United States Medical Licensing Exam, a three-part exam. Step one is generally taken at the end of the second year of Medical School, while Step two is taken at the end of the fourth year. Candidates’ scores on step one are typically used to predict performance in a residency.

Additionally, during the third and fourth years of medical school, you will complete your clinical rotations. From your rotation directors, you’ll receive an evaluation. Residency admissions councils use these evaluation to predict how you will perform in the residency, as clinical rotations are somewhat similar in substance to residency work.

What is a Match, Anyway?

Based on where you went to medical school, as well as your letters of recommendation and scores on Step 1 and Step 2, you are granted interviews at a number of medical schools.

Based on these interviews, the schools rank the applicants and the applicants rank the schools. Then all the choices are entered into a program, and all the results are sorted by a complicated computer algorithm. Then, sometime in March or April, all the results are released. Some schools release the results publicly, and other ones will just send a letter. It depends on the school. Generally brand-name medical schools will match to prestigious residencies with excellent results, so they will announce the results publicly.

The process of being match to a top residency is not an easy one, but as long as you’re at a top medical school, you score well on your tests, and you work hard while in your clinical rotations and impress the directors, then getting matched to a top program will not be a problem at all.

Choosing where to apply for med school, as well as where you’ll eventually enroll, is one of the most important choices you’ll make. While you are deciding which schools are right for you, here are some important things to keep in mind (in no particular order):

1. Location

Never underestimate the importance of a school’s location. The location of your school will determine what type of weather you’ll experience, the opportunities available in the surrounding area, and the people you’ll be able to visit.

I grew up in California. I love its warm weather, and my family lives there. When I was applying to medical schools, I knew I wanted to stay in California if I could.

Maybe you like cooler weather. Or maybe you want to be more independent and live farther away from your relatives. Maybe there’s an awesome city with activities that you have always wanted to experience.

These are all things that should factor into your decision.

2. Research-Centered Schools

If you’re really interested in research, you should choose a school with a good reputation for research. Some schools may have particular facilities or programs specializing in one of your main areas of inquiry. Maybe there’s a particular mentor you’d want to work with.

You can bring these questions up in your application and in your interview. Asking will demonstrate your engagement with the school and give you a grasp on what a school has to offer in terms of research opportunities.

3. Schools That Excel In Multiple Areas

First and foremost, you will want to pick schools that excel in the area you want to specialize in. Each school has its own strengths, so it’s up to you to see how those strengths align with your ambitions. Since you might change your mind about your intended specialty, you’ll want a school that does a good job with your alternative specialties.

What is also important is seeing what other quality programs a school has to offer. If you intend on pursuing an MD/MBA, you should consider a university with a good business school as well, like Harvard or Stanford.

If you were going to Stanford and wanted to get a Master of Public Health degree, you would be traveling across the Bay to take public health coursework through Berkeley. (Stanford does not have an MPH program). Other schools have MPH programs within the school, such as Columbia or Johns Hopkins.

4. Are The Students Happy?

The atmosphere and culture of a school are also important. Take a look at a school’s students and see if they’re generally happy. Remember, if you choose to go to that school, you’ll be one of those students.

If you’re going to spend 4 years of your life somewhere, you should choose somewhere where you’ll be happy.

5. Track Record

After medical school, students go into residency, where they get training in a particular specialty. You should look into previous years’ “Match lists”, which are lists of residency programs that medical students in years past have gone into. By looking at this list, you can get a feeling for what kind of future training you can reasonably expect.

What residency programs are the students going to? What specialties are they entering? (Some specialties are more competitive than others.) If you can get a sense of these trends, you’ll get an idea of how a school is perceived by residency programs.

8 year med school programs, where you go straight through and do your undergrad and medical school at the same school all as part of one program, are becoming more and more popular.

I completed an 8 year program at Brown University. So in high school, I applied to Brown, and there were a couple of boxes at the tail end of the application asking about my academic interests. I checked the “Medicine” box and wrote a short essay about medicine, believing that the more essays I wrote, the better chance I had of getting into Brown.

Ultimately, I was accepted to their eight year program, which I didn’t even realize until I was already at Brown. There are a lot of pros and cons to eight year programs, but whether they’re appropriate depends a lot on the individual program, and the individual candidate.

The Pros

If you’re even considering applying to an eight year program, that’s a good sign. It means that you’re ambitious enough to have ideas about what you want to do pretty early on.

Separately, one of the best parts about the 8-year program, at Brown at least, is that we did not have to take the MCAT. Being able to skip out on the MCAT not only makes your undergraduate experience much more enjoyable, but it also allows you to take a broad spectrum of classes. Normally you have to take a lot of Biology and Organic Chemistry in order to develop a sufficient understanding of science to excel on the MCAT. So with the eight year program, at Brown at least, you’re able to avoid this MCAT Straitjacket.

Additionally, with the program at Brown at least, there were no special requirements beyond taking basic pre-med classes. We were able to study any major, and obtain a very broad education prior to medical school. So, in a lot of ways, the program was very liberating, and allowed me to focus less on medicine as an undergraduate than I would have had to at a different school. For example, I studied computer science as an undergraduate, which I may have not been able to do without the eight year program, and which has been useful at different points throughout my career.

The Cons

When you apply to an 8 year med school program, you’re usually only 16 or 17 years old. And its very difficult to know that early on what you want to do with your life. Consider when you go to college, how many times you change your mind, and how many times you think about doing something different. College tends to be a time when people explore a lot of things and really figure themselves out. So with the eight year programs there is a bit of risk of forcing yourself to make your mind up before you know what you want to do.

There are definitely some major benefits to an eight year medical school program, but it is also important to think long and hard about why you want to be a doctor before committing to one, and to understand some of the risks of trying to force yourself to make up your mind too early.

You’ll spend four years as an undergraduate student and four years as a medical school student. Unfortunately, there aren’t many other similarities. Understanding the differences can help ease the transition and make things easier.

A Different Tack

The orientation is a little bit different between undergrad and med school. You really have to change gears. It isn’t just about exploring yourself and taking a wide variety of classes in different departments. Although medical school allows for some exploration, for example in terms of choosing your specialty , you’re not really trying to find your interests anymore. By the time you’re in medical school, you should know that you want to study medicine, and be focused within that field.

Medical School Classroom Work

The first two years of medical school are pre-clinical. In terms of the kind of work you’re doing, those two years have some similarities to undergrad. You’re still reading books, studying in the library, going to classes, and taking tests. So the substance of the work is different, in that you’re not studying history, math, or foreign languages anymore; you’re only studying medicine. But there isn’t a huge difference in kind right away.

The Transition to Clinical Work

The big transition comes in the third year, when you begin your clinical rotations. It’s almost more like work than class. It is a huge transition because clinical rotations will not be like any kind of work or study that you will have done before. Clinicals can actually give you a pretty good idea of what life is like as a resident. You’re basically working in hospital, learning all about a specialty for four weeks, then moving on to your next rotation, in a different specialty.

Additionally, there are a lot more stresses. Instead of just studying and getting good grades, like you’ve always done in school, you are working. You’re trying to do a good job in your clinical rotation, learn medicine, trying to impress your clinical directors because they will be writing your reviews, and possibly also your letters of recommendation for residency. All the while you’re trying to survive and not make any mistakes.

Perhaps most importantly, if you understand that medical school is different from undergrad and understand the ways in which it is different, it will allow you to prepare yourself for the transition and make the transition that much easier.

A medical education requires applying to many different schools and programs, as well as performing successfully in each of these programs. However, there are a couple points to keep in mind which will help you on any application process, whether you’re trying to get into an Ivy League University, a top Medical School, or a prestigious residency.

Get great grades, and get great grades consistently. You want to consistently show scholarship in your classes. Not just the classes that relate directly to medical school, but all of your classes. You want to demonstrate academic ability, creativity, and diligence.

Ace your exams every step of the way. For example, for University you take the SAT, for Medical School you take the MCAT, and for Residency there are two tests which you take during Medical School, called Step 1 and Step 2. It is essential to ace all of these exams so you can get into a great school for the next portion of your education.

However, putting so much stress on grades is not to undervalue the importance of relationships. A great letter of recommendation can do wonders to get you into a program that you might be on the fence for.  Throughout your academic career, it is essential to find advocates. These can be teachers, professors, academic counselors, thesis advisors, anyone who can advocate for you and say that you’re a great candidate.

You can’t ask a teacher or professor to write you a letter of recommendation two days before your application is due.  Identify potential advocates with whom you click, and work to develop the relationship over months and years. That way when you ask them for a letter, they’ll have excellent things to say about you.

Stand out from the crowd. You will be applying to the same school as your classmates, so make sure that you’re doing something which makes you different. Join clubs, start a club, excel at a sport, play in a band. It doesn’t matter as much what the activity is. What matters is that you demonstrate that you can be proactive, and that you can focus on a few things and really excel at them.

Also, as with anything, its important to show consistency. So don’t just join a club during your last year so that you can throw it on your application. Medical school admissions councils value consistency and dedication.

All the application processes involved in becoming a doctor can seem pretty daunting, but as long as you work hard, apply yourself, and follow these simple steps, the applications will be a lot easier.

A stellar letter of recommendation can make a good application into a great one, or get you into a school that you otherwise might not have been accepted to. So its important to plan ahead, identify the people who will write your letters early on, and build relationships with them over a long period of time. The last thing you want to do is walk into the office a professor who you hardly know and ask him for a letter two weeks before you need to send out your application.

Identify Advocates

Throughout your time in high school, university, and medical school, try to identify teachers and professors who can act as your advocates. Of course you’ll be advocating for yourself in your application, but it carries a lot more weight if someone who knows you in a professional or academic manner can also advocate for you.

It is going to be hit or miss sometimes. It’s not just finding one teacher or counselor. You’re going to be developing relationships with a lot of your teachers, professors, bosses, all kinds of professionals. And then you’ll probably find one or two who click. Then you need to be proactive, and find times to meet with them outside of class.

Build Relationships

Its important to build relationships over a long period of time, and see them regularly outside of class. This can be done through sports, clubs, school activities, or research projects. There are limitless avenues to develop meaningful relationships with people who can write letters for you.

A lot of professors consider a part of their job to write the occasional letter of recommendation. However, it will be obvious to the admissions council if the letter was written and the recommender didn’t really know you too well. So in order to get a stellar letter, you need to build meaningful relationships over a long period of time.

For example, I was involved in the academic decathlon in high school, and the club coordinator was my history teacher. So I was able to get to know my history teacher, and get to work with her a bit in a setting outside the classroom. And through that, she was able to see personality, my goals, and ambitions. She was able to witness how hard I worked, and how proactive I was in terms of my education.

On a side note, its always good to ask a humanities teacher to write a letter for you, because you know it will be a good letter. As opposed to asking a math teacher, who may really like your work, but doesn’t have as strong of a background in writing.

Getting teachers, professors, and bosses to know you, and then getting them to support you, is the best way to ensure that you get great letters of recommendation.