medical school admission, medical school admissions

When we talk about academic admissions strategies, and specifically the role of intrinsic motivation or vocational calling, we’re engaging in a discussion that stretches back to at least the beginning of the 20th century. As the structure and focus of higher education has evolved throughout the modern era, so too have the tools used to determine students’ abilities and fitness for specific types of academic training, and the role of motivation has been a continuous touchstone for these discussions.

Our current array of admissions tools are, as we’ve laid out here repeatedly, imperfect. This is no surprise, nor should our expectation be that we can somehow create a perfect toolkit for student selection. However, we must continually reassess what has worked and what hasn’t, and in our current moment there are a number of near-universally accepted qualitative tools like the personal statement and in-person interview that are, perhaps, in need of some reassessment.

In this article, we’d like to discuss how these self-expressed elements in the admissions process are part of an ongoing effort to assess motivation and dedication but, crucially, do not wholly avoid bias. The personal statement, for instance, is absolutely a more effective tool than GPA at determining these subtler qualities in a student, but reliance upon it comes with some significant dangers or blind spots for which admissions committees must remain on guard. Additionally, many intrinsically motivated students find it quite difficult to adequately use these tools to their advantage, and so struggle to show to others what feels subjectively like incontrovertible truth.

The Personal Statement Translates the Personal…Almost

Whether we’re talking about medical school personal statement examples or medical school secondary essays, application and admission essays follow some general patterns. One of which is the demand to answer the question “Why do you want to be a doctor?” Some version of this question pervades all forms of self-assessment or -explanation in admissions, and on the surface it seems like a perfectly reasonable question whose answers are a matter of simple self-expression.

Our advice to students is to treat the personal statement like a story, and really focus on constructing a cohesive and engaging narrative that shows, rather than tells, why this is the case for them personally. However, this is so thoroughly dependent on written communication skills that many students, especially those who have dedicated nearly all of their educational efforts to the sciences thus far, struggle to construct such a narrative, even through months of hard work. This is also the case for students whose first language is not the one they’re using to write their personal statement, who also run into the difficulty of translating complex personal experiences into the personal statement’s narrative.

The point here is not that the personal statement is inherently ineffective or unfair, but rather that we must contextualize its value as an index of communication skills first and foremost, and of an admission of vocational zeal second. We may want to invert this, but the reality is that many talented and driven students in highly focused academic tracks struggle to develop their skills in writing enough to tackle this task especially well on their own. For younger students applying to BS/MD programs, as well as MD-PhD program applicants for whom scientific research has been a central concern, this kind of writing is especially difficult and often quite unfamiliar. We should therefore exercise caution in seeing the personal statement as an uncomplicated exercise in personal story, and instead understand its limitations as testing skills sometimes quite distinct from dedication to medicine, and in many cases more effectively developed my students already at an institutional and economic advantage.

Interviews and the Challenge of the Institution

The interview process also tells us a bit about the limitations of self-expression. In addition to “why do you want to become a doctor,” medical school interview questions often include some version of “tell me about yourself” and “what is your greatest weakness?” The point of these questions is of course not simply to trip up the student, but rather to challenge them to illustrate their ability to be introspective and reflective. This requires not only well-honed communication skills, but an ability to engage in a careful tightrope-walk of confession and constructive self-criticism.

This, again, privileges students’ abilities in communication, but this time under the immense pressure of the interview panel. To be clear, it’s not that this is somehow unfair or incorrect, but rather that these skills take a considerably long time to really develop well, often not perfectly in sync with a student’s premed timeline. In our practice, it sometimes takes months to help a student be able to naturally respond to this kind of prompt. Additionally, many students may simply not have as much personal experience that lends itself to being utilized in this context. A student who has struggled throughout their undergraduate years to work part- or even full-time in order make ends meet may not feel that they have a surplus of relevant material to use for conversational questions like these, and therefore require a significant amount of preliminary work to sort out how to translate their experiences into this context. Even with free or sliding-scale prep services available, many students simply will not have adequate time to gain comfort with exchanges like this.

The challenge in unpacking and interpreting interview answers then becomes far greater for the institution. Again, our argument is not that these kinds of ice breaker questions be scrapped altogether. But we should be aware that in order to glean anything more than conversational skills in the interview, committees have a significant responsibility to really dig into not only students’ specific utterances but into their overall history in order to contextualize their responses. Given how busy and daunting the sheer volume of exchanges like this are during interview season, it’s entirely likely that the full breadth of this work simply cannot be properly undertaken, and otherwise talented and driven students may fall through the cracks.

Work and Activities, But What if it’s All Work?

To return to the struggle of many students to support themselves throughout their undergraduate years, the AMCAS Work and Activities section and the OMSAS sketch each show us another aspect of the fundamentally limited nature of self-expression in the application process. Indeed, what if your experience as a premed was not sprinkled with regular physician shadowing and volunteering? What if your hours outside of the classroom were spent grinding away in a kitchen, or scorching your eyes with spreadsheets?

There is an obvious draw to tools like the “Most Meaningful Experiences” portion of the AMCAS Work and Activities section, in that they provide a kind of highly concentrated and controlled, even guided, exercise in self-narrative. But this narrative can be extremely difficult to construct if you haven’t been afforded the privilege of ample free time to devote to a variety of extracurriculars, and almost impossible to do within the constraints of a word-limited tool like the sketch of Work & Activities section. Given the resources to pursue such activities, virtually all students would do so—but for a not-insignificant number of them they simply cannot yet.

This then circles back to the personal statement, and of the immense pressure many hitherto-disadvantaged/underrepresented students are under to adequately capture their experience. That is, if an individual’s socio-economic circumstances significantly impaired their ability to engage in unpaid extracurriculars, they would then need to shed light on this in something like the personal statement, or in interviews. Which, again, can be quite difficult for the reasons listed above and more. And as far as illustrating genuinely intrinsic motivation, these tools are therefore quite limited, even potentially misrepresentative in some cases if a student cannot afford the time or money to adequately hone the skills and confidence needed to translate 40 hours of weekly food service work into a compelling, triumphant saga.

Medicine Beyond Vocational Romance

It’s not all doom and gloom though. Our point here is to engage in a bit of self-criticism of our own, and decisively note that while these tools are pitched as opportunities for self-expression, they come with the potential for unacknowledged bias and even counterproductive stifling of otherwise adamant vocational desire.

We want to understand students’ intrinsic motivation, and moreover we want them to be able to explain this in a sincere and illuminating way. We want to understand them as subjects, to use a dash of philosophical language—to understand how they operate and experience the world in the context of their own beliefs and values. Part of this task on the side of admissions is then to provide them the structures in which to do this, and in many cases, this isn’t so simple as asking them to do exactly this over the course of an essay or interview. We want to help initiate a process of maturation and intellectual development in order to evolve what is surely rooted in an almost primal emotional connection into something that equips the student to navigate the difficult and often bureaucratic roads ahead.

Of course, this isn’t the ultimate point of admissions selections, but it is an important part of admissions to gauge a student’s potential for undertaking this kind of development. If our goal is to create empathic, intelligent, and engaged medical professionals, we need to ensure that our strategies for selection are continually self-aware and mindful of the long-running institutional tensions of which they’re a part. In a sense, it’s a kind of de-romanticization of the very structures of education, yet without falling into purely technocratic solutions. We need to be continually and contextually aware of the way concepts like intrinsic motivation and vocation play a part in our assessment of students’ experience, even if not in those terms exactly, and continue to evolve our own selection strategies to help them communicate as clearly as possible.