Episode 20: Decisions, Decisions…


Joni chats with us about how to decide where to apply and where to go once you’re in.

If you have questions for us, please send them to pritzkerquestions@gmail.com.

[Music: Stephen Asma – Check It]


Episode 20 Transcript

Ben Ferguson: So Joni, today we’re talking about selecting a medical school and possibly choosing between two medical schools or more, if you’ve been lucky enough to have been accepted to more than one. So we do realize that we’re sort of in an overlapping timeframe here, as you said, Joni, earlier as we were talking. We realize that some people might’ve been accepted to schools already and there’s also some people who are just starting the application process and trying to figure out a list of schools to apply to. So, Joni, I want to welcome you to the show, and do you want to talk a little bit about some of the questions that people should be asking themselves, and schools as well, when they’re trying to decide where to go to school or where to apply to school?

Joni Krapec: Oh, yeah, Absolutely. I think the two biggest things that I would keep in mind for any listener out there as I go through these questions is, first of all, realizing that this is a very individual process. So what might be right for you in terms of your selection may or may not be right for your roommate or for your parent or for friends that you have who are also going through the process. So, to really pay attention to what you actually want in this process and not kind of listening to everybody else telling you what you should do or what you should not do. And then the other thing, for those people who are still in the gathering-a-list phase and will be applying for the fall of 2010, is to also to keep in mind and have conversations with pre-med advisors, thinking about where you’re competitive. Because it’s great to create kind of a list of schools, but if you’re not paying attention to the kinds of people that those schools typically accept, you might be doing yourself a disservice and kind of applying to schools that may or may not be within a good competitive range for you to apply to. So those are just kind of the two background questions that I would encourage people to kind of let float around in their head while I talk about the more exacting questions or specific questions that I encourage people to ask. Does that make sense?

BF: Sure. And certainly, I mean, it’s worth mentioning, too: It’s good to make a list of a diverse range of schools in terms of where you might fall with the current students, I guess, in terms of numbers, in terms of aptitude, and so forth.

JK: Exactly.

BF: It’s not a good idea necessarily to generate a list of, you know, 20 dream schools and expect to get into even one of them. It’s always a good idea to have sort of a backup school or school that you feel a little bit more confident about in terms of where you stand in their admissions process.

JK: Exactly. Exactly. So I can just kind of start talking through these questions, and then Ben, feel free to chime in with your perspective and kind of your insights as I talk about these.

BF: Sure.

JK: But I think for people, one of the easiest things to think about first is overall, where do you want to be geographically? And the way that I think about that is not only in terms of kind of region of the country, but also in terms of, do you want a rural environment? A suburban environment? An urban environment? How much of a priority is that for you? And also, thinking about how that might influence your patient population and what you’re able to see as you’re doing your medical training in terms of conditions and diseases presented by your patients. And then the other way that I kind of think about geography is not just area of the country, state in which you would like to live, and what kind of environment from urban to suburban or rural, but also thinking about what is the geography of the medical school to the rest of the university? Is it important to you to be on campus with the main undergraduate institution or do you mind if the medical school might be separated by a half an hour–in some cases, three hours–from the undergraduate campus with which it’s affiliated? That’s something that’s always good to kind of pay attention to.

BF: Sure. So just for examples of that, I think two that really come to my mind are something like a UCSF, where there really is no undergraduate population on that campus, and then also Northwestern, which is just right up the coast of Lake Michigan from us, where the undergrad institution is in Evanston but the medical school is downtown Chicago, which is about a 20-minute drive. So, yeah, I think it’s worth noting, again, Joni, that you just need to decide whether you need that sort of university atmosphere or whether you are just looking for the medical school perks, I guess.

JK: Exactly. And I think about it, too, which might sound silly–and maybe, Ben, you’ll agree with this, being a student here–but I not only think about whether or not you could pursue dual-degree opportunities, do some interdisciplinary work, but also thinking about, do you want to be kind of surrounded by med students all the time?

BF: Right.

JK: And for myself, even when I was in graduate school–and granted it wasn’t med school–but I needed people not in my program that were in similar trajectories in terms of also being graduate students but who not were the same people that I saw day in and day out, they were my escape valve to an extent, to have friends that were in other graduate programs across the university.

BF: Sure. Yeah, I mean, it just depends on your taste. Some people find that really distracting to have other people around and some people really appreciate the distraction. So, yeah, it’s up to you.

JK: Absolutely. And that kind of leads me into the next question that I encourage people to think about, which is, what do you want to learn? What are you trying to gain from the medical school experience? And obviously, kind of the easy answer is, well, I want to learn how to be a doctor. But in thinking about that a little bit more broadly, are you primarily focused on being a clinical physician? And so you want to learn the best clinical skills possible, the best clinical practices. That’s where you’re focusing what you want to do. Do you want to learn how to be an investigator? Whether that’s with basic science research or whether that’s clinical research, thinking about policy, economics, if you have this idea that you want to be an investigator, think about what that might mean in terms of the resources that you need available to you at that school. Maybe you’re thinking about becoming a leader within the field of medicine, which maybe sounds a little cheesy to say, you know, I want to be a leader. But for a lot of people, they think about their medical career not only in terms of an individual existence with each individual patient, but also saying, you know, eventually, I’d like to be a little bit higher level, and to think about medicine at a community level or at a state or governmental level. And that’s something to pay attention to, whether the school gives you leadership opportunities. Like we just talked about, thinking about interdisciplinary studies, how many different perspectives do you want to think about when it comes to the practice of medicine? Would it be helpful to you to know that you could pick up a sociology course or a health care economics course if you wanted to?

And then also thinking about those dual-degree opportunities. At most medical schools, doing the MSTP program, where your MD and your PhD in the sciences are kind of taking place at the same time, is a pretty reasonable thing to expect out of one medical school. But what if you have an interest in an MBA? Or you’re thinking about a public policy degree? Does that mean that you would need to physically move in order to participate in those dual-degree opportunities? And when thinking about those, how quickly do you need to know that you want to pursue a dual degree? Maybe it’s just kind of a loose idea at this point and you’re applying to medical schools where, if you’re thinking about a dual degree, you need to know immediately walking in that that’s what it is that you want to do. So that’s something else that I just kind of encourage people to think about. What are you hoping to gain from medical school not only in terms of obviously becoming a doctor but also thinking about what you are hoping to have as a part of your overall medical career, and how much help will you get with that from the medical school and the surrounding community itself?

BF: Sure, and if I could just expand on that, too. I don’t know if you’re going to talk about this a little bit later, but I think it’s worth looking into the fields that you’re interested in as well–

JK: Sure.

BF: –because if you want to come to the University of Chicago, for example, and be a psychiatrist, our psychiatry program, to be honest with you, is not very strong, at least for the medical school rotations, whereas, you know, if you want to do internal medicine, Harvard is probably a very good place to go because you’ll be working at Mass General. They have a very strong medicine program and so forth. So, I think it’s worth doing a little soul-searching. And if you have any inkling of what field you’d be interested in, or if you’re really dead set on orthopedic surgery, like some people are coming into medical school, then it might behoove you to look for schools that are associated with hospitals that are known to be strong in those fields.

JK: Exactly. And I would say, too, we’ve kind of done some loose surveys around here about, you know, when somebody does come in feeling like they know exactly what field of medicine they’re going to go into, does that actually pan out? And most people only stick with that decision about 10% of the time.

BF: Wow.

JK: So I think it’s important, as you were saying, to think about if you have strong leanings in one direction or another. Absolutely check out the resources for that at that medical school, but at the same time also think about, well, is this all that the medical school does?

BF: Sure.

JK: And granted that’s not going to be the case in most places, but if you’re thinking, I absolutely want psychiatry, and so you go to a school that has a fantastic psychiatry program, and then halfway through you kind of say, well, wait a second, now I’m getting into orthopedics and what are my chances there? I think it’s important to look to make sure that there is still a broad distribution and relative strength in all areas so that if you do decide to change once you get exposed to more fields of medicine, you don’t feel like you’re kind of sunk in terms of the opportunities that you have.

BF: Exactly, yeah.

JK: And then, the next thing that I would encourage people to think about is how do I learn? And how do I want to learn? Are you a person that’s more interested in a lecture-based format? Are you a person that is interested in problem-based learning and a more hands-on approach? Think about the overall teaching method, both within science and within the clinical medicine rotations that you will have. How will you be taught? What is the student-faculty ratio? Do you have a certain amount of autonomy? Do your faculty pay attention to what you’re saying or are they kind of just droning on along and hoping that you’ll follow along and kind of catch up eventually? I think those are all important things to be looking at when you’re considering the teaching methodology and how you will be learning this information. I think it’s also really important to think about the grading system that you have at that medical school.At some schools like ours, we have a pass-fail environment for the first two years, so we try as much as possible to take away some of that competition so you’re not feeling like I’m competing for my place in the class from day one. Other people find that that’s really important to them, and they want grades and they want to be competing for a place in the class and that’s something that they find to be a motivational strategy. So that’s something good to just kind of pay attention to.

I think it’s also really good to think about the overall flexibility that you might have in the curriculum. If you wanted to do a dual degree, do you have the flexibility of deciding that? If you wanted to do a leave of absence to pursue a research opportunity, that might be something that you’re interested in, that’s something good to pay attention to. And do I have that flexibility to step away from the curriculum if I need to? And also to think about, what flexibility do I have in terms of electives? Or, like we talked about earlier, taking on a class like health care economics that might be run by a business school at the university. Do you have the flexibility to do that?

And specifically, in terms of clinical medicine–and Ben you started talking about this when thinking about your residency choices and your specialties–where are you going to be having your patient interactions? Is it going to be faculty members from that medical school overseeing you? Or will there be adjunct faculty members? And does that matter to you? For some people, it might not. And what is your overall flexibility when it comes to choosing your rotation schedule? Getting sub-internships? Getting electives within your clinical environment? That’s something that’ll be an important thing to consider. And another thing that I encourage people to think about is whether or not this medical school has a research requirement. More and more medical schools are having a thesis requirement as part of the medical school experience, and it’s therefore important to think about, is that something that I would want to participate in? And how is that structured? That does that mean that I might need to stay at medical school for a fifth year to finish that research? And is that something that I’m willing to do?

BF: Sure. And certainly for people applying to Pritzker, you might want to go back through the archives because we are starting up a new scholarly project as part of the graduation requirements here going forward, so you might want to take a list of those as well. Something to consider, certainly. Yeah, I just want to go back to the grading system. I have always thought that the pass-fail grading system here at Pritzker has been fantastic. And I actually think it’s so important in my life that I personally, probably, if I were doing this again, would not apply to any schools with any semblance of a grading system just because it reduces so much stress in my life that I think that’s certainly a very important thing to look into. Even if you don’t necessarily find it important now, you know, you had grades in college, big deal, blah blah blah, you’d be surprised at how much stress it reduces in your life as a medical student, which is always a very important thing in terms of quality of life while being a medical student.

JK: Oh, absolutely. Absolutely. And that actually kind of leads into the next question that I encourage people to think about, which is who are you going to be learning from? And we immediately think about faculty and how prestigious are the faculty. Are they experts in their field? I always think about, do they actually want to be teaching me? Or would they rather be in their research lab? And that’s something that could influence the overall style of the classroom environment. But then I also think about, who will my classmates be? Because, obviously, Ben and I are both here at Pritzker and we see the ways in which our students are able to learn from the diverse experiences that their classmates have, and having that pass-fail environment allows you to really learn from each other because you’re not competing with each other. So think about who your classmates are and what their diversity is in terms of their educational background, where they’re from, what their overall cultural influences have been, because that all is going to feed into how you learn about your patients. And certainly you will learn about your patients. So that’s probably the people in medical school that you will learn the most from. And so it’s important, I think, to consider: what is my patient base going to be? Who will the patients be? What will their demographics be? What are some of the ways in which I’m able to learn from the patients? How early do I get to start seeing those patients? Is it an environment where you need to wait until your third year in order to gain patient experiences? Or is it a place, like it is here, where you’re starting to learn from patients right away in your first quarter of medical school? So I think about who will I learn from, not only my faculty and understanding who they are, but also in terms of my classmates and my patients.

BF: Sure. And I think this goes back also and relates a bit to the curriculum style as well, whether it’s sort of lecture-based or problem-based learning. And I’ve heard a lot about problem-based learning structures that are more sort of student-based where it’s really exclusively students teaching each other. And some others might have a faculty member or an attending present at those sessions that are sort of giving a mini-lecture before they sort of break out into small-group discussions. And sometimes it’s really just a good mix of lecture versus problem-based learning. But I personally would shy a little bit away from the problem-based learning curricula that are exclusively based on students teaching each other because, you know, I’m paying a lot of money, to be honest, to be at medical school. Everybody else is as well. And to be taught exclusively by other students and not necessarily from faculty all the time is a little bit disconcerting to me. I like to have experts in the field teaching me rather than someone who might’ve been up until 12 o’clock last night reading Wikipedia and then reading it back to me.

JK: Exactly.

BF: So that’s something that you need to consider as well in terms of who’s teaching you, and also looking into the real details of any problem-based learning curricula that are out there.

JK: Absolutely. And I think it’s also important to think about the extracurricular environment. So a question that I encourage people to ask is, what about outside of the classroom? What is there for me to participate in and do? And I think for most pre-meds, they think about free clinics and community service and research opportunities, all of which I think is really important. But then I would also think about, what are some of the social activities that people get involved with? Is this a place where I meet friends and we have a great time outside of class going out for dinner or watching sports or whatever it might be? I also think it’s absolutely appropriate to think about, what is my personal exploration within that city or within that town in which I will live? Because for most of our students, they’re going to be here for four years.

For most people, it’s kind of their mid- to upper-20s in which they might be a medical student, and so I think it’s perfectly appropriate to think about, you know, this is a good chunk of my 20s and I want to be able to enjoy the place that I am outside of medical school as well and have the opportunity to get involved with whether it’s sports, whether as a participant or as an observer, going out to great restaurants, maybe you’re somebody who loves orchestras and music, maybe you like museums. But thinking about what can I do within that city, because you don’t want–or at least I shouldn’t impose my own values. For myself, I would not want to simply have the school exclusively as my one experience or outlet for four years. I think most people need a little bit more than that and want to know that they can kind of pursue a little bit more than just being a medical student during that time of their life. And I think it’s very valid to think about that. I think sometimes in working with previous students, they think, well, that really shouldn’t matter. I should pay most attention to the medical school itself. And I don’t think that’s true. Absolutely, yes, pay attention to your medical school, but I also think that if you’re a person who loves being able to get out and do things and explore different activities, and maybe throughout your college years you were off-campus a lot getting involved in things, you don’t want to come to medical school and not have that opportunity.

BF: Yep. 100% agree.

JK: Yeah. And then I think, too, about who’s going to help me. Certainly, medical school is a great experience, but there will be times that you need help with something. Every single person will have a moment of struggle while they’re in medical school, and sometimes it has to do with medical school itself. So you want to think about what are the mentors that I’ll have available? What is the administration like? Can I talk to people? Or is it a student-unfriendly administration? But then also thinking about, what if I’m struggling outside of medical school? We all have families, we all have friends that may be going through something that puts additional strain on us during that timeframe, and so I think about, what is your overall support network going to be? Not only within the medical school, but do you have friends and family that might be nearby? What are the overall university resources? If you do need counseling that goes beyond help in biochemistry, do you have the opportunity to get involved with that? And, really, when you’re at the school and thinking about the classmates that you’re seeing and the relationships that you see among classmates, does this feel like a place where you will find your friends and where you’ll find people who are like you who will be those people that kind of give you a boost as you’re going through the medical school years?

And then going back to something that Ben alluded to a little bit earlier, how much will it cost? That is a huge question. That is a huge question to be asking. And so I encourage students to think about, what is the availability of scholarships? What is the tuition in-state versus out-of-state if you’re thinking about a public medical school, not only tuition but also think about fees. One of the things that I came to learn as an advisor was that for a lot of the California system schools, your tuition as an in-state student was ridiculously cheap. But fees is where you paid a pretty considerable amount of money, and most of it us think of fees as like a couple of hundred dollars. We don’t think about your "fees" totaling tens of thousands of dollars. And so that might be something to definitely pay attention to. Also think about the overall cost of living. Not just in terms of, what is my financial aid package? What do they budget in for cost of living? But think about, is that realistic? Think about where you are located and where you need to be. So for people who may be coming to school here at Pritzker but their families are in Florida, you’re going to need to get back and forth at least a couple times of the year for holidays. Think about where–

BF: If you choose.

JK: If you choose.

BF: Yeah.

JK: That is true.

JK: If you choose. If your mother is like mine–

BF: For some people that would be a benefit, being so far from Florida.

JK: That is true. That is true. But if anyone has a mother like mine, main holidays are not a choice.

BF: Yeah.

JK: They are a requirement. So you might need to get back. And you might be balancing a relationship with somebody that maybe you can pull it off that you’re both in the same city. Maybe you might need to be thinking about a long-distance relationship and what the not only phone bill costs, but also transportation cost of that might be to negotiate. So to think about those things. Think about the average debt levels at different institutions. We all will give you that information. Most of us have it on our website, what is the average indebtedness of a graduating person from our school. And the big thing that I encourage people to think about is, definitely consider all of those factors when you’re creating your list of schools to apply to. And for those of you that are considering among medical schools, I very much encourage people not to make a final decision or to eliminate an opportunity until they have a financial aid package in their hands. Because a lot of times, those of us that have the most expensive tuition and overall cost of attendance also have scholarship money that we can give. And so what you might see in black and white as the total cost of attendance may be very far removed from what your actual individual cost will be based on scholarship and financial aid that you’re able to receive.

And then also to really think about, especially for those of you that are currently making a decision about medical school, what is my four-year total, not what is my first-year against first-year totals.You want to compare full four years against full four years at the other institutions to make sure that your scholarship dollars hold. Think about those third and fourth years of medical school are always more expensive because you’re going to school for a longer duration of time. So think about those four-year totals back-to-back, you know, or kind of across the board before making it a firm decision.

BF: Right. Good point.

JK: And then really my final question, unless Ben wants to throw in any others, is, how do I get started with all of this? How on earth do I begin researching medical schools? A couple of just quick plugs and then, certainly Ben, feel free to chime in. I absolutely encourage people to get–the AAMC produces a book that’s called Medical School Admissions Requirements. It tells you about every single individual medical school. And it’s the only book out there that every single one of us actually writes to and gives our most up-to-date information, gives our data for the previous year. We all participate in that book. You can get it on Amazon. I think it’s like $35 or $40. Most universities have a couple of copies of it in their pre-med office as well. So definitely take a look at that.

Speaking of pre-med offices, talk to your advisors. Get their opinions. And also ask whether or not they have alumni surveys. A lot of universities will poll graduates who are now in their first year of medical school at various institutions to write their reflections on how their medical experience is and to kind of give advice back to the undergraduates at their home institution about what that medical school experience is like. So, hang out with your pre-med advisor. Get some of their advice. Check out that Medical School Admissions Requirements book. See if there’s any alumni surveys that you can have access to as well.

BF: So where would the alumni surveys be posted? Is that on school-specific sites or is that something that the advisers would have?

JK: It depends on the university. For most places, it’s becoming electronic now. But you usually need a username and a password. So it’s like, in your pre-health advisor website, you’ll see a link for alumni surveys. You click on that link and then it’s often your email address and password that’s tied to that university that gets you into those resources.

BF: Sure. So it’s not like a publication put out by the AAMC.

JK: No, no, no no. Unfortunately not.

BF: Yeah. That would be nice.

JK: Yeah. And then I encourage people to check out individual medical school websites. We all have a lot of information on there. Most prospective students go to the Prospective Student page and stop there. Do not do that. I always encourage people to go to Current Student pages as well because a lot of those Current Student pages are not password-protected, so you can gain access to class listings. Our schedule is up on our Current Student page. Every single day, you can see what our students are doing in lecture and lab. We encourage people to look at the student activities that are going on. Learn about that through the Current Student site as well. And certainly, if you stumble across our website, you’ll see these podcasts that we do. There may be other medical schools out there doing other fun things like blogs, day-in-the-life kind of stuff. I don’t know of anybody else who’s doing podcasts, but there may be some of those people out there. So check out individual school websites to get some of that advice as well.

BF: Cool! Good points. Thanks, Joni.

JK: Sure! And then, my last two cents would just be to go back to those original two questions that I asked at the very, very beginning of all of this: What is most important to you as an individual person, knowing that it might not be the same values that your friends might hold as well? And also remembering to always think about where you’re competitive. And kind of adjusting your list accordingly so, as Ben mentioned earlier, you’re not sitting there with 15 dream schools and you’re not getting interviews. You want to make sure that you’re competitive with the range of schools that you’re applying to.

BF: Right. Alrighty. Thanks, Joni. I think that’s a good start.

JK: Oh, you’re more than welcome. Thanks, Ben.

BF: Take care.

JK: Thanks. You too.

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BF: So thanks again for listening to the Pritzker Podcast. To hear more, visit iTunes or pritzkerpodcast.libsyn.com. We also hope that this is an informative resource for you. And if it is, we’d love for you to send us an email to tell us about it. You can contact us at pritzkerquestions@gmail.com and also you can comment on our podcast page directly in the iTunes telling us how we’re doing. We’d also love for you to submit questions of your own so we can address them on the air for all of our listeners. Chances are there are many people out there with the same question. Also, if you want to hear more about a certain topic in depth in the future, don’t hesitate to write in. Take care!