What To Look for in a Medical School

Choosing the Right Medical School

Medical education continues to fascinate researchers, clinicians, and the popular press how physicians are trained, many believe, directly impacts how they care for patients. Since the standardization of medical curriculums in the early twentieth century, there have been numerous attempts to update medical education to meet public health goals and the evolving images of the physician in society. Educators in the 1960s expanded basic science training, hoping to create physicians who were also scientists. The 1980s brought great praise for Harvard's New Pathway program, which sought to train physicians to be better clinicians, both more humanistic and more analytical. Finally, the 1990s have seen a shift from hospital-based to office based education, emphasizing the real world of medicine and the need for more primary care physicians.
A very reasonable argument can be made that the revolutions in medicine are a lot of bunk. True, there have been marked changes in the science and organization of health care. However, compared to forty years ago, the physicians of today are probably just as (un)humanistic, (un)scientific, and {im)practical as they have ever been. The medical profession, you will soon learn, is a trade, and like masonry and carpentry, the practice may change, but the principles are still the same.

If you understand that medicine is more of a trade than it is an art, then you can also understand why the principles medical education has not changed that much, and, more important, why U.S. medical schools are not that much different from each other. Ask any practicing physician and he or she will be hard-pressed to tell you whether fellow colleagues went to Harvard or East Tennessee State even more important, he or she does not care and nor do his or her patients.
As an applicant, you should not wonder whether you will be a good doctor if you go to a top ten school or be a bad doctor if you go to a bottom-ten school. The most important question you should ask yourself is: Is this school going to help me get where I want to go and become who I want to become? There are several factors that affect this decision, and you must evaluate each one of them to decide what you want and, based on your credentials, what you can have: prestige, location, curriculum, clinical training, support services, residency matching, research emphasis, degree programs, and tuition.

Prestige

U.S. News & World Report makes an enormous amount of money every year with its pseudoscientific assessment of what makes a medical school good and, conversely, bad. Curiously, this list of medical schools doesn't exactly correlate with its ranking of the best hospitals. Why is Iowa ranked by U.S. News & World Report as one of the top-ten medical centers but not one of the top-ten medical schools? Or, alternatively, Yale one of the top-ten schools but not one of the top-ten centers? This discrepancy should concern you since a school's clinical facilities have as much impact on your education as do its researchers. Who you meet in the hospital (i.e., your professional mentors) often do more to shape your career than an institution's Nobel laureates do.
It is important to use these rankings the way most colleges use SAT scores: to group schools into one of three categories (somewhere near the top, somewhere in the middle, and somewhere at the bottom). A higher ranked school will, in general, assure you of the following: students that have lofty professional aspirations, physicianmentors with lots of research money and contacts at other major medical centers, and better match statistics. Top schools tend to inbreed a lot and thereby bolster each other's reputations, particularly on the East Coast. Prestige does not, however, guarantee some other important characteristics, such as the humanistic quality of students and physicians, opportunities for social outreach, and quality and quantity of clinical training. For example, the clinical judgment and procedural skills of some of my colleagues from the University of Southern California (a hands-on, understaffed medical center), for example, vastly e.xceeds that of some of my colleagues from top-five medical schools (centers that are routinely overstaffed with doctors).

Location

Where a school is located greatly affects your life both inside and outside of school. Attending school in a large city may mean high patient volume and more procedures but may give you a more cynical view of health care and may leave less time for teaching. Similarly, it may mean more opportunities for social outreach (public education initiatives, free clinics), but less opportunity for escaping to more quiet surroundings. Remember that this is going to be your home for four years and often more so keep your longterm goals in mind.

Curriculum

This is probably the least variable element between schools. Virtually aU schools separate education into preclinical and clinical years, and almost all schools have recently attempted to blur this distinction as much as possible. Medical education critics argued in the 1990s that patient exposure should begin as soon as possible, that the traditional basic science years do not prepare students adequately for clinical medicine, and that case-based learning is superior to lecture-based learning. Most schools have changed their curriculums to respond to these critics. Whether or not a school is making these changes, though, is less important in content than it is in style. A school that updates its curriculum is probably more progressive and more welcome to student input than one that is slow to make innovations.

A more important aspect of the curriculum is grading. There is no doubt that pass/fail systems are vastly more student-friendly than letter grading systems medical school is far more enjoyable and equally educational when it fosters cooperation rather than competition.

Clinical Training

Most applicants do not focus much on clinical training because they have little idea what it involves. In general, applicants should demand an institution that has more than one teaching facility, including preferably a Veterans Administration (VA) hospital (an excellent place to learn by doing); that encourages training in outpatient settings and outside hospitals; that has high patient volume, particularly in fields you might be interested (obstetrics, for example); and that gives students ample time for electives. Ask about the number of requirements there are beyond the standard core clerkships (medicine, surgery, psychiatry, ob/gyn, pediatrics) and whether or not students feel they have enough time to make a decision about their future careers.

Student Services

No matter how large an institution is, it may not offer medical students all the things that make student life more livable. There should be a note-taking service that is dependable (Do students prepare for exams with textbooks, syllabi, or notes?). Counselors should be available to students who are experiencing academic or personal problems (How many students have dropped out in the past year? Did they rejoin the class? How many students have committed suicide in the past five years?). Extracurricular activities should be abundant and a regular part of student life; no matter how difficult classes are, a vibrant extracurricular life speaks to a happy student body (Is there a student-run clinic, a student-run newspaper, or student-run drama production?).

Residency Match

Still a mystery to many who've been through it, the residency match is the process whereby medical students pick the hospital where they will gain their specialty training. This training will likely have a far greater impact on your education and career than your choice of a medical school. When you apply for residency, hospitals consider the reputation of your medical school, but how much this is factored in is highly variable. It is safe to say that graduates of the top five to ten schools have a distinct advantage, but, after that, it usually does not matter where you attend school. Unlike applications for college or medical school, being the big fish in a small pond usually ensures a top match, no matter how small the pond.

DO NOT go to MEDICAL SCHOOL (If This is You)

Primary Care
Though many students express an interest in primary care when applying, particularly now that admissions committees are looking for applicants to say this, few really understand the advantages and disadvantages of such a career until they get a chance to work in this setting. Nevertheless, if you are considering a career in family medicine, make sure your institution offers ample encouragement of such a career. Some top medical schools do not even have a formal family medicine department or clerkship experience. Ask about the percentage of students who pursue family medicine (not just primary care, which often deceptively includes ob/gyn), how politically powerful the family medicine department is, whether or not the hospital has a family medicine service (a sign of how busy and respected the department is), and what rural or inner city (i.e., non-Universitybased) clinical opportunities exist.

Combined-Degree Programs

It is beyond the scope of this blog to discuss all the variations on a medical school career, but suffice it to say, the opportunities are boundless. The most common advanced degree is the M.D.-Ph.D., usually pursued via the National Institutes of Health-funded Medical Scientist Training Program (MSTP). If you are considering this, remember that it is a big time commitment, a Ph.D. is not required to perform university-based research, and a number of students prematurely drop out of the program. Nevertheless, it is a powerful and prestigious degree and quite useful if you are already dedicated to a career in academic medicine. One important consideration is whether or not your program allows you to do clinical clerkships before you begin your Ph.D. studies: this is a valuable chance to expand on your research interests and to decide if you really want to work in the lab.

How to Choose the RIGHT Medical School

Other possible degree programs include Master's in Public Health (an excellent time to pursue this is between third and fourth years), JD (for those interested in malpractice or intellectual property law), and M.B.A. (for those interested in health-care policy and economics). Ask to talk to recent graduates if you are weighing one of these options.

Tuition/Financial Aid

An unfortunate trend in the past ten years has been the increase in medical school tuition, the decrease in physician salaries, and the rescinding of unlimited residenc)' deferments for most government loans. The net result? Most medical students graduate with a lot of debt and not a lot of money to pay it back. Since many of you will begin your family lives while in medical school or residency, the debt you incur now, though seemingly manageable, may severely limit your choice of career and location in the future. Strongly consider applying to your state's medical school, applying for scholarships even if they seem long shots, and asking each school for the average student debt.

Easiest Medical Schools To Get Into And Where to Apply to Medical School

You have a difficult decision ahead, but, believe it or not, this decision is not nearly as important as you think it is. Few people ever truly regret having gone to their medical school. What they regret more is not having the right perspective and guidance when they applied. Your goal in picking a school should be to find the best combination of prestige, location, clinical training, and cost. Keep in mind that you will have a life outside of medical school, that you do not want to limit your future by financial decisions you make now, and, most important, that everyone who graduates, even if last in the class, is a still a doctor.

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