Archive for category Misc

Getting into medical school: Part 1, college choice and grades

Since so many people reading this could be working in fire and EMS to get prepared for medical school, I thought I would take a little time and talk about my thoughts on this. For the people reading who are in med school already, go back to studying or go see your patients.

First, my qualifications to talk about this. Other than being an MD for 24 years, and getting into med school along with my wife, my wife and I were both on the admissions committee at MCV/VCU in our senior years and participated completely: evaluation of applications, interviewing applicants, and sitting in and voting on final decisions. Also, I have worked with hundreds of medical students over these 22 years, and I always make a point of finding out: where you went to college, what your major was, and your path to medical school. From this, I have been able to draw many conclusions about how to become a physician. I have little or no experience with DO admissions, but in general, everything is fairly similar, except your GPA and MCAT scores can be lower (about 0.2 for GPA, and about 15% lower for MCATS, these are estimates). Also, all my sons want to be physicians, so I have had to relearn some of the statistics and strategies.

Lets go through the factors and my strong opinions about them. If you are medical student or college student and think I’m wrong, you are probably wrong. If you are a Dean of Admissions at a MD or DO school and think I’m wrong, please write in and tell me where I am incorrect so the readers get the best information.

College choice: In my opinion, meaningless. There is  absolutely no reason to choose an Ivy league school over a state school solely for the purpose of improving your chance of getting in. Can you get into med school from VCU? Absolutely. Can you get in from Elon college? Absolutely. Can you get in from Liberty University? Absolutely. I have worked with multiple medical students at UVA from all these colleges. In fact one of the physicians I respect most went to community college for 2 years, then finished his degree , and was accepted at multiple places. Med school costs money, and debt hurts. While there may be other solid reasons to go to Harvard over Penn State, improving your chances at med school admissions is a very weak one. Spending $50,000/year at Princeton vs spending $15,000 at Ohio State will increase your debt by $140,000 BEFORE YOU EVEN BEGIN MEDICAL SCHOOL. And then you add the debt from medical school. If you know you want to be a physician, go to a solid school and do well and you’ll get in. If you go to Yale and have a 3.2 GPA and get a 21 on your MCATS will you get into med school? You probably have less than a 15% chance of getting in. If you go to Iowa Stae and have a 3.7 and a 28 on the MCATS, you have a 60% chance. Nuff said

Grades: You only need to remember one thing: GPA, GPA, GPA, etc. What does it mean to a med school admissions committe if you have a 3.2? It means you have trouble gathering information, processing it, and delivering that information when asked for. What do you do in med school? Gather information, process it, and deliver it. What do you do as a doctor? Gather information, process it, and deliver it. If you cant do that, you’re screwed. Do med schools care if you’re taking the high level organic chem, vs the low level “pre-med” organic chem? If someone told you they do, think of this: that admissions committee sees 10,000 applications, often they have a GPA cutoff before they even open your file (usually around 3.1-3.2) so you have a 3.0, you’re gone and they wont open your file and know what course you took. Lets say they dont filter and the file makes it to a reviewer, do you actually think that the admissions committee member knows the difference between organic chem 2301 at Harvard and organic chem 252 at UVA???  They have no idea. Maybe if youre from the same institution, they have some concept of the numberic of honors courses, but invariably they dont. So get as high a GPA as humanly possible, especially your science GPA.

I recommend you take the lowest level science courses you can for pre-med unless you are CERTAIN you can get an A. Talk to people who have taken the higher level course, look at the grade distribution, go to the web and research. If 10% of students get an A, there’s a 90% chance YOU WON’T. Will it make a difference as to the type of doctor you will become? No. Will it prepare you better for med school? Simple answer, no. More complex answer – maybe, but if you dont get into med school, you’ll never know if it prepared you better.

Next post – extracurricular activity and medical experience.


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Thanks to Tom Joyce and Orange County Fire and EMS for being the first sponsor of and We’ll try to make their investment worthwhile.

Acceptance by deception….

Acceptance by deception…what an absolutely fantastic phrase. As much as I try to read everything I can about error and screwups, it is amazing to me I had not run across it until two days ago. I pulled up the Squad Operators handbook for the rescue organization I am working with that was written by an old friend, John Burruss. In the introduction is an excerpt from an article written by Michael Wilbur, a lieutenant for the FDNY in Firehouse magazine. It describes a emergency vehicle crash, and its root causes. He says “It is bad enough that many apparatus operators take risks when driving and many of
those risks are taken unnecessarily. But in this case the operator had little or no training at all with which to take these risks and with nothing in writing what ever occurred as far as training really did not occur in the eyes of the court. For if it is not in writing, it simply did not happen in the eyes of the law. So not only do we have a young man volunteering his time that has ruined his life, we have fellow firefighters and officers that led the driver to this fate.
This is where the acceptance by deception comes into play.”
In essence, my definition would be those practices that you put into place in your organization, that you know are sub-optimal (or even dangerous) and yet you find reasons to rationalize to yourself and others that “it’ll be fine, stop whining”. This applies to training (“continuing ed is a waste of time, can’t we just say that you did it?”), release of drivers, medics, and hospital personnel (“look we need people working, some training and experience is better than none, or having no one working that shift, isn’t it?”), analysis of error (“sh*t happens, its a one-off”), corrective action (“look we don’t need to do all that, we don’t have the funds, just try harder next time”), etc., etc.
It’s possible that acceptance by deception may be the single greatest cause of mediocre performance, and error that exists.

Think about it.


It continues to astound me that a vocation that has been around as long as medicine has, continues to have so many unknowns. We don’t know the best way to teach new clinicians, the best way to measure quality, the best way to measure outcomes, or even a viable consistent method to compare clinical care between practitioners and institutions.
This is certainly not from lack of effort, but it does exemplify the incredible complexity of medical care, and the difficulties inherent in trying to teach people to effectively deliver a service with consistent results.
A big part of the issue is that “optimal” care is such a moving target. Optimal care both in and out of the hospital has changed so many times for several conditions that it really makes you wonder if what we are doing now will not be found to be detrimental in the future. ACLS and BLS are great examples of entities taught with absolute certainty 20 years ago, that now have almost entirely different care processes in 2012.
I think this is a very strong reason for decreasing the amount of factual information we ask our students to learn, and increasing the amount of tactical thinking they do. I think there is about a 0% chance that any medical textbook’s information will not be changed significantly in the next 10 years. So drilling that information into student’s heads will lead to knowledge with a potentially very short half life. However, running students through scenarios where they can identify their knowledge gaps, and then fill them, I believe, will lead to better clinicians in the future.
I did research in education for several years, and was amazed at how much was known about learning that had not made it into medical education. Only in the past 1-2 years have many medical schools begun to embrace some of this information, but we still have no good data to know if those changes are helpful.
Textbooks and multiple choice tests work well for teachers and schools because they allow teachers to give standardized tests, with standardized responses, that generate a bell curve of apparent competence. However, as the military and aviation learned, you cant have someone who knows 85% of what to do and pronounce them competent. 85% of the knowledge of how to land a plane will not work out well. Those domains demand their students to demonstrate 100% mastery of the process 100% of the time, and we should as well.
As students, it is vital that you learn to question the medical knowledge you possess. With the tremendous information access at your disposal, there is no good reason why you couldn’t Google the last 10 peer reviewed papers on diverticulitis within an hour of seeing a patient with that condition. You should then have an intelligent discussion with your teacher about why you are doing things the way you are doing, as long as it doesn’t delay emergent care. In emergent situations, following protocols is vital, but afterwards you should make certain you understand why you did what you did. Any teacher who says “this is the way we do it, because I said so” is not a good teacher, and likely not a very good clinician. Anyone who thinks they can write a care guideline that will be optimal for more than a year is probably deluding themselves. Also, be aware that national guidelines are really the “best guess” of a group of smart and experienced people. That guideline should be where you start learning and understanding what to do, not the end of it.

Here is the lecture on Tactical Decision Making I give to the medical students:

This is the lecture I give to the medical students here. I usually have to run through it pretty quickly so I thought I’d post it here so you could look at it at your leisure.



Clinical Brain Training How-To Manual

Here is the manual that shows you how to set up simulation sessions similar to what we ran for over 700 students and residents.
The how-to manual tells you the learning objectives, how we construct and present the cases, how to grade responses, and how to provide feedback. Click on the link below and then the same link on the page that comes up to get the PDF file.


The entire manual is also available for Kindle for $1 to offset the costs of putting up the website and podcast, but I’m certain you would rather get it for free by clicking the link above. If you want to pay a dollar and get the manual for the kindle, just click on the link below:
Clinical Brain Training How-To Manual

RSS and iTunes links

Thanks to David Jackson and the School of Podcasting for helping me figure out how to get iTunes and RSS links in the sidebar. Try them out.

Spam comments

Just wanted to let people know I am getting a lot of spam comments (10 spam to 1 real comment) so its getting hard to respond to the real ones. Thanks