“The waiting is the hardest part.
Every day you get one more yard.
You take it on faith, you take it to the heart.
The waiting is the hardest part.”
I heard a cover of a Tom Petty classic by Linda Ronstadt this morning on my way into work. It’s funny that I’ve heard the late, great, Tom Petty sing this song hundreds of times, but a different voice conveyed the message in a new way. There’s a larger metaphor in that, I’m sure. And as I was on my way to work, I started thinking about all the students we work with to support their goals of becoming our physicians one day. And so now you all get a blog installment.
Have you ever paused and really contemplated all the effort we collectively expend each cycle?
Students spend their young lives chasing the dream of medical school acceptance through years of schooling and co-curricular activities. Supporting families and other mentors invest nearly the same amount of time and treasure in their students. Teachers and professors impart wisdom and knowledge, and pre-health advisors on college campuses rush through thousands of desk lunches to cram in all those appointments and edit countless drafts of personal statements and resumes. Admission folks such as myself and our committee volunteers each review and interview dozens of candidates annually; each one better than the next — thanks to all of you.
It's a metric ton of work. But that’s not the hardest part.
The Annual Game of Musical Chairs
From late fall through April the annual game of musical chairs occurs where medical schools accept candidates and candidates accept medical schools. We accept students, they accept us. We deny students, they deny us. They change their minds, and we accept more students. And so it goes until the hierarchy starts to solidify. First the elites finish their class shaping, then the next tier, and so on, until we all finish shaping our classes.
I have been following the AAMC chatter critiquing the protracted length of this process. Though the AAMC Application and Acceptance Protocols (aka “traffic rules”) offer guardrails to both school officials and candidates, compliance is voluntary. April 30th is a date of significance as candidates are asked to choose the school/program to which they plan to matriculate and promptly withdraw acceptances from all other schools or programs. Of course, there is no interface with AMCAS or the recently developed Choose Your Medical School Tool that would enforce this thoughtful milestone to actually require candidates to rank acceptances and perhaps automatically rescind acceptance to the runner up schools. If that were the case, schools could move rapidly to accept wait list students in the same manner as the Supplemental Offer and Acceptance Program (the “SOAP”) after the first-round of clinical residency match. Instead, hundreds of great candidates needlessly wait for weeks on the outside looking in anticipating a seat offer. Rather than working with efficient collaboration, we rely on the kindness of strangers, so to speak, to do the right thing and take voluntary action by May 1st. I guess the litigators term cooperation benefiting students as “collusion” or something when it comes to medical school admission as opposed to when clinical entities cooperate to complete residency match. Makes perfect sense. Not really. It is indeed an imperfect world.
The Waiting Game
Like everyone else, we made our first-round of acceptance offers a while ago. The rest of our candidate pool waits patiently or impatiently, reaching out with updates and letters of commitment that hold no sway. The February through May waiting period is arguably the most mentally challenging portion of the admission process for viable medical school candidates.
So, what do I tell these candidates?
- I tell them the truth. For us at NEOMED, we have a long way to go in the process of shaping our class. We stopped sharing alternate list rankings for individual candidates several cycles ago. The fluidity with which these rankings change due to candidates receiving acceptances and finalizing plans ranges from somewhat active to extremely fluid. I have had candidates withdraw prematurely simply not understanding the nature of the process. I have counseled others who are devastated they were so close to an offer at the end and a seat did not open. Until a candidate lands her or his desired first choice, I would advise them to hang in the alternate pool until the last allowable date by a medical school.
- “Should I accept the offer to ________ ? I really want to be at NEOMED.” We get this question dozens of times annually. As my partner in this effort, Dr. Doug Moses, our dean for admission says so well, “I would tell my own daughters and my son to never turn down any offer from any medical school.” I agree. As much as I dislike the volume of acceptances and the musical chairs game, without some centralized processes established in the same vein as provided for clinical sites via match, is there a better way to assure the best fit of schools for prospective students to consider? And if you believe it is about them and not us, why would you seek to exclude that opportunity for every student to find her or his best fit?
- “Can you tell me how I can improve my application and submit updates?” Again, let’s share the truth. It’s all we can do to organize and execute a process to entertain the thousand of applications we review with as much integrity as our expertise and resources allow over an eight month interview and review cycle. Candidates really think we can do that repeatedly? As our students would say, “Naw, fam.” We are simply unable to offer re-reviews to candidates. How can we justify offering selective opportunities to some but not all? We love hearing from our candidates for no other reason than we’re here to help. But any urban legends about that magic update leading to the offer out of the blue is probably folklore. Rest assured as a candidate that you did your best and “controlled the controlables” and the rest involves circumstances. Now reaching that level of acceptance might be even harder than “the waiting”, to be honest!
I used to know everything. Ask anyone who knew me before I reached about 45 years old. It took me a while to approach our work with what begins to reflect the proper sense of humility. I now see our efforts in light of the limits of our human imperfection. No matter how much we analyze our processes and metrics, no matter how much we calibrate, redesign, and “PDCA”, introspection suggests that we will never fully escape the inherent situational and conditional biases infusing the element of chance into candidate evaluation. What we often celebrate as the “art” meeting the ”science” in any holistic process results in imperfect decisions among so many great candidates.
A pre-health advising colleague of mine just shared that near the end of every cycle he and a colleague review their candidates and try to figure out why one candidate was accepted and the other wasn’t by the same medical school when their metrics were so similar. Guess what? We do the same thing on our end. We review the list of those alternate list candidates not accepted and think about whether we could have been of greater service in hindsight.
As some of our greatest strengths are embedded in our areas of vulnerability, we started thinking at NEOMED about how to leverage these challenges to be helpful to all concerned. Accepting that we “miss” some great candidates for medical school and these candidates seek out gap year experiences anyway, we started wondering if we should create a new opportunity that benefits our next M.D. class should students complete a gap year experience at NEOMED. The thought of creating our own localized version of a SOAP scramble has inspired the transformational year early assurance program at NEOMED.
Opportunity Knocks
Starting this summer, we will work with candidates who applied for our Doctor of Medicine (M.D.) program through AMCAS for 2023 acceptance who reached our alternate list stage for whom we do not have an M.D. seat for 2023 at the end of the admission cycle. Should these candidates have an interest in completing a one-year NEOMED master’s degree as their choice of a gap year experience, we will begin to extend a limited number of early assurance opportunities for future acceptance into our M.D. cohort for 2024.
With this approach we will create a sort of end of admission cycle scramble for candidates seeking a high-value gap year credential we can then matriculate to our M.D. program where they will contribute in a distinctive manner. We want our M.D. program to be shaped by thought leaders, innovators, trail blazers of systemic global health change, and future physicians representative of the patients they will one day serve. To foster this mission, a selected group of students will complete a one-year NEOMED master’s degree in the 2023 – 2024 academic year and then matriculate into our M.D program to begin first-year study in 2024.
Here is the list of our NEOMED one-year master’s programs linked to M.D. early assurance opportunities for 2023:
- The Foundations of Medicine program
- Leadership in Health Systems Science program
- Global Health & Innovation program
- Basic and Translational Biomedicine program: Innovation Track
The prospective students we reached out to in the pilot phase of this approach over the past cycle generally asked us if these opportunities paired with future early assurance to medical school is too good to be true. It’s not too good to be true. It’s real. All of it.
Make the Connection
If you want to discover more opportunities to help your candidates who applied to NEOMED, please reach out to me to learn more. We can email, visit over Zoom, or I can connect you with one of the faculty program directors to learn more. Hit me up at JBarrett1@neomed.edu.
Together, maybe we can reshape “the waiting” from the hardest part to the most exciting part knowing there are some great backup options while anticipating the good news of acceptance to medical school.
Have a thought or something to add? Or just want to give me another perspective? I might use it in the next blog. Feel free to continue the conversation at JBarrett1@neomed.edu.
Why am I receiving this?
Whenever I speak with college advisors, faculty who mentor students, or career counselors, their curiosity and the depth of their questions always impress me. So does their motivation to help students. One week I thought it might be helpful to share thoughts and answers to frequently asked questions to a group in our region, so I dedicated several hours looking up names and emails college by college in our region. If you would rather not receive these about once-a-month, please feel free to opt out by clicking here. My intention is not to annoy anyone!
Encourage your advisees to schedule a visit whether they applied this year or are preparing to apply next year!