What matters in a medical school?

As a fourth-year medical student, I’m no stranger to admissions processes; I’ve been through two, am currently in one, and have at least one more ahead. At each stage, one of the most challenging elements of finding and selecting a ‘best fit’ institution is knowing, in advance, what really matters in a training program. You have an important decision before you—a four-year investment, which will provide the foundations upon which you’ll care for tens of thousands of patients—but, if you’re like me, an unclear sense of the essential factors that ought to shape that decision. What am I really looking for in a prospective institution?

I write about this now because, going through residency interviews, it’s currently all I think about. Every 15 minutes, I’m asked, “So, what questions do you have for me?” I dine with residents, interview with faculty, and tour hospitals, all to address the nebulous question of which program is optimally suitable to launch my career. My co-interviewees and I ask all sorts of queries, with widely varying degrees of significance to the training experience.

  • What is the didactics curriculum like?
  • How is your call schedule structured?
  • Where do residents live in relation to the hospital?
  • How many livers do you do each year?
  • Are there moonlighting opportunities?
  • What’s the free food situation?

It feels clumsy, murky, and at times even silly; am I really going to weigh the ‘food situation’ in my residency decision? How ‘mission-critical’ are strong didactics, case volumes, or moonlighting opportunities, really? While I can’t speak to any of those questions at present, I’ll offer my perspectives on the process on which I now do feel somewhat better equipped to advise: what matters when selecting a medical school.

Does the institution’s mission statement match yours?

A mission statement is more than boilerplate text. It outlines what the institution values and aspires to—and by extension, the role they envision for you as a future physician. My medical school, for instance, defines itself as a regional referral center for complex cases, as well as a hub for leadership, innovation, and scholarship in subspecialty care. The faculty it recruits, the programs it invests in, and the curriculum it instills all reflect those objectives. For the aspiring physician-scientist or sub-subspecialist, it’s a strong fit. For those with professional interests in ‘country doc’ or ‘safety net’ medicine, perhaps less so.

Does the curriculum align with your learning habits?

By now, you likely have a sense of how you learn and study best, so find a school where the educational activities mirror those preferences. If you like to study in groups, favor discussion-based courses, or retain content better when you can situate it in an experiential framework, look for schools that emphasize active learning over traditional lecture. If you’re unable to self-structure your time productively, maybe a school that requires attendance is best for you. The more honest you can be with yourself here, the better your chances of selecting a setting where you’ll succeed academically.

How flexible or adaptable is the curriculum to meet your goals?

Academic interests evolve, almost inevitably. Therefore, even if you’re certain a future in pediatric cardiothoracic surgery awaits, pick a curriculum that affords you the flexibility to pivot if you discover a late latent passion for, say, family medicine or geriatrics. At my medical school, for instance, the third and fourth years are almost entirely elective-driven, which gives students the flexibility to choose their own adventure and adapt as their goals shift.

Even if you’re set on your path, flexibility matters a lot. Medicine offers infinite opportunities to customize your career. In addition to the myriad specialty and subspecialty routes available, physicians can be scientists, entrepreneurs, technologists, administrators, policymakers, activists, educators, ethicists, creatives, and much more. While there are some competencies which are foundational for all physicians, your classmates paths may look profoundly different from yours, and the best curriculum is one that provides the time and resources to train you for the particular career you want.

Is there a formal, student-engaged process to elicit and implement learner feedback?

No medical school is perfect, but the best ones are committed to the idea of rapid-cycle, feedback-driven improvement. When considering a school, ask students and faculty for examples of changes in response to student-voiced needs or interests. Ask how often students have face time with educators and administrators, and what mechanisms exist for students to relay feedback—or even better, to shape administrative decisions in collaboration with deans and leaders. Of course, every school will think it achieves this objective exceptionally well, so seek input from multiple perspectives and ask for particular examples.

Is it an environment where, when you’re not in the classroom, at the library, or on the wards, you’ll be happy?

There’s a lot of down-time in medical school. While it might not feel that way the week before a block exam or during a surgery rotation, medical school (usually) won’t be your life. You will have time to pursue hobbies, hang out with loved ones, explore your surroundings, and have fun .. so make sure your environment is conducive to it. If you’re someone who draws heavily upon support from family, going somewhere distant might not be worth it. If you’re ‘single and searching,’ a small town may not be your scene. Academics matter, but four years is a long time to “grin and bear it.” Pick a place where you’ll find happiness as you define it, and where you can be the person you want to be.

But wait! What about the U.S. News and World Report rankings?

Frequently—looking at you, Indian dinner parties and Student Doctor Network forums—pre-meds wonder how much weight to ascribe to rankings when selecting a school. The unpleasant answer is: they sort of matter, but they sort of don’t.

Reputation, in itself, isn’t terribly important. But those ‘name-brand’ schools are also the tertiary or quaternary care centers where you’ll see the most complex cases, where you’ll build connections with mentors that are leaders in their respective fields, where you’ll reap the educational and scholarly resources that come with a major research institution and a generous endowment. Those opportunities aren’t necessarily exclusive to “elite” institutions, but they might come easier at some places than others. Therefore, my standard advice is this: don’t focus on the rank number, but look for the benefits and advantages that come with it.

That’s a lot to think about, so I’ll close with some words of comfort: I’ve worked under many incredibly bright and gifted residents at Vanderbilt, enough to know that it’s nearly impossible to distinguish from observing someone’s clinical skills whether he/she went to Harvard Med or State U. If you’re smart enough to get accepted to medical school and build upon that inherent intelligence with diligent effort, you can go anywhere from anywhere. When the process feels daunting, think back on that, and you’ll get through just fine.

Medical students and physicians: what do you now feel is important in a medical school that you would advise prospective students to consider?


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