The cutthroat pre-med culture needs to change

I eyed my chat screen with a good amount of suspicion. A friend of a friend who I had rarely spoken to had initiated a chat conversation with me with the opening line “How are medical school apps going?” The cursor blinked in anticipation.

I began to think about possible ulterior motives that she, another pre-medical student, could have had. Perhaps she just wanted to use me as a comparison for her own chances, a gauge for her success, or an excuse to feel better about herself. I doubted if she truly cared whether I had found success or not. When it comes to premedical undergraduate students, commonly referred to as “premeds”, friends are few amongst the competition, and that’s very unfortunate.

She had asked me that same question two weeks ago when no medicals schools had contacted me about my application. I told her that nothing had changed since she inquired last. That was a lie. I had been rejected five times since then, but I didn’t want her to know that nor did I want to become the object of gossip. I had a fragile reputation to protect.

Getting into medical school is difficult and with good reason. We don’t want just anyone to wear a white coat and bear the responsibility of our medical, and often personal, secrets. The path to medical school, however, is a free-for-all of sorts – every student for him or herself. In this microcosm of intense academic pressure and high expectations, premeds often resort to underhanded tactics to overachieve.

Multiple horror stories exist detailing how competitive pre-medical students purposefully sabotaged others in order to boost their own chances. These acts range from dispensing calculated misinformation, to hogging office time with a professor, to deviously slashing the car tires of the commuting class curve setter before an exam.

It’s unsettling to think that some of these people will be our future doctors. In a career path that epitomizes selfless service where does this kind of behavior come into play? How can a competitive and sometimes subversive student suddenly metamorphose into the compassionate physician we all want to visit? More importantly, are we setting up the right kind of environment for our future doctors’ mentalities to culture in?

I often times ask other premeds why we strive for good grades. Why does an ‘A’ on an exam mean so much to a person? Often times others’ answers boil down under two generalized themes; competition or extrinsic fulfillment. In terms of competition, getting a better grade means one is doing that much better than the next student. After exams are finished, professors usually present the class with statistics on performance. Audible sighs of relief are heard when exam averages are low, thus increasing the odds that an individual premed scored well relative to the class. Getting an ‘A’ in the class is that much easier. The theory of relativity seems to resonate with this scenario. Premeds today seem to want to do just enough to be better than their competition, but not enough to satisfy a higher calling. Grades become a moving reference frame and premeds hope that it will slow down just enough for them to move ahead.

In terms of extrinsic fulfillment, getting a good grade satisfies parental or cultural expectations or medical school requirements. Some premeds have revealed that their entire motivation for medical school comes from their parents. Their parents chose medical school as their profession and forced their children into it. Sometimes cultural expectations pushed them towards medical school instead of a career they really wanted. Barring any disadvantaged conditions, extrinsic fulfillment seems a poor excuse to become a physician.

Rarely do I hear intrinsic curiosity as a reason behind getting good grades. It would seem the purest motivation behind learning has absconded for theoretical research fields, leaving most premeds without the mentality of learning for learning’s sake. As future physicians we will be learning from fellow colleagues, patients, and research literature everyday. Medical schools boast that their graduates are imbued with a love of learning after four years of rigorous academics, as if philomathy can be taught somehow. I ask, why don’t premeds already have a love of learning? For example, when I receive a test score I calculate my raw score, before I even consider the curve, and gauge my success relative to the absolute. I’ll still be disappointed in myself if I scored a C+ relative to the absolute, but a A with the curve. Is this a love of learning? I’m not sure, but it’s something closer to it than those who study to beat the curve. I’m not saying a worthy premed is one who attains academic perfection. That’s a feat reserved for a remarkable few. I’m saying a worthy premed is one who pursues perfection for genuine reasons.

Although I hold no definitive solutions, I feel a part of the answer to that question lies within medical school admissions themselves. For the most part, preliminary medical school application reviews are primarily a numbers game. Does the applicant have the right GPA and MCAT scores? While these are undoubtedly important when choosing a future physician, it’s not all that matters. Personality and character are, in my opinion, much more pertinent factors than performance in organic chemistry and English courses. That is to imply, physicians can always be taught scientific information, but character has essentially become a permanent fixture by this time in their lives. They aren’t going to change who they quintessentially are when they exit medical school. Granted, medical schools do take character into account through the examination of extracurricular activities and interview impressions, but they’ve got it backwards. I feel the preliminary application review should be one of personality. Isolate students with the makings of a great doctor and then, from that pool, pick the ones who would did well academically. A few medical schools may have already undergone this process, but more need to join to truly cause an impetus for change.

If the admissions cycle were thus spun on its head, the effects on competition would be tremendous. Students would focus less on out-competing and more on self-gauging performance. Did I do as well as I could have? Did I take the time to truly learn the material? Did I grow from this experience? The question “Did I beat the curve?” will no longer hold as much sway. The love of learning will have already been imbued in the ones who follow these notions, thus leading to a more self-selecting pool of medical school applicants – those who know they want to be physicians for the right reasons. I feel this will lead to a much more mature and introspective student, perfectly molded for medical school’s final polish.

Roheet Kakaday is a pre-medical student who blogs at The Biopsy.

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  • Magnánimo Anónimo

    I did my undergrad at an ivy league school with a very competitive premed environment. To me the solution was obvious – don’t grade on a curve. The most “cutthroat” courses were those where our grade was completely dependent on how our peers performed. In contrast I took many science courses with pre-designated grade cut offs so that in theory, every student in the class could earn an A if they performed well (of course in practice that never happened). In general I found such courses to be far more collegial. The question of whether or not performance in calculus, chemistry and physics should be used to predict performance in medical school and therefore success as a physician is well, a question for another day.

  • athelas314

    People respond to incentives.  As long as medical schools do the easy thing and look at superficial extracurriculars (done mostly to look good), interviews (that measure charisma more than character), and grades, the cutthroat will get ahead.

  • westeasterly

    “Be the change you want to see in the world”  -Mahatma Gandhi

  • http://www.facebook.com/people/Terence-Ivfmd-Lee/1523282856 Terence Ivfmd Lee

    A pure way to look at any vocational education would be as follows:
    1. SEEK TO ACQUIRE THE KNOWLEDGE AND SKILLS in whatever way you can
    2. PASS TESTING to prove that your knowledge and skills are sufficient
    3. Go out and SERVE THE WORLD

    However, medical education is subject to the politics of “regulation” and “accreditation”. Because of this, there is less room for competition and innovation. The medical schools industry gets special privilege to prevent others from competing and as a result, they control the process. Without this special privilege, then the field of medical education would be wide open to anyone who can figure out how to do it less expensively, more effectively, in less time and with a more pleasant and useful experience for students AND as pointed out in this article, with a less impersonal selection process.By the way, I teach at two standard medical schools, but I am still in favor of opening up the field to alternative options. For example, a Khan Academy model supplemented by extensive clinical shadowing sounds like a great idea to me.

  • drlisachu

    Very perceptive observations about the disconnect between the selection/training of doctors and the attributes required to actually be a healing presence to other human beings. Follow your intuition. If you nourish your core, and heal yourself, you will find a way to be of service to others, whether it is in the medical system or not. My experience is there are many, many opportunities to truly heal and support others outside of medicine and our “health care” system.

  • Christine Hall

    I remember back in the day (way back) my pre med friends getting upset when I did better in Science courses than they did – I was Pre-Law…
    Of course now, I work in a Science Education setting and see people getting into things that they THINK they want because it is really the competition that they are thriving on and finding out once they are there that is isn’t what they wanted at all…much better to start with character and experience in the field (volunteering in a medical setting, perhaps) and then looking to grades.

  • http://abnormalfacies.wordpress.com/ Jim

     Why don’t all premeds have a love of learning? Because they’re high school and college kids, and on the whole, not matured yet.

    I went to a large institution with competitive premed courses and never felt a touch of that cutthroat nature others described – mostly because I never concerned myself with it.  I made friends, got pretty good grades, and enjoyed plenty of courses that had nothing to do with pre-med requirements.

    Medical schools are under no obligation to first select for character, then grades.  There’s a surplus of applicants and so it becomes a buyer’s market.  Much easier to weed out the academically weak (however compassionate they may be), then choose your matriculants based on more subjective qualities.  Further, how do you suggest that personality or character-based screening is applied to the entire applicant pool before it’s narrowed down by academics?

  • buzzkillersmith

    The cutthroat premed culture will change when doctors get paid as much as schoolteachers.  Don’t hold your breath, young guy. 

    • LBENT

      And you will have people who don’t know how to bear up under the intense pressure of being a doctor.  And hour for hour doctors don’t get paid much more over a life time. 

  • http://profile.yahoo.com/3Z2LWLQSCNCYF7PGV35TGUYWDE Joe

    I agree with Jim. 

    Character isn’t a tangible concept. Grades are measurable and has comparative value. How do you measure someone’s character against another’s? With the resources and time available, it just isn’t feasible for medical schools to do this. And to be honest, I think most careers should require character. Why is it that only doctors should hold character to be an important quality. I think, we can only hope, that for future medical students, the medical school admissions process becomes an exercise for building character. 

    Also, the cut-throat competition isn’t only apparent for medical schools. I’ve heard of other careers that are much more competitive. Naturally, we expect character in any professional career. Although I hope my doctor is the good-hearted kind, with a good intentions, as patients, we shouldn’t always expect this. It puts a lot of pressure on doctors to always be “perfect” when they’re just human beings like you and me, who sometimes makes mistakes. I think holding doctors to a higher standard is unrealistic. Their job is important but doctors can’t cure everyone. What about the researchers, bankers, dentists, lawyers, etc…shouldn’t we hold this standard against them too? 

  • http://twitter.com/ddwebster Dana Webster

    This message could have been written by me when I was completing my undergraduate studies and deciding the cut-throat environment made it unsavory for me to even consider applying to med schools. 

    I had written an excellent article by Dr. C. Everett Coop in LIFE magazine right after my graduation.  He lamented that medicine had transformed so vastly from when he began his career and still made house calls, had the time to talk to patients, and to learn about them as part of his pathological evaluation.  7 minute exam times, fierce competition to get into med school.  He saw the personality of the phyician transform from someone interested in the patient and making them well.  Bedside manner and the ability to relate to other people were trumped by genius, GPAs, and MCAT scores.

    I regret my decision not to apply to med school.  I’ve worked closely in the medical environment since then.  I’ve spoken with hundreds of healthcare professionals, most of whom have told me not to go back.  Some have encouraged me to apply to med school.  Now in my mid 30′s, a mother of two, and a two time cancer survivor, I’m not willing to make the sacrifices needed to be successful in med school.

    I hope this healthcare crisis our country is facing will be a wake-up call that brains aren’t enough. Seeking to understand the patient should be right up there – it seems to be a skill sorely lacking in the extensive team of medical providers who now monitor my cancer post stem-cell transplant.  To them, my body is a petri dish either destroying or incubating cancer.  They forget I am a person who has gone through hell and will always carry deep personal scars from the experiences to make me well again.

  • merc

    Perhaps, but only perhaps.  If people are not pushed, with pressure, they don’t grow stronger.  Pressure is always in our lives, and it is up to each of us to determine the way we respond and grow beyond the pressure.

    Focus on your work, your worth, your learning.  Do not focus on the negatives.

  • LBENT

    Sad to read this.  My daughter didn’t experience this because she was taught to follow her interests.  And she did.  We write about it on a blog Like Mother Like Doctor.
    I coach young women who want to be or are becoming or are already physicians.  It doesn’t have to be this way.  If you are interested in personalized attention, contact me through WomenMD Resources (formerly “Expediting the Inevitable” if you want to experience the approach to a less stressful career path to becoming a woman physician.  (I am a surgeon, educator, researcher, and entrepreneur with 30 years experience in mentoring and coaching).

  • http://dr-souz.blogspot.com/ Dr Souz


    Does the applicant have the right GPA and MCAT scores? While these are undoubtedly important when choosing a future physician, it’s not all that matters. Personality and character are, in my opinion, much more pertinent factors than performance in organic chemistry and English courses.”

    Good luck getting a fair impression of someone’s personality and character through reading a couple of essays and a one hour conversation. While your point seems reasonable – there is no reliable way to measure these things. GPA’s and MCATs are standardized, thus their relevance to admissions is higher. 

    Things didn’t get to be the way they were because simultaneously 190 medical schools thought something dumb. It’s because figuring out who is and isn’t right for something is INCREDIBLY difficult. Just ask anyone who actually has to make these decisions.

  • http://twitter.com/MNAHEC Minnesota AHEC

    Certainly a concerning trend. Hopefully the profession can foster the idea that working together, rather than against each other, not only brings about better professional experiences but a better healthcare system.