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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