The premedical baccalaureate period is critical to shaping a high-achieving, diverse, and service-oriented medical school applicant pool. The focus on achieving superior academic performance in premedical coursework captures the attention of most premedical students, but equal attention must be paid to developing the personal qualities and experiences that will form the foundation of their future capacity to understand and communicate with patients. Premedical students are best served to major in a field for authentic intellectual reasons regardless of the field's immediate connection to the health care field. There is a growing trend for applicants to have a gap year or more between the undergraduate period and medical school. The authors discuss the role of letters of evaluation and the premedical committee in the application process. The authors have more than 40 years of combined experience in premedical academic and career advising at a large, research-focused public institution.
TopBackground
The roots of the modern American medical education model can be traced to the late nineteenth century when medical educators first called for a premedical education period leading to a baccalaureate degree or its equivalent in preparation for medical training. These recommendations were established to ensure that medical trainees were properly prepared in the sciences and classics such that they would possess the academic fitness to complete a medical doctor degree that was becoming increasingly based on scientific practice (Fishbein, 2001). Decades later in 1910, in his comprehensive review of the American and Canadian medical education system, Abraham Flexner of the Carnegie Foundation concluded that “a two-year college training, in which the sciences are featured is the minimum basis upon which modern medicine can be successfully taught” and advocated further for medical departments to adopt a stricter standard of a prerequisite baccalaureate degree (Flexner, 1910). The 1920s saw the development of the the Moss Test, a forbearer of the Medical College Admission Test (MCAT), a tool designed to objectively assess an applicant’s intellectual qualities with the aim of reducing the medical school attrition rate which had climbed to as high as 50% in that period (McGaghie, 2002). In the postwar period, under the direction of the Association of American Medical Colleges (AAMC), the exam evolved into a multiple-choice test of verbal, quantitative, and science ability and knowledge of “modern society.” The MCAT has undergone numerous revisions and updates with the latest in 2015. The MCAT and the undergraduate record continue to be the key indicators of academic readiness in the medical school application process (Schwartzstein, Rosenfeld, Hilborn, Oyewole, & Mitchell, 2013).
This uniquely American rite of passage has played out for generations in elite liberal arts colleges and universities, the most prized recruiting grounds for medical schools. The decades that followed have witnessed considerable debate about the objectives of this premedical education period, and while such debates are still ongoing, a baccalaureate degree for the modern American premedical student is de rigueur. In an undergraduate experience characterized by competition, sacrifice and persistence (Richardson, Mulvihill, & Latz, 2014), the premedical student not only must demonstrate excellence in coursework, research, and service and achieve a high MCAT score, but also demonstrate mature personal development and obtain formal letters of support from several faculty. The numbers are not in the premedical student’s favor with fewer than 50% of applicants each year gaining admission to U.S. MD-granting schools (Applying to Medical School: 2018 AMCAS Medical School Applications by the Numbers, 2019).