Choosing a Medical School: The Deal Breakers

• Curriculum
  
• Finances
  
• Location
  
• Personal Reasons
  
• Reputation

Here's a brief exploration of some things to keep in mind regarding these five categories:

Curriculum

For some, curriculum is THE definitive factor, as it tends to be a major variable among different schools. Unfortunately, a school's style is often not easy to ascertain, especially before you have the chance to visit. That said, a few dominant schools of thought have emerged, and upon visiting schools it can quickly become clear which methodology a particular school espouses. First, there is the traditional approach. Typically such a curriculum is largely lecture-based, and composed of a number of separate courses in various disciplines. For example, during the first few months of the year one might study basic science, like genetics and biochemistry, and have exams in each of these courses, which exist at entirely separate entities with separate grades, professors, etc. Later on in the year one might take courses in anatomy, physiology, etc., and again, exams and laboratory exercises would likely be separate, although clinical experiences and a limited amount of small group work is often incorporated.

On the other hand, a growing number of schools employ newer, "non-traditional" techniques, like problem-based learning (PBL). As the amount of lecture time is being decreased at many schools across the country, PBL has emerged as a more dominant, in-vogue methodology. In such a curriculum, lecture hours are typically minimized, or somehow diminished compared to those at a more traditional school, so as to accommodate group exercises. In these exercises, one is given a case study or specific assignment, which is subsequently discussed in small groups, typically facilitated by a clinician or other faculty member(s). Work is divided amongst participants, research is done at home, and subsequent presentations to the group may occur, followed by discussions. This is a relatively new initiative in medical education, having emerged more prominently over the past few decades. Its rationale is predicated upon the notion that group learning is more "active" learning, and that active learning tends to impart more longevity. As the amount of medical knowledge continues to escalate, schools have come to recognize that students cannot possibly learn everything about medicine in 4 years. Instead, curricular innovations like PBL aim to prepare students to be "lifelong learners," able to stay up-to-date in the rapidly changing field of medicine.

Clearly, there are positives and negatives to the various educational methodologies, and often what is a positive feature for some may be a drawback for others. In addition, while some schools employ a mixture of these different methodologies, a general philosophy is often evident. For example, Duke is known for being very non-traditional in its overall style, and is quite unique in placing students on the hospital wards full-time during the second year, rather than waiting until the third year as most schools do. Only a handful of other schools endorse this practice, including the University of Pennsylvania, and Baylor College of Medicine. With these differences in mind, it is particularly important to ascertain what style might work best FOR YOU, to help you make an informed choice about which school best fits your preferences. Although some worry about board scores, residency match statistics, etc., it's probably not a good idea for you to attend a school that uses a group learning style when you know you're more of a didactic or individual learner, for example. Examine the particular websites of each school, which typically contain curricular information, as well as discussion-based websites like the Student Doctor Network (www.studentdoctor.net). The AAMC also complies a "curriculum directory," which aims to detail the courses, grading philosophy, and other important aspects of each school, although it remains incomplete (http://services.aamc.org/currdir/start.cfm). In many cases, you may not be able to ascertain the curricular style of a school until you have the opportunity to interview there and speak to current students. This is often the best way to get a feel for what life is really like at a particular school, and whether or not it suits your learning style. School websites may also be helpful, many of which are easily reached via this website: http://www.aamc.org/students/applying/admissions.htm.

Some students find themselves confused about what style they prefer, and that's okay. For some, curriculum is not a critical factor in choosing a school, perhaps because both learning styles are amiable, or because other factors are much more important to them. Consider the following questions to help you ascertain which style best suits you. First, think back to those lecture-based classes you had as an undergraduate.

• What was good about this style?
  
• What was bad?
  
• Did you attend class, or prefer to learn by reading on your own, at home or in the library?
  
• Do you need the pressure of an upcoming exam to really get motivated, or do you read throughout the semester?

Next, compare and contrast this experience with that of the small seminars you might have taken.

• What was good about this style?
  
• What was bad?
  
• Did you benefit from more active participation?
  
• Was learning more, or less efficient?
  
• Was learning more, or less enjoyable?

Now think about small group projects you may have done.

• Did you thrive in this setting, or dread having to be so dependent on others?
  
• Were you frustrated at the lack of preparation from other students, or did you thrive in this environment?
  
• Did you find many projects or small group exercises to be valuable, or a waste of time?
  

Finally, consider some of your favorite classes, and ponder what made them special or educationally valuable.

Contemplating these factors may help you recognize an underlying curricular preference. And, as always, talk to students! No one knows what a school is like better than the students who live through it every day!

Finances

When faced with the difficult decision of choosing which school to attend, it's hard for money not to enter into the equation. In particular, financial aid packages can become an enormous headache, for it's not at all uncommon for a student to be offered little aid at their top choice school, whereas other institutions may offer substantial grant money, loans, or even scholarships. And tuition at state schools is typically significantly lower than at private schools. What should you do if your first choice is a private school that costs $50,000 per year, whereas your state school would only be around $5,000 per year?

There are two basic schools of thought on this issue. Some hold that it is preferable to minimize the amount of money one borrows or has to pay to attend medical school, since it becomes difficult to pay off the loans once deferment periods end, especially during residency/fellowship when salaries are quite low. That said, it is generally easy for most residents to apply for a deferment, which can cover you for up to three years of residency, and also for an unlimited period of time during fellowship training. For others, finances are simply not an issue, either because family is helping with tuition and expenses, or because of other important factors that trump financial concern. Also, loans can often be paid off over extended periods of time without much stress, although at a higher total cost. While it may initially be frightening to consider bearing the weight of $200,000 in student loans, even high totals such as this are reasonable for physicians to pay off, given the average salary rates.

But if you depend on financial aid you should make sure to compare packages from different schools. If you're unhappy with one, don't hesitate to contact the school about your situation. It's not at all uncommon for financial aid offices to adjust packages if a student anticipates hardship, or receives a better offer elsewhere. Also, remember that there are a number of different types of loans, so the total numbers presented in packages can be deceiving. Typically a large component of an offer is composed of UNSUBSIDIZED government loans, which accrue interest while you're still in school, although you typically don't have to start paying them off until you finish with school or your deferment runs out. So while a package may look great at first glance, it may not be your best option in the long run. Talk to a loan officer about it, and get help calculating your total borrowed amount over 4 years, your projected repayment, etc. It can be very enlightening and helpful.

Location

It is absolutely critical that you're familiar with your own preferences in this regard. It is quite common to hear students talk about applying to a number of schools in a particular area, which becomes quite expensive with application and interview costs, before realizing they would actually be unhappy living there! So make sure you put in lots of time thinking about places you've lived, and find out about places you know little about, even if you're sure you'd like being there. Better safe than sorry! And again, talk to students, because it's easy to get a false impression of life in a particular area after spending only a day or two there for an interview. Also, be sure to go to second look programs if they're offered to get a better idea about life at that school, in that particular area.

To help with this process, here are some specific questions you might want to think about to help flesh out your preferences:

• Where have you lived before?
  
• What type of climate do you like, and why? Is a change welcomed?
  
• Are you a city person? Why do you think so/not?
  
• Do you want to TRY to be? Make sure you test it out somehow!
  
• What activities do you like? Are they available nearby?
  
• Do you like a school located on/near its undergraduate campus?
  
• Other particular things you'd like in a city (music, food, sports, etc.)
  
• Where would you live? (apartment, townhouse, dorm, etc.)
  
• What's the cost of living in this area?
  
• Would you need a car? If so, how expensive is parking?
  

Personal

Another very common factor in choosing a school involves personal issues regarding things like proximity to family, to significant others, to a spouse, etc. Concern about how busy one will be in medical school often enters into such decisions as well. What happens if you really love a school in California, but the love of your life lives on the east coast? Do long-distance relationships work in medical school? How busy will you be? Will you have time for this person? These are very common worries that need to be considered during the decision-making process. It's up to you to know what's most important to you and decide accordingly.

Reputation

What's in a name? For some people, a name says lot! Reputation is one of those hotly debated issues, thus some applicants accordingly place a lot of emphasis on it throughout their decision process. And it makes sense. After all most pre-medical students are always working hard, striving to be the best, trying to get papers published, get into honor societies, so it's only natural that they'd also want to attend a school with the most prestige, the most door-opening power, etc. But let's face it, not everyone can go to a top 5 school, and quite honestly, one of those schools might not be the best fit for you. Ultimately, your happiness should be paramount, and if being happy means going to your state school and turning down that top 10 institution, so be it!

Realistically though, the difficulty of turning down a top school, and the bragging rights that go along with being able to say you went to that famous school everyone knows about, often lead to students making the medical school decision based almost solely on name. And there ARE some reasons why one might want to attend schools with the best reputations. First off, it is commonly said by residents, faculty, and residency program directors, that the name on your diploma will help you greatly during the residency match process. For example, many Duke students who recently went through the match process recall having received interview offers literally within minutes of submitting their electronic applications, and knew their applications were not read in their entirety before these offers were extended. Rather, they were extended offers based on their school of attendance. Many reputable sources, such as residency program directors, continually confirm this notion. However, it is also important to remember that those match lists you see everywhere need to be taken with a grain of salt. It seems that every school brags about 90 or so percent of their students getting one of their top three choices. But how do you know what those choices are? Even first-year medical students know little about what residencies are more prestigious, desirable, competitive, etc. How can you be expected to be an expert as an applicant? The answer is, you can't. So don't put too much emphasis on match data, especially since it is hardly an indicator of your happiness for 4 years. And don't neglect those other critical 4 factors discussed above.

Decision Tips

Here are some important general points for this process:

• Show initiative. Go out of your way to get as much info as you can, both about yourself and the schools you're interested in/accepted at.
  
• Start early. It's never too early to start learning about schools! Talk to advisors at your school, check out websites, utilize resources like studentdoctor.net, listed in the back of this book. .
  
• Talk to students at every school. Pick their brains. More often than not they'll be honest about the ups and downs of their school. When you interview, stay with students if you can. If a school doesn't appear to offer hosting, contact admissions and ask, because most schools do although they often don't advertise it. .
  
• Go back and visit. Go to the 2nd look weekend, but remember that it's a "show" of sorts, and might not necessarily be representative of daily life at that school. Don't be quick to judge. Remember that you might be visiting during a really tough week between a string of exams, or maybe you only talked to a certain subset of the class with whom you might not identify. Again, it all comes back to making sure you talk to as many people as possible. .
  
• If you're playing the waitlist game, don't just settle, stick with it. Show your top choice school that you want to be a student there more than anything; they'll appreciate it. Write letters, but don't be obnoxious by calling all the time. Be sincere. And remember, your happiness is really important in this process, so be sure to think twice when you're contemplating not taking that last-minute waitlist acceptance just because it means changing your plans, losing a $500 apartment deposit, etc. What's worth more, your happiness or your wallet? .
  
• Last but not least, don't be afraid to go with your gut feelings. After all, you know yourself best!