Wouldn't You Like to Know? An Interview with Brenda Armstrong, Director of Admissions, Duke Medical School.

Every pre-med wants the inside scoop on how to conquer the application process. I know what you're thinking: "Who would know more about the application process than the Director of Admissions?" We all know the answer...no one! This is why we asked the Director of Admissions at Duke, Dr. Brenda Armstrong, about her candid feelings on questions that undergraduates are dying to know. Not only was this interview informative, some of the answers may surprise you.

Question one, what's the most common misconception about the medical school admissions process?

Armstrong: The most common misconception is that all you need is high grades and high MCAT scores to get into medical school. Most people come in thinking that they don't have to do the other pieces: that they're not expected to have done a fair amount of community service and volunteerism. Extracurricular leadership on campus is just as important to us as grades and MCATS.

Well&I guess you've answered my second question! How important are extracurricular activities as opposed to GPA and MCAT scores?

A: It varies from school to school but at Duke we weigh these activities the same as grades and MCAT scores. It's one of multiple parameters that we look at when we start evaluating an applicant.

How vital is research during undergrad?

A: If you are applying for an MD/PhD program, it's absolutely essential. Outside of that, you really ought to do it because you're interested in it and not because you think it will look good on your transcript. Some of it depends on the type of school you are applying to. If you are applying to a research institution it will carry some value. If you are applying to a school that is known for clinical practice, it won't be as important.

How has the admissions process changed over the last few years?

A: I think people are finally realizing that MCATs and grade point averages don't predict who will be a good doctor. It doesn't even predict who is going to be a good researcher. There are other things that are equally important that tell you about whether someone will be successful as a medical student. A great deal of it has to do with building a total picture of an applicant: looking at what their educational and personal experiences have been, whether they have had obstacles to overcome, whether they have had incredible advantages that they have used to do something with, whether they've had an investment in people, whether or not they took the time to see part of life that is different from there own so that they would appreciate it and treat it with respect and dignity if they saw it again as medical students and physicians. All of those things are very important and they are just as important as how you study for a chemistry exam or how well you prepared for the MCAT.

Does the choice of major or double majoring affect the admissions decision?

A: No&that's easy. Not only does the choice of major not have a real significant impact, whether you decide to major in two different areas does not have an impact either.

How should students use medical school rankings when deciding on schools?

A: They shouldn't. It's unfortunate that so many people put too much emphasis on these rankings that are arbitrary. They really do not measure an institution for anything more than how many research dollars they bring in and some index of how "smart the schools are" and those indices are usually MCATs and average GPAs. We all know that there are huge fallacies in trusting that and nothing else. I'm saying that coming from Duke where Duke ends up in the top 6 of these rankings every year, but if people are coming to Duke because of this they will be sorely disappointed.

What advice would you give to undergraduates who want to apply to medical school?

A: They have to realize that the process of applying to medical school starts in the first year and they should see it as a four year process. They should seek out good advice and find out who their pre-med advisors are and identify themselves early as being pre-med. They should not only take the prerequisites but take difficult courses in everything, not just science. Take difficult courses in the things that they are interested in, their majors, which may be in humanities. They should also take the time to explore a diversity of classes because it will be the last time they will be able to do that. They have to time manage very well in undergraduate school in order to be able to not only put appropriate priorities to their academics but also to have time to do something else. I would encourage students to really take the time to see medicine up close so they can decide whether or not medicine is something they really want to do.

Does it look bad to take the MCAT more than once? What if you do worse the second or third time around?

A: Most schools will take the best scores, first of all. There is a great deal of data that suggests that after two times it becomes diminishing returns in that you really don't see that much of a change.

Does one bad grade ruin an applicant's chance?

A: No. Most of us look at grades like trends. We look at the bottom line but then we look at how you got to the bottom line. We want to make sure of what happened to make you have a bad grade. If things started out bad and you worked your way through, statistical analysis will tell you that if you had a really bad semester it takes you awhile to overcome it. Instead of just looking at the bottom line we also look at trends.

What is the one thing that you always wanted to tell premeds but never got the chance to say?

A: I think the one thing that I'm so impressed about is the fact that they obsess so much at the interview and they seem so unnatural at the interview because of it. Usually I always try to tell them that no one is out to get them and that the interview day, for instance here at Duke, we try to make it a comfortable day. We try to have people that will ask questions in a respectful and inquiring way without threatening or demeaning the students. We also try to give them lots of opportunity to meet students who are the only persons who can really reassure the prospective students that they won't get eaten alive once they get here. I think of all the things I want to tell them, the top one is when they get to the interview piece of it, they really ought to relax and enjoy the day and come with an agenda to find out more about the school.

Does it look bad to take science courses away from your undergraduate institution?

A: It looks bad to take your premedical prerequisites away. You do not ever want to do that. You can take other courses that are not required but you do not want to take prerequisites anywhere other than your base school.

Scientific versus non-scientific summer programs. Does it matter?

A: I think everybody should do something related to science or health at least one summer. Whether it is research, a summer program, a shadowing or volunteering experience, I think at least one of the three summers for traditional students ought to be that kind of context.

Does it matter which medical school you attend when it comes to internship and residency positions in the future?

A: That's difficult. The real answer is that good students are everywhere. Whether you went to a "top tier school" or not, good students are everywhere. The politics of the residency match have a handicap that favors students who go to elite schools. No one will say that or stand up and say it. Truth of the matter is that if you're a good student at an elite school, it makes it easier for you as you start to look, especially among very competitive residencies. We're finding now that we have more slots than we can even fill. If you go to medical school and do well, you will stand out and people will notice that in the process. It's just that you end up having to have a set of cheerleaders at the school that is not quite so well known and you might not need that if you are coming out of a school that is very well known or thought to be a "top tier school".

Older versus younger applicants. Pros and Cons.

A: Older applicants bring a perspective of maturity that is very settling. I think the nice thing in our classes is that older students are able to put things in perspective a lot better because they have seen a little more of life. An exam does not caring the same angst for them that it will carry for a student coming right out of college. The younger students have an enthusiasm and sort of naivety about medicine that is really refreshing. Having a mix of both in the class is nice.

Do you need any clinical experience to be considered for medical school?

A: You have to some clinical experience. Even students who have limited time and focus more on research and want to get into MD/PhD programs are expected to have some clinical exposure.

Do Admissions Committees look down on taking a year off before starting medical school?

A: No. In fact we are encouraging students to do more of that because it gives students independence and maturity and we don't care what they do during that year. Most students feel they have to do an internship or something else. They don't have to do anything: they just have to be able to say "I took a year off because I needed a break before I started these intense 8 or more years". We want people to come to medical school when they are ready.

Last question: what factors go into putting a class of 100 together?

A: That's the toughest question. We try to think about people who have a number of different talents. We want people who are interested in research because this is a research institution. We want people who are interested in learning how to take care of patients and then developing newer ways of taking care of patients. We want people who might end up in research but don't want to go the MD/PhD route. We want people who are thinking about better ways to deliver healthcare and new policies for healthcare. We want women and minorities. We want the faces in our classes to look like the communities that they will go out and serve. By doing it that way, the people in our classes learn the kind of respect for patients by learning to respect their classmates and their gifts. As a result, they are much more powerfully equipped to do culturally competent care when their class is culturally competent. Those are the things that we look at.
--Kara King