The "Pre-Med Mentality" & How to Cure It
Opinion: Is the pressurized culture of current pre-med students actually hurting our chances of being a better physician?
The pre-med “gunners.” You may have bumped into these people before, sat in class with them, grumbled and griped about them, or even—gasp—been one of them. It’s a term that describes students who dedicate their entire college existence to enhancing their medical school prospects, often at the expense of their peers, by fostering a sense of competition. Surely, it’s just their personalities that predispose these people to act in such a way? If not, then it must be the decimating competition of medical school admissions that breeds such behavior?
Reducing this “gunner” problem so curtly is naïve. The underlying issue of even why many of us feel so put off by the “gunners” is set in a larger epidemic—one that rises above the pressures of checking off boxes or crafting a meticulous resumé—that pervades college campuses across America. So, how can we address what I call the “Pre-Med Mentality”—this gunner mindset?
Before everyone is up in arms about my critical analysis, I confess that I too am a pre-med student. I’ve been guilty of all the things I’m going to investigate, and I have struggled to address them myself. I know full well the burden of preparing for medical school. This road is not easy, and working to correct the mindset can be equally challenging. I get it.
But if we are dedicating ourselves to such a noble profession, I would argue its preparation must uphold an equally stringent integrity. I also know pre-med students hail from all corners of higher education, and I will operate under the assumption that most of these students are concentrated in the College of Liberal Arts and Sciences. Other majors and colleges contain pre-med students, and the following lessons may also apply to you, though more indirectly.
My encounters with the Pre-Med Mentality (PMM) began as early as freshman year at UConn. Growing up as the son of two immigrants, I learned that a getting an education—more importantly, a well-rounded education—was as important as eating, breathing, and sleeping. So, as a first-year student I charted a course in liberal arts education. English literature, economics, psychology, anthropology, and philosophy peppered my class schedule between biology, chemistry, and physics. However, what I envisioned as “breaks” among my typical science courses quickly devolved into “I-don’t-have-time- to-learn-that.” More often than not, I resented completing my Logic assignments in lieu of studying for organic chemistry, which made (funnily enough) more sense. Sophomore year blurred into junior year as I struggled to balance my time examining the scientific world with thinking about the reasons why it even matters at all. And, slowly, I realized that my desire to flesh out my understanding of the world aside from molecules and proteins had dwindled.
I can hear you already saying, “But Matt, I expect my doctor to be an exquisitely trained professional. I couldn’t give two hoots about her ability to understand Plato!” And to a certain extent, you are right. Shouldn’t we expect our exorbitantly-paid, strung-out, supremely educated doctors to perform at the highest level of clinical care? I’m not arguing that they shouldn’t be. In fact, I am arguing precisely in favor of your sentiment. Medical institutions in other countries believe in this model so much so that they take their students straight from high school. But I believe that a liberal arts education builds a strong foundation for students to become far better leaders in medicine precisely because America prides itself on a higher education system that allows its students to formulate a vision of the world and prepare them to be productive members in it. To this end, the value of an education in liberal arts prior to a highly specialized training in medicine shapes us into better practitioners, researchers, and life-long learners.
To better illustrate, consider aspects of a medical career that don’t immediately come to mind. Take economics. Medicine in America is a business, no matter how obstinately we insist it ‘isn’t about the money.’ Rather than burying our heads into the sand, discerning how to run a business (from a micro and macro standpoint), studying structures of insurance payments, knowing organizational models, and balancing opportunity costs prepares students to take on the vicissitudes of the biomedical-industrial complex. With social humanities like psychology and sociology, knowing how to deal with people and approach their issues compassionately is crucial to establishing robust and meaningful patient-doctor relationships. Learning about mental health uncovers the invisible symptoms that can influence physical manifestations. These examples demonstrate not only how people behave but why, bringing to light many perspectives that can be hidden from the general population. Furthermore, thinking about ethics and philosophy is paramount in a profession that faces ethical dilemmas and challenges daily. What do you do in a situation that has no set standards of care? How can you approach a problem where your decision impacts another person’s life, but there are no good options? Why would you opt to do something or not do something and how can you justify your actions? These considerations are important beyond just theoretical musings. As a final illustration, politics and history help us scrutinize the bureaucracy of medicine, the repercussions of social determinants of health, sharpening skills in health advocacy, education, communication, and more. It’s hard to ignore the constant bickering that we hear from political leadership on the need to overhaul the health care system. There are many problems to fix, and (perhaps to our dismay) science is not always the solution.
Downplaying these aspects of liberal arts, I believe, is why we have seen a sudden rise in our “gunner” population. In an increasingly metric-measured process, things like academic pressures, hyper-specialization, and a competitive process breed a culture where motivated and intelligent students shy away from such critical components of their education. What are these barriers to overcoming the PMM and how can we address them?
Academic Pressures
(1) Scheduling problems. Fitting all of the required pre-med courses can feel nearly impossible in the four years of undergrad, let alone when thinking about volunteering, MCAT, research...the list never seems to end. However, with gap years on the rise to accommodate the mounting expectations from medical admissions committees, the additional time might actually be conducive to scheduling. So, take advantage of the extra year to explore your passion in human rights or health psychology. Use your summer and winter classes to take a writing course. Beyond just making your academic profile more interesting to admissions boards, the demonstrated interest in non-science curricula will help form a fuller picture of the people, the system, and the problems with which you will work.
(2) GPA stranglehold. It’s an undiluted fact that successful medical applicants need a strong GPA. Why risk a B- in British Literature, when you could maintain that 3.8 by skipping it altogether? Why not take the easiest electives possible to score a good grade and check off that
requirement? This is one of the biggest hurdles for any pre-med student to surmount, and perhaps why many students choose not to venture outside of the required coursework. But college, I would argue, is a time to discover the complexities of the human experience, to challenge and be challenged, and to obtain a broad education. Liberal arts are meant to provide that experience. A worse grade in a tough philosophy course may not seem like a good plan, but when you’re dealing with a patient who does not want to be resuscitated even if he can be saved you will know how to deal with the situation. If you are more realistic than idealistic, a great workaround is to take courses on a Pass/Fail basis. You still receive credit, without the stress of being graded.
(3) General Education requirements are trivialized. I noticed that many of my classmates in the courses were often uninterested in the material at hand, or perhaps unwilling to devote enough time to picking apart the details of discussion. By and large, you might hear a pre-med student say they’re getting their gen-eds “out of the way” so they can focus on what they want to learn. This line of thinking causes students to devalue the lessons they may learn outside of basic science. Though such a mindset is tough to address, I would advise taking a few courses that you find fun and would probably never be exposed to ever again in your education. Pottery, choir, nutrition, women and gender studies are a few examples that come to mind. Expand your horizons and enjoy it!
Narrow focus
(1) Mastery of knowledge requires specialization. The rigor of science courses is undeniable; they demand a constant attention to detail and deeper understanding not only of how or what, but of why. Of course, these are the things that draws pre-meds to the study of biology in the first place. But many late nights at the library to go over a signaling pathway, reviewing anatomical systems, or covering metabolic steps is exhausting in breadth and depth of knowledge. Though there is nothing inherently wrong with deeper learning, this siloed approach does not allow for cross-disciplinary learning. Dr. Keat Sanford, former dean of the UConn School of Medicine and current pre-med advisor, advises students to “look at each semester as an opportunity to provide some balance and try to get some engagement in the three areas that the Association of American Medical Colleges (AAMC) has determined important (cultural competency, interpersonal skills, professional development).” Working on these soft skills is not a waste of time and a reason that social sciences have become requisite coursework for the MCAT.
(2) Pre-professional preparation drives students to begin much earlier. I realized that my future prospects as a medical school applicant relied on academic excellence in science-related areas on top of research, volunteer work, and clinical experience. While important to building the foundation of knowledge in the field that I wanted to enter, such preparation lured my attention away from the basic ideas and ideals of a liberal arts education. Our culture of maximizing results with minimal effort (“most bang for your buck”) and instant gratification also contributed to this shifting focus. Rising costs of higher education makes it harder to think beyond preparing for a career and job, and certainly, for other technical careers this sentiment is strong. However, aspiring doctors should be comforted knowing that the rate of unemployment for physicians was 0.4% in 2014, and their median income was greater than $200,000. Despite these facts, students may still find it difficult to justify taking an indirectly related course for their professional career. Beyond the tangible benefits that I’ve already outlined, the critical thinking involved in reading literature, connecting historical events, and learning language equips students to problem-solve in situations that warrant more than just basic science knowledge.
Writing and speaking to communicate findings well and advocating for disenfranchised individuals, using statistics to peel apart convoluted data, utilizing Spanish to communicate to native-speaking patients are only a few applications of things that should be learned as an
undergraduate.
Nature of the beast
(1) Resume padding. Starting earlier in the pre-professional training has also led to the “checkbox effect.” Have you taken all the courses? Check. Have you shadowed doctors? Check. Have you started a club or joined a club about health care? Did you start doing research? Have you volunteered? Check, check, check. More often than not, the reason for engaging in activities can trace its way back to looking good for an application. Yes, it is paramount to have a good understanding of a career in medicine and to pursue extracurriculars that reflect your interest. By the same token, being passionate about what you do, trying new things for the sake of interest and not a means to an end, invariably makes you a more remarkable person and candidate. Dr. Sanford adds: “Be careful and selective what you choose to be involved in. You want to be passionate about these things so they don’t end up as checklist items on your list...it’s so transparent to schools [admissions committees].” It’s time to stop thinking like a pre-student of medicine and more like a college student interested in medicine.
(2) Numbers game. A large culprit for the PMM is certainly the numbers game that the admissions process uses. There is no escaping it. However, organizations and institutions have recognized this problem and—believe it or not—have been trying to address it for years. Holistic admissions is the process of looking at an entire person’s application package and taking the whole rather than the sum of its parts into consideration. Since the early 2000’s, several programs have adopted an “early assurance” track allow undergraduate students direct admission into affiliated medical schools, some even scrubbing the MCAT requirement altogether and pushing students to pursue a liberal education. A look at some top ranked schools will also show that the median MCAT scores and GPAs for an incoming class are rarely at the 99th percentile. That is to say, medical schools are looking for more than knowledge gurus who can test well. They are looking for interesting students who have done meaningful things. There is no set pathway or heuristic to get into medical school; what works for one student does not guarantee success for another.
Move away from this mindset of “there’s no way I can possibly get in and do this,” says Dr. Sanford. “Don’t let anyone tell you that you can’t do something.” In a process full of numbers, excelling in other areas you’re passionate about will help you stand above the crowd.Becoming a physician is exceedingly difficult now more than ever before. More students are flocking to the industry that continues to make strides in technology, research, and outcomes. We should be excited about these advancements, but not let the ends justify the means of maximizing our American higher education. The Pre-Med Mentality is a symptom of a gasping liberal arts education, and it’s preventing us from becoming the best professionals possible. If we can understand that healthcare is a team effort, that learning about more than just science builds a broader skill base, that devoting our time and effort to passion projects will enable us to connect with our patients more effectively, then we stand to serve as better thinkers, leaders, and practitioners. With luck, we might shed the PMM and along the way also become better people. But hey, what do I know—I’m just a “gunner.”
About the Author: Matthew Lin is a Biological Science major in his senior year. He will be heading to medical school next year.
References:
Bureau of Labor Statistics, U. S. D. of L. (2017). Physicians and Surgeons : Occupational Outlook Handbook. Retrieved January 4, 2018, from https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm#tab-1
MarketWatch. (2016). 10 professions with the best job security. Retrieved January 4, 2018, from https://www.marketwatch.com/story/10-professions-with-the-best-job-security-2015-03-20 Medical Doctor International Studies. (n.d.). Medical Studies In Europe: Schools and Costs. Retrieved January 4, 2018, from https://www.medicaldoctor-studies.com/study-medicine-abroad/
Mead, Walter Russell (April 25, 2017). The Vanishing Liberal Arts Degree. Retrieved from https://www.the-american-interest.com/2017/04/25/the-vanishing-liberal-arts-degree/
Nguyen, R. (2013). The Gunner Mentality. Retrieved December 18, 2017, from https://futuremedblog.wordpress.com/2013/10/08/the-gunner-mentality/