Here it is, early spring of 2008 and the end of another interview season in the world of medical school admissions. As the admissions cycle unfolds over the seasons from late summer into winter and now spring, I often think of my personal experiences over two decades ago in this whole admissions process, and I have to wonder at times..."was is worth it?"

In these comments, I'd like to cover some personal reflections on the admissions process, and I would then like to generally share some observations about the process from my current perspective as an admissions dean.

The medical school admissions process can be a bit daunting as well as frustrating and exciting at the same time. There's the whole build-up of taking challenging courses, getting clinical experiences, doing volunteer and service work, trying to figure out what is being "looked for" by the medical school admissions committee, asking for the letters of recommendation, and the actual interviews themselves, if one is lucky enough to get them. And the there's all of that waiting-filling out the primary application and waiting to have it verified, waiting for the secondary applications to come. Filling those out and waiting more, then waiting to see if the interview invitations come. The interviews themselves are varied as well. Some are one-on-one, some are panels, some are faculty only, and others utilize students. At that time, having been a first generation college student, I had no idea of what to expect. The process seems a bit solitary, yet it goes on in the midst of large groups of people. By solitary, I could also consider using descriptions like selfish or self-centered. The whole process is focused on my grades, my MCAT scores and GPA, my letters of recommendation, my essays, and my interpersonal and communication skills. Yet, hasn't someone said that medicine is a "team sport"?

Now fast-forwarding a few years, I find myself in the admissions office. Things are different in some very amazing ways yet some things remain similar. Some of the differences I note include the electronic application systems for both primary and secondary applications, the electronic MCAT and all of the new elements that go along with it, the availability of scholarships, the influence of medical school rankings and how that has led to a recruitment stance on the part of medical schools. Years ago the pervasive attitude whether spoken aloud or just implied was "don't call us, we'll call you" whereas now I regularly make visits to college campuses, to recruitment fairs and host second look days, events put together to give accepted applicants another look at the medical school outside of the context of the interview day-less stressful, more relaxed.

There's still a lot of waiting, despite the faster processing. We begin interviews in the early autumn and continue into the springtime. Having just finished another round of interviews, I notice some themes that emerge:

On several occasions throughout an interview season, I have heard a faculty admissions committee member comment "I'd never get into medical school these days!" We seem to see strong GPAs, and the MCAT scores continue to rise. Why this is occurring is up for speculation, but there are clearly some bright and motivated young people who wish to study medicine. And it goes beyond the numbers, as you will see below.

In my interactions with applicants who interview at our program, and in my conversations with students and advisors around the country on my travels, there seems to be strong interest in global issues. Just exactly why is unclear, and in fact I recently had a conversation with a well-seasoned, almost ready-to-retire pre-medical advisor and former admissions dean about this phenomenon. Is it that students are truly interested in the global community? Some are. Is this felt to be another way to differentiate oneself in a sea of similarly strong and well-prepared applicants? Maybe, yet it's becoming common enough that it may no longer be the thing that helps one to "stand out". Is it just another way to have an exotic spring break while doing some good on the side? Possibly, but hopefully not the sole reason for most. For whatever reasons there are, a global awareness seems apparent. At our medical school we have found that our own medical students come in with this awareness and then proceed to play it out while in medical school by participation in interest groups, organizing activities, studying language on campus or in a foreign country and by doing medical mission trips and clerkships abroad.

Many of our applicants have been involved in research during their undergraduate years, and certainly some come with graduate work as well. Research does allow one the possibility of tangible outputs for distinguishing oneself-things like abstracts, papers, posters and platform presentations. There is clear evidence when a project has worked well enough that a peer-reviewed process acknowledges it and decides that others should know about it. Yet not all of the research work done makes it to the point of publication or presentation, and I always encourage students to figure out what they learned in the process of doing research by reflecting on that experience. Certainly they learn about the subject being researched or studied, but I hope they've learned some patience and perseverance, some teamwork skills, some oral and written presentation skills, some organizations skills, some interpersonal skills and some self-reflective practices. That seems like a lot to get out of a summer in a lab or in the field, yet I think that they can be achieved. Another key element of the research experience is that students may be able to get to know a mentor well enough to get a strong letter of recommendation. It is especially difficult for students to get letters from faculty at large universities where class sections may be prohibitively large, or at a college or university where there is no well-organized premedical committee structure.

Toward the end of interview season, when students realize that time is running out relative to the number of interview spaces available, the admissions office may get contacted in a number of ways-letters, phone calls and e-mails arrive that extol the virtues of the candidate. Some get one's attention in a positive way and despite the fact that all files get a review, sometimes a directed review can be helpful. On the other hand, most of these experiences just once again confirm why the candidate was not invited in the first place, and when they get a bit aggressive, the answer is very clear that the display of conduct-unbecoming of a physician is what is being shown.

I cannot help but think about my own experiences as a medical student during almost each day of my life right now. I finished medical school and proceeded to do residency and fellowship training in academic institutions, always intending to join a faculty. My faculty career started where I did my fellowship, and I have now been a faculty member at three medical schools. In those settings, I have had clinical service, research, teaching and administrative duties, and the experiences I have valued the most have been those related to the teaching duties. Teaching in an academic medicine setting is a little different than one might think of in more traditional settings. Even when I attempt to answer that question..."so, you teach?"....to friends and family outside of academic medicine, the answer gets complicated. I recently reread The House of God by Samuel Shem, and that experience of rereading a book I read over twenty years ago helped to provide a different degree of insight on the academic medical center. Some things are the same, others are different, yet they're all so interesting. And as an admissions dean and a faculty member, I am left wondering how have the forces at work in our world influenced the art and the practice of medicine. The science of medicine has clearly been affected by the research and technology advances. Even if one does no research, the advances of technology can impact one in this information age. It's been years since I've done things like write a progress note, open a hospital chart, called a lab for blood test results, went to the radiology department to "pull films" or write an order for a patient. These days we rely on computers to help with all of these tasks so that the good old days of a decade ago seem like remote history. I cannot honestly remember the last time I actually touched a radiograph! That amazes me. These elements of enhanced technology can help us be more efficient, and in some ways that can give us more time with the patient. After all, isn't the essence of medicine the doctor-patient relationship? Yet, I think because of our reliance on technology, the very fact that we can manipulate the data like graphing trends in vitals signs or lab results on a computer screen, or that we can order things and get the results with a few punches on the computer, we sometimes feel even more disconnected from the patients.

In summary, the medical school admissions process is challenging, frustrating and exciting all at the same time. I find it only slightly less mystifying from my current angle, yet I see admissions committee members continually committed to the process. The process is not all about finding the next entering class, but finding tomorrow's doctors. This work is also rewarding in many ways, and as a faculty member I get the added benefit of working with the student that I personally interviewed on interview day in the clinical setting, or I get asked to mentor a student I got to know early in the time here. There are many benefits to a life in medicine. Some of the most profound for me personally are to get to pass along my skills, attitudes and feelings about my vocation to enter medicine to future generations of physicians and to not only pay back the positive role models in my academic life, but also to hopefully pay forward to improve the lives of our peers. With positively influenced students, my hope is that we nurture the careers of future physicians who promote a positive attitude within our profession and toward the patients for whom we provide care. When I ask myself that important question: "was is worth it?"...only one word comes to mind: "Yes!"

Shem, Samuel. The House of God. Bantam Dell, Div. of Random House, NY. 1978.