The Complete MD/PhD Applicant Guide: How to Become a Double Doctor [1st ed.] 9783030556242, 9783030556259

Table of contents :
Front Matter ....Pages i-xxv
What Is an MD/PhD? (Jonathan Sussman, Jordan Setayesh, Amitej Venapally)....Pages 1-6
What Do MD/PhDs Do and Who Should Become One? (Jonathan Sussman, Jordan Setayesh, Amitej Venapally)....Pages 7-16
Prerequisite Requirements (Jonathan Sussman, Jordan Setayesh, Amitej Venapally)....Pages 17-29
The MD/PhD Application Basics and Timeline (Jonathan Sussman, Jordan Setayesh, Amitej Venapally)....Pages 31-44
Researching Schools: Where to Apply (Jonathan Sussman, Jordan Setayesh, Amitej Venapally)....Pages 45-53
The Personal Comments Essay (Jonathan Sussman, Jordan Setayesh, Amitej Venapally)....Pages 55-58
The MD/PhD Essay (Jonathan Sussman, Jordan Setayesh, Amitej Venapally)....Pages 59-60
The Significant Research Experience Essay (Jonathan Sussman, Jordan Setayesh, Amitej Venapally)....Pages 61-65
The Work and Activities Section (Jonathan Sussman, Jordan Setayesh, Amitej Venapally)....Pages 67-76
Secondary Applications and the CASPer Test (Jonathan Sussman, Jordan Setayesh, Amitej Venapally)....Pages 77-88
Interview Invitations: What to Expect (Jonathan Sussman, Jordan Setayesh, Amitej Venapally)....Pages 89-96
Interview Types: Preparation and Strategy (Jonathan Sussman, Jordan Setayesh, Amitej Venapally)....Pages 97-117
The Waiting Game: It’s Not Over Yet (Jonathan Sussman, Jordan Setayesh, Amitej Venapally)....Pages 119-126
Acceptances, Second Looks, and Matriculation (Jonathan Sussman, Jordan Setayesh, Amitej Venapally)....Pages 127-130
Additional Resources (Jonathan Sussman, Jordan Setayesh, Amitej Venapally)....Pages 131-184
Back Matter ....Pages 185-189

Citation preview

The Complete MD/PhD Applicant Guide How to Become a Double Doctor Jonathan Sussman Jordan Setayesh Amitej Venapally

123

The Complete MD/PhD Applicant Guide

Jonathan Sussman • Jordan Setayesh Amitej Venapally

The Complete MD/PhD Applicant Guide How to Become a Double Doctor

Jonathan Sussman Perelman School of Medicine University of Pennsylvania Philadelphia, PA USA

Jordan Setayesh University of Michigan Medical School University of Michigan Ann Arbor, MI USA

Amitej Venapally Emory School of Medicine Emory University Atlanta, GA USA

ISBN 978-3-030-55624-2    ISBN 978-3-030-55625-9 (eBook) https://doi.org/10.1007/978-3-030-55625-9 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

We are deeply grateful to the myriad of people who have made our journeys toward becoming physician-scientists possible. We would like to dedicate this book to our families, who have supported us in every possible way throughout our academic and personal endeavors; our academic and research mentors, who have invested time and resources into our development as scientists and future physicians; and, last but not least, the administrators and students within our respective MD/PhD programs, with whom we look forward to developing long-lasting friendships and collaborations.

Foreword

Applying to MD/PhD programs used to be comparatively straightforward. My own handful of applications were submitted in 1969, in the fall of my final year of college. I didn’t spend a lot of time preparing to do it and I don’t recall studying much for the MCAT. I was a chemistry major, went to a well-reputed college, and spent my spare time and summers working in the lab of my undergraduate chemistry advisor. He didn’t know anything about MD/PhD programs, but he was kind enough to write a positive, but brief, letter of recommendation despite his skepticism about combining graduate school and medical school. After all, who would have thought that one person could be both a scientist (a full-time job) and a physician (also a full-time job)? All I had to keep me moving forward was the vague notion that doctors can do more than treat patients and that being trained as both a physician and a scientist would allow me to spend time digging into how things work, which appealed to me. In contrast to many of you who are reading this, I had done very little volunteering in clinical settings, hadn’t spent my college breaks doing international service programs, hadn’t started a business, taken an MCAT prep course, thought deeply about the role of physician-scientists in society, and didn’t know how to play a musical instrument, let alone play it well. In short, I had done few of the many things that the accompanying guidebook talks about when I applied to a handful of programs in 1969. MD/PhD programs had been around for a while (the earliest started in the 1950s), but there were not many of them yet, and the list of places to apply was short enough to fit on one of the back pages of a pamphlet that I picked up about applying to medical school. Probably from the AAMC. How things have changed in the 50 years since. Where dozens of recent college graduates (mostly white men) began MD/PhD programs in 1970, there are now about 1900 men and women who apply to MD/PhD programs every year and 700 who are accepted. Where there used to be a handful of small MD/PhD programs,

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there are now 90 active programs ranging in size up to about 200 total students, many of whom spent 1–3 years working full time in a research setting after graduating from college [1, 2]. The haphazard approach to applying that I followed is less likely to be successful now. Instead, applying to MD/PhD programs has become a carefully choreographed dance that often begins early in college and requires applicants to devote as much time as possible improving their grades, MCAT scores, activity portfolios, research and clinical experiences, and obtaining letters of recommendation. In short, it has taken on the qualities of a part-time job whose demands help to explain why the number of applicants to MD/PhD programs has been flat for years, while the number of applicants to medical school continues to grow [3–5]. The time and the costs help to raise the barrier of entry to otherwise compelling candidates who either have never spoken to someone who is a physician-scientist or who lack the financial wherewithal to apply. Lest you choose to put this book back on the digital rack and run away to seek a job in a tech startup, let me add some heartfelt words of encouragement: a career as a physician-scientist is truly a thing of wonder. If Cinderella’s fairy godmother pulled up beside me in her pumpkin coach and offered me a do-over, I would do it all again. Without hesitation. After graduating from an MD/PhD program, I completed a residency in internal medicine, a double fellowship in hematology and oncology, and started my own lab as a tenure-track assistant professor in 1979. Since then, I’ve been paid (well) to take care of interesting patients, run a lab that studies the mechanisms behind hemostasis and thrombosis (and anything else that attracts my attention), taught and mentored thousands of medical students and graduate students, collaborated with large numbers of really smart women and men, had a chance to be at hand while the knowledge of human biology and human disease has grown exponentially, and had the enormously gratifying job of looking after hundreds of men and women in Penn’s Medical Scientist Training Program, which I have directed since 1998—all because somebody mentioned this thing called an MD/PhD program while I was in college. Where does that leave those of you who are thinking about reading this guidebook? Hopefully, you have already decided that applying to an MD/PhD program is what you are going to do. If so, then this guide offers a chance to benefit from the perspectives obtained by Jordan Setayesh, Jonathan Sussman, and Amitej Venapally while applying successfully to MD/PhD programs in 2019/2020. They learned a lot, describe it well in this guide, and have drawn conclusions that I mainly agree with. Since all 3 of them are men, they do not have the firsthand perspective of being a woman applying to MD/PhD programs, so I hope you will seek that elsewhere. Since none of them (as far as I know) are in groups underrepresented in medicine, you’ll need to seek that important perspective elsewhere, too. Those things aside, the pages of this book are filled with good advice that will help you navigate the

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path to becoming an MD/PhD student and, even more importantly, a physician-­ scientist. It will also help fill the gaps faced by many pre-health advisors when they try to guide the comparatively small number of medical school applicants applying to MD/PhD program each year. MD/PhD programs are for people of all races, ethnicities, and genders who want a career blending together the best parts of being a scientist and physician. True chimeras who have a passion for research and improving health through the discovery and translation of new knowledge. When I and other program directors look at applications, we look for 4 things: (1) research and clinical experience sufficient to demonstrate you love it and can do it; (2) academic success that demonstrates that you can handle the flood of new things that you will learn and discover over a career that spans decades; (3) strong letters of recommendation from those you have worked with, especially in the research setting so they can vouch for your potential; and (4) the ability to talk about your research and why you want to follow this strange/wonderful career path. Put differently, most MD/PhD program directors look for well-lopsided individuals—lopsided in the direction of research. I suspect that DO/PhD program directors do the same. The bad news about the complexity of the MD/PhD program application process described in this book is that it sucks up a lot of time and energy. This, unfortunately, along with the lengthy training path, dissuades many from taking the first steps. The good news from my perspective as a program director is that applicants are far better prepared now than they used to be and, therefore, are arguably more likely to complete the training program and become physician-scientists. An MD/ PhD program is not the only way to become a physician-scientist [6, 7], but there is now ample evidence that the 3% of medical school graduates who have completed MD/PhD programs are more likely than the 97% who have not to have careers in science as well as medicine. MD/PhD graduates are more likely to work in academia, the biotech and pharmaceutical industries, and at places like the Centers for Disease Control (CDC). They are more likely than other medical school graduates to apply successfully and persistently for NIH grants and are more likely to become leaders in medical schools [2, 8]. Outcomes data also show that women do as well as men in these programs and individuals from underrepresented groups do as well as those who are not—but first they have to apply [5]. The bottom line is that all of the preparation and training can be worth it, so can reading this book and other resources, and talking to graduates and directors of MD/ PhD programs before you apply. Some of those resources are included in this guide. Others can be found on the websites of the AAMC Section on MD/PhD training (https://students-residents.aamc.org/choosing-medical-career/article/md-phd-rightfor-me/) and the American Physician Scientists Association (APSA) (https://physicianscientists.site-ym.com/page/about). In full disclosure, I am a founding member of the former and a member of the board of the latter.

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The worldwide SARS-CoV2 epidemic is still active as I write this in June 2020. The disaster caused by this disease outbreak provides as convincing a case as I can make for having more physician-scientists. Don’t hesitate. We do want you to join us. Dive in.

Lawrence (Skip) Brass, MD, PhD Professor of Medicine Professor of Systems Pharmacology and Translational Therapeutics Associate Dean for Combined Degree and Physician Scholars Programs Director, Penn MSTP Department of Medicine and Pharmacology Perelman School of Medicine at the University of Pennsylvania Philadelphia, PA, USA

References 1. Brass LF, Akabas MH, Burnley LD, Engman DM, Wiley CA, Andersen OS.  Are MD-PhD programs meeting their goals? An analysis of career choices made by graduates of 24 MD-PhD programs. Acad Med. 2010;85(4):692–701. https://doi.org/10.1097/ACM.0b013e3181d3ca17. 2. Ginsburg D, Shurin SB, Mills S. NIH Physician-Scientist Workforce (PSW) Working Group report. 2014. 3. Harding CV, Akabas MH, Andersen OS. History and outcomes of 50 years of physician-scientist training in medical scientist training programs. Acad Med. 2017;92(10):1390–98. https:// doi.org/10.1097/ACM.0000000000001779. 4. Akabas MH, Brass LF.  The national MD-PhD program outcomes study: outcomes variation by sex, race, and ethnicity. JCI Insight. 2019;4(19):e133010. https://doi.org/10.1172/jci. insight.133010. 5. Brass LF, Akabas MH.  The national MD-PhD program outcomes study: relationships between medical specialty, training duration, research effort, and career paths. JCI Insight. 2019;4(19):e133009. https://doi.org/10.1172/jci.insight.133009. 6. Brass LF. Is an MD/PhD program right for me? Advice on becoming a physician-­scientist. Mol Biol Cell. 2018;29(8):881–85. https://doi.org/10.1091/mbc.E17-12-0721.

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7. Payne AS, Brass LF. Finding Nirvana: paths to becoming a physician-scientist. Sci Careers. 2013. https://doi.org/10.1126/science.caredit.a1300227. 8. Akabas MH, Tartakovsky I, Brass LF.  The national MD-PhD program outcomes study. American Association of Medical Colleges reports. 2018.

Preface

This book was written at a very unique time in world history. Beginning in January 2020, a worldwide coronavirus (COVID-19) pandemic took the world by storm. Countries like Italy, France, China, and the United States experienced exponential increases in COVID-19 cases in early 2020, forcing prolonged periods of stay-at-­ home orders in various regions of these countries. In the United States, the stay-at-­ home orders trickled in throughout March in various cities and states, which, conveniently or inconveniently, was right after we had completed our MD/PhD application cycle. At this point, we had largely settled on which programs we would attend the next fall. The combination of being accepted into medical school and having been ordered to stay home for an extended period yielded the free time necessary for the creation of this book. Most students looking to enter into a career in medicine have a vast array of resources available to them during their undergraduate studies and perhaps even during high school as well. The majority of colleges have pre-medical advisors and student organizations, and there are many books on a wide range of pre-medical topics, including how to build a solid application, write compelling essays, and approach interview preparation. Within all of these options are some truly great resources that we took advantage of when applying to medical school. However, there are far fewer resources available that provide guidance to MD/PhD applicants and address their specific concerns. The relatively small number of MD/PhD applicants, compared to their MD counterparts, generates much less demand for these resources; therefore, less is supplied. Thus, the ultimate purpose of this book is to provide a guide that is tailored to the MD/PhD application process from the perspective of successful applicants. Although this book contains great tips and guidelines for MD applicants, the vast majority of the content is tailored toward the unique experiences that MD/PhD applicants will have during the application cycle. The main goals of this book are to help future applicants: 1. Determine if they want to pursue a career as a physician-scientist 2. Understand what a strong MD/PhD application looks like 3. Navigate the technical aspects of the AMCAS medical school application xiii

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4. Select programs at which to apply 5. Create and submit the best possible version of their application 6. Prepare for and succeed in MD/PhD interviews 7. Understand when and how to communicate with MD/PhD programs throughout the process 8. Decide which program to attend Additionally, it is incumbent upon us to address the inherent limitations of this book: 1. This book presents the perspectives of a limited number of successful applicants; therefore, we cannot address all of the experiences that are encountered by the broad range of applicants. We are currently working with a diverse group of MD/ PhD students to publish additional works addressing a wider range of experiences, especially including the perspectives of students who are underrepresented in science and medicine. 2. Because we have not served on admissions committees, we are writing this book from an applicant’s perspective, and we do not claim to have intimate knowledge of the inner workings of the admissions review process. As we gain additional insights, we plan to provide updates, as needed, on the website listed at the end of this preface. 3. The admissions process varies by institution and is continuously evolving, so although we believe that our advice is sufficiently generalized, we cannot describe the specifics of every MD/PhD program and urge our readers to refer to the most recent official policies and guidelines. Primarily, we want to help relieve as much of your stress as possible. All of the unknowns in the MD/PhD application process can be overwhelming, especially without a guide to answer your questions along the way. In this book, you will find objective answers to technical questions about the application process in addition to an aggregation of many personal opinions, anecdotes, and tips that may help you better understand what to expect. Furthermore, the Additional Resources chapter contains example essays for each component of the application. However, we must provide a full disclaimer that the views expressed in this book are solely the personal, professional, and academic opinions of the authors and do not reflect the institutional opinions of the American Association of Medical Colleges (AAMC), National Institutes of Health (NIH), or any other organization mentioned in this book. We are simply three students who were fortunate enough to have been successful in our MD/PhD applications, and we would like to share our experiences and ideas with future applicants. This book is modeled after what we wish had been available when we were applying, so we hope that you will benefit from our trials and errors. If time permits, we suggest reading this book in its entirety before you begin the application cycle. In life, it is easier to know what to do in the moment if you know where you are going, so having a holistic understanding of the application process will help you at each stage independently. For answers to frequently asked

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questions, important updates, and other resources, please visit https://sites.google. com/view/mdphdguide. We look forward to receiving feedback and success stories from our readers and any questions or concerns that you may have. If you would like to share any of these, please email us at [email protected]. We wish you the best of luck and hope that you enjoy this book! Atlanta, GA, USA Philadelphia, PA, USA Ann Arbor, MI, USA 



Amitej Venapally Jonathan Sussman Jordan Setayesh

About the Book

This book is meant to be a comprehensive applicant guide for anyone who aspires to become an MD/PhD student and, ultimately, a physician-scientist. The first three chapters of this book cover the important topics that potential applicants should consider before applying. Chapter 1 provides a brief overview of what the MD/PhD training entails, including its structure, duration, and costs (or lack thereof). Chapter 2 dives into the potential career opportunities available to MD/PhD program graduates and presents the key findings from a survey of MD/PhD graduates in the workforce. Chapter 3 outlines the various prerequisite requirements with which applicants should be familiar. Chapters 4, 5, 6, 7, 8, 9, 10, 11, and 12 focus on the various components of the application process itself, such as choosing an appropriate school list (Chap. 5), completing each component of the primary and secondary applications (Chaps. 6, 7, 8, 9, and 10), and preparing for the MD/PhD interviews (Chaps. 11 and 12). Chapter 4 provides an overview of the entire application process and provides an ideal timeline that applicants can follow. Chapters 5 and 12 have unique sub-sections titled “Author Perspectives,” which provide an in-depth look into the individualized experiences and stories from our own application cycles to illustrate concepts covered in those chapters. These experiences are concrete examples that provide a clearer picture of what applicants may encounter as well as the strategies and logic that applicants should consider. Chapters 13 and 14 are dedicated to describing the relevant logistics after an applicant’s interview season has come to an end. We provide tips, guidelines, and established protocols for sending application updates, Letters of Interest, and Letters of Intent, as well as navigating the waitlist and the AAMC traffic rules. The end of the application cycle can be the most stressful time for many applicants, so this section aims to help applicants manage their stress and anxiety. Lastly, what truly sets this book apart from the few MD/PhD-specific resources that currently exist are the materials in Chap. 15 (Additional Resources). First, we include an extended “Author Perspectives” section, which outlines our perceptions of the benefits derived from our specific activities and the logic we used to navigate our explorations of research and medical fields. The second part of this chapter xvii

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contains a collection of example essays for each written component of the application, including the Personal Comments essay, the MD/PhD essay, the Significant Research Experience essay, the Work and Activities entries, and various common secondary essays. These essays are not intended as precise templates for your own essays, but rather as a reference for the proper tone, depth, and content. We dedicate an entire chapter on how to craft each type of essay, so these examples provide an opportunity to demonstrate these principles. We sincerely hope that the content and resources provided in this book tangibly improve your experience when applying to MD/PhD programs. As applicants who wrote this book soon after applying, we strongly believe that this book fills a niche within the MD/PhD community.

Contents

1 What Is an MD/PhD?������������������������������������������������������������������������������    1 Useful Resources ������������������������������������������������������������������������������������     5 References������������������������������������������������������������������������������������������������     6 2 What Do MD/PhDs Do and Who Should Become One?����������������������    7 Useful Resources ������������������������������������������������������������������������������������    14 References������������������������������������������������������������������������������������������������    15 3 Prerequisite Requirements����������������������������������������������������������������������   17 Standardized Tests������������������������������������������������������������������������������������    17 GPA����������������������������������������������������������������������������������������������������������    18 Coursework����������������������������������������������������������������������������������������������    19 Letters of Recommendation��������������������������������������������������������������������    21 Extracurriculars and Other Activities������������������������������������������������������    24 International Applicants ��������������������������������������������������������������������������    28 Useful Resources ������������������������������������������������������������������������������������    29 References������������������������������������������������������������������������������������������������    29 4 The MD/PhD Application Basics and Timeline������������������������������������   31 Applying MD-Only as a Backup ������������������������������������������������������������    31 When to Take the MCAT ������������������������������������������������������������������������    34 Submitting the Primary Application to AMCAS ������������������������������������    35 The Importance of Accuracy��������������������������������������������������������������������    36 Submitting Your Letters of Recommendation to AMCAS����������������������    37 Screening and Secondary Applications����������������������������������������������������    39 The CASPer Test and AAMC Situational Judgment Test������������������������    40 Interview Invitations��������������������������������������������������������������������������������    40 Application Costs������������������������������������������������������������������������������������    41 Ideal Application Timeline����������������������������������������������������������������������    41 Useful Resources ������������������������������������������������������������������������������������    43 References������������������������������������������������������������������������������������������������    44

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Contents

5 Researching Schools: Where to Apply ������������������������������������������������    45 Important Factors for Choosing MD/PhD Programs ����������������������������     45 Crafting a School List����������������������������������������������������������������������������     47 The Dos and Don’ts of Applying to MD/PhD Programs ����������������������     49 Author Perspectives ������������������������������������������������������������������������������     50 Useful Resources ����������������������������������������������������������������������������������     53 Reference ����������������������������������������������������������������������������������������������     53 6 The Personal Comments Essay��������������������������������������������������������������   55 Reference ������������������������������������������������������������������������������������������������    58 7 The MD/PhD Essay����������������������������������������������������������������������������������   59 Reference ������������������������������������������������������������������������������������������������    60 8 The Significant Research Experience Essay������������������������������������������   61 Reference ������������������������������������������������������������������������������������������������    65 9 The Work and Activities Section������������������������������������������������������������   67 Activity Categories����������������������������������������������������������������������������������    68 Most Meaningful Activities ��������������������������������������������������������������������    69 Technical Considerations: Anatomy of an Entry ������������������������������������    69 Entry Descriptions: A General Structure ������������������������������������������������    71 Research��������������������������������������������������������������������������������������������������    72 Publications and Presentations����������������������������������������������������������������    73 Clinical Experiences and Shadowing������������������������������������������������������    74 Volunteering: Clinical and Nonclinical����������������������������������������������������    74 Leadership������������������������������������������������������������������������������������������������    75 Awards and Honors����������������������������������������������������������������������������������    75 Other Interests and Hobbies��������������������������������������������������������������������    76 Reference ������������������������������������������������������������������������������������������������    76 10 Secondary Applications and the CASPer Test��������������������������������������   77 Prewriting Secondary Essays ������������������������������������������������������������������    79 Common Secondary Essays��������������������������������������������������������������������    82 MD/PhD Research and Work Experiences����������������������������������������������    86 CASPer Test��������������������������������������������������������������������������������������������    87 Useful Resources ������������������������������������������������������������������������������������    88 References������������������������������������������������������������������������������������������������    88 11 Interview Invitations: What to Expect ��������������������������������������������������   89 Interview Invitations and Planning����������������������������������������������������������    89 Interview Experience Overview��������������������������������������������������������������    90 Strategies for Planning and Scheduling Interviews ��������������������������������    92 Sample Interview Schedules��������������������������������������������������������������������    94 1-Day Interview Example��������������������������������������������������������������������    94 2-Day Interview Schedule��������������������������������������������������������������������    95 Useful Resources ������������������������������������������������������������������������������������    96 References������������������������������������������������������������������������������������������������    96

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12 Interview Types: Preparation and Strategy����������������������������������������    97 Purpose of MD/PhD Interviews������������������������������������������������������������     98 General Preparation ����������������������������������������������������������������������������     100 MD Interviews ������������������������������������������������������������������������������������     103 Multiple Mini Interviews (MMIs)���������������������������������������������������������    106 PhD/Research Interest Interviews����������������������������������������������������������    107 Interviews with MD/PhD Program Leadership ������������������������������������    110 Presentations������������������������������������������������������������������������������������������    111 Thank You Notes and Conclusion����������������������������������������������������������    112 Useful Resources ����������������������������������������������������������������������������������    113 Author Perspectives ������������������������������������������������������������������������������    113 References����������������������������������������������������������������������������������������������    117 13 The Waiting Game: It’s Not Over Yet����������������������������������������������������  119 Application Updates��������������������������������������������������������������������������������   120 Waitlists: Letter of Intent Versus Letter of Interest����������������������������������   122 Reapplying ����������������������������������������������������������������������������������������������   124 Reference ������������������������������������������������������������������������������������������������   126 14 Acceptances, Second Looks, and Matriculation������������������������������������  127 Useful Resources ������������������������������������������������������������������������������������   130 Reference ������������������������������������������������������������������������������������������������   130 15 Additional Resources ������������������������������������������������������������������������������  131 Author Perspectives on Activities������������������������������������������������������������   131 Setayesh ����������������������������������������������������������������������������������������������   132 Sussman ����������������������������������������������������������������������������������������������   134 Venapally����������������������������������������������������������������������������������������������   136 Successful Applications ��������������������������������������������������������������������������   138 Personal Comments Essay ������������������������������������������������������������������   138 The MD/PhD Essay ����������������������������������������������������������������������������   143 Significant Research Experience Essay ����������������������������������������������   148 Work and Activities Entries ����������������������������������������������������������������   156 Secondary Essays��������������������������������������������������������������������������������   168 Index����������������������������������������������������������������������������������������������������������������   185

About the Authors

Jordan Setayesh  grew up in Topeka, Kansas, and graduated from the University of California San Diego in 2018 with a degree in Biochemistry and Cell Biology. His research focus is developmental biology, which he explored as an Undergraduate Researcher at the Sanford Consortium for Regenerative Medicine from 2016 to 2020. In his free time, he writes economics articles from the perspective of the Austrian School of Economics, many of which have been published by FEE.org and the Mises Institute. He is now pursuing an MD/PhD degree at the University of Michigan Medical School and Rackham Graduate School. Jonathan Sussman  grew up in San Diego, California, and graduated from the University of Southern California (USC) in 2019 with dual degrees in Biomedical Engineering from the Viterbi School of Engineering and Music Performance from the Thornton School of Music. He has conducted Systems Cancer Biology research at USC as an Undergraduate Researcher and Molecular Biology research at The Scripps Research Institute as a Research Assistant and is now pursuing an MD/PhD at the University of Pennsylvania in the Department of Cell and Molecular Biology with an emphasis in Cancer Biology. Outside of scientific pursuits, Jonathan is a concert musician, having won national competitions on the flute, and performs frequently on the flute, viola, and piano. He is also an avid cyclist and enjoys hiking and trail running.

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About the Authors

Amitej  Venapally  was born in Hyderabad, India, and immigrated to the United States with his family when he was in middle school. Since moving to the USA, he has remained in Atlanta, Georgia, and has graduated from the Georgia Institute of Technology in 2020 with dual degrees in Biochemistry and Computer Science. He has conducted RNA Biology and Origin of Life research at Georgia Tech as an Undergraduate Researcher. In his free time, he enjoys baking desserts, biking, playing badminton, traveling, and painting. He is now pursuing an MD/PhD degree at the Emory University School of Medicine.

Common Acronyms and Abbreviations

AACOM AAMC AMA AMCAS APSA BCPM CAS CASPer CYMS DO GPA GPP MCAT MD MMI MSAR MSTP NIGMS NIH NMA NRMP NRSA PhD PI SDN SJT TMDSAS URM USMLE USNWR

American Association of Osteopathic Medicine Association of American Medical Colleges American Medical Association American Medical College Application Service American Physician Scientist Association Biology, Chemistry, Physics, Mathematics Centralized Application Service Computer-Based Assessment for Sampling Personal Characteristics Choose Your Medical School (tool on AMCAS) Doctor of Osteopathic Medicine Grade Point Average Graduate Partnerships Program Medical College Admissions Test Doctor of Medicine Multiple Mini Interviews Medical School Admissions Requirements Medical Scientist Training Program National Institute of General Medical Sciences National Institutes of Health National Medical Association National Resident Matching Program National Research Service Award Doctor of Philosophy Principal Investigator (usually in reference to the head of a research lab) Student Doctor Network Situational Judgement Test Texas Medical & Dental Schools Application Service Underrepresented Minority/Underrepresented in Medicine United States Medical Licensing Examination U.S. News & World Report

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Chapter 1

What Is an MD/PhD?

If you have picked up this guidebook, you are most likely interested in a career in medicine and research, or you have way too much free time on your hands. Either way, you may be wondering what an MD/PhD degree stands for and what it means. MD stands for Medical Doctor, and PhD stands for Doctor of Philosophy, and as you may have guessed by now, an MD/PhD is someone who took the time to become both. The purpose of this chapter is to provide an introduction to what it takes to become an MD/PhD and what graduates do once they make it to the other end of the long journey. An MD/PhD is a dual-degree program that offers graduate students the opportunity to obtain both an MD and a PhD. Let’s start with the MD side of things. The typical curriculum for medical school is a 4-year program that is split into two parts: preclinical and clinical. The preclinical portion encompasses what we call the “book learning” or didactic portion of medical education. Students learn all of the information that is required to pass the USMLE Step 1 Exam (The Boards). This includes basic sciences such as microbiology, genetics, biochemistry, cell biology, and immunology as well as the anatomy, embryology, physiology, pathology, and pharmacology encompassing each of our beloved organ systems. The curriculum covers both the normal and abnormal physiology of each organ system in addition to the basic practical skills required to be a physician, including physical diagnostic and patient care protocols. All of this usually takes around 2 years to complete; however, many schools are shifting to a preclinical curriculum that only takes 1–1.5 years. In fact, the University of Michigan, University of Pennsylvania, Emory University, Duke University, Harvard University, and Vanderbilt University are just some of the schools that have made this transition. The clinical years encompass all of the practical skills that students will need to provide excellent patient care and function within the modern healthcare system. Students begin by completing a set of standardized core clerkships, including specialties such as Internal Medicine, Psychiatry, Primary Care, and Surgery. This is where students will gain all of the knowledge and skills needed to pass the USMLE © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 J. Sussman et al., The Complete MD/PhD Applicant Guide, https://doi.org/10.1007/978-3-030-55625-9_1

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1  What Is an MD/PhD?

Step 2 Exam, which is split up into Clinical Skills (CS) and Clinical Knowledge (CK) sections. Finally, students will spend the latter part of their clinical training completing electives, which are rotations that can be tailored to a student’s interests and specialty of choice. Why would anyone, after spending 4 years completing all of this intense and exhausting training, voluntarily sign up for even more training? In fact, almost 2000 students apply to MD/PhD programs each year, and hundreds of these applicants matriculate into one of these programs [1]. The reasons that students choose this path will be the focus of the next chapter. Before we get there, let’s talk about the other half of the MD/PhD training. Most PhD programs take between 5 and 7 years to complete, require both coursework and research, and culminate in a written dissertation. However, in an MD/PhD program, the PhD is usually completed in 3–5 years. The average time to completion for the PhD portion is around 4 years and is inserted somewhere between the preclinical and clinical training of medical school, depending on the program. MD/PhD candidates can complete their thesis work much faster than their PhD counterparts because of agreements between the medical school and graduate school, which aim to integrate the medical and research aspects of the training. This often includes graduate school coursework exemptions for MD/PhD students. Furthermore, in most programs, MD/PhD program directors and associate directors advocate on behalf of their students, ensuring the timely defense of their graduate dissertation. While less frequent, students may be required to spend additional years completing their PhD in (generally non-MSTP) MD/PhD programs, as some programs have limited cross talk between the medical and graduate schools. In these programs, the MD/PhD students essentially complete their MD and PhD components independently rather than having a truly integrated program. However, it is important to note that in all cases, students will receive a complete MD and PhD training and gain all associated skills and knowledge, regardless of the exact program structure. When exactly MD/PhD students complete the PhD portion of their training depends on their specific school, but most schools follow the 2-4-2 structure. This structure starts with two preclinical years of medical school followed by the approximately 4-year PhD training, after which students return and complete the last 2 years of medical school. An increasing number of schools, however, are restructuring the first 2 years to encompass various aspects of clinical training. The goal of these curriculum revisions is to prevent MD/PhD students from having to wait until the 7th year of the program before receiving any formal clinical training in a hospital setting. Moreover, as noted above, many MD/PhD programs strive to integrate the phases of the combined training by providing special classes for MD/PhD students relevant to physician-scientists and translational researchers. These programs also ensure that students have clinical opportunities during the graduate phase and opportunities to become involved in research during the first 2 years of the training, such as through summer lab rotations. Importantly, while many PhD programs accept students directly into a particular department and sometimes even into a specific thesis lab before they begin the program, MD/PhD programs allow (and

1  What Is an MD/PhD?

Pre-Clinical Medicine (2 Years) Pre-Clinical Med. Clin. 0.5 Yr. (1.5 Years) Pre-Clinical (1 Year)

Clinical (1 Year)

Pre-Clinical Med. (1.5 Years)

Clinical Med. (1.5 Year)

(Pre-Clinical Med. Clin. 0.5 Yr. 1.5 Years)

3

Graduate Phase/PhD Research (~4 Years)

Clinical Medicine (2 Years)

Graduate Phase/PhD Research (~4 Years)

Clinical Medicine (2 Years)

Graduate Phase/PhD Research (~4 Years)

Clinical (1 Year)

Graduate Phase/PhD Research (~4 Years)

Graduate Phase/PhD Research (~3.5 Years)

Clinical (1 Year) Clinical Medicine (1.5 Years)

Fig. 1.1  Variations of the MD/PhD curriculum structure, indicating pre-clinical medicine (green), clinical medicine (blue), and graduate research (red)

generally require) students to explore multiple labs and research areas before deciding which thesis lab is the best match for them through these research rotations. In Fig.  1.1 we present the general structure of several of the curriculum variations, including some 7-year and some 8-year programs. What type of research can MD/PhD candidates engage in? The answer is both frightening and exciting at the same time. An MD/PhD candidate can pursue training in almost any field imaginable, including biomedical sciences, bioinformatics, biomedical engineering, philosophy, sociology, anthropology, economics, public health, and many others. While the vast opportunities can be exciting, the almost infinite options can be daunting to choose between, especially given that MD/PhD students tend to be naturally curious and ambitious people. Nearly every scientific discipline is possible to study, and the Association of American Medical Colleges (AAMC) provides a list of nonscience areas available for doctoral study by subject and by school (see the resources at the end of this chapter), but this list is still extremely limited. Many MD/PhD programs are willing to make arrangements with other departments at the institution with or without requiring an additional application. Therefore, individual program websites and program administrators are the best resources if you wish to pursue a PhD in a nontraditional program. Now that you have a basic idea of what the MD/PhD training entails, let’s dive into the details. As of 2020, there are 119 MD/PhD programs across the United States, according to the AAMC Medical School Admission Requirements database. However, some of these programs are very small and rarely admit a student. In 2019, 110 of these programs had at least 1 applicant, and only 95 had at least 1 matriculating student [1]. To make matters more confusing, there is a subtype of MD/PhD programs called Medical Scientist Training Programs (MSTPs), which are MD/PhD programs that are funded by the National Institute of General Medical Sciences (NIGMS), which is part of the National Institutes of Health (NIH) [2]. Universities with MD/PhD programs must undergo a rigorous application and

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1  What Is an MD/PhD?

vetting process in order to become an MSTP, but the inflow of dollars and increased status that comes with receiving one of these grants often pays off. Additionally, students at some MSTPs are able to complete their PhD at the NIH through the NIH Graduate Partnerships Program (GPP), although this requires an additional application and selection process. Of the 119 MD/PhD programs, 50 are designated as MSTPs [3]. If all of this is still confusing, the relationship between MD/PhD programs and MSTPs can be summarized in one simple sentence. All MSTPs are MD/PhD programs, but not all MD/ PhD programs are MSTPs. Lastly, for the sake of being comprehensive, as of 2020, there are an additional 7 US institutions which offer a DO (Doctor of Osteopathic Medicine)/PhD combined degree. Although MD/PhD and DO/PhD programs share many basic prerequisites, aspects of the program structure, learning outcomes, and career opportunities, they are different programs and have different application processes. Applications to DO/PhD programs are facilitated by the American Association of Colleges of Osteopathic Medicine (AACOM), not the AAMC. Therefore, further discussion of DO/PhD programs is beyond the scope of this book. Now, let’s talk numbers. We already mentioned that there are 119 MD/PhD programs with 50 of those being MSTPs. But how many students apply? And, of course, the big question is: How many of them are accepted? In the 2018–2019 application cycle, 1813 students applied for MD/PhD programs through AMCAS, the centralized medical school application service [1]. Of those who applied, 708 (40%) matriculated into an MD/PhD program in the fall of 2019 [1]. The corresponding statistics for all medical school applicants and matriculants are quite similar. For the 2018–2019 application cycle, there were 53,371 applicants, and 21,869 (41%) of them matriculated into a medical school class [4]. The size of each MD/ PhD cohort can range anywhere from a single student to over 30. MSTPs generally tend to be larger in size than non-MSTP MD/PhD programs. There is no publicly available data on how many of the ~1800 applicants receive at least one interview invitation, but we estimate that the number is most likely less than 1000. Each MD/PhD program has a similar structure. The program will either have a director or two co-directors. They are highly qualified and accomplished MDs, PhDs, or MD/PhDs who are in charge of running the program, and throughout the 7–9  years you are in the program, students will interact with them frequently. Therefore, an important factor when considering MD/PhD programs is whether you like the personality and mentoring style of the director, which is mostly ascertained during the interview stage. Ultimately, the program director(s) are akin to CEOs of a business. Most programs also have associate directors who help them with admissions decisions, curriculum changes, and many of the other factors that go into managing an MD/PhD program. Then, there are the amazing program coordinators and assistant coordinators, who are like the branch managers. They are the lifeline of students and are available to respond to any requests or concerns. Finally, there are the students. After 8 years, most MD/PhD students become close to a few, if not all, of the other students in their cohort. Even by the first year, many students treat their cohort as basically a family, hosting birthday parties and holiday celebrations frequently. Becoming close to your cohort is one of the most fulfilling and rewarding parts of the MD/PhD experience.

Useful Resources

5

Last, but not least, it is time to talk about money. As you may know by now, medical school is expensive. Most medical school graduates are in a hurry to fly through residency so that they can make big bucks and chip away at any debt they may have accumulated. Because of such high costs, most students are not willing to take a 4-year break to do a PhD and delay that hefty salary any longer, which is why the vast majority of MD/PhD programs, and all MSTPs, are fully funded. When a program is fully funded, that means the tuition for medical school and graduate school is completely waived. Yes, you read that correctly. Most MD/PhD students do not pay any tuition and do not accrue any debt as a result of their medical and graduate training. In addition to having their tuition waived, most programs provide a living stipend of about $30,000 a year plus or minus a few thousands depending on the school. Schools in expensive cities such as New York City, San Francisco, and Los Angeles can have stipends that approach $40,000. Not only are these stipends provided for each year that you are in the program, but they generally also include health insurance coverage. Although this amount may not seem that large, if you add in the money saved from having your tuition waived and the many miscellaneous amenities that an MD/PhD program includes, such as advising and travel, the MD/PhD financial package is quite substantial. In fact, program directors have indicated that it costs about $750,000 to train one MD/PhD student. This is one of the main reasons why the admissions process is highly selective. As an important note, international students (those who are not US citizens or permanent residents) are not eligible to receive funding from NIH grants. MSTPs at certain institutions allow a small number of international applicants to join and find other ways to fund these students, but it is statistically twice as difficult for international students to gain admissions to an MD/PhD program in general based on the matriculation rate of international applicants [5, 6]. We hope that this chapter provided you with a solid introduction into what an MD/PhD program entails and what it is like to join one. Although it is undoubtedly a lot of work to gain acceptance to and complete an MD/PhD training, the next chapter will go into detail as to why so many students are eager to embark on such a rigorous journey.

Useful Resources 1. Association of American Medical Colleges (AAMC) https://www.aamc.org/ 2. List of MD/PhD Degree Programs by State https://students-residents.aamc.org/applying-medical-school/article/ mdphd-degree-programs-state/ 3. List of Medical Scientist Training Program (MSTP) Institutions https://www.nigms.nih.gov/training/instpredoc/pages/PredocInst-MSTP.aspx

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1  What Is an MD/PhD?

4. MD/PhD in “Social Sciences or Humanities” and “Other Non-Traditional Fields of Graduate Study” by School (AAMC) https://students-residents.aamc.org/choosing-medical-career/careers-medical-research/md-phd-dual-degree-training/non-basicscience-phd-training-school/ 5. MD/PhD in “Social Sciences or Humanities” and “Other Non-Traditional Fields of Graduate Study” by Area of Doctoral Study https://students-residents.aamc.org/choosing-medical-career/careers-medical-research/md-phd-dual-degree-training/non-basicscience-phd-training-field-study/ 6. Tools for MD/PhD Applicants https://students-residents.aamc.org/applying-medical-school/applying-medical-research-programs/applying-mdphd-programs/tools-mdphd-applicants/ –– See “Individual MD-PhD Program Information for Prospective Applicants” for current information on program funding, program size, international applicants, and other important details. However, it is important to note that this resource is not always up to date, so information therein should be verified with official program websites. 7. NIH MD/PhD Partnership Training Program https://mdphd.gpp.nih.gov/

References 1. Association of American Medical Colleges. U.S. medical school MD-PhD applications and matriculants by school, in-state status, and sex, 2019–2020. In: 2019 FACTS: enrollment, graduates, and MD-PhD data. 2019. https://www.aamc.org/system/files/2019-12/2019_FACTS_ Table_B-8.pdf. Accessed 20 May 2020. 2. National Institute of General Medical Sciences: Medical Scientist Training Program. 2020. https://www.nigms.nih.gov/training/instpredoc/pages/predocoverview-mstp.aspx. Accessed 22 Apr 2020. 3. National Institute of General Medical Sciences: Medical Scientist Training Program (MSTP) Institutions. 2020. https://www.nigms.nih.gov/training/instpredoc/pages/PredocInst-MSTP. aspx. Accessed 22 Apr 2020. 4. Association of American Medical Colleges. Applicants, matriculants, enrollment, and graduates of U.S. medical schools, 2010–2011 through 2019–2020. In: 2019 FACTS: enrollment, graduates, and MD-PhD Data. 2019. https://www.aamc.org/system/files/2019-11/2019_ FACTS_Table_1_0.pdf. Accessed 20 May 2020. 5. Association of American Medical Colleges. MD-PhD matriculants to U.S. medical schools by race/ethnicity (alone) and state of legal residence, 2019–2020. In: 2019 FACTS: enrollment, graduates, and MD-PhD data. 2019. https://www.aamc.org/system/files/2019-12/2019_ FACTS_Table_B-9.pdf. Accessed 20 May 2020. 6. Association of American Medical Colleges. MD-PhD applicants to U.S. medical schools by race/ethnicity (alone) and state of legal residence, 2019–2020. In: 2019 FACTS: e­ nrollment, graduates, and MD-PhD Data. 2019. https://www.aamc.org/system/files/2019-12/2019_ FACTS_Table_B-7.pdf. Accessed 20 May 2020.

Chapter 2

What Do MD/PhDs Do and Who Should Become One?

Now that you know what an MD/PhD program is, this is by far the most important chapter in the book. The goal here is to help you better understand what life as a physician-scientist will entail after completing the 7–9 years of intense training. We hope that you will use the information in this chapter to determine whether that is a role you can see yourself fulfilling. If you do not have a strong grasp of the goal of the physician-scientist training and why you feel personally passionate about becoming one, then the rest of this book is of little use. With that said, not all physician-­scientists have the exact same career trajectory and day-to-day responsibilities. This chapter covers both the vast array of career paths taken by physician-­ scientists and the questions you should be asking yourself in order to help decide if this is the right career for you. “Bench to bedside” is the phrase you will probably hear numerous times throughout the application process, and it is the core goal of the physician-scientist training. In an age of unprecedented biomedical research and innovation, there is an increasing need for researchers who can translate this rapid influx of information into tangible applications for a variety of patients. Thus, physician-scientists aim to take the information from the benches of researchers to the bedside of clinicians and their patients. While this may seem like a very straightforward goal, there are, in fact, numerous ways to both approach translational research and structure a career as a physician-scientist. The exact combination of clinical and research responsibilities that a physician-­ scientist takes on after graduation can depend on the exact postgraduate training that they choose. Graduates of MD/PhD programs can opt for residency training in a clinical specialty, postdoctoral research training, or enter directly into the workforce, such as working for biotechnology or other industry companies. Residency training is by far the most common choice, with more than 90% of MD/PhD program graduates taking this route [1]. Although applicants clearly have plenty of time before deciding which route they want to take, it is helpful to have a rough description and clear reasoning for your ideal career trajectory before starting the © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 J. Sussman et al., The Complete MD/PhD Applicant Guide, https://doi.org/10.1007/978-3-030-55625-9_2

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application cycle. In order to help you develop your own ideas, let us examine what a career as a physician-scientist could potentially look like in more depth. In April of 2018, the AAMC published the National MD-PhD Outcomes Study [2], which examined the career outcomes of MD/PhDs across the United States. It will be useful here to explore some of the facts from this study and what they mean about the vast clinical and research opportunities open to physician-scientists. The study surveyed 10,591 alumni, garnering 6786 (64%) respondents [2]. Unsurprisingly, 60% of the respondents were faculty at US medical schools, according to the AAMC Faculty Roster [2]. Accordingly, almost “80% are either full-time faculty members or work for the NIH, research institutes, industry, and government agencies” [2]. Therefore, it is clear that MD/PhD program graduates are committed to a career heavily focused on research and disproportionately follow a career path in academia. However, this does not mean that research-intensive careers in academia are the only path available to MD/PhD program graduates. Of the respondents, 16% entered private practice and 0.8% entered law, consulting, or finance [2]. A surprising 6.3% even reported having a career that could be classified as “Other,” meaning that their careers do not fit within any of the aforementioned career categories [2]. It should be evident by now that MD/PhD program graduates have the entire fields of medicine, science, and society open to them, presenting innumerable possible career paths. Of course, MD/PhD graduates are still limited by the constraints of time and space. Every minute they spend doing research is one less minute they can spend seeing patients, unless the two are somehow linked (which is sometimes possible). In order to get a better sense of how physician-scientists balance this tension in their careers, the study also examined the distribution between research time and clinical time across the survey’s respondents. Interestingly, the survey found something different than the anecdotal 80:20 distribution often touted on Reddit pages and Student Doctor Network posts. As you can see in Fig. 2.1, the distribution of research time is a continuum. From this survey, we want to emphasize that 53% of the survey respondents with full-time academic appointments reported devoting at least half of their time to research and only 17% reported devoting at least 80% of their time to research. Likewise, only 23% reported devoting most of their time to clinical activities [2]. This indicates that MD/PhD graduates are able to balance research and clinical duties as well as teaching and other activities in many different ways. Now that we know what MD/PhDs do once they graduate, it is time to look at how successful they are. Of course, success is subjective and can be measured in many different ways, so we will stick to the measures that were covered by the study. As researchers, one key measure of success is grant awards. Among the respondents who have applied for NIH grants as a principal investigator, 76.9% were successful [2]. Additionally, 86.4% of those who reported having funding from the NIH also had non-NIH sources of funding, and 51.0% only had funding from non-NIH sources [2]. MD/PhDs have clearly been very successful in securing research funding for their projects, which is not surprising given the rigorous nature of their training. Within the respondents, there was also a Lasker Award winner, two Nobel Laureates, and 56 Howard Hughes Medical Institute investigators [2].

2  What Do MD/PhDs Do and Who Should Become One?

9 Clinical %

90% 80% 70% 60%

≥80% research effort: 17.1% ≥70% research effort: 36.2% ≥50% research effort: 52.7%

50% 40% 30% 20% 10% 0%

100 200 300 400 500 600 700 800 900 1,000 1,100 1,200 1,300 1,400 1,500 1,600 1,700 1,800 1,900 2,000 2,100 2,200 2,300 2,400 2,500 2,600 2,700 2,800 2,900 3,000

% of Research Effort and % of Clinical Effort

Research %

100%

Respondent Number, From More to Less Research Effort

Fig. 2.1  Research and clinical effort reported by participating MD/PhD program alumni employed in academia full-time. The histogram shows the percentage of research and clinical efforts arranged from left to right by decreasing research effort. The percentages for each respondent do not always equal 100% because the survey also included teaching, administration, consulting, and other (not shown in the histogram) [2]

We have spent a lot of time talking about the research that MD/PhD graduates undertake, but what about the clinical pursuits of these graduates? They are still medical doctors, after all. Figure 2.2 illustrates the distribution of MD/PhD graduate choice of residency and subsequent distribution of specialties. By the way, when we say choice, we really do mean choice. Most MD/PhD program graduates do very well when it comes to matching for residency, with the large majority matching into one of their top two or three choices. The study also presents data on the demographics of the physician-scientist graduates who responded to the survey. Before 1975, the physician-scientist field consisted of nearly 99% men [2]; however, the ratio of men to women has been approaching 1:1 at a reasonably fast pace. In fact, 34.5% of physician-scientists who graduated between 2005 and 2014 were women [2]. Accordingly, in the 2019–2020 academic year, women made up exactly 50.0% of the matriculants into MD/PhD programs [3]. However, this statistic may be misleading, as fewer than 50% of the applicants to MD/PhD programs are women [3]. Although we have tried to provide as unbiased a perspective as possible, we do recognize that the experiences that come with applying to MD/PhD programs, completing the MD/PhD training, and advancing in a career in academic medicine often differ between men and women. In order to address this disparity, many MD/PhD programs have student organizations dedicated to supporting women in science and medicine, which focus on a wide range of topics, including career development, mentorship, and recruiting the next class of female physician-scientists. Oftentimes,

10

a

2  What Do MD/PhDs Do and Who Should Become One? Internal medicine

(1,174) 25.3% (641) 13.2%

Pathology Pediatrics

(584) 12.6% (381) 8.2%

Neurology Others

(228) 7.4%

Surgery

(329) 7.1%

Psychiatry

(243) 5.2% (190) 4.1%

Radiology

(178) 3.8%

Dermatology

(174) 3.7%

Ophthalmology Radiation oncology

(141) 3.0% (136) 2.9%

Anesthesiology Medical genetics

(93) 2.0% (68) 1.5%

Obstetrics and gynecology Allergy and immunology

(59) 1.3%

Emergency medicine

(58) 1.2% (42) 0.9%

Family medicine

(21) 0.5%

Nuclear medicine Pysical medicine and rehabilitation Preventive medicine

(9) 0.2%

Pain medicine

(8) 0.2%

(14) 0.3%

Surgical specialities

b

1.8% 0.3% 4.9% 6.7%

Internal medicine subspecialities 1.2% 1.3% 4.4% 4.4%

1.1%

0.9% 0.5%

25.2%

26.4% 4.9%

8.5%

15.8%

20.9%

3.8% 4.5%

9.6% 24.0%

1.2% 1.2%

3.7%

5.3% 12.8%

Pediatric subspecialities 2.0% 2.3% 2.3% 2.7% 2.7% 3.3%

17.2% 11.1%

20.7%

4.7% 6.8% 6.8%

11.5%

10.4%

Neurosurgery

Plastic surgery

Hematology-oncology

Nephrology

Hematology-oncology

General

Cardiothoracic

No subspecialty

No subspecialty

Orthopedic

Vascular

Cardiology

Otorhinolaryngology

Colon and rectal

Infectious disease

Medical genetics Allergy and immunology

Urology

Endocrinology Rheumatology Pulmonary and critical care medicine Gastroenterologyhepatology

Other subspecialties Geriatrics Palliative medicine

Medical genetics Endocrinology Infectious disease Neurology Rheumatology Cardiology Neonatology Gastroenterologyhepatology

Allergy and immunology Critical care medicine Nephrology Pulmonary Neonatal and perinatal Other subspecialties Psychiatry

Fig. 2.2 (a) Residency fields chosen by MD/PhD program alumni. Respondents were allowed to select multiple specialties, so the percentages add up to more than 100% (b) Surgical specialties, internal medicine subspecialties, and pediatric subspecialties that were chosen by participating program alumni [2]

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2  What Do MD/PhDs Do and Who Should Become One?

the contact information for the board members of these outreach groups are available on that institution’s MD/PhD website. We encourage female applicants who would like the perspective of women who have been through the application process to reach out to the board members at any institution, particularly one that you are interested in applying to. We provide a link to one example for a prominent MD/ PhD program as a resource at the end of this chapter. Additionally, there are a number of online journal articles that provide a female perspective on the unique challenges that women face in academic medicine, one of which is also referenced at the end of the chapter. In addition, there is a marked increase in the number of international (non-US citizen or nonpermanent resident) MD/PhD students and graduates. Despite the current underrepresentation of multiple racial and ethnic groups in MD/PhD programs and in the larger physician-scientist workforce, MD/PhD matriculants and graduates are slowly becoming more diverse among various racial and ethnic demographics. However, the disparities are still quite large, and more work is needed to reach the goal of recruiting a diverse applicant pool [4]. Table 2.1 shows the racial and ethnic breakdown of MD/PhD program graduates before 2005, MD/PhD program graduates between 2005 and 2014, and MD/PhD matriculants for the 2019–2020 academic year. Last but not least, let’s take a look at graduate satisfaction with their MD/PhD training. The study asked respondents if they would choose to do MD/PhD training again if they could go back in time. From the results, it looks like most graduates are satisfied with their training and career outcomes. In fact, 49.4% said “definitely yes” Table 2.1  Race and ethnicity of MD/PhD program graduates and matriculants [2, 5]

Race/ethnicity American Indian or Alaska native Asian Black or African American Hispanic, Latino, or of Spanish origin Native Hawaiian or other Pacific islander White Other Multiple race/ethnicity Unknown race/ethnicity Non-US citizen and nonpermanent resident

Percent of MD/PhD program graduates before 2005a 0.2%

Percent of MD/PhD Percent of program graduates 2019–2020 MD/ between 2005 and 2014a PhD matriculantsb 0.6% 0.1%

15.7% 2.7% 2.2%

22.3% 5.2% 4.8%

23.4% 5.8% 4.7%

0.1%

0.2%

0.0%

74.7% 0.3% N/A 2.7% 1.7%

66.8% 2.7% N/A 0.1% 3.7%

45.6% 1.6% 9.6% 5.8% 3.5%

Note: The sum of these percentages may not equal to 100% due to various inconsistencies in the data collection or their calculations a Data from the National MD-PhD Outcomes Study [2] b AAMC data on 2019–2020 MD/PhD matriculants [5]

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2  What Do MD/PhDs Do and Who Should Become One?

and 32.9% said “probably yes”; therefore, a total of 82.6% of respondents answered in the affirmative [2]. However, this may be an example of response bias where people who were not satisfied with their training did not bother to fill out the survey, so consider these results accordingly. Now that you have a solid idea of what a physician-scientist career path looks like, it is time for some deep introspection. You need to decide if this career path is something that will motivate you to get out of bed in the morning, keep you attentive during the day, and leave you happy when you get home from work. The answer to this question is not easy, and even when you make a decision, it will still be an uncertain one. However, the good news is that you have a wide range of career options at the end of the journey, so you will not necessarily be stuck with the same job your entire life. How did previous MD/PhD applicants decide to pursue this training? Well, the answer is going to vary widely. Some people will invariably be attracted to the prestige of being a “double doctor.” Others will enjoy the career flexibility that having a dual degree will afford. Many applicants, during their interviews, will cite their passion for both research and medicine and their inability to choose between them or will explain how their career goals require the synthesis of clinical medicine and academic research in a way where this dual training would be invaluable. And, of course, there will be those looking for a free ride through medical school, although this is never a good answer during an interview. With huge life decisions like this, there is no way to guarantee that it will be the right choice for you. A decision of this magnitude should be made by weighing the risks and rewards. For instance, if you are the type of person who is innately curious, has an aptitude for science, and is naturally hardworking, then there is very little risk in pursuing a career as a physician-scientist. Even if the training does not live up to your every expectation, you will probably enjoy the experience and will likely succeed with a valiant effort. And even if you decide the whole bench-to-­ bedside thing is not for you, the training will still be highly valuable and informative. You will have graduated debt-free with two very prestigious degrees and most of the scientific world open to your exploration. However, if you are not the type of person who enjoys learning for the sake of learning and is only motivated by external rewards, then the risk might not be worth it. You may have a very good reason for pursuing the dual degree, but if that reason does not pan out and your personality does not match the daily realities of the training, then it probably is not a worthwhile endeavor. Ultimately, only you can make this decision. In order to help you get a sense of what the training selects for, we have devised a list of statements you can use to better understand if the physician-scientist training is the right path for you. Every question below should be answered on a scale of 1–5. Although this is a very subjective quiz, the greater your score (ideally over 40/50), the more likely an MD/PhD training would be a worthwhile path for you. You do not need to answer 5 for every question in order to be a solid applicant, but

2  What Do MD/PhDs Do and Who Should Become One?

13

these statements are just to encourage you to think about the personal qualities and goals you should be considering. The authors of this book have each taken this quiz and posted their scores below. 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree 1. I enjoy studying scientific topics, particularly the human body. 2. I am very good at studying scientific topics, particularly the human body. 3. I am in high school or I am an underclassman in college, and I am motivated to find a research position and make it a priority in my life (15–25 hours per week). Or I am a junior or senior in college, and I am motivated to take the necessary gap years to gain substantial and productive research experience, or I have already had significant research experience during my time as an undergraduate. Or I graduated from college more than 2 years ago, and I am willing to make a change to my career trajectory in order to pursue further training. 4. I am someone who has successfully made or is willing to make many sacrifices in order to balance my academic commitments, research, clinical and community volunteering, shadowing, personal interests, and physical and mental health throughout college. 5. I am willing to make no more than $40,000 a year during the entire duration of my MD/PhD training and make no more than $80,000 during a residency of variable length. 6. In general, I am willing to take on long-term projects which lack instantaneous gratification. 7. In general, I am an independent thinker who requires little to no guidance when completing a complex task. 8. I am well-organized, highly motivated, and willing to be challenged daily. 9. I care enough about the advancement of biomedical research and healthcare innovation that I am willing to reduce my clinical time as a physician in order to pursue research and possibly take a relative pay cut. 10. I am willing to prioritize my MD/PhD training over my desire to live in a certain city or region. Author scores: • Setayesh: 44/50 • Sussman: 45/50 • Venapally: 44/50

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We hope this chapter has helped you gain an even stronger understanding of the purpose of the MD/PhD training and what happens after you graduate in addition to guiding your thought processes on whether this is the right career path for you. If you are still having a tough time deciding whether or not to pursue this route, there are many other ways to help you make your decision easier. You can find physician-­ scientists at your respective university and ask to meet with them or, better yet, shadow them in the clinic if possible. Moreover, if an MD/PhD program exists at your institution or at a nearby institution, you can reach out to MD/PhD students. Additionally, you can even reach out to MD/PhD students at schools to which you are thinking about applying, and many of them would be very willing to speak with you. Moreover, the American Physician Scientist Association (APSA) is a national organization dedicated to furthering the training of physician-scientists and offers many valuable opportunities for prospective MD/PhD applicants. For example, the APSA’s Undergraduate Mentoring Program helps to connect prospective applicants with MD/PhD mentors who can share insight into their experiences. The APSA also provides webinars for students to help make connections, learn about career opportunities, and gain insights on the application process. Furthermore, some universities have student chapters of the APSA. This can provide a great platform to connect with mentors as well as other students who are interested in becoming physician-scientists. Ultimately, the best way to learn about MD/PhD training and career opportunities is through the lens of accomplished physician-scientists. Before concluding this chapter, we would like to present several articles by physician-scientists and MD/ PhD program directors, which we view as highly valuable resources for anyone considering a career as a physician-scientist and strongly suggest reading.

Useful Resources 1. “Is an MD/PhD Program Right for Me? Advice on Becoming a Physician-­ Scientist” [6] –– This article is by Skip Brass, the director of the University of Pennsylvania MD/PhD program, the largest MSTP program. He describes different ways to become a physician-scientist, career outcomes, and offers valuable advice on how to apply and how to select a program. 2. “My Life as a Clinician-Scientist: Trying to Bridge the Perceived Gap Between Medicine and Science” [7] –– This article was written by Peter G.E. Kennedy, a professor at the University of Glasgow, who is internationally recognized for his research on viral infections of the nervous system. He is a great example of a physician-scientist

References

15

who has successfully integrated substantial and meaningful clinical and research careers. 3. The Vanishing Physician-Scientist? [8] –– Written by Andrew Schaefer, professor of Medicine in Hematology-­Oncology at Weill Cornell Medicine, this book discusses how the roles of physicians have shifted over time. He argues that the physician-scientist will create the paradigm of the future of medicine, which is strongly driven by advancements in science. 4. “The national MD-PhD program outcomes study: Relationships between medical specialty, training duration, research effort, and career paths” [1] –– This study analytically examines the career paths and outcomes of MD/PhD training in great detail. This work shows just how broad and diverse the paths of MD/PhD graduates are and demonstrates that MD/PhD training is highly valuable in many different professional contexts. 5. “Women MD-PhDs: Life in the Trenches” [9] –– This piece explores some of the many challenges that women face as MD/ PhD students and physician-scientists, providing a much-needed perspective. 6. University of Pennsylvania MSTP Association of Women Student MD-PhDs https://www.med.upenn.edu/mstp/awsm/

References 1. Brass LF, Akabas MH.  The national MD-PhD program outcomes study: relationships between medical specialty, training duration, research effort, and career paths. JCI Insight. 2019;4(19):e133009. https://doi.org/10.1172/jci.insight.133009. 2. Akabas MH, Tartakovsky I, Brass LF.  The national MD-PhD program outcomes study. American Association of Medical Colleges Reports. 2018. 3. Association of American Medical Colleges. U.S. medical school MD-PhD applications and matriculants by school, in-state status, and sex, 2019–2020. In: 2019 FACTS: enrollment, graduates, and MD-PhD data. 2019. https://www.aamc.org/system/files/2019-12/2019_FACTS_ Table_B-8.pdf. Accessed 20 May 2020. 4. Christophers B, Gotian R.  Using admission statistics to encourage diverse applicants to MD-PhD programs. J Clin Invest. 2020;130(1):17–9. https://doi.org/10.1172/JCI134941. 5. Association of American Medical Colleges. MD-PhD matriculants to U.S. medical schools by race/ethnicity (alone) and state of legal residence, 2019–2020. In: 2019 FACTS: enrollment, graduates, and MD-PhD data. 2019. https://www.aamc.org/system/files/2019-12/2019_ FACTS_Table_B-9.pdf. Accessed 20 May 2020. 6. Brass LF. Is an MD/PhD program right for me? Advice on becoming a physician-scientist. Mol Biol Cell. 2018;29(8):881–5. https://doi.org/10.1091/mbc.E17-12-0721.

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7. Kennedy PG. My life as a clinician-scientist: trying to bridge the perceived gap between medicine and science. DNA Cell Biol. 2015;34(6):383–90. https://doi.org/10.1089/dna.2015.2860. 8. Schafer AI.  The vanishing physician-scientist? Transl Res. 2010;155:1):1–2. https://doi. org/10.1016/j.trsl.2009.09.006. 9. Hede K. Women M.D.-Ph.D.s: life in the trenches. Science. 2009. https://doi.org/10.1126/science.caredit.a0900014.

Chapter 3

Prerequisite Requirements

As an MD/PhD applicant, you are applying to both medical school and graduate school. However, the applications for American medical schools are processed primarily through the medical school at each institution and utilize the application system and timeline of the American Medical College Application Service (AMCAS). Therefore, the prerequisite requirements are more aligned with an MD-only medical school applicant than with a PhD-only graduate school applicant. Yet, there are some important differences that become frequent points of confusion for applicants. The goal of this chapter is to review both the explicit prerequisites such as standardized test scores and unwritten/implicit prerequisites such as clinical and volunteer experiences. We also want to clarify the most important ways in which the requirements vary for MD/PhD applicants when compared to MD-only and PhD-only applicants.

Standardized Tests Every medical school requires the Medical College Admission Test (MCAT), which is no different for MD/PhD applicants. However, applicants and matriculants to MD/PhD programs tend to have slightly higher MCAT scores on average than their fellow MD-only applicants and matriculants, which is illustrated in Table 3.1. Keep in mind that comparing your score to the mean MCAT scores of MD/PhD matriculants is more useful than using the data for all applicants, as it illustrates the average scores for successful applicants as opposed to all applicants. It is important not to perseverate over these values because the range of successful values varies so widely by institution. It is much more effective to use the Medical School Admission Requirements (MSAR) database to determine how your score fits into the range of successful scores at individual institutions. This will be discussed more in Chap. 5. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 J. Sussman et al., The Complete MD/PhD Applicant Guide, https://doi.org/10.1007/978-3-030-55625-9_3

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18

Table 3.1  Mean MCAT scores for medical school and MD/PhD applicants and matriculants from 2017 to 2020 Academic year 2017–2018 2018–2019 2019–2020 Academic year 2017–2018 2018–2019 2019–2020

Mean MCAT scores of all applicants 504.7 505.6 506.1 Mean MCAT scores of matriculants 510.4 511.2 511.5

Mean MCAT scores of all MD/PhD applicants 509.6 510.1 511.0 Mean MCAT scores of MD/PhD matriculants 515.4 515.6 516.1

Academic year includes applicants and matriculants who applied to enter medical school in the fall of the given year [1, 2] The standard deviation for all points in the applicant data varies between 9.3 and 9.6, and the standard deviation for all points in the matriculant data varies between 5.4 and 6.6, which is appreciably large [1, 2]

There are hundreds of resources for preparing for the MCAT including textbooks, online courses, and in-person courses. While preparing for the MCAT is beyond the scope of this book, as there are hundreds of preparatory books on the subject, we have listed a few rudimentary resources at the end of the chapter if you are having difficulty getting started. The GRE, in general, is not required, nor considered, for most MD/PhD programs. Most applicants do not take the GRE, and taking it when not required would not be beneficial. The MCAT comprehensively covers scientific reasoning, critical reading, and general biology, which is why the GRE is not required for most MD/ PhD students pursuing biomedical PhDs, even though their PhD-only counterparts are required to take the GRE. However, taking the GRE may be required for MD/ PhD applicants applying to PhD fields outside of the basic sciences and engineering, including anthropology, economics, sociology, etc. If you are considering a social science or humanities-based PhD, it would be worthwhile to check with individual MD/PhD programs to determine if the GRE is required before taking the exam.

GPA A strong GPA is imperative for MD/PhD applicants. Table 3.2 outlines the mean GPAs for both applicants and matriculants for all medical school and MD/PhD programs, respectively. As we mentioned earlier, the data corresponding to matriculants is much more useful than the data for all applicants. As with the MCAT, the range of successful values varies widely by institution, and it is much more effective to consult the MSAR database. Many of the top schools mostly accept students with a GPA above 3.90, and this is even higher for

Coursework

19

Table 3.2  Mean GPA for MD-only and MD/PhD applicants and matriculants from 2017–2020 Academic year 2017–2018 2018–2019 2019–2020 Academic year 2017–2018 2018–2019 2019–2020

Mean GPA for all applicants 3.56 3.57 3.58 Mean GPA for matriculants 3.71 3.72 3.73

Mean GPA for all MD/PhD applicants 3.64 3.64 3.67 Mean GPA for MD/PhD matriculants 3.79 3.79 3.80

Academic year includes applicants and matriculants who applied to enter medical school in the fall of the given year [1, 2] The standard deviation for all points in the applicant data varies between 0.32 and 0.34, and the standard deviation for all points in the matriculant data varies between 0.18 and 0.25, which is appreciably large [1, 2]

MD/PhD applicants. However, an applicant’s GPA is considered in the context of that person’s life; therefore, a GPA significantly below these averages does not necessarily bar you from admissions, but it may reduce your application’s likelihood of succeeding. Importantly, however, MD/PhD program directors have indicated that correlation between high numerical metrics (MCAT and GPA) and application success does not necessarily indicate causation. High-achieving applicants who demonstrate competency and innovation through their research and extracurricular activities also tend to perform well in their coursework, rendering these statistics potentially misleading and discouraging to highly competitive applicants. Moreover, it is impossible to summarize your entire educational history in one number. The AMCAS application automatically calculates a subcategory of your GPA, known as the “science GPA,” which only includes classes in the fields of biology, chemistry, physics, and math. Generally, medical schools tend to place more weight on the science GPA than the overall GPA. It also presents your individual GPAs for each year of college. If you have a lower GPA, but it has increased significantly throughout your time in college, then your academic trend may illustrate growth over time and make up for a rough freshman year. And if schools are still not satisfied with these metrics, admissions committees can view your grades for each individual course. While it is impossible for us to draw any general conclusions about the quality of an application at this level of detail, remember that your GPA is only one metric of your academic history and medical schools view applicants in a holistic manner.

Coursework In terms of college majors and degrees, there is no specific requirement aside from obtaining a Bachelor’s degree. The vast majority of MD/PhD applicants have degrees in the biological (and occasionally physical) sciences, such as biochemistry,

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biology, or biomedical engineering with extensive laboratory-based coursework. This is similar between MD and MD/PhD applicants. However, some successful applicants have degrees in the humanities or social sciences. Usually, this is a unique degree that is directly connected to their intended social science PhD like anthropology or bioethics and is accompanied by relevant health-related research in that field. In other cases, these applicants have extensive research experiences in the basic sciences often spanning multiple gap years. Your degree does not need to be in the field in which you ultimately hope to conduct research, but it is just one of the many ways through which you can demonstrate interest in a particular field. Most medical schools have some level of specifically required coursework. This generally includes 1 year of biology with lab, 1 year of physics with lab, 1 year of English/writing, 1 year of general chemistry with lab, 1 year of organic chemistry with lab, and sometimes one or two semesters of mathematics. Although not required by every school, it is often helpful to have displayed interest in the humanities and social sciences, particularly through coursework in psychology and sociology. Humanities classes can help fulfill medical school requirements for writing-intensive coursework if your school does not offer standard English classes. It is critical to consult the MSAR database for the specific requirements for each institution. Most medical schools are loosening these requirements, realizing that they constrain students’ ability to take more advanced coursework. Nearly all medical schools will allow AP tests to substitute for some of these requirements, especially at the lowest level of general biology and general chemistry. Moreover, many medical schools are moving to a “competency”-based system. Instead of explicitly requiring two semesters of general chemistry, competency in this subject could be obtained through upper-level coursework, practical lab experience, or other means. However, AP exam exemptions and other substitutions are not intended so that students can avoid studying a subject. Rather, they allow students to pursue more advanced and meaningful coursework in the subject. MD/PhD programs especially value rigorous and advanced coursework as this demonstrates preparedness for PhD-level coursework. Moreover, completing multiple degrees is highly valued, especially in disparate and unique fields. While MD/PhD applicants must still meet the explicit medical school admission requirements, MD/PhD programs prefer students who have completed a difficult degree and obtained practical experience rather than those who have spent the majority of their time completing additional basic or lower-level coursework. Consequently, classes that are listed as recommendations, including psychology, sociology, and statistics, may be helpful to students in preparing for the MCAT, but not having taken these classes will generally not negatively impact your MD/PhD application, assuming you have demonstrated competency in other ways. Competency in these areas can be clearly demonstrated by the MCAT score itself, through the completion of a challenging degree such as neuroscience or biochemical engineering, or even by applying the relevant concepts through independent research.

Letters of Recommendation

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It is often asked if taking required courses at another institution, such as summer classes at a community college, will negatively impact one’s application. While every institution views this differently, MD/PhD programs prioritize the big picture of your studies and long-term goals. If taking classes online or at a community college allows you to complete a challenging degree, pursue a research project, or engage in a unique extracurricular activity, then this is undoubtedly warranted. For example, Setayesh took two humanities classes online at a community college in order to pursue a summer research scholarship and do full-time research. Additionally, he had also received an A in the three other humanities courses in the sequence. Therefore, he had already demonstrated proficiency in writing and critical analysis, so his choice to take online classes supplemented his application by demonstrating a commitment to research. Sussman took two organic chemistry classes at a community college to enable the completion of a rigorous dual degree in 4 years. These examples are provided to serve an illustrative purpose, and you should make these decisions based on your individual circumstances. Lastly, it is important to note that required prerequisite courses taken online are sometimes not accepted and that required courses generally must be taken for a letter grade, rather than pass/fail. However, exceptions are currently being made because of the coronavirus pandemic. If you are ever concerned about whether or not you have met the course requirements for a particular school, do not hesitate to directly contact the MD/PhD program to discuss your circumstances before applying. MD/PhD programs consider applicants holistically so they may be flexible with the requirements.

Letters of Recommendation Recommendation letters are an important part of the application and should not be overlooked just because they require less time on the part of the applicant. Each medical school has its own requirements for letters of recommendation, and the MD/PhD program often has its own requirements that may be in addition to the medical school’s requirements or override the requirements set forth by the medical school. The most frequent requirement is obtaining letters of recommendations from each principal investigator who is familiar with your research capabilities. Therefore, it is strongly advised to obtain a recommendation from any PI that oversaw any research work that you mention in your primary application essays or in the activities section. Although the MSAR database lists the letter of recommendation requirements for each school, these can often be outdated or incorrect. Additionally, they often apply to the MD-only applicants and not the MD/PhD applicants. In fact, the limit on the number of letters is often higher for MD/PhD applicants because of the additional research letter requirements. Therefore, it is critical to compare the requirements that are listed on the MSAR database, the requirements listed on the individual medical school admissions website, and the requirements listed on the MD/PhD

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3  Prerequisite Requirements

program website. Doing this for each school to which you apply will be vitally important in order to avoid sending the wrong combination of letters of recommendation. Therefore, you should contact the school about any discrepancies or confusion. If you are still unable to obtain reliable information about the letter of recommendation requirements for any number of schools, then you can wait until you receive the supplemental (secondary) application before assigning letters to each school. This must be done for each school individually because each school requires a different combination of letters. Although it is recommended that you have your letters of recommendation submitted to the centralized application service long before you receive your secondary applications, you do not have to assign these letters to a school until you submit your secondary application. Setayesh made the mistake of assigning letters before he received his secondary application, and he accidentally submitted the wrong combination of letters to a few schools. The details involved in the process of submitting letters of recommendation will be discussed further in the next chapter. As mentioned earlier, letters of recommendation should be sought several months before you intend to apply. The first step is to consult with your university’s pre-­ health advising department. There are three types of letters, according to AMCAS: 1. Committee or composite letter: A letter written by the pre-health committee which is a compilation of letters, interviews, and other sources. Many universities do not have this option, and those that do have their own unique processes. 2. Letter packet: A set of letters collected and distributed by the pre-health advising department. 3. Individual letter: A letter sent directly from the recommender to AMCAS. First, every medical school has an option for recommenders and pre-health committees to directly send any of these three letter types to the AMCAS service as part of the primary application, which will be discussed in Chap. 4. Some medical schools prefer the committee letter if it is offered by your institution. Your university should provide proper guidelines for obtaining it. If you request a packet of letters, then you can only assign the entire packet to a particular school; you cannot select individual letters from the packet. However, medical schools understand this and will accept your letter packet as a whole, even if it exceeds their maximum allowed letters. Note that even if you send a letter packet or committee letter, you can still send additional individual letters. This is especially important for MD/PhD applicants because many undergraduate institutions limit how many letters are allowed to be included in the packet. This can cause an issue for MD/PhD applicants who have worked in multiple labs and need to obtain letters from several PIs (discussed later). In this case, you can include the letters that you view to be the strongest in the letter packet and send the remainder of the letters as individual letters. If you request a committee letter or letter packet and additional individual letters, these can be split up into any combination that will allow you to best fulfill the requirements of each school. Be sure that your letter packet contains a broad range of letters that

Letters of Recommendation

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showcase a variety of strengths. The discussion below regarding individual letters is applicable to letter packets as well but must be tailored to the process and requirements of your specific undergraduate institution. Lastly, note that if your school offers a letter packet or committee letter and you choose not to use that service, you will likely be asked to explain why you made this choice. This could potentially be perceived negatively and should generally be avoided. In obtaining individual letters, it is worthwhile to request letters from two basic science professors (i.e., biology, chemistry, biochemistry, physics, etc.) with whom you have taken classes, two nonscience professors with whom you have taken classes, at least two research mentors (cannot include PhD students), and two personal references such as an advisor for a club, volunteer coordinator, etc. Many MD/ PhD programs request a letter from every faculty research mentor with whom you have directly worked or a letter for each main research experience, a requirement that is often overlooked. If you begin a research experience after your application has been submitted, it is understandable to not have a letter in this case, and the secondary application may ask for this justification instead. For engineering students, it is generally acceptable if one of the science professors is an engineering professor (preferably in a biochemical or biomedical field); otherwise, these letters should be from pure science professors. Since MD/PhD programs often require two letters from research mentors (and sometimes even encourage more when possible), if you have only worked in one lab, consider your lab’s collaborators, or ask your PI for suggestions. It is always better to ask for too many letters than too few if you are still uncertain about the requirements. The letters suggested above are for your “letter bank” of potential requirements for any school to which you may apply. You will not submit every letter to every school. Most importantly, in terms of the content of each letter, be sure to ask your letter writers to focus on specific aspects and examples of your qualifications. Your letters from research mentors should focus more on your ability to independently conduct rigorous research (the PhD side of your application), and your other letters should focus on your ability to thrive academically in medical school or your promising future as a physician (the MD side of your application). However, the best letters always address the dual nature of the combined degree to some extent, so you should be clear about your educational and career goals when discussing the letters. As will be emphasized in the next chapter, the letters are sent to multiple schools which you may not have even identified at this point, so the letters should not mention any specific schools. The AAMC provides a very useful document detailing their guidelines for writing an effective letter of evaluation for medical school applicants (linked at the end of the chapter). This document is important for anyone writing a letter in support of your application. It details how letter writers should describe their interactions with you to address your personal and professional strengths rather than merely restating your resume or other parts of your application. Lastly, the content of the letter is significantly more important than the title of the letter writer. While it may be nice to get a letter from an MD/PhD or MD if possible, a compelling, personal letter from an Assistant Professor is a much better choice.

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You may be wondering how to even begin asking someone to write a letter for you. It is easy to become intimidated by a professor that you may not know very well. In fact, if you are intimidated by someone, this may be an indication that they do not know you well enough to write you a strong letter. In any case, it is best to request the letter in person. Try to set up a meeting with them where you can catch up and exchange life updates rather than jumping straight to the point. This will demonstrate that you find value in your professional relationship with them. Ultimately, a good personal rapport will improve the quality of the letters that you will receive. In the case that someone declines to write a letter for you, don’t try to convince them otherwise, and certainly don’t be offended. Professors decline letter requests often because they genuinely do not feel that they can provide the quality of letter you need and deserve, either because they are simply too busy or they do not know you well enough to provide the specific examples that create a strong letter. You should send the letter writers a current resume/CV, a transcript, and a draft of one or two of your personal statements so they can get to know you better, and it will help them to consider your strongest attributes and specific examples to illustrate your qualifications. However, strong letters discuss qualifications and provide examples that go far beyond your resume, so your letter writers should not merely duplicate or confirm other parts of your application. Additionally, if your letter writer has not had much direct experience writing letters for medical school or MD/ PhD applicants, we suggest providing the AAMC guidelines discussed above to your letter writer. If you send these items before you meet, the letter writer will have time to read about your activities and goals, and you will have a more engaging discussion. If you have just begun a lab position, it is very reasonable to ask for a letter, but the aforementioned advice becomes even more important. Even after a couple of weeks, a PI can attest to your potential in the lab and your motivation to succeed in your new position, which can have a large impact on your application. Briefly, when requesting letters, it is important to remind the letter writers to write their letters on official letterhead and sign them. While this may seem obvious, letter writers who have not specifically written letters for the AMCAS application may not realize this, causing the letters to be rejected by the medical schools. This happened to Sussman. The first school to notice the issue was aware that this is out of the applicant’s control and allowed the letters to be resubmitted. The resubmitted letters replaced the original letters for all schools (as will be discussed in Chap. 4), solving the issue entirely.

Extracurriculars and Other Activities MD/PhD programs seek students with experiences and accomplishments that are relevant to both clinical medicine and academic research. Most MD/PhD programs have vague requirements about what types of extracurricular experiences are required, which leads to more questions than answers. This section will provide an overview of these implicit requirements, which should be taken only as

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recommendations that have been shown to be successful. More details and anecdotal comments on activities will be provided in Chap. 9 as it pertains to how you should present them in the Work and Activities section of the application. It is important to note that this is the most variable and subjective part of the application. While we try to be quantitative by presenting reasonable estimates for recommended time commitments for various activities, what you accomplished through each activity and how each activity enabled you to grow personally and professionally matter far more. The suggested time commitments we provide are based on discussions with and comments from program directors, premedical advisors, program websites, and anecdotal experiences. Regardless of whether or not MD/PhD programs specifically require our exact suggestions, we believe that these recommendations will more broadly benefit your personal preparedness for the interview process as well as help solidify your decision to pursue the physician-scientist training. In Chap. 15 (Additional Resources), the authors present their individual experiences, perspectives, and advice regarding the activities below in order to illustrate examples of specific experiences and discuss how they were particularly significant for their application process and career development: 1. Research Experience: This is by far the most important aspect of any MD/PhD application. MD-only applicants typically have 1 or 2 years of part-time research experience; however, for MD/PhD applicants, a more extensive research resume is typical. We affirm that it is important to get a broad understanding of what a career in research will entail. While there are many ways to accomplish this, we recommend that applicants pursue at least 2 years of sustained, part-time research effort, which is often a direct requirement for some MD/PhD programs. Additionally, many applicants pursue at least one summer of full-time research, and many take a whole year (or more) to do full-time research after completing their undergraduate degree. In terms of the number of hours, we concur that a minimum of 1000 hours of research experience is advisable if no gap years are taken. Otherwise, we recommend spending at least 1 gap year committed to fulltime research, which should bring your total research experience to over 2000 hours and demonstrate a clear commitment to research. Although many successful applicants have at least one accepted publication, publications are absolutely not required. Many successful applicants have not co-authored publications, and admissions committees recognize the variable nature of publications, especially for undergraduate students. However, it is still imperative to show concrete evidence that you contributed in a meaningful way to your research. This can include poster presentations, conference submissions, or a detailed description of your contributions within a letter of recommendation, which will be discussed further in a later section. A relatively short part-time research experience that resulted in the completion of several projects can contribute to a highly successful application; however, a longer full-time research experience that results in no meaningful scientific contributions would be more likely to result in an unsuccessful application.

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2. Physician Shadowing: In general, clinical activities are less of a priority for MD/ PhD programs as compared to MD-only programs. However, physician shadowing is a worthwhile endeavor even if it is not an explicit requirement for all programs. Therefore, we suggest that 60–100 hours of shadowing experience can help broaden your perspective on medicine and provide experiences that are helpful when completing your application essays and interviews. It is also important to note that many applicants are successful with little to no shadowing experiences. Additional time here would be spent more productively doing research or taking part in volunteer efforts since physician shadowing generally only benefits the observer and makes no significant contribution to the clinic. Lastly, a range of shadowing experiences may be personally helpful but is not critical for your application. 3. Clinical Volunteering: As with physician shadowing, clinical volunteering can be useful when demonstrating a sustained interest in medicine and an ability to navigate a clinical environment. It will also help you confirm that pursuing medical training is the right choice for you. Therefore, we suggest that applicants pursue at least 100–200 hours of clinical experience in order to inform their decision to pursue medicine and gain meaningful experiences to highlight throughout the application essays. While you may certainly exceed 200 hours of clinical experience, this range is likely to be viewed as sufficient. As before, a variety of experiences may be personally helpful but is not critical. Interaction with patients is preferred over strictly administrative roles, although you are not expected (and in most cases not allowed) to participate in medical procedures. In interviews, you may be asked to discuss meaningful interactions with patients, so it is clear that this is highly valued. In general, any basic volunteer position at a local hospital or clinic will provide the necessary experience, although you may need to actively seek out ways to interact with patients. 4. Community Volunteering: Medical schools value students who are involved in their communities. The range of activities this includes is extremely broad, and does not have to be directly related to medicine. From volunteering at a food bank to volunteering to tutor children at a local school, it is important to take some time out of your day to engage with the broader community and interact with people from all walks of life. For many applicants, community volunteering overlaps with other types of activities. It may be part of a club (leadership) or an extension of their clinical volunteering that involves interacting with the community. While there are no explicit volunteering requirements for MD/PhD applicants, we suggest 200–400  hours of dedicated community service, and involvement is a worthwhile goal for MD/PhD applicants, especially if none of your other activities include this type of experience. While there is never a strict requirement for the number of hours completed, we believe that long-term community service endeavors are important for personal and professional development, especially because medicine is a service-oriented profession. 5. Leadership Experience: While highly variable, MD/PhD programs like to see that you have taken initiative in projects, organizations, and clubs. Accomplishing something meaningful and writing about these experiences in a compelling man-

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ner are more important than how many hours you have spent in any particular activity. Whether you started an organization or you took on a role in a student club, leadership experiences demonstrate that applicants can manage a multitude of time commitments, are self-motivated, and can work in groups with other people. As applicants whose personal development benefited tremendously from our involvement in leadership activities, we concur that these experiences can be the most formative opportunities available to students in college and beyond. Therefore, we hesitantly suggest that 500–1000 hours of leadership experiences would maximize the personal and professional growth gained from these opportunities; however, this is by no means an explicit requirement for any medical school. Any amount of leadership experience is a fundamentally worthwhile endeavor for you as an applicant and as a future physician-scientist. 6 . Nonacademic Interests/Hobbies: This category is often a significant contributor to what makes each applicant stand out. It is important to have other interests outside of research. MD/PhD programs are very small compared to medical schools as a whole, so it is even more important for MD/PhD students to bring something fun and unique to the culture of the program. This can include sports, music, art, etc. The possibilities are endless. As examples from the authors, Sussman is a concert flutist, and Setayesh writes economics articles. The best activities in this category are interests you have had for many years and are a strong part of your life, and they do not need to relate to medicine in any way. You should not select an activity merely to impress MD/PhD programs. Instead, you should find ways to participate in activities that demonstrate concrete interest and involvement in any of your passions outside of academia. There is no way to place an hour requirement on this criterion. It is most important to simply share your honest interests and experiences. As you will see later, interviewers love to talk to applicants about these types of unique activities, and we hope you will enjoy talking about your fun activities as well. Lastly, we want to directly address the topic of gap years. According to the AAMC, about 60% percent of entering medical school students reported taking at least 1 gap year [3]. However, due to the lack of available specific data for MD/PhD applicants, we cannot present precise data on this matter. Based on our observations and discussions with MD/PhD program leaders, the statistic is very similar for MD/ PhD applicants, and it has been increasing over time. The vast majority of applicants that do take a gap year conduct full-time research. Several applicants choose to take multiple gap years to pursue a longer research project, such as through a 2-year research internship at the NIH Postbac IRTA Program. Others find ways to incorporate additional clinical work but generally in the context of, or in addition to, a major research commitment. Taking gap years to pursue research is always viewed favorably, but is not necessary if you have completed all the prerequisites addressed in this chapter and can afford the time to travel to interviews, which can accumulate to over a month of total travel time. MD/PhD programs, to different extents, calibrate their expectations of applicants’ accomplishments based on whether or not gap years were taken.

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Venapally had extensive research experience that resulted in a publication while still an undergraduate student and was able to continue his coursework while traveling for interviews, so he did not take a gap year. Sussman completed a double major in engineering and music, which limited his time for research, and frequent music performances rendered constant traveling impossible. Therefore, taking a gap year allowed him to devote himself to his undergraduate studies to complete both degrees in 4 years while providing a year of full-time research that was critical in his application. While most applicants use their gap years to conduct full-time research, some applicants simultaneously pursue a Master’s degree, have a significant engagement in clinical activities, or participate in activities abroad. Ultimately, the decision of whether or not to take a gap year (or multiple), and what to do during that time, is yours. If you have completed all the prerequisites and are ready to apply, there is no need to delay your education and your career. If a gap year will provide you with an opportunity to do something meaningful and will substantially contribute to your application strength or success during your MD/PhD and if you have a clear plan, then you should not hesitate to take this time. If you enter a gap year with no clear plans for how you intend to improve the strength of your application or prepare for an MD/PhD program, you may encounter difficulties in justifying your decision to take a gap year, which may ultimately be detrimental to your application.

International Applicants About 7% of MD/PhD applicants are international (non-US citizens and nonpermanent residents) [4], so we want to address some of the requirements and considerations that are unique to this group. As noted in Chap. 1, about 20% of international MD/PhD applicants eventually matriculate, which is considerably lower than the 40% of all applicants. This is primarily due to the lack of NIH funding that is available to international applicants, which precludes many MSTP programs from considering international applicants at all. However, international students are often very strong applicants for certain schools, so do not be discouraged by this statistic. There are a few considerations and technical requirements that will help international applicants succeed. In the United States, fewer than 30 MD/PhD programs regularly accept international students. Permanent residents (Green Card holders) are generally treated the same as US citizens and are not considered international applicants. Additionally, policies pertaining to DACA applicants, which are different from those regarding international applicants, are constantly evolving and vary widely by institution. To determine which programs accept international applicants, you can first determine on the MSAR database which medical schools accept international applicants (~40 schools). Then, we advise that you visit the MD/PhD website of each program, as the MD/PhD program often has additional requirements than the medical school and are generally not listed on the MSAR database. Some medical schools accept

References

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international applicants, but the respective MD/PhD programs do not. Next, you will need to consult both the medical school and MD/PhD program websites to ensure you have met the specific requirements placed upon international applications, which can vary by institution. These requirements generally include 1 or 2 years of study in the United States and a demonstration of English competency. In general, a Bachelor’s degree from an American university will satisfy the requirements of all MD/PhD programs that accept international applicants.

Useful Resources 1. Medical School Admission Requirements (MSAR) Database https://students-residents.aamc.org/applying-medical-school/applying-medical-school-process/medical-school-admission-requirements/ 2. AAMC MCAT Official Prep: Free Planning and Study Resources https://students-residents.aamc.org/applying-medical-school/taking-mcatexam/prepare-mcat-exam/free-planning-and-study-resources/ 3. Princeton Review: How to Study for the MCAT https://www.princetonreview.com/med-school-advice/mcat-study-guide 4. Kaplan Test Prep: How to Study for the MCAT in 3 Months https://www.kaptest.com/study/mcat/mcat-study-guide-and-schedule-3-months/ 5. Guidelines for Writing a Letter of Evaluation for a Medical School Applicant (AAMC) https://www.aamc.org/system/files?file=2019-09/lettersguidelinesbrochure.pdf

References 1. Association of American Medical Colleges. MCAT scores and GPAs for MD-PhD applicants and matriculants to U.S. medical schools, 2017–2018 through 2019–2020. In: 2019 FACTS: enrollment, graduates, and MD-PhD data. 2019. https://www.aamc.org/system/ files/2019-12/2019_FACTS_Table_B-10.pdf. Accessed 20 May 2020. 2. Association of American Medical Colleges. MCAT scores and GPAs for applicants and matriculants to U.S. medical schools, 2017–2018 through 2019–2020. In: 2019 FACTS: enrollment, graduates, and MD-PhD data. 2019. https://www.aamc.org/system/files/2019-10/2019_ FACTS_Table_A-16.pdf. Accessed 20 May 2020. 3. Association of American Medical Colleges. What to do during a gap year(s). In: AAMC for students, applicants, and residents. 2017. https://students-residents.aamc.org/applying-medical-school/article/what-do-during-gap-years. Accessed 20 May 2020. 4. Association of American Medical Colleges. MD-PhD applicants to U.S. medical schools by race/ethnicity (alone) and state of legal residence, 2019–2020. In: 2019 FACTS: enrollment, graduates, and MD-PhD Data. 2019. https://www.aamc.org/system/files/2019-12/2019_ FACTS_Table_B-7.pdf. Accessed 20 May 2020.

Chapter 4

The MD/PhD Application Basics and Timeline

Once you are satisfied that you have all the experiences and requirements that make a strong MD/PhD applicant, it is time to get into the basics of the application process itself. The first step of the MD/PhD application is completed through the American Medical College Application Service (AMCAS), which facilitates admission to the majority of American medical schools. This is a common application that receives and reviews transcripts, test scores, demographic information, letters of recommendation, and essays to send to medical schools. It is commonly referred to as the “primary application.” MD/PhD programs outside of the United States do not use this application service and are beyond the scope of this book. To clarify a frequent point of confusion for MD/PhD applicants, while many Texas medical schools utilize the Texas Medical & Dental Schools Application Service (TMDSAS) for MD-only applicants, all MD/PhD applications are facilitated through AMCAS. MD/ PhD applicants do not need to complete the TMDSAS, even for Texas medical schools. The AMCAS application process is long and arduous for admissions into an MD program, and intuitively, the MD/PhD process requires even more work, about twice as much. Specifically, you not only must write two additional essays for the primary AMCAS application, but you also must write additional MD/PhD-specific supplemental essays for each school, which will be discussed in Chap. 10. In this chapter, we will discuss the timing of all the different parts of the application and strategies for keeping yourself on track.

Applying MD-Only as a Backup Before we discuss the individual steps of the application, given that applying to MD/PhD programs seems more difficult than MD programs, many applicants deliberate over whether they should apply to some schools as MD-only and other schools © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 J. Sussman et al., The Complete MD/PhD Applicant Guide, https://doi.org/10.1007/978-3-030-55625-9_4

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as MD/PhD to maximize their chances of getting into a medical school or because they are uncertain about their career path, educational goals, or qualifications. Many medical schools allow current students to add a PhD after they matriculate at the school, essentially joining the MD/PhD program. However, these students, who are known as “internal applicants,” may have to forgo a portion of the MD/PhD funding. Also note that an MD-only degree will still allow you to pursue a career as a physician-scientist with some additional self-guided research training. However, we recommend that you apply to a school as an MD-only applicant only if you truly are confident that you are not interested in that school’s MD/PhD program. Not only do MD/PhD programs want applicants who are committed to pursuing an MD/PhD, but applicants with extensive research and less clinical activities are often more competitive for MD/PhD programs than MD-only programs. Furthermore, these applicants are often more competitive for MD-only programs at schools that emphasize research in the curriculum, as opposed to schools that emphasize clinical work and community service. A school’s emphasis on research is often evident by the presence of a several-month-long “discovery” or “scholarly” phase in the medical curriculum. Of course, individual schools have no way of knowing where else you applied or if you applied concurrently to MD-only programs. However, an MD-only application is still fundamentally different than an MD/PhD application even though they share many of the same components, and MD/PhD programs look for a strong commitment to research throughout the entire application. As you will see in Chap. 9, the way in which MD/PhD applicants discuss their activities is unique as they describe the factors that led them to become “physician-scientists.” However, this part of the application is shared among all schools (both MD-only and MD/PhD programs) and cannot easily be tailored to both. Lastly, in the case that you are simply uncertain about your career path or qualifications, we suggest returning to Chaps. 1, 2, and 3 to find ways to learn more about both paths and the requirements for MD/PhD programs at various institutions. Having clarity and confidence at this point in the application process will help you in every subsequent step, so we recommend having a clear goal, not only for the admissions committees but, more importantly, for yourself. That being said, many schools provide the option at a later point, generally as part of the secondary application, to indicate whether or not you would want to be considered for a position in the MD class if you were to not be accepted into the MD/PhD program. Whether or not to select this option is a major point of contention for many applicants. There is evidence, based on online forums (which tend to scare many applicants), that admissions committee members at some institutions may screen against applicants who would want to still be considered for MD-only admissions. However, based on our own discussions with members of admissions committees, we have found that at most institutions, this choice is not even seen unless the applicant is rejected from the MD/PhD program. Furthermore, at certain institutions, this consideration is given by default without needing to opt in. In general, whether or not you select this option will not hinder your overall success as an MD/PhD applicant as long as it is clear in your application that your

Applying MD-Only as a Backup

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preference is to pursue an MD/PhD. If you believe your career hinges upon an MD/ PhD or you would simply not be satisfied with only an MD, then there is no need to check this option. Ask yourself: if you are not accepted to any MD/PhD programs, would you rather reapply the following year to MD/PhD and/or PhD programs or accept with an MD-only offer? If you would be satisfied with an MD from a particular school as a “backup” or “last resort” option, given that you will still be able to pursue a career as a physician-scientist, and may even be able to join the MD/PhD program at that institution at a later point, then it is advisable to select this option. The authors have received interview invitations for MD-only programs after receiving an MD/PhD rejection. However, we acknowledge that the MD program does not review your application until you are rejected from the MD/PhD program, so acceptance to the corresponding MD-only program at this point becomes significantly more difficult, but it is still possible. Ultimately, enabling yourself to be considered for MD-only admission is advisable in most cases as not doing so presents more of a risk than a benefit, so selecting the option should not be a cause for concern. To clarify a frequent question that applicants have, if you do have a change of heart while applying and no longer wish to pursue the PhD training, you will generally have to discuss this with the individual schools. At each school, based on its individual policies, you may be able to then withdraw your application from the MD/PhD pool and reenter it into the MD-only pool. As noted earlier, MD/PhD applicants and MD-only applicants undergo a fundamentally different review process involving different people. Therefore, this will likely induce a delay in your application. Additionally, to reiterate, keep in mind that MD/PhD and MD-only admissions committees look for different attributes, so the strength of your application may vary based on which committee is reviewing it. Once you are accepted into an MD/PhD program, if you choose to not complete the PhD portion of your degree, the process will vary by institution. It is understandable that extenuating circumstances may sometimes occur, and you should be open to discussing them with the program leadership. Lastly, because graduate school PhD-only applications and admissions processes are entirely separate from both MD-only and MD/PhD applications, you typically cannot be considered for PhD-program admission if rejected from the MD/PhD program. Therefore, applicants who are interested in a PhD as a “backup plan” sometimes choose to apply to additional PhD programs, but you should not attempt to apply to the MD/PhD program and a PhD program at the same institution. PhD programs, particularly in highly specialized fields, are often significantly less competitive than MD/PhD programs. While your efforts will be most effectively spent in creating the best possible MD/PhD application, you may want to consider this option if your clinical experiences are considerably lacking or if your research is of the utmost priority to you, especially in a very specific field or even a particular lab. However, note that some MD/PhD programs allow internal PhD students to apply, although they must go through the entire medical school application process. Any further discussion of applying to PhD programs is beyond the scope of this text.

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4  The MD/PhD Application Basics and Timeline

When to Take the MCAT That discussion aside, the first step in applying to medical school is, of course, taking the MCAT. Fortunately, there are many dates that you can sign up to take the 7.5-hour test. Unfortunately, the spots fill up fast in highly populated areas (sometimes months in advance), making the planning process highly inflexible. Inversely, in less populated areas, there are fewer testing centers, so you may even need to travel a significant distance to take the test. Therefore, it is important to register for the test through the AAMC well in advance of when you intend to take it and resolve any logistical difficulties before they arise. The AAMC MCAT Calendar listed at the end of the chapter provides a complete list of all the available dates and provides links to search for testing centers and, subsequently, to register for the test. Many applicants take this grueling exam the summer or fall the year before the application cycle, although the winter and early spring of that same year are also suitable options. Taking the exam relatively early allows applicants to have ample time to prepare for the exam as well as receive their score well in advance of the application cycle, leaving enough time to retake it if is necessary. Therefore, applicants who take the MCAT earlier can carefully consider where to apply based on their score and be fully devoted to completing the application and writing the essays without being weighed down by the stressful nature of the test. The best-case scenario is to take the MCAT by the end of March so that you can focus on your application and writing your essays during April and May. However, according to the MCAT Calendar (see end of chapter), the latest date that you can take the MCAT and also receive your score before the application opens for submission is the end of April, as it takes about a month to receive your score. You can still take the MCAT later, but your primary application will go through the verification process and be sent to selected schools lacking this information. Some schools, which do not screen for MCAT scores and GPA before sending secondary applications (discussed shortly), do not require the MCAT initially. Other schools require the MCAT in order to proceed with your application, and your application will not be considered complete until they receive your score. In this case, if you submit the application, it will be automatically finalized and processed by the school when your score is received. Theoretically, since schools will not receive your application until around June 28 at the earliest after the verification process (discussed below), you could take the MCAT by the middle of May and still see your score before selecting the majority of your schools without a delay in your application. We include this in our discussion to be comprehensive, but we strongly advise against this last-minute approach. Since the MCAT is effectively a prerequisite to the application and not a part of the application process, it should ideally be finalized before starting the application. Trying to combine them could result in a lose-lose situation which can severely jeopardize your MCAT performance as well as the quality of your application.

Submitting the Primary Application to AMCAS

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It is important to note that the MCAT scores are sent automatically to AMCAS, which immediately sends this information to all schools to which you have applied, so no additional work needs to be done on your part to transmit the scores. This presents a downside for students who take the test multiple times, as schools will receive all of your scores. Taking the test multiple times is not ideal unless you are confident you can raise your score significantly, such as in the case of unforeseen circumstances or illness the day of the test. If you are not highly certain you will score better the second time, we do not recommend taking the test again, but further comments on this matter are not covered in the book.

Submitting the Primary Application to AMCAS The ideal time to submit your primary AMCAS application is at the end of May, when it opens for submission. While you can start filling out your application around May 1, the earliest date that you can submit your application is around May 30, plus or minus a few days from year to year (exact dates are listed in the Premed Calendar linked at the end of the chapter). Therefore, if you want to submit your application on the earliest possible date, you have approximately 30 days to fill out your application. However, since you already know the prompts for the required essays ahead of time, the only timeline you really have is the one that you impose on yourself. The rest of the application, aside from the three required essays and the Work and Activities section, which includes listing your courses and demographic information, usually does not take more than a few days to complete and review. However, there is a catch. When you submit your AMCAS application, it does not immediately get sent to the schools to which you have chosen to apply. AMCAS must first process your application, which can take up to 6 weeks, depending on when you submit your application. During this process, an AMCAS employee manually checks that the courses that you have entered on your application match your transcripts and recalculates your overall GPA. In this way, you only have to send your transcripts to AMCAS and not to each individual school. AMCAS will not look at or check your essays nor do they require letters of recommendation or an MCAT score, only the technical information. The first date that AMCAS will release verified applications to your selected schools is usually around June 28 (varies yearly by a few days). This is where some game theory and strategy come into play. The closer to May 30 you submit your application, the more likely you are to be verified before June 28. In fact, if you submit your application immediately when it opens, it may take only a few days to become verified. However, the longer you wait, the more time you will have to work on and perfect your application, but you risk not having your application be sent with that initial wave of applications. The good news is that your application only needs to be verified once. Once it is verified, if you select additional schools, the application will be automatically sent to these schools with no

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4  The MD/PhD Application Basics and Timeline

delay. For example, if your application is verified on June 3 and you select an additional school on June 27, both schools will receive the application on June 28 with no effect on your application. In fact, only one school must be selected for your application to be submitted and verified. However, keep in mind that if certain mistakes on your application prevent it from being verified, it will have to be corrected and resubmitted, so submitting it early will allow you to correct mistakes before AMCAS begins delivering your application to schools. Since most medical school admissions operate on a rolling basis when it comes to providing interviews, earlier is always better. For MD/PhD applications specifically, completing such a long application early is very impressive and will show a strong commitment and interest. To be clear, the October to December “deadlines” posted on school websites for the primary (and later secondary) applications mean almost nothing to applicants. They simply indicate when the schools close their websites for submissions, but in reality, submitting your applications anywhere close to these dates provides virtually no chance of acceptance. Ultimately, there is no right date to submit your application, but, in general, we would strongly urge you to submit your application within the first week of June. If you find yourself prone to procrastination, we recommend viewing the date that the application opens as the effective due date. Otherwise, it is easy to spiral into endlessly delaying your application until you are no longer competitive for many schools. There are only two circumstances under which you should delay submitting your application, and that is if you know with certainty that you can significantly improve the quality of your application or you need more time to make sure the information you are submitting is correct.

The Importance of Accuracy This brings us to the next and arguably most important point. Accuracy is a very important attribute for the primary AMCAS application. In general, when verifying your application, AMCAS will correct a limited number of minor typos (