Let’s Talk a Little Pre-Med Heresy

Let’s Talk a Little Pre-Med Heresy

Keith Bradley, MDCEO/CMO

National Alliance of Research Associates Programs (NARAP)

Why Listen to this Guy?• West Point• Notre Dame• St. Clare’s Hospital (Hell’s Kitchen)• Tulane University School of Medicine• Medical College of Pennsylvania – EM• Norwalk Hospital• Lincoln Med and Mental Health Center (S. Bronx)• Bridgeport Hospital / Yale Emergency Medicine• St. Vincent’s Medical Center

Why Listen to this Guy?

• > 30 years as an academic emergency physician– hundreds of medical students and residents

• 7 years as a Health Professions Adviser– hundreds of pre-health professional students

• Research Associates (RA) Programs x 20 years– thousands of RAs

Agenda

• Help you see the process of preparing for a career in the health professions from a different perspective

• Recruit you – Line RA as a college undergrad– Chief RA as a college graduate

Heresies

• “Pre- Med”

• Why you go to medical school ?

• Research is very important, but …

• Significant clinical experience not optional

• Post-Bac is the preferable option

“Pre-Med”

• No “Pre- anything”

• Career begins with “I think I might want to be a ____.”– you want to be in control of how long or short

• Career Building ≠ just getting into medical school– medical school is a means not an end

Why Do You Go to Medical School?

• Do you want to go to medical school to become a physician?

• Go to medical school to become a resident;finish a residency to become a physician

• Only a physician can practice medicine• Trade School ≈ a medieval craft

– medical student = apprentice– resident = journeyman/woman

– physician = master craftsman/woman

Getting a Residency = Immediate Goal

• PG training for 3, 5, 7 years … to “forever”

• Competitive Residencies: A RODEO

– Anesthesiology

– Radiology

– Dermatology

– Emergency Medicine

– Orthopedics, Ophthalmology, Otolaryngology

Getting a Residency = Immediate Goal

• PG training for 3, 5, 7 years … to “forever”

• Competitive Residencies: A RODEO

• The Residency Dilemma

Residency Dilemma – 30% by ‘15AAMC Statement on the Physician Workforce

↓ Supply• aging work force

– retiring, dying, quitting early• working fewer hours … thank goodness

↑ Demand• more health care available• “Baby Boomers” getting older


Problem: 85,000 doctor shortfall by 2020

Solution: 30% increase in AAMC MS 1 slots by 2015

Residency Dilemma – 30% by ‘15Benchmark Year = 2002

• 16,000 MD graduates– last med school expansion in 1970’s

for physician shortage– end of federal money for med schools in 1980’s

for physician oversupply

• 24,000 PGY 1 positions– 15% USIMG and 15% FMG


Problem: 85,000 doctor shortfall by 2020

Solution: 30% increase in AAMC MS 1 slots by 2015

Issue: ask wrong question, get wrong answer

Only licensed residency grads practice medicine, not “doctors”

Residency Dilemma - Do the Math30% by ‘15

• ↑ 2002 AAMC slots by 30% ≈ 5,000 → 21K

• Osteopathic ≈ 1/5 of med school grads → 4 K

• Off-Shore ≈ 2.5 K

24 K – 27.5 K = - 3.5 K

… and no additional physicians!

Residency Dilemma - Consequences

• Competition for all residency programs

• Earlier decision on specialty of medicine

• Medical school > competitive, < collaborative

• Off-Shore option has very great risk

Selecting PGY1s

• MS1s MS4s are “smart enough”– able to compete on MCATs →– pass USMLE →– pass Specialty Boards = fully qualified physician

master craftsman/woman

Selecting PGY1s

• MS1s MS4s are “smart enough”

• How many times can you cut the cream?

• More important “other” criteria– hardest workers– nice, interesting, fun to teach– bring something extra to the table?

Research Is Very Important, But …

Bench

• traditional

• more available

• discernment

>>> research career

Clinical

• new

• less available

• career-building!

>>> clinical career

Significant clinical experience not optional• Why?

– discernment– qualification– development

• Shadowing is not significant– short time, little commitment, passive, available

• Working with patients is significant– long time, huge commitment, active– usually need “two letters” (e.g., MD, DO, RN, PA, PT)– except …

Getting Clinical Experience

RA Programs• Research Associates (RAs) enroll patients and

their visitors in clinical studies in the ED

Getting Clinical Experience

RA Programs• Research Associates (RAs) enroll patients and

their visitors in clinical studies in the ED– SOAP as a physician– Study Protocol as a RA

• One, 4-hour shift per week• Clinical + Research

National Alliance of Research Associates Programs

NARAP• growing consortium of hospitals around the

country

NARAP Member Institutions

CT Hartford Hospital/UConn

Lawrence & Memorial

St. Vincent’s

DC Georgetown

MA UMass

MO St. Louis UniversityNJ Hackensack U.

Medical Center

NY University of Rochester

NV University of Nevada

PA Jefferson

TX Seton / U Texas, Austin

VT UVM

WA Pullman Regional

National Alliance of Research Associates Programs

NARAP• growing consortium of hospitals around the country • utilizing the RA model • produce large scale, clinical studies over short time

frames with minimal cost• Tobacco Cessation study:

- > 19,000 participants, thousands of RAs- 4th largest prospective, interventional study ever in U.S.

Post-Bac is the Preferable Option

Guiding Concepts

• College ≠ getting into medical school

• MCATs takes 400 hours of prep for success

• Career-building, not just admissions

• Residency is the immediate goal

2nd semester, Junior Year

Best Semester of Your Life … Academically

• Upper level major courses

• Best electives

• Cost of Attendance ≈ $___ K per semester

• No second chance

• Ramping up

MCATA “Useless” Test, Except …

• material you will never use again

• format you will never endure again

• purpose you should never face again

MCATWhy spend 400 hours getting ready for MCATs?

• Get into medical school!

• Become an expert test-taker – USMLE – Specialty Boards

MCAT 400 Hour Prep Timeline

If ... Graduation --> Medical School

Activity No later than

matriculate August after graduation

interview 1st semester, Sr year AMCAS

1 July, after Jr year MCAT mid–

May, after Jr year

MCAT prep 2nd semester, Jr year


Medical School after GraduationIssues• January to mid-May ≈ 20 weeks

assume study 5 d/wk = 4 hours of study per day• Out of “best academic semester of your life,”

spend 4 hours/day cramming for a test that is only useful if you– get a competitive score for medical school admissions– learn to be an expert test-taker


Medical School after GraduationConsequences

• Not “the best academic semester of your life”• Not ramping up

• Not really do 400 hours prep → Oops on MCAT

→ forced post-bac year(s)


If ... Planned Post-Bac Year

Activity No later than

matriculate August after PB year

interview fall semester, PB year

AMCAS 1 July of PB year

MCAT September, Sr year

MCAT prep summer, Between Jr – Sr years


Planned Post-Bac Year

• MCAT prep from mid-May to mid-September

• ≈ 20 weeks, 5 days / week → 4 hours per day


Planned Post-Bac YearAdvantages• 2nd semester, Junior =“best semester of your life”

– better grades, better ramping up• 1 “bad” summer

– has to be done sometime!– still time for work, maybe even a little fun

• Oops on MCAT,time to take again and stay on schedule


Planned Post-Bac YearAdvantages• Post-bac year ≠ “year-off,” = YEAR-ON

• Apply with

– optimal grades

– MCATs

– accomplishments from YEAR ON


If ... Planned Post-Bac YearAdvantages• Post-bac year ≠ “year-off,” = YEAR-ON

• Apply with

– optimal grades

– MCATs

– accomplishments from a YEAR ON

Post-Bac Year On

• Do what you may never have the chance to do again

• Career-Build = Clinical Research → Residency• Take 1st year of med school before med school

– be an MS1 with time → more clinical research!• Make money

– knock down undergraduate debt• Have fun!

Post-Bac Year OnNARAP Chief Research Associate

• Middle managers of RA Programs at NARAP affiliates

Post-Bac Year On

Post-Bac Year OnNARAP Chief Research Associate

• Middle managers of RA Programs at NARAP affiliates• Involved in all aspects of clinical research from initial

concept through publication• Networking with top clinical researchers at

residency programs• Residency application:

– published author in a clinical journal– start/help manage a RA program to get their research

done

NARAP RA and Chief RA

www.theNARAP.org

Documents

Let’s Talk a Little Pre-Med Heresy