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


• West Point• Notre Dame


• West Point• Notre Dame• St. Clare’s Hospital (Hell’s Kitchen)


• West Point• Notre Dame• St. Clare’s Hospital (Hell’s Kitchen)• Tulane University School of Medicine


• West Point• Notre Dame• St. Clare’s Hospital (Hell’s Kitchen)• Tulane University School of Medicine• Medical College of Pennsylvania – EM


• West Point• Notre Dame• St. Clare’s Hospital (Hell’s Kitchen)• Tulane University School of Medicine• Medical College of Pennsylvania – EM• Norwalk Hospital


• 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)


• 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

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


• > 30 years as an academic emergency physician


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



• 7 years as a Health Professions Adviser



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




• Research Associates Programs x 20 years




• 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

Agenda


• Recruit you

Agenda


• Recruit you – Line RA as a college undergrad

Agenda


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

Heresies

• “Pre- Med”

• Why do you go to medical school ?

• Research is very important, but …

• Significant clinical experience not optional

• Post-Bac is the preferable option

Heresies

• “Pre- Med”

“Pre-Med”

• No “Pre- anything”

“Pre-Med”


• Career begins with “I think I might want to be a ____.”

“Pre-Med”


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

“Pre-Med”


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

• Career Building ≠ just getting into medical school

“Pre-Med”


• 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

Heresies

• “Pre- Med”

• Why do you go to medical school ?

Why 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;



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




• Only a physician can practice medicine




• Only a physician can practice medicine• Medical training ≈ a medieval craft





– medical student = apprentice





– medical student = apprentice– resident = journeyman/woman





– 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




• The Residency Dilemma

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


↓ Supply


↓ Supply• aging work force



– retiring



– retiring, dying



– retiring, dying, quitting early



– retiring, dying, quitting early• working fewer hours



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




↑ Demand




↑ Demand• more health care available




↑ 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


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

for physician shortage



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

for physician oversupply





• 24,000 PGY 1 positions





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




Issue: ask wrong question, get wrong answer





Only licensed residency grads practice medicine,





Only licensed residency grads practice medicine, not “doctors”

Residency Dilemma - Do the Math30% by ’15

Residency Dilemma - Do the Math30% by ‘15

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


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

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


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


• Off-Shore ≈ 2.5 K


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



24K residency slots


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



24K residency slots – 27.5K med grads


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



24K residency slots – 27.5K med grads = - 3.5 K


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



24 K – 27.5 K = - 3.5 K

… and no additional physicians!

Residency Dilemma - Consequences


• Competition for all residency programs



• Earlier decision on medical specialty




• Medical school > competitive, < collaborative




• Medical school > competitive, < collaborative

• Off-Shore option has very great risk

Selecting PGY1s

Selecting PGY1s

• 97% of MS1s MD, DO

Selecting PGY1s

• MS1s MS4s are “smart enough”

Selecting PGY1s

• MS1s MS4s are “smart enough”– able to compete on MCATs

Selecting PGY1s

• MS1s MS4s are “smart enough”– able to compete on MCATs – pass USMLE

Selecting PGY1s

• MS1s MS4s are “smart enough”– able to compete on MCATs – pass USMLE – pass Specialty Boards

Selecting PGY1s

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

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


• How many times can you cut the cream?

Selecting PGY1s



• More important “other” criteria

Selecting PGY1s



• More important “other” criteria– hardest workers

Selecting PGY1s



• More important “other” criteria– hardest workers– nice, interesting, fun to teach

Selecting PGY1s



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

Heresies

• “Pre- Med”

• Why you go to medical school ?




Research Is Very Important, But …


Bench Clinical


Bench

• traditional

• more available

• discernment

Clinical


Bench

• traditional

• more available

• discernment

Clinical

• new

• less available

• career-building!


Bench

• traditional

• more available

• discernment

>>> research career

Clinical

• new

• less available



Bench

• traditional

• more available

• discernment

>>> research career

Clinical

• new

• less available


>>> clinical career

Heresies

• “Pre- Med”





Significant clinical experience not optional

• Why?


• Why?– discernment– qualification– development



• Shadowing is not significant



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



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



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

• Working with patients is significant




• Working with patients is significant– long time, huge commitment, active




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

Significant clinical experience not optional• Why?

– discernment– qualification– development


• 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


RA Programs• Research Associates (RAs) enroll patients and

their visitors in clinical studies in the ED



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



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




• One, 4-hour shift per week




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

National Alliance of Research Associates Programs

NARAP


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



country • utilizing the RA model



country • utilizing the RA model • produce large scale, clinical studies over short

time frames with minimal cost




time frames with minimal cost• Tobacco Cessation study:




time frames with minimal cost• Tobacco Cessation study:

- > 19,000 participants, thousands of RAs


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.

Heresies

• “Pre- Med”





Post-Bac is the Preferable Option


Guiding Concepts


Guiding Concepts

• College ≠ getting into medical school


Guiding Concepts


• MCATs takes 400 hours of prep for success


Guiding Concepts



• Career-building, not just admissions


Guiding Concepts



• Career-building, not just admissions

• Remember, residency is the immediate goal

2nd semester, Junior Year


Best Semester of Your Life …


Best Semester of Your Life … Academically



• Upper level major courses




• Best electives




• Best electives

• Cost of Attendance ≈ $ ___ K per semester




• Best electives


• No second chance




• Best electives


• No second chance

• Ramping up

MCAT

MCATA “Useless” Test, Except …


• material you will never use again



• format you will never endure 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 … Duh!



• Become an expert test-taker



• Become an expert test-taker – USMLE



• 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





interview 1st semester, Sr year AMCAS

1 July, after Jr year






1 July, after Jr year MCAT

mid–May, after JR year






1 July, after Jr year MCAT mid–

May, after Jr year

MCAT prep 2nd semester, Jr year


If ... Graduation --> Medical SchoolIssues


If ... Graduation --> Medical SchoolIssues• January to mid-May ≈ 20 weeks



assume study 5 d/wk = 4 hours of study per day



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




spend 4 hours/day cramming for a test that is only useful if you




spend 4 hours/day cramming for a test that is only useful if you– get a competitive score for medical school admissions




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


If ... Graduation --> Medical SchoolConsequences



• Not “the best academic semester of your life”



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




• Don’t really do 400 hours prep → Oops on MCAT




• Don’t really do 400 hours prep → Oops on MCAT

→ forced post-bac year(s)


If ... Planned Post-Bac Year




matriculate August after PB year





interview fall semester, PB year






AMCAS 1 July of PB year







MCAT September, Sr year







MCAT September, Sr year

MCAT prep summer, Between Jr – Sr years



• MCAT prep from mid-May to mid-September



• MCAT prep from mid-May to mid-September

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


If ... Planned Post-Bac YearAdvantages


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



– better grades, better ramping up



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




– has to be done sometime!




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





• Oops on MCAT





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


If ... Planned Post-Bac YearMore Advantages


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


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

• Apply with

– optimal grades

– MCATs

– accomplishments from YEAR ON

Post-Bac Year On

Post-Bac Year On

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

Post-Bac Year On


• Career-Build = Clinical Research → Residency

Post-Bac Year On


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

Post-Bac Year On



– be an MS1 with time → more clinical research!

Post-Bac Year On



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

Post-Bac Year On




– knock down undergraduate debt

Post-Bac Year On




– 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



• Involved in all aspects of clinical research from initial concept through publication




• Networking with top clinical researchers at residency programs





• Residency application:





• Residency application:– published author in a clinical journal





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

done

NARAP RAs and Chief RAs

www.theNARAP.org

3 ?s

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Let’s Talk a Little Pre-Med Heresy