Let’s Talk a Little Pre-Med Heresy
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Transcript of Let’s Talk a Little Pre-Med Heresy
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Let’s Talk a Little Pre-Med Heresy
Keith Bradley, MDCEO/CMO
National Alliance of Research Associates Programs (NARAP)
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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
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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
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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
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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
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“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
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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
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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
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Getting a Residency = Immediate Goal
• PG training for 3, 5, 7 years … to “forever”
• Competitive Residencies: A RODEO
• The Residency Dilemma
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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
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Residency Dilemma – 30% by ‘15AAMC Statement on the Physician Workforce
Problem: 85,000 doctor shortfall by 2020
Solution: 30% increase in AAMC MS 1 slots by 2015
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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
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Residency Dilemma – 30% by ‘15AAMC Statement on the Physician Workforce
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”
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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!
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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
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Selecting PGY1s
• MS1s MS4s are “smart enough”– able to compete on MCATs →– pass USMLE →– pass Specialty Boards = fully qualified physician
master craftsman/woman
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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?
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Research Is Very Important, But …
Bench
• traditional
• more available
• discernment
>>> research career
Clinical
• new
• less available
• career-building!
>>> clinical career
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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 …
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Getting Clinical Experience
RA Programs• Research Associates (RAs) enroll patients and
their visitors in clinical studies in the ED
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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
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National Alliance of Research Associates Programs
NARAP• growing consortium of hospitals around the
country
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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
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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.
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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
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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
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MCATA “Useless” Test, Except …
• material you will never use again
• format you will never endure again
• purpose you should never face again
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MCATWhy spend 400 hours getting ready for MCATs?
• Get into medical school!
• Become an expert test-taker – USMLE – Specialty Boards
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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
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MCAT 400 Hour Prep Timeline
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
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MCAT 400 Hour Prep Timeline
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)
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MCAT 400 Hour Prep Timeline
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
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MCAT 400 Hour Prep Timeline
Planned Post-Bac Year
• MCAT prep from mid-May to mid-September
• ≈ 20 weeks, 5 days / week → 4 hours per day
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MCAT 400 Hour Prep Timeline
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
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MCAT 400 Hour Prep Timeline
Planned Post-Bac YearAdvantages• Post-bac year ≠ “year-off,” = YEAR-ON
• Apply with
– optimal grades
– MCATs
– accomplishments from YEAR ON
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MCAT 400 Hour Prep Timeline
If ... Planned Post-Bac YearAdvantages• Post-bac year ≠ “year-off,” = YEAR-ON
• Apply with
– optimal grades
– MCATs
– accomplishments from a YEAR ON
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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!
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Post-Bac Year OnNARAP Chief Research Associate
• Middle managers of RA Programs at NARAP affiliates
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Post-Bac Year On
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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
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NARAP RA and Chief RA
www.theNARAP.org