By Leland D. Husband, MBA, MS, M2, University of Mississippi School of Medicine
Thirty years ago, the World Health Organization announced smallpox’s eradication, Benny Clark lived 122 days with a Jarvik-7 artificial heart, and the world recognized HIV. Thirty years ago, students progressed directly from college to medical school, completing a fifteen-year effort to double medical school class sizes. Thirty years ago, I, like many others, would have been rejected from medical school.
The rejection would have come in a letter with some official-speak offering modest encouragement like “try again next year” or “this year was unusually competitive,” but I would have known the real reason. I would have seen it in the interviewer’s eyes as he viewed my salty hair. I would have heard it in his voice when he asked, “Why do you want to be a physician?” Yes, the rejection letter would have feigned encouragement, but the real message would have been perfectly clear—I was too old. I was a “non-traditional” applicant.
For most, including me, “non-traditional” means a career before medical school; for others, it means gender, race, religion, non-stellar grades, mediocre MCAT, and many other social, cultural, and academic differences. Before medical school, I helped companies improve efficiency, medical practices trim support costs, and the government understand changing shorelines across the globe. Sometime between arguing with locals about fuel bladders and a MiG jet attempting to escort our plane to a foreign landing site, I realized that all the problems I solved were the same; they just lived in different domains. To make matters worse, I didn’t find the problems interesting or meaningful. After a quick chat with an admissions officer, another couple months overseas, and a palpitation-inducing pay cut, I changed my life. For the next year, I immersed myself in medicine, a domain with interesting and meaningful problems. During the day, I did physiology research. At night, I re-took prerequisites. In the wee hours before dawn, I practiced the MCAT. I did, like most students would, everything to get into medical school. There were no second chances.
Second chances make it easy to spot a “non-traditional” student. We’re the ones who are genuinely surprised to be medical students. It’s also easy to spot us because we pepper so many schools today.
Sometime in the past thirty years, someone or some group, like Drs. Steven Case and Peggy Davis, admissions deans, did at my school, asked, “What are we missing?” The result? My class is a mix of traditional and non-traditional students. We are schoolteachers, musicians, soldiers, engineers, accountants, mothers, fathers, and so many more. We are experience and inexperience working together toward a common goal. We are just like every school that embraces holistic admissions.
Holistic admissions have increased over the last thirty years. My experience with the Association of American Medical College’s Organization of Student Representatives has shown me what can happen when the veteran actor works with the newly minted college graduate. Bridging experience and inexperience and mashing culturally diverse groups fosters new ideas and better solutions. These ideas and solutions range from large-scale peer-led Step 1 review courses, capstone courses, and interdisciplinary projects to shared study strategies and hallway discussions on how to handle tough situations. Whatever the problem, students work together, share experiences, and help each other become better versions of themselves. Holistic admissions make these outcomes possible. It provides many tools and may improve tolerance for ambiguity—a trait that Dr. Gail Geller, in her article in this month’s issue of Academic Medicine, argues is fundamental to medical school success.
Tolerance for ambiguity isn’t all you’ll find in this month’s issue of Academic Medicine, but it is part of the larger theme that we must work to assess applicants and students beyond simple numbers and rubrics. We must look at the whole picture—see the applicant holistically.
Thirty years ago, American physicians were mythical figures. Their decisions were unquestioned. Their power near limitless. We now stand at a precipice created by booming technology and booming costs. And just as Prometheus’s fire shifted the relationship between the Greeks and their gods, technology and costs are shifting the relationship between society and physicians. We now live in a world of flattened communication, where patients and physicians share information. We live in a world where the government and patients question health care costs and decisions. We live in a world where medicine is changing.
Whatever the outcomes, we know that future physicians will need more cultural competence and better social skills. They will need teamwork and resilience. They will need to adapt and accept ambiguity.
As you read through this month’s articles and learn about tolerance for ambiguity and the changes in medical school admissions since the 1980s, note the MCAT changes and how they will help you identify students who have the core competencies we know future physicians will need. But most importantly, ask, “What are we missing?”