RICHARD GUNDERMAN, MD

The competition to get into medical school is fierce.  The Association of American Medical Colleges just announced that this year, nearly 50,000 students applied for just over 20,000 positions at the nation’s 141 MD-granting schools – a record.  But medical schools do not have a monopoly on selectivity.  The average student applies to approximately 15 schools, and many are accepted by more than one.  Students attempting to sort out where to apply and which admission offer to accept face a big challenge, and they often look for guidance to medical school rankings.

Among the organizations that rank medical schools, perhaps the best-known is US News and World Report (USNWR).  It ranks the nation’s most prestigious schools using the assessments of deans and chairs (20%), assessments by residency program directors (20%), research activity (grant dollars received, 30%), student selectivity (difficulty of gaining admission, 20%), and faculty resources (10%).   Based on these methods, the top three schools are Harvard, Stanford, and Johns Hopkins.

Rankings seem important, but do they tell applicants what they really need to know?  I recently sat down with a group of a dozen fourth-year medical students who represent a broad range of undergraduate backgrounds and medical specialty interests.  I posed this question: How important are medical school rankings, and are there any other factors you wish you had paid more attention to when you chose which school to attend?

The students immediately expressed doubts about the value of rankings.  “Many factors, such as research funding, don’t necessarily translate into better medical school teaching,” said one student.  “In fact, some of the most research-focused faculty members seem to see teaching as a nuisance, and don’t do a very good job.“  Said another, “Research activity is a way for schools to compete for spots in their pecking order, but not a sign of how good a doctor they will make you.”

Another student criticized selectivity.  “In some cases, selective schools often foster a competitive environment that pits students against one another.”  The students felt that the difficulty of getting into the school is less important than what the school does for students once they get there.  Said another student, “Ranking schools by selectivity reminds me of Groucho Marx’s old line that he wouldn’t want to join any organization that would accept him as a member.”

What factors should applicants pay more attention to in selecting the best school?  To begin with, the students said that most medical schools are more similar than different.  Said one, “Students from every school take identical medical licensing exams and apply to the same residency programs, so all of them naturally end up studying the same subjects.  The issue isn’t so much what they teach or even how they teach it, but whether the students there are thriving.”

When it comes to specific factors that applicants should pay closest attention to, the students came up with four, none of which lends itself easily to quantitative scoring.  Research dollars and grade point averages are easy to calculate and rank, but in the students’ view, other less measurable factors are actually more important in becoming the best possible doctor.  “The key,” one said, “is to talk to the students at the school, because no one knows it better than they do.”

The students’ first recommendation: Pay close attention to whether the school helps its students develop their interests and abilities.  For example, do students have the opportunity to take elective courses, to pursue creative research and service projects, and to make distinctive contributions to the school and the community?  Said one student, “Too often, medical schools merely homogenize students, rather than drawing out the best of their unique capabilities.”

To play this role, the faculty and administration of a medical school need to show real interest in students.  “How can you tell?” I asked.  The students responded with questions to pose: “Do they know their students by name?”  “When you ask them about students they are most proud of, do they talk about test scores or do they tell their stories?”  Warned one student, “If your visit leaves you feeling as though they treat students like numbers, the school gets a failing grade.”

The students’ second recommendation: Look for institutions where students are well-informed and engaged in the life of the school.  At the best schools, they say, students share a sense of ownership with the administration and faculty.  “When you speak with them,” said one student, “they talk in terms of ‘my school’ and “our school.’  Students are actively involved in key activities, such as recruiting new students and faculty.”

The students cautioned against placing too much stock in printed and web-based promotional materials.  “Just because there is a position for a student on a committee, don’t think it necessarily means anything,” said one student.  “What looks good on paper does not always translate into practice.  To find out what is really going on, you need to talk to the right people, ask good questions, and really listen.”

The students’ third recommendation is to make sure that the institution stands for something.  What do people think their school aspires to?  If the best they can offer is that it aims to be “top 10” in something, then its vision probably isn’t very meaningful.  On the other hand, if students tell compelling stories about the difference the school is making in their lives, in the community, and in the profession, “then it is probably on to something.”

As one student expressed it, “At good schools, students say little about than the tests they need to study for or the forms they need to fill out.  Instead of focusing on the hoops they need to jump through, they talk about how their studies are making them better doctors.”  Said another, “Ask yourself this: How often do students highlight a meaningful relationship they have developed with a faculty member, and the difference it is making in their professional development?”

The students’ final recommendation is more of a warning than anything else.  Simply put, do students feel trusted by the school?  One student described it this way.  “I know of a school that treats its students almost like inmates.  If a student falls ill, they need to get a doctor’s note to prove that they were really sick.  If a relative dies, they need to spend so much time filling out forms to get their absence excused that some end up just skipping the funeral.  It’s like first grade.”

“Let’s face it,” said another student, “medical students are paying hundreds of thousands of dollars to be there.  In a few years, they are going to be working with patients to make life-and-death decisions.  If a medical school’s faculty and administration don’t trust their students, where is the encouragement to develop into trustworthy professionals?  A really good school places less emphasis on defining misconduct than on developing students’ internal compass.”

The students admit that, compared to looking up a school’s rung on the rankings ladder, assessing such attributes takes more effort.  Said on student, “It means keeping your eyes and ears open and making a concerted effort to talk to students.”  But the payoff is big: “It not only helps applicants pick the best schools – it also shows schools what factors applicants take most seriously.”  In the course of identifying the best schools, applicants can encourage all schools to become better.