Applying to Medical School — primary and secondary apps, being unique, diversity, and culture.

Adam Roussas
Jul 24, 2017 · 17 min read

*Disclaimers*

1) These are my opinions and do not necessarily reflect those of my institution or any medical school admissions committee.

2) Everyone is different; this advice is meant to be broadly applicable, but may not work for you.

3) I tried to be as concise as possible, but the primary/secondary applications are deceivingly complex and deserving of this lengthy article.

*Disclaimers*

TL;DR

The crux of the advice I give just about everyone on how to apply AND interview (that will be a separate article) revolves around the AAMC’s 15 core competencies for entering medical students. I’d argue that one of the major reasons primary and secondary applications exist is to see how well you exhibit these 15 competencies. These essays also serve to identify your level of maturity, fit with the school, and what type of diversity you contribute to their cohort. So, your main objective as an applicant is to effectively communicate all of that. Further, don’t try and sound smart when you write, don’t try and be something you’re not, and (in this same vein) embrace what makes you yourself (I know these last two sound pretty fluffy, but read the explanations for #wisdom).

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Table of Contents

1) What’s the point of all this writing? It’s so hard. I can’t. I’m going to bed. Wake me never.

2) Primaries

a. What you should be writing and how.

b. What 3 experiences you should expand upon.

3) Secondaries

a. Answer the question the prompt is actually asking.

b. What you should be writing and how.

c. Timing and how to maximize it.

4) What sets me apart? Uh…

a. What medical schools want.

b. Figuring yourself out and writing about it.

5) “Your school’s culture? How do you even have a culture, and how should I know?”

6) Advice on how to write and other important things to consider.

— — — — — — — — — — — — — — —

1) What’s the point of all this writing? It’s so hard. I can’t. I’m going to bed. Wake me never.

Most describe these essays as a way for medical schools to “get to know you better,” which, to me (and probably you), is annoyingly vague. There are various ways to interpret what that really means, and it likely varies by program. Nonetheless, I think the most widely applicable explanation is that they are an opportunity to detail how well you exhibit the AAMC’s 15 core competencies (CCs) for entering medical students. If you’re not familiar, get familiar. As the name implies, these are the fifteen characteristics that, to my knowledge, schools will use as a barometer to “grade” you when reviewing your application and interview, amongst other parameters that will be discussed later. As such, a majority of the content in this article relates to these competencies.

In general, I found this list to be an excellent guide for how to structure responses on both the primary and secondary applications. If I got stuck or wasn’t sure how to frame a specific experience, I came back to this list to re-center. Further, the list will help you keep track of personal characteristics you’ve already discussed, which you should be considering when trying to build a well-balanced primary application (discussed more in #3).

In addition to the core competencies, schools are trying to determine how well you will thrive in their program, e.g. do you have a connection to the school like family, friends, fond memories, etc…; what type of diversity you provide to the incoming class (discussed in #4); and how well you will actually fit in with a program’s culture (discussed in #5).

2) Primary application essays

a) What exactly should be on your primary application.

This section assumes you’re not having difficulty filling all fifteen slots. If that is you, you might find some guidance in part 4 of this article; otherwise, I’d recommend sitting down with your pre-health counselor to discuss how you might fill in gaps or discuss opportunities to grow your resume.

Overall, you can think of the primary as 15 opportunities to show the admissions committee how you represent the CCs. That alone should build a pretty strong primary application. However, you should also save at least one spot for a hobby: music, sports, gaming, travel, outdoors, writing… whatever it is that you do in your spare time, you MUST talk about it on your primary. There are several reasons for this. First, admissions committees want to see that you have interests outside of medicine that can be used as emotional outlets during your tenure as a medical student. Second, you should try and give them a way to remember you. And third, it’s highly likely that your hobby/interest also satisfies a core competency, so it’s really a win-win. For example, if you love rock climbing and you started or led an interest club in college, you get to talk about a hobby, substantiate the leadership CC, and give the admissions committee an easy way to remember you. Although you will most likely have the opportunity to communicate this again on your secondary, I still recommend including a hobby or interest on your primary just in case you don’t (some secondaries are very short). In addition to a hobby or interest, you should try to highlight something that might make you particularly unique. For example, if you’re a non-traditional applicant, talk about your last career or a major event/accomplishment you experienced during your time off, especially if you haven’t mentioned it anywhere else. This conveys to the committee that you have substantial life experience and also acts as a way for them to remember you in the same way the last example did. In general, I wouldn’t necessarily think of anything (within reason) as “off limits” to include your list of fifteen, but you definitely want to drive home a majority of the CCs, discuss a hobby or interest, and/or highlight a unique experience you have had.

b) What 3 experiences you should expand on.

As you probably know, you have the opportunity to *w0w-ee-w0w* the reader by going more in-depth with three of your entrees. Now, this isn’t an opportunity for you go into crazy detail about a research project you did using plasmonic nano-materials to develop a fibrin based adhesive gel to mitigate leakage in surgical anastomoses (that sucked to read, right?), but rather it’s a chance for you to drive home some aspects of the CCs you’ve exercised with experience. Again, you may not get the opportunity to do so on your secondary! So, choose wisely: sometimes it might be best to sacrifice the flashy story or research project for a more substantive one. For example, saving a burning bus full of orphan puppies is incredibly adorable and heroic, but volunteering with a team of volunteers at your local animal shelter might offer you more substance relative to succeeding in a medical program.

3) Secondaries

a) Answer the question the prompt is actually asking.

Often, students miss the deeper question hidden within an essay prompt of the secondary application. That is, basically all secondary questions are meant to act as a vessel for you to describe how you exhibit one or more of the CCs or some other trait the school finds desireable. That being said, I think the easiest way to approach the essays is to simply decide which of the CCs seems to best fit the underlying meaning of the prompt. Similarly, you can also determine which of the CCs would be easiest for you to discuss for any given prompt and go with that. As an example, the rest of this section will discuss how to approach the “describe a non-academic failure you experienced” question.

b) What you should be writing and how.

The failure theme is a common choice for secondary prompts and you will invariably see it somewhere. That being said, most people tend to draw a big fat blank on this question, and for good reason: we’re all nerds who do nothing but study. Ha, no, but really, it can be difficult for some of us to identify a time that we failed, especially the non-competitors. However, once we understand what the actual question is here, it shouldn’t be too difficult for just about anyone to think of something (and if not, we’ll cover that, too). Thinking about failure and glancing over the core competencies, you might begin to realize that this question has a lot more to do with resilience, adaptability, problem solving, and capacity for improvement (i.e. intrapersonal competencies) than it does describing a time you failed.

Nonetheless, uncovering the meaning behind a prompt can be kind of difficult sometimes. So, how do you identify the underlying question within a more abstruse question? I think that methodologically beginning to write works well. To illustrate what I mean, we’ll break down the failure question. First, identify whatever the prompt is asking for, in this case a non-academic failure you experienced. Next, start describing the failure; try and build an interesting but concise narrative to engage the reader. Okay, now that you’ve got the beginnings of a strong response together, how would you bring together a full essay? For most, by discussing how you overcame the situation and/or how it affected you personally. And badabing-badaboom, you’ve identified a new avenue for response and the true meaning behind the prompt: for you to identify a time when you were not able to accomplish a goal you aspired to and, more importantly, how you dealt with it and what you learned from it (i.e. intrapersonal competencies). Some prompts I’ve seen recently will actually ask you exactly that, which is nice, but in case it doesn’t, engaging in the writing process can help illuminate what you should be looking for.

With all this in mind, you can now craft a number of different responses. For most applicants, sports, music, gaming, and other competitive activities come to mind. For others, it might be balancing multiple responsibilities, maintaining certain relationships, or leadership failures, amongst other things. Either way, it really doesn’t matter what experience you choose because that’s not the point. The point is to convey that you have had some failure and that you possess the emotional faculties to process, assess, and grow from this situation in a mature and productive manner.

Okay, but what if you can’t think of anything? Well, at this point (and in general), just be honest! With respect to our prompt, if you’ve just had a #blessed life and/or been so realistic with yourself and your decision making that you’ve somehow managed to avert all kinds of failure, talk about why that is and what you might do if something truly devastating did happen. Further, make sure to justify your reasoning for circumventing what the prompt is asking. Using the failure prompt again as our example, you could suggest that you don’t feel the tribulations you’ve overcome are particularly noteworthy and that it feels disingenuous to attempt to suggest otherwise. As a general principle, another important aspect of these essays I think a lot of people forget is that you need to communicate to the admissions committee that you can readily identify social dynamics and be realistic with yourself. So, just focusing on the true meaning of any prompt (i.e. what core competencies are relevant), while not ideal, can be valid if you approach it the right way. Again, I must emphasize that this technique must be employed carefully and only used as a last ditch effort, as what seems realistic to you may be unrealistic to the reader. I highly recommend discussing your strategy with others, ideally current medical students, faculty, advisors, or admissions personnel.

c) Timing and how to maximize it.

Some schools will actually have hard deadlines for when you have to submit your secondary. Others will offer more flexibility. There’s speculation amongst the pre-medical community about whether or not it affects your application to take a month to write your secondary, but that’s all it is: speculation. While it might be true for some programs, it probably varies and there’s really no way to no for sure. One thing you can be confident about, however, is that the longer you wait the more likely it is that your interview spot gets taken by a similarly competitive applicant. So, I personally think you shouldn’t wait more than a week, two at most, to return a secondary.

Now, I know a week sounds really short, especially for those of us who can’t just sit around and write all day. However, there are ways to increase the amount of time you get with your secondary. Namely, forums: websites where students will post a school’s secondary prompts, amongst other discussion topics, so you can get a head start. If you’re one of those early applicants and worried you won’t have the same advantage, fear not! Usually these forums go back several years. So, you can look to the previous years prompts and use those with the hopes that the prompt didn’t change too much, if at all. Either way you’ll have some practice and hopefully good content to pull from to expedite the writing process.

As far as what website I used… I went on student doctor network, a website I would NEVER suggest you go for ANYTHING other than finding secondary prompts. In fact, my normal advice to pre-meds is to stay as far away from those threads as possible; the website is an absurd conflagration of liars and horrible advice. That being said, the website is also an excellent repository of neurotic students who have collected the secondaries for basically every school you can think of. So, aside from finding secondary prompts, shield your eyes from most of the other content on the site and don’t get sucked into the black hole of checking for acceptance updates… that’s just torture.

4) What sets me apart? Uh…

a) What medical schools want.

The problem you’re probably facing right now, as are many others, is identifying what exactly makes you a unique candidate or even just how you write about it. However, before I dive into the details of what this means and how you can write about it, it’s first important to understand the weight that schools now apply to the various components of your application.

Contrary to popular belief, the MCAT, grades, and research do not carry as heavy skew as they used to for many schools. While these items are, of course, very important (GPA is still the major independent predictor of medical student success(1)), especially when applying to highly competitive programs, you can get through without them being stellar. This is because many programs have now realized that high achievement in the clinical years of medical school is not necessarily correlated with these items and that personality traits are strong non-cognitive predictors of both student and physician performance (2, 3, 4, 5). Similarly, the incidence of depression amongst medical students is unbelievably high (6). So, what many programs have now realized is that placing a strong emphasis on only cognitive measurements might not produce the most effective physicians long term. Thus, the primary and secondary applications are now used to gauge these parameters and more. Further, programs at many schools are focused on building a diverse class, not necessarily of just culture, race, ethnicity, sexual orientation, and all those buzz words we normally think about when we hear the word diversity, but also of educational background, field of study, major interests, professions, talents, and so on.

Okay, now back to the how-do-I-set-myself-apart-I’m-not-very-unique dilemma.

b) Figuring yourself out and writing about it.

As a general rule of thumb when discussing what makes you unique, we must remember that most medical schools aren’t actually interested in whether or not you’re the most interesting person on the planet. Instead, they want to get to know you for the reasons listed above: do you have the all the ingredients to produce a thriving (and happy) medical student/physician and do you offer anything unique to their cohort. So, just like we talked about for the primary, call upon anything and everything non-academic you can to give the admissions committee a better idea of who you are outside of just an MCAT and GPA. Further, you shouldn’t just say that you like to hike or play music or do hood rat things with your friends, talk about why you do these things in terms of work/life balance and, you guessed it, the core competencies.

That being said, the very specific “what makes you unique or sets you apart from the other applicants” type of questions are absolutely designed to highlight a particularly unique characterstics and/or accomplishments, so if you have one or more definitely go with that (and remember to tie in the core competencies)! However, if you feel you can’t effectively answer this question in such a way, I think there are several valuable paths forward. First, talk to your friends and family and ask them what they think. I know this is difficult and does sound incredibly lame, but making yourself vulnerable and asking others for help when you need it is a huge part of medicine, so you should be practicing this anyway. At any rate, aside from hopefully being a nice ego boost, you might learn something neat about yourself that you can write about. Maybe you’re a great ping-pong player (seriously, write about it). If this doesn’t work out for you, don’t fret. These prompts are also just a way for you to describe yourself as a whole, you can talk about where your from, the things you do on the weekend, some talents you have, basically just build a nice picture of yourself for committee. Really spend some time here describing yourself; you never know what someone else might think or remember about you. In this vein, I think another substantive approach, especially when painting a picture of yourself, is to simply acknowledge that you might not break the mold in a substantial way. What’s valuable here is emphasizing your self-awareness and appreciation for what many consider the reality of American society and what current social norms are. Of course, that can’t be your entire response, but rather just the opening or small piece of a larger narrative. After this, a discussion of your values, ambitions, and/or motivations might be warranted.

Stepping away from a specific prompt and more into just talking about yourself, let’s say you’re in the group of students who really, genuinely does not have any hobbies or interests outside of medicine. First, I again encourage you to implore those closest to you for perspective, second I think it’s important to remember that spending time with your friends and family or your cat (just kidding unless you’re me) is actually a valuable way to spend your time. In fact, medical culture, from my perspective, is starting to acknowledge more and more how important maintaining family and community ties are, so I think it’s at least a reasonable alternative to a major hobby or interest to describe why you spend so much time with your family/friends if you approach it well. With this in mind, I’m sure you can think of other ways you spend your time outside of school or the lab that are just as valuable.

For those who feel they cannot relate to the last paragraph, fear not, for I have ideas for you, too. Effectively, you should see this as an opportunity to discuss “capacity for improvement” (core competency #9). That is, you know that not having outlets is a problem and you’re actively trying to fix it. Effective introspection, as we’ve discussed already, is a huge part of succeeding in medicine, so you must discuss that you acknowledge this and substantiate that you demonstrate this competency by taking tangible steps to fill this gap (getting hobbies, spending time with family, etc.). As a side note, if you fall into this group and do not understand why it’s important, seriously consider your motivations for going into medicine, as you will have to vigorously defend them. I don’t mean to offend, but I can’t stress enough how difficult just medical school can be, and without a support system or emotional outlet, well, that’s how you become a statistic.

In summary, you have to remember that almost everything you do is relevant: family time, friend time, hobby time, work time, gaming time (gotta take a good angle on this one, granted), everything. It is all these items and more that make you unique, and schools are interested in knowing what makes you yourself, so never hesitate to talk about something that might not fit what you think a school is looking for. Lastly, to make life even easier as you’re writing, you should try build the foundations of your response in terms of the core competencies.

5) What do you mean “Your school’s culture? How do you even have a culture, and how should I know? I’ve never been there!”

These are actual quotes I said to myself when I first read that omnipresent and seemingly unanswerable “school culture” question. Literally no one I knew, in medical school or out, could give me a solid answer to what it meant. I was told “read the mission statement,” which as you’ve likely found by now, is effectively identical at every program. It wasn’t until I started interviewing that I understood.

School’s absolutely do have culture, it’s just not a culture in how we think about it colloquially. It’s more so a culture of academics and lifestyle. For example, some programs value academic success and research over everything else. So, at this type of school, you can likely be guaranteed to be dedicating every waking moment of your being to preparing to crush the board or shelf exams, which to some people are very important and is totally manageable. While at other programs, there will be more of an emphasis on maintaining social support systems and “enjoying” your life. I put enjoying in quotes for a reason: it’s completely relative. Some people are, despite what you may believe, actually quite happy studying and researching all day, while others may need other forms of stimulation. So, what one school thinks is appropriate to foster healthy lifestyles in their students will be drastically different from one to place to another, so make sure you figure this out and that their approach works for you. That all being said, other programs might have a good mix of the two. Lastly, you can also safely assume that most schools will mirror the culture of the geographic region in which it is located, so looking for insight in this respect may also help demystify the subject.

Now, how exactly you figure that out before an interview, I think, comes down to outreach on your part. I would recommend contacting the admissions department and asking if they can provide you with contact information for some students you can ask pointed questions to. For example, “What do you do for fun?” “What would you say is most important to you in getting through medical school?” “What would you say is most important to your class in getting through medical school?” “How much time do you spend with your classmates?” “How much time do your classmates spend together? “Does your school have a wellness program?” “What advice would you give to someone in my position?” There are undoubtedly more pointed questions you can ask depending on what’s important to you, but I think these are good broad questions you could lob at anyone and get a good idea of what their program is like (and maybe more importantly if it’s right for you).

6) Advice on how to write and other things to consider.

a) When writing these prompts, I think it’s important to take a step back from what you’re writing and ask yourself, “would I actually say this in real life?” Barring lewd remarks and regional colloquialisms, I would suggest trying to write using rhetoric similar to how you would sound having a regular conversation. It’s striking how much better writing can get when you’re not trying to sound smart. Further, it makes your essays sound much more genuine (and easier to read), which is a parameter that could influence how readers rate your essays for committee review.

b) Write as much as you possibly can and then start whittling down to what’s relevant. I’m sure you’ve come across this advice before, but if not, then I’ll explain. Basically, most of the secondary prompts are loaded questions and you can probably take several approaches to each one, which stops some people from writing at all because they can’t figure out where to start. To get the creative juices flowing, don’t worry about starting to write a perfect essay and instead just spew the contents of your brain onto the paper (or MS word document). Personally, I start with outlines and just make bullet lists of everything that comes to mind for content of any kind. If a good opener, closer, zinger, or whatever comes to me as I’m doing that, I jot it down for later.

d) Remember that committees are reading an absurd amount of responses to the same question. A way to set yourself apart from the other essays is to write in an engaging manner. There are a million “how to write engaging content” essays on the web, so I’ll leave it to your googling skills for that, but I think referring back to (a) above is also valuable.

e) Have as many people read your essays as possible and make them turn on the review button. You want as much feedback as you can get from as many personalities as possible. It’s amazing the things you don’t think of about yourself that someone else might.

Written by

MD/MBA candidate, BSE/MSE Biomedical Engineering — writing about medical school, health policy, health technology, and whatever comes up.

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