What I wish I had known about the medical school application process

Tips and reflections after navigating the process

Introduction

In the 2018–2019 application cycle, I was fortunate to be accepted to medical school. I decided to apply in my late 20’s, long after college, which left me mostly on my own to navigate the application process. As I moved through the process, I found I had many questions which few resources could answer fully. I have tried to collect my learnings, observations, and retrospective understanding in this article to answer many of those questions. I hope this information can provide you more clarity through the process. As a disclaimer, this is written from my own experience and research. Other people may offer different perspectives.

The first time you read this, it may be a little overwhelming. Remember, you do not do all this in a day, a week, or even a month. The entire process takes six months to a year or more. I would also suggest reading the whole article so you understand the entire process. Take a deep breath, and let’s get started.

Overview of the Application Process

There are five steps in the cycle (below). I will provide a brief comment here, and then later give much more detail on each step.

1. MCAT
2. Primary Application and Letters of Recommendation
3. Secondary Applications
4. Interviews
5. Decisions

To begin, you will need to complete the MCAT. You will then be ready to start the primary application which you submit through AMCAS. This is the “Common App” for medical school. You also specify the schools you wish to apply to and designate your letter writers for your letters of recommendation.

Once you submit your primary application, some (or all) of the schools you selected will respond with secondary applications. These applications involve more essays which are tailored to the specific school. Once completed, the schools will review your application and consider offering you an interview. After completing your interviews, hopefully, at least one school will accept you. While waiting to hear, time will slow to a crawl. With the basic process in mind, let’s look at important dates.

Timeline and Important Dates

General Timeline

Below is a chart showing roughly when events occur during the application process. For secondary applications through final admission decisions, each school has a different timeline.

Timeline For Stages of the Application Cycle

Primary applications can be submitted starting at the end of May. Secondaries often start being sent to applicants by late June or early July and interviews can be granted as early as August. The less clear component is when the process concludes for each school. Many schools have rolling admission which means admission is granted as the school finds optimal candidates. Fewer slots are available as the application cycle proceeds. Generally, the process is drawn out and varies widely by school. I had my first interview invitation in October and my last interview invitation in February. Interview invitations can come as early as August and as late as February or March. Admissions decisions can come as early as October.

MCAT and Score Availability Delay

The MCAT is only offered at specific times and gets more expensive the longer you wait to commit to a test date (see Bronze, Silver, and Gold pricing in the above link). After you take the MCAT, your scores are not available for a month. Be sure to pay attention to the score availability dates when you sign up for the test. While you can submit your primary application without having seen your MCAT scores, you may want to know your scores before you apply.

Primary Application and Transcript Verification

The AMCAS primary application becomes available at the beginning of May each year and can be submitted starting on May 31. Check the dates each year to be sure. Once you submit your application, it goes through a transcript verification process with AMCAS. The later you submit, the larger the backlog of applications that are ahead of you. For example, if you apply on May 31, your transcripts will be verified within a few days to weeks, and your application will be released to schools for consideration on the first possible day which occurs in late June.

However, if you submit later, such a smooth and fast turnaround will not happen. In the 2018–2019 cycle, I tracked how many days behind the current day of submission the transcript verification process was lagging (graphed below). For example, by July 7, there was a 28-day delay between submission of your application and AMCAS completing its verification and releasing your application to schools. This delay is one of the reasons many resources encourage you to apply early.

Days behind the current date for AMCAS transcript verification (2018–2019 cycle)

Advice: Try to Apply Early. I ended up taking the MCAT on June 30 which meant my scores were not available until the end of July. As such, I submitted my primary application on July 31, and it took 33 days for transcript verification. Schools did not start looking at my application until early September which put me at a very significant disadvantage compared with applicants who submitted much earlier. Interviews and offers are generally given on a rolling basis. As a result, my application was considered for a smaller number of possible slots.

Letters of Recommendation and Application Completion

Your letter writers have an essential role in ensuring the successful completion of your applications. You will designate your letter writers in the primary application for each school, but you do not need to have all of the letters uploaded to submit your primary application. Once you submit a school’s secondary application, most schools will not consider your application completed for review until ALL letter writers have submitted their letters. For planning, a safe bet is to have your letters of recommendation uploaded by the time your primary application is submitted. Alternatively, shoot for all of your letter writers to submit by the time you complete your first secondary application.

Now, let’s talk about each step in the process in more detail.

MCAT Details

Understanding the Test

MCAT scores are weird. Scores range from 472 to 528 with an average score of 500. The scores represent your score’s location on a normal distribution. For example, a score of 521 or above is in the 99th percentile of test takers. Your score is calculated from four sub-scores each with a maximum score of 132 representing the four sections of the test:

• Biological and Biochemical Foundations of Living Systems
• Chemical and Physical Foundations of Biological Systems
• Psychological, Social, and Biological Foundations of Behavior
• Critical Analysis and Reasoning Skills

As implied by the titles above, the test covers a lot of material including General Biology, Biochemistry, Cellular Biology, Anatomy and Physiology, General and Organic Chemistry, Physics, Cognitive and Social Psychology, Sociology, and Critical Reading. The three science sections are 95 minutes long each with 59 multiple choice questions. The reading section is 90 minutes long with 53 questions. There is no essay. Almost all questions on the MCAT are passage-based, requiring you to read an excerpt of an article, look at data, integrate the content with your background knowledge, and answer associated questions.

Study Tactics

I hope to write a more in-depth article at some point about approaching the MCAT, but here is my quick advice:

• If you are very self-motivated, do not waste your money on an MCAT class. It is crazy expensive, and you can get most of the content for much cheaper. You are paying for discipline and structure. Make a realistic study schedule and try to stick to it. Consider buying a review book series (I used the Kaplan books) and work through the fantastic free Khan Academy resources.
• Practice tests are also helpful to get you comfortable with the format and brutal 8-hour length of the test. Many of the “practice” tests that Kaplan and other companies provide do not represent the exact experience of taking the MCAT or have questions that do not directly parallel the true format. They offer some good practice, but you should get comfortable with taking a few practice tests in the exact format you will be taking the test. The AAMC provides several true-to-form practice tests that you can purchase.
• For the critical reading section, make some time regularly to read about non-science topics to build your speed and comprehension of this type of material. Try to read challenging articles on many different topics. The Economist and the editorial section of the New York Times are excellent sources. This doesn’t have to be a major time investment, but try to get a few articles in here and there to build your abilities.
• Study in 95-minute blocks if you can. I read this somewhere and found it incredibly helpful for building up my stamina and attention span for taking the test.

Is my score good enough?

Many articles talking about what score you should aim to achieve are available and it is probably worth spending some time reviewing different advice. MSAR is a great resource to get a sense for the average statistics of the schools you are considering.

Advice | The Perfect MCAT. Do not waste your time trying for a 528. If you are that good naturally and manage it the first time, major kudos. What you want to do is put in enough time and energy to achieve a score which is strong enough for whatever group of schools you are considering.

Primary Application Details

There are nine sections of the AMCAS primary application. There are a few important items in each section that I want to highlight.

Identifying Information | Part 1

This is a straightforward section. They will ask for your basic information and any school ID’s that appear on your transcript(s) or other documents you submit.

Schools Attended | Part 2

AMCAS wants you to list any schools you attended while earning higher education degrees. This includes college courses you may have taken in high school or universities where you studied abroad. You will need to supply transcripts from all of these institutions, so get ready to do some sleuthing if it has been awhile.

Biographic Information | Part 3

This is another straightforward section. Who are you? Where do you live? Who are your parents and siblings? Etc.

Course Work | Part 4

This is the most tedious section. You must type out all of your transcripts one class at a time using the special coding and input framework provided by AMCAS. Be sure to do this right the first time because if you do a poor job, AMCAS will send your application back for corrections during the transcript verification process and you may end up in the back of the line.

Make sure that you review your individual schools’ prerequisites before you apply to them to make sure you meet the requirements. You can find this on their websites. Most schools also provide details on what types of AP credit they will accept along with their perspective on community college credit and necessity of lab courses.

Advice | Future Coursework. You will have the opportunity to specify any current or future classes you will be taking in the fall or spring of the application cycle if you are still completing prereq courses.

Work/Activities | Part 5

Here you have a chance to report up to fifteen work experiences or activities. These can include jobs, volunteer experiences, awards, publications, shadowing, research, and/or anything else which has enriched you to aid your future pursuit of medicine. This is a time-consuming activity both picking which items you want to include and writing descriptions for each item. For each activity, you’ll need the following:

• Meaningful title
• Category from the list (ex. “Physician Shadowing/Clinical Observation”)
• Timeframe (start and stop month and year)
• Hours (estimated, as best you can)
• Associated organization and location
• Contact person (name, title, email, phone)
• Description (700 characters including spaces and new lines)

Three activities are designated as the most meaningful experiences and get an additional 1325 characters to expand on the 700 character description of how the experience impacted or changed you.

While writing these, do not forget to edit, edit, edit, and proofread. Get help from your friend who is neurotic about grammar. Also, consider using Grammarly or other advanced spellchecking apps to review your writing and grammar (there is a free tier).

Advice: How Many Items to Include. Chances are if you are applying later in life (late 20’s and beyond), you probably have a lot of different types of experiences you will want to share in this section. Do not be afraid to group items. For example, you might group any publications or presentations into a single entry. On the opposite end, be extremely methodical in considering what activities or experiences truly will add value to your application. You do not have to use all fifteen slots.

Letters of Evaluation | Part 6

This is where you designate letter writers. Make sure you let your letter writers know early and look at the timing section above. You also can designate different combinations of letters for different schools if you have a specific letter writer who has a special connection with one or several of the schools you are applying but do not want to include in other schools’ applications. The best thing about this system is the letter writers need only upload a single letter which is then distributed to all of the associated schools.

Medical Schools | Part 7

This is where you select your medical schools. MSAR is a good resource for comparing schools and evaluating your viability as an applicant. While thinking about schools and the rest of your application, if you have not already, consider the following:

• Are you interested in allopathic (MD) or osteopathic (DO) medicine?
• Are you interested in clinical practice, research, or both?
• Are you interested in private practice or academic medicine?
• Are you interested in primary care or a specialty?

These questions may help you tease out what you want to prioritize in your school selection.

Personal Comments Essay | Part 8

AKA your personal statement. The prompt is simple: “Use the space provided to explain why you want to go to medical school.” You get 5300 characters including spaces and new lines. It is a painful process, but it is an opportunity to distill down why you want to become a physician in a concise and powerful story.

Advice: Give Your Statement Space and Time. Give yourself a lot of time and space to write your personal statement. Start now if you can. You will want to put it off because it is hard, but sit yourself down and write something. The first try probably will not be good, but you are starting the creative process. Keep iterating and exploring new directions. Also, get feedback early and often. Get input from multiple people. You will quickly lose any objective perspective, and other peoples’ honest feedback is a gift which will help you develop and refine your story.

Secondary Application Details

Medical schools take many different approaches to secondary applications. The first concept to understand for secondaries is screening. Some schools screen and others do not. After you decide to submit your primary application to a school, some schools send secondary applications to everyone. Other schools will review your primary application, and then select a subset of screened applicants to receive the secondary application.

Applicant Funnels for Screening vs. No Screening Schools

When to Expect Secondaries

When you submit your primary application, some schools will automatically send you a secondary within a few days (before verification is complete) either because (a) they send everyone secondaries or (b) your quantitative qualifications such as GPA and MCAT exceeded an automatic minimum screening threshold. Other schools will send you secondaries shortly after AMCAS verifies your primary application. Finally, some schools which screen might send you secondaries weeks or months after your primary application is verified.

**If you submit in late May and early June**, there may be a larger delay initially for secondaries because the primary applications are not released to schools until later in June.

What to Expect from Secondary Applications

Secondary applications vary substantially in difficulty and length. Out of respect for each school’s process, I cannot disclose specific questions or application formats from a given school. Generally, you can expect to write at least one or more essays or a number of short answer questions. Topics can cover many different areas including, but not limited to:

• Your potential contribution to the diversity of the school
• Your aspirations in medicine
• Your specific interests in the school
• Your past experience and what insights you learned from them
• Your perspective on specific medical issues
• Other challenging self-reflective questions

Advice | Secondary Deadlines. You should try to complete secondary applicatoins as promptly as you can. Many sources say two weeks is a good turnaround, but consider the volume you are receiving and be realistic. Prioritize the applications which are most important to you. Some schools also set deadlines. Get the applications out as quickly as you can while presenting strong and thoughtful answers. Be sure to, edit, edit, edit.

Personality Screens

Some schools have started to assess your personality and interpersonal skills before they offer you an interview. One of the common methods is the CASPer test. The test sets up difficult ethical dilemmas or nuanced social situations. You are then given short bursts of time to answer specific questions about how you would handle the scenarios. Although you provide written answers, the CASPer test does not penalize you for misspelling while typing quickly. Embrace reckless, fast typing to get your thoughts out.

Advice: Do Not Pay for CASPer Prep. Do not be tricked into paying someone to help you prep for the test. Read CASPer’s prep guide and do their practice questions. You may not need much else. Just be you. If you happen to be a psychopath you probably will not pass.

Interview Details

Interview Days of the Week

Medical school interviews can be scheduled on any day of the week (usually M-F). Some schools will stack their interviews towards the beginning or end of the week while others might put them right in the middle. In my own experience, I had several interview invitations which offered Friday slots and several which offered Tuesday or Thursday slots. Regardless, since each school will have different scheduling restrictions, you could land an interview on most days of the week. You usually have a fair bit of warning which should help you adjust your schedule.

Formats

There are many different approaches that schools select when interviewing candidates. Your interview day will probably include some set of interviews, a presentation about the program, and time to mingle with current students. They will usually give you details about the interview format when they offer you the interview. Two of the most common formats are the traditional interview and the MMI (multiple mini-interviews).

• Traditional Interview Format. In this format, you sit down with one or several members of the admissions committee and have a conversation that is either structured (with specific questions) or unstructured. There might be a group interview with several other candidates as well. I found The Medical School Interview by Desai and Katta very helpful for starting my preparation for interviews.
• Multiple Mini Interviews (MMI). The MMI format may be a less familiar interview format. In these interviews, you have a series of short stations. At each station, you receive a prompt which will set up a situation, activity, or dilemma. You will briefly be allowed to review the prompt, collect your thoughts, and then you will either discuss the situation with an evaluator or interact with a simulated scenario with actors while an evaluator is scoring your behavior. There are lots of great resources out there to prepare. A good place to start is Desai’s Multiple Mini Interview book. You probably don’t need to pay someone to coach you, but be sure to make time for practicing this format. Consider videotaping yourself to identify ticks or habits you have that may be distracting or detract from your overall presentation.

Other Interview Preparation

The Princeton Review and Prospective Doctor have useful lists of questions which you should review and probably be able to answer before you interview. Ethical dilemmas are also very common in interviews, especially in MMIs. The University of Washington has an excellent resource with case studies on various medical bioethics topics. Georgetown also has a useful EdX course on bioethics if you like lectures. Another great resource is to start regularly reading the AMA Journal of Ethics.

You also will benefit from having a solid understanding of the structure and functioning of the US healthcare system. The Healthcare Handbook is an excellent primer on the US healthcare system and the Affordable Care Act. I also found a great Youtube series on the structure of various countries’ healthcare systems. A related video also talks about why US healthcare is currently so expensive. “What the Health?” is a great podcast to start listening to if you are interested in learning more about current health policy issues.

Advice: Spread Out Your Interview Prep. Like every other step of the process, being well prepared for medical school interviews is fairly involved. It will become substantially less overwhelming if you can start early and spread out the work of developing your skills, knowledge, and answers over months rather than a few days or a week or two.

Decision Details

At the end of your interview day, an admission officer will likely give you a timeframe in which you will hear back. This is an important time to exercise your empathy muscles. You will want to know your fate, but the admissions process is hard and complex. The school wants to get you a decision as quickly as they can, but the process takes time and its hard to get all of the decision makers in one room. Be patient, you will hear. There are three outcomes: acceptance, rejection, and the waitlist.

Acceptance

Congrats! If the school says yes, you will have a limited time to accept their offer, often two weeks. The odd thing about the application process is that you can hold multiple acceptances. Some schools will charge you a deposit to accept. On April 15, you must narrow down to only three accepted schools. On April 30, you must make your final decision for your school. Stay current on these traffic rules because there have been some updates recently.

Rejection

Rejection hurts, but try not to take it too personally. From the perspective of the admissions committee, they receive a huge number of amazingly qualified applicants and they are tasked with narrowing down the pile. Many schools start with 7,000+ applicants and must end up with 100–200 students in the incoming class. Part of this process has to be subjective and not every school is going to work out for you.

Rejections can come in a lot of different forms. The first form is not receiving a secondary. This will likely be a silent rejection. You will simply not hear anything from the school. You may not have met the screening requirements. However, some secondaries could come weeks or months after your primary application, so initial silence is not always an ominous sign.

Next, after you submit a secondary, you may hear nothing, but do not lose hope. I received my final interview invite in February (five months later). You can look at the timeline on each schools website to get a sense for when the interview process concludes. If it is February and the school website states that interviews run through December, things probably did not work out and you may have a silence rejection. You may also receive a formal rejection via email. These can come at any time during the process.

Rejection can also come after the interview. The upshot here is that you will hear something. As I already talked about, you will get an offer of admission, a rejection, or the third category, the waitlist. Almost everyone will be rejected somewhere. Do not go into this process expecting to get interviews everywhere you apply. I know you are amazing, but so is everyone else.

Waitlist

Each school will reserve the right to say “maybe” to some applicants. This can put you in an awkward position where even into the summer, past the April 30th decision deadline, you may still have the opportunity to be admitted. There are many resources online on how to approach this process.

A Few Other Items To Consider

Budgeting for Application Costs

Applying to medical school is expensive, although a drop in the bucket compared with actually paying tuition. In any case, you will want to start thinking about budgeting for it. The MCAT costs >$300 with an additional >$200 for study materials. The AMCAS application cost is $160 plus $40 per school you apply to. The secondary applications generally each cost around $100. The medical schools do not pay for anything as part of the interview process, so you will need to budget for airfare (if you need to fly) or gas along with lodging. Many schools do offer host-stays where you can stay with a medical student the night before to save money and bond with the current students.

Staying Organized

You may choose to apply to many schools. I applied to ten schools and keeping track of all of the deadlines, current status, and communications was fairly manageable. However, doubling or tripling that number can create a situation that becomes very time consuming to track. I encourage you to use a spreadsheet or set up some system to track the status and action items needed for all phases of your applications for each school. In the future, I hope to post another article talking about my approach to organizing and tracking my applications.

Time Commitment

There is a large time commitment required to complete all of these tasks. If you plan your time well and start early, balancing the application demands with existing employment or studies is likely feasible. If you wait until the summer to tackle everything, you may find it difficult to balance your other responsibilities with the application process.

Embracing Uncertainty

Each step of this process is highly variable and advancing to the next step or rejection can occur at any point during the process. This is very mentally and emotionally taxing. Pay attention to how you are doing and make sure you are taking care of yourself and not being too hard on yourself. It is a difficult and uncertain process with lots of waiting, but it does have a finite window. It will come to a conclusion.

Concluding Remarks

Take a deep breath. There is a lot to unpack in this article, but I hope you now have a better sense of what needs to be done and when you should start thinking about it. I want to commend you on taking this first step. This is an exciting moment. Yes, the application process takes a considerable amount of time and energy and you may get in the first time or you may not. But, keep in mind why you are applying. You are passionate about medicine and something from your life has led you to this big decision. It is easy to lose your way in the middle of the process and keeping your goal in mind will help surpass each new hurdle. There are a lot of amazing applicants for medical school. The application process is humbling and has lots of subjectivity and luck baked in. If you don’t get in the first time, you may have just gotten unlucky. Try to stay positive, learn from your mistakes, and reap the benefits of what you will learn about yourself along the way.

I want to wish you the best of luck. If you have any questions, thoughts, or suggestions, please feel free to leave a comment or message me at brandon@medmusing.com.

I have no affiliation with any of the companies or authors in the linked articles, books, and services.