Med School Admissions: The “CLASS” Framework (Clinical, Leadership, Academic, Service, Social)

(soft music) This is Jack Weston's pre-med admissions podcast, helping you get accepted with Dr. Anita Paschol. - Hello, hello everyone. Okay, my name's Molly Kilty. I'm the director of instruction here at Jack Weston and I'm gonna be your host for today's session. I just have to first say, you are in the exact right place if you wanna learn about how to get into medical school. So without further ado, I'm gonna go ahead and introduce our amazing speaker today. Dr. Anita Paschol, one of my great friends here at Jack Weston, one of the most qualified human beings that you could possibly be learning from in this space. MD, double PhD. (laughing) Like just let that's again for a moment. MD double PhD, who does that? Anita does. Okay, absolutely phenomenal. So intelligent but also so personable, so funny. It's a treat working with you Anita. And I'm so excited for you to be able to come up here and really share your experience, your expertise as all of our individuals, or preparing for the MCAT. Yeah, Dr. Dr. Dr. Anita Paschol. (laughing) I love that. Yeah, and beyond just the degrees you guys, she also has more than 30 years of experience, helping individuals get into medical school. Like again, no possible better person to be leading us today. Anita, I'm gonna give you the floor. (laughing) I appreciate it. And I'm really excited to enlighten, provide you info, and most importantly, hopefully to answer your questions. Because yes, I have been doing this. I have sat on eight different admissions committees over the past 30 years. I continue to support five. So what I'm hoping to bring to you guys today is a step beyond, okay, here's what I need. I want you guys to understand on the committee side what we're looking for, how we're looking at it, and why it's important in our review process, and why it's so important that you nail in on those. So just like all of you guys, I've been the pre-med. I've been the anxious pre-med, wanting to make sure that I got everything I needed. And pre-meds, I mean, you love me, hate us, because we are test masters. We know what we gotta do. But when we're talking about where things are, I've been like you guys, the pre-med. I've guided pre-meds as an instructor at a D1 institution for years. But more importantly, what I'm really wanting to share with you guys today is what today's admissions committees are looking for, and how we evaluate that when we're evaluating applicants. Because the way I break this down into it, is there's like, everybody's like, what do I do? What do I, I don't know what I'm supposed to do? I'm gonna give you a framework for how you're gonna think about it. And there are the key components that help you get the core competencies that AMCAS is looking for. So I break this into, and I often say it's your class, to get your A for acceptance, and class stands for clinical leadership academic. When I say academic, I'm talking about not your GPA and your MCAT, the things that we see as academic related that builds your foundation, service, and social. When we're talking about the stats, the medical data, in any given year, we have between 50,000, and the most I think we had was 63,000 right post COVID. It tends, the sweet spot tends to be about 54 to 58,000. As I've said, last year was a down year. I mean, if you were gonna apply, last year would have been the year, because that was the lowest number we had had in almost 10 years. Okay, but regardless year over year, where we are seats, the acceptance range, range, between 40 and 44%. And when you're talking about letting that sink in, when you applied to college, bright people who wanna get a med school, you knew you were gonna get into college. You may not have gotten into the exact college you wanted to get into, but you were gonna get in. Okay, when it comes to med school, it's literally like going from college athletics to pro athletics. I don't know how many of you guys are watching the Olympics right now, but that's that level. When I was in college, I was a gymnast. I was pre-elympic qualifier, but there wasn't a chance I was gonna make the Olympics. It is that competitive and more. About 60% of people get denied every year. And of everybody who gets denied, 50% of those have the GPA and the MCAT score that they need. And so that additional, they're not getting in because they don't have the right experiences in the right quantity. Most commonly, it is not enough clinical and not enough service. We're gonna focus in on all of the areas and what you need to bring to the table. So yes, we know it's a numbers game. It is what it is. Okay, rejections typically at the MD level are due to scores that are lower than 506, 508, that kind of range, which guys, if you're thinking about the 50th percentile being in the low 500s, we're talking about the screening at 511, 512 is in the like 85th percentile. That's the average for a matriculate. And the average GPA is 375. Okay, that doesn't mean if you're below that, you're not gonna get in. But what it does mean is that you've gotta bring even more to the table. We say that a lousy MCAT score kills a 4o GPA 18 different ways. But a really, really strong G MCAT score, 515, 518 above can help offset a slightly lower MCAT GPAs of like in the 335, 345 range. But you've really got to balance that out for where you are. Once you get through their baseline screen, and as we've talked about, most med schools, the way we do baseline screens, if the average med school is gonna get 10,000 applications. Okay, we're not hand going through those applications. We are taking and doing an americ screen. So basically what we will do as a general rule is we'll go to our median MCAT. Okay, so if a school's median MCAT is about a 512, they're gonna electronically screen everyone to about two points below that MCAT score. Then they're gonna go back and take what's left and then they're gonna screen on categories, back down, background. So this is where people always go, should I put that I'm first generation? Should I put from underrepresented groups? Should I put my heritage of African American, Hispanic, whatever, absolutely. Because then we're gonna hand screen for slightly lower MCAT scores or slightly lower GPAs that may fit into specific categories, backgrounds, components. So keeping all of that in mind and how that could impact your screening is a huge part of it. But once we get through the GPA and the MCAT screen, as we talked about last week, it's literally gonna spit out to us a grid. This grid is broken down by all the AAMC categories. It's going to show me which categories you used on your application, how many hours and the length of time. And we're really gonna focus in on that diversity and those components. So you want to be well rounded, okay? You don't want any one category. You may have great research. You may have done research in five different settings, but you've got 15 AAMC categories. You don't want eight to nine of those to all be research. So you may want to combine those because we've got to show our strength in all the areas of class. So you want to find categories that are going to indemnify or going to show your competencies in all those areas. So let's get right into it because I wanna talk to you about the areas and I wanna talk to you about what we're looking for, the criteria and how more importantly, what you've done might be important in your application. So let's start first with clinical 'cause that's what everybody's always focused on, okay? It is amazing to me that at this point in people's academic careers where there are two months away from applying, come to me and I see they've made me shadowed 20 hours max in one or two specialties. And I want you to be reflective on why we expect you to have engaged in shadowing, okay? So the first part of it is you talk about, I wanna be a doctor, I wanna help and serve and make a difference in all that other yada yada stuff we hear, okay? But have you truly taken the time to figure out about what this career is? Other than maybe watching the pit, which by the way, if you're not watching the pit, oh, great show. But you've watched it on television and we always see, I play a doctor on television, you don't want to be playing going into your application. They want to know that you have taken the time to go out there and explore. And this is where you want to do quality over quantity. Because I'll often see somebody who's maybe shadowed for 200 hours in orthopedics, but they have no other shadowing. And they'll may say, but I wanna be an orthopedist. Okay, great, but how do you know that? 'Cause you're not an orthopedist yet. So we want to see diversity. So out the gate, when we talk about clinical, okay? And we talk about shadowing. Clinical's broken into shadowing and hands on patient care. They are equally important. In terms of shadowing, we want a bare minimum of 100 hours of shadowing, ideally in three to five different areas, but we want it broken out. So when you're doing your experiences, I would far rather see one experience where you put all your shadowing into a single category and you've broken it out. Order the key areas we're looking at, primary, specialty, indigent, and international health care, and a special focus right now in this day and time, primary care, and indigent care, underserved populations. Once you start reviewing secondary applications, you're going to find that almost every med school out there is wanting to know about your engagement with underserved, underrepresented populations. An exceptional way to get that is through that care. So let's talk first about each category. Primary care is either family medicine, OBGYN, or pediatrics. Okay? So reach out to your pediatrician, to your family doc, to your OBGYN, someone that you're already engaged with as a patient and ask about, and where I said quantity over quality, typically ask, I need you to think about it. We as physicians don't have time to give out internships to all kinds of, it's like going to a mechanic and saying, hey, do you mind if I work on a few cars over here if you have no experience in it? You're not qualified to necessarily do it, but you are qualified to observe, but they're busy. Okay? So you're more likely to get a receptive physician if you ask if you can existentially shadow them for maybe two half days in a week. Most of us can carve out two half days. We can't carve out six weeks. The sweet spot is about 20 hours, so maybe half days for a week, but even eight hours, a couple of half days, get you some flavor of what's happening in that office. So that's a great kind of sweet spot. And the way I always like in this is think about your in college and your a freshman. And I bring you a kindergartner. And I'm like, Sally over here, she's going to tag along with you for the day. Steve, you'll be receptive to have a little kindergartner with you for a day because you can teach her what you know, but are you going to have her for an entire semester tagging along? You don't have time for that. Put yourself in the spot of the physician you're asking to shadow. Be respectful of their time. Show it professionally. Keep a notebook of journaling what you see so that you can track your hours and who you've worked with, but primary care is a must. Then specialty care, ideally, we want three to five different specialties. I'm going to give you a trick for a way you can bump up your specialties. Okay. Think about maybe shadowing in an emergency department or volunteering or working as an ed tech, because then you can get hands on and exposure. You are shadowing physicians in your role, volunteering in the emergency department, observed physicians in their role while they're there, but not only ed physicians for those of you watching the pit, think about it. They're calling in consultations all the time. So I've got somebody in congestive heart failure and the cardiologist is called down, observe and engage his engagement with that patient, his interaction, journaling right these downs, somebody with a GI bleed, incomes the gastroenterologist. We've got a necrotizing fasciitis, which by the way happened on the pit, not too long ago, and they call in the surgeon, observe, existentially and write these down as you go. Do call calling, call office managers, again, ask for one to two days. Tell them about your background where you are, but be active in that outreach. And if you find a physician who lets you shadow, then ask him if he can maybe connect you with someone else. Then so we've got primary care, specialty care, indigent care. Guys, I cannot emphasize this enough. Getting an opportunity to volunteer in an underserved clinic, a refugee clinic, I help care for the homeless, a street medicine clinic, can be phenomenal to your understanding of the barriers that underserved people face. But more importantly, it's a great opportunity for you to diversify your experiences because volunteering in a free or street medicine clinic, one, gets you cultural competency. Oh, one of those AMC core competencies, it gets you service. That is community service medical. It gets you an area we want to fill in the primary specialty, indigent, and international health care. Boom, fills that. And these clinics are always in need of an extra hand, volunteering in the pharmacy, doing patient intake, taking vitals, and it is a potential way for you to add hands-on patient care. All right, the last is international. That is not a hard and fast. It is a bonus if you are able to do it, because it's great to understand how health care distribution applies in the US versus somewhere internationally. But I'm going to give you a tip. There are lots of programs out there where people are able to volunteer internationally and they're understaffed, and you get an opportunity to engage in more extensive hands-on care. This is especially true for dental because you do a dental mission trip. They'll let you pull teeth right and left. But on your application, okay, you should never speak to in a capacity where you're shadowing, where you truly engage on providing clinical care. Okay, so if you step in and help perform a pap smear or something like that, especially internationally, depending upon who may be reviewing your application, you may have done that all the well to you, didn't kill a patient, but please don't talk about it in your application because some and a lot of medical school reviewers will give a lot of pushback to that. Only if you're qualified and doing and working in a role is that acceptable, okay? So keep that in mind in the background. Why is this important? So actually figuring out what happens and do you have the stomach for it. I'm going to tell you a little embarrassing story about me. We all have them, okay? When I and I'm five-foot tall and blonde on a good day, so it's like not uncommon for me to walk in and they'll go, um, what's the physician coming in? Because I don't command a lot of, you know, kind of presidents in an exam room. Well, when I was the summer after my first year of medical school, I did a clinical clerkship with a clinician in my local area. And it was wonderful. He was a family doc. It's where I got my first passion for family medicine. And he definitely was trial by fire. And so going through the clerkship, I'd been in the clerkship for about four weeks and he said, "Now it's time for you to fly. I need you to go in, do the H&P and do the exam on this particular person. He's here for a sports physical. It should be easy for you." Well, you've got to remember at this time, I'm 22 and he sends me into the room with this high school football player. I mean, big, ominous presence and I'm going through it. I'm supposed to do his full exam. I'm a little bashful. I'm a little shy. Needless to say, I skipped over a key portion of the exam where you examine males and everything. I come back out and he goes, "Did you find anything?" And he's kind of smiling at me. And I was like, "Nope, everything looked good. Heart longs, duh, duh, duh, duh, duh, duh, where we went." And he goes, "Really?" And you did a full exam and I went, maybe not. As it turns out, this particular male had something that we call a varicoseal. A varicoseal is a abnormality in the male testicles where the veins and everything kind of get dilated. And we talk about it actually feels like a bag of worms. It would have been a very obvious thing, but it was also very obvious that in my little naive state, I did not even know how to approach the patient to do this. Later that day, we came in and we had somebody came in with an infected lipoma, a fat kind of accumulation underneath the skin on his back. But it was about the size of a dessert plate. It was about this big, okay, on his back. And he goes, "Would you like to help in the exision of this?" Me, nae, not knowing where I am, I'm like right in, right in, ready to go. And that one, when we liced it, these smell would have cleared the room. So literally, my physician was trial by fire. And I never ever, ever get nauseous. I almost had to leave the room. And he walked out and said, "Now you're learning that just because you think you want to do it, you've got to learn it, you've got to experience it, you've got to walk it." And taking opportunities to observe things you've seen and understand from them is really that whole aspect of shadowing the diversity and what goes into it, because you can't know what you don't know, and you can't know without actually walking through it and experiencing it. This is especially true in the indigent care clinic settings, understanding truly what people who may avoid care because they're afraid of taking off from work and losing their job, or afraid of getting the diagnosis, or afraid of having a diagnosis that they can't afford, and learning techniques that these clinics use to bridge those barriers and how you might have a role in it. I'm going to come back to that in just a minute. So, let's go to the hands-on care. So, when we're talking about shadowing, we said 350 hours is the sweet spot in primary specialty, indigent, and if possible, international care bare minimum is 100 hours, quality over quantity. I would rather see eight different shadowing experiences for you know, eight to 20 hours versus one experience for 200 hours. And you're going to get a lot more credibility for that. When you are volunteering in that Indigent Care Clinic and you're getting that service, if you volunteer on a regular basis, something that you could do that could be memorable is finding a way to help bridge those barriers. That's what I'm going to talk about in a minute. But the hands-on care, working as an MA, CNA, medical scribe, EMT, if you're going to work as an EMT though, getting your EMT certification like the summer after you've applied and using it, actually can backfire on you. Because one of the things medical schools don't want to see people doing is taking a spot from somebody else in an EMT class, taking an instructor's time to get something that you're maybe going to use for six months and be done, we would rather see you've gotten your EMT certification and you've used it over a span of one to two years. Okay. Does not have to be paid, that hands-on can be paid or unpaid, but what I'm really looking for is the actual patient engagement. Another great way, if you have strong research and you're using a gap year, is working in clinical trials as a CRC or a CRA. That's a clinical research coordinator or associate where you're doing clinical trials with patient facing aspects. Where you're maybe doing blood draws, you're doing informed consent, you're actually getting vitals enrolling them in the study because that covers so many areas because not only does it cover research, but it covers that hands-on care. And so you're getting double bang for your buck, plus you're also getting patient communication, you're getting engagement, and you're working with diverse populations who are in these trials in hope for their lives. Okay. So how all of the different nuances fit in is really important. Okay. One thing I wanted to note in different states EMT-B has different impacts. In some states EMT-Bs can basically just ride in the ambulance and keep patients company. Other states they can push simple meds like Narcan, they can do CPR, they can deliver babies. It's going to have more cloud if you actually get that engagement. I don't want that you just drove the ambulance. Okay. So let's talk about how it's done right. Let's say you're shadowing in family medicine. All right. Three to four ED specialists, wherever you are. What it's going to do is it's going to demonstrate your breadth. Okay. Getting that underserved populations is really key. And it provides a lot of material for personal statements reflective of patient encounters that you've seen. And I can give you a perfect example. One when I was shadowing as a student. Okay. And one of my neighbors actually came in to the practice that I was shadowing in. And we were joking while I was talking to him about just kind of he he was known for sort of being a little antsy about his care. And so if he had a call if he had a cold, you can guarantee he was coming in. So we were joking about and you're in for what today. And it was like I got just pain in my hip. And I was like trying to run because we used to run together. And I said, you know, you're pushing it too hard. So we come in. We do the exam. There's a little tenderness over the area. So get an x ray comes back x ray. His pelvis is eat up with metastatic cancer. Couple of weeks later. So this is my neighbor. We're there in that particular moment where we've gone from lighthearted joking jovial making fun of him being hypokondriate to oh my goodness. This is this is serious. And in that particular time. We went in a span of 30 minutes from lighthearted joking to realizing he had later on stage for metastatic cancer. When both of his children were supposed to get married just three months later. And following in that journey with him and watching at the wedding, watching his kids spend what they knew was probably going to be the one of the last years with their father. And we actually lost him five months later. But understanding how any given day in any given practice, we somebody's life can change for the good or for the bad. But we're there to partner with them getting those nuances out of those experiences. That's what we're looking for. Okay. Now in your clinical role, it actually takes you from observer to actually delivering that care. So let's consider working as a med scribe. Okay. And a lot of people take gap years to get this experience. But anything you can get before submitting your application is going to really count that much better. So let's say if you're a medical scribe for 18 months part time, you could work a weekend shift. You could work one or two night shifts a week. But getting that direct patient care where you're working in an ED again, observing the things that bring people into the ED, the different types of settings. You're working with people who may be having one of the worst days of their life. And your role standing as a scribe behind the provider, observing his engagements, learning how to document the key things that you should be asking in the part of that and writing it all down. You are a witness to what's going on. You are in sustained community activity. If it's unpaid, then that's great unpaid clinical service or paid, but it's in a high pressure setting where you're understanding the physician's roles. And you are picking up on the nuances of the delivery of care, understanding the key components of it. All right. At we go from C to L. L is leadership isn't easy one to get because we're typically looking for at least two leadership roles. But why is leadership important? Okay. As a future healthcare provider. Okay. You're going to have a practice or you're going to have people working with you. You're going to have MAs. You're going to have nurses. You're going to have office managers. You're going to have your front desk staff. And they are counting on you for their salaries, for their livelihood. So not only do your patients need to trust in you, but your staff does. So a strong leader knows how to effectively lead and build trust. But it's not all about being the leader who demands your people's respect. It's about do you cultivate respect from your your staff? That your staff feels a part of your team that they are valued. And that is where you're in engagement. Your interaction with the people who work not for you, but with you. I definitely learned this in med school because when we were on rotations, I was very, very adamant about not only just taking care of my patients, but interacting and engaging with the nursing staff. Because I can promise you they can make or break your clinical rotation. And they can make or break your colonites as well. So learning that the respect and the role that everybody plays in the delivery of care and the importance of teamwork really can come from how you cut your teeth in a leadership role. Because I guarantee all of you guys have been out there in a leadership role where you were like, yeah, I'm going to run for that office because I know I can do this much better than you. And then you get in that role. And it's a lot harder than you realize. So what are your management skills? Can you coordinate the ongoing? How are you in a crisis? Because in my practice, pretty much every day was a crisis. So when something goes wrong, can you maintain your composure? Can you pull your team together in team building to make everybody fill a part of that team? I'm going to tell you culture in a workforce is 90 to 95% of how well everything functions. And the culture that you provide in your team in the leadership role you take is beyond it. So think beyond titles. Everybody's like, I was president of this. I was president of nine different clubs. Well, that's great. But what did you actually do? And it's more than that leading an independent research project, creating new content for somebody working as a TA. All of these can play in. So let's say you're a premed student and you're actually volunteering in that free clinic. I told you I was going to come back to this. And you're volunteering in this free clinic or you're volunteering in your pre-health club. And you've got a bunch of first generation people. And they're struggling. They don't know what to do. They've not had anybody in their family who's ever gone to med school. So you decide to found a premed mentoring ship program. Now I get this all the time because premeds will come to me and go, I'm going to file my own organization. It is important. Founding an organization that fails can hurt you more than helps you. Or a founding an organization that doesn't extend beyond you. You've got to demonstrate that not only can you found it, but you create a framework for it to extend and exist after you are gone. So if you plan this program and you grow your membership from 10 to 80 individuals, and then you organize specific work tops because it's a lot to found something, but to sustain it involves recruiting people, creating a sustainable component of it, organizing your workshops, show the initiative to fill a gap, founding it, demonstrate sustained commitment, form a board of people who will follow after you, reflect on the active service mindset, what did you create, and what were your outcomes. And then provide when you talk about it, clear, concrete, measurable outcomes. I grew it. These people fell down in town, they got access to what they did. they needed and we changed acceptance rates from 20% to 80% in this population. The best leadership stories begin with noting a problem choosing how to solve it and then showing you were successful. All right, we're coming to A, which is a big one. It's got multiple levels to it, so the non-GPA components of academic enrichment are research, teaching and tutoring, and cultural competency, which is your exposure to different populations and your ability to communicate with them, or what I call language proficiency. So when we're talking about research, we are looking for at least one year of research. Okay, summer research programs, if they're full-time, get a lot of hours, which is good, but we generally feel like you have to have sustained research for at least a year, so that can be a summer into a fall or fall and spring, even better if there's more, the average number of research hours was 1300, which is really a lot. For most midline schools, if you've got between 300 and 600 hours, you're going to be pretty solid, okay? But not only does it teach critical thinking and the understanding of the research process, but it teaches you that research is truly about collaboration. It's about learning from your mistakes, and it's about moving forward and what it takes to actually take medicine from bench top to bedside. If you guys were with me a few weeks ago, I talked about probably one of my greatest research mistakes ever, which is I was working in a research lab, and my research professor had asked me to feed one of our research creatures, which was a large mouth bass, his weekly frog allotment. And I was dropping frogs over into his aquarium when my research professor walked in and screamed, "No!" And I turned to look at him as I was dangling the frog over the aquarium, and the fish jumped out, grabbed my hand in my frog. I threw the fish all the way across the room. He lived, don't worry. But what I was actually doing was feeding this particular fish our special research frogs, which actually cost $2,000 a piece. So I had fed that fish $8,000 worth of frogs. But the key thing was, is that this fish would not open his mouth for the next three days. I'd sworn I'd broken his jaw. What actually turned out, as a major screw-up and a mistake, was that we found a neurotoxin in the skin of the frog that actually paralyzed his jaw for up to three days. And my research professor led on this created a whole new research study 10 years later. Okay, 10 years. He was publishing papers about how this toxin was used in anti-part care since medications, which it is actually still used now. But the whole thing was, it was a mistake. We regrouped. We figured out it was trial and error that took almost 10 years to go from a mistake to an outcome. Research does not happen overnight. It is a long, thoughtful process that requires teamwork. That's what we're looking for insight from you on. What about teaching and tutoring? Why would teaching and tutoring be important? Because it's 90% of the job that you do in medicine. So that can be working as a TA, an LA, an SI, tutoring other individuals. But what we really like to see is, can you communicate complicated information to people who necessarily don't understand it? Because the majority of people who come into your practice are not going to be clinically trained. And we often talk about, you can be the greatest physician in the world. But if you come strolling in and going, what a fatty, you fat, you got diabetes, you're going to die. Or dude, if you don't lose 40 pounds, if you don't lose 60 pounds, you're going to die. That's automatic pushback from a, like somebody doesn't even truly understand that. And I know oftentimes we have people who get diagnosed with diabetes who come back in, who talk about their sugars, but have no understanding of what that is. Okay. So how can you communicate information effectively? And that's where we often say, you may not be the greatest smartest doctor in the world. But if you can get your patient's trust, then they're going to work with you to understand. And I'm going to give you an example of how you dial down information and how you might talk about that in your application. But then also it all fits in. Not everybody you're going to be treating looks just like you. And it is important for you to understand different cultures, different backgrounds, different religions. And whenever possible, fluency in multiple languages is going to only magnify your, your ability to communicate with people. I speak Criol, Tweet, Romanian, Russian, German. And finally, three years ago, I was like, I got to learn Spanish because so much of our populations are Hispanic and being able to bridge those barriers for your clients is important, especially in Mandarin or Spanish because a quarter of the world's population speaks both of those. So what's a good cadence for research? Because we were going to, we talked about what they are, what do you need? A compelling story might be where as a freshman, you started just out in a research lab. About 150 hours, your freshman year, like me, cleaning glassware, taking care of animals. Your second year, you took ownership of your own sub project that is independent research that brings you leadership capabilities. By your third year, you may have been named on an abstract or a publication and presented at your undergrad symposium. Again, what is more important is the patience, the persistence, and understanding research methodology. Publications and presentations are beneficial, but I'll be honest with you, if your publication authorship is not like fourth on it to us, basically we feel like your, your professor just threw you on a publication. And we oftentimes realize that a lot of props will put people on all kinds of publications. So it may just be the difference of your particular PI. I'm looking more for the understanding of the research project. Let's talk about an academic example beyond the classroom. Okay, let's say that you're volunteering in that free clinic. Okay, and you've noticed an issue or a high incidence of diabetes. My daughter did this. She developed a diabetic education manual for our for a for our underserved clinic. Twice a month, she taught a class on diabetes to new onset diabetics. Then she went back and did a retrospective study of people who did her class and didn't do her class and their understanding of their diabetes. What a win because leadership teaching and tutoring underserved bridging barriers figure out ways that things you could do have impact beyond the barriers of any walls of a clinic and how that fits in when I used to teach, well, when I still teach, one of the things was I always knew when we got to RNA and protein synthesis, people look like deer in the headlights. And I literally explained how protein synthesis occurs like a cookbook. And I said, your DNA is like a massive cookbook and every gene is a recipe on your DNA. You want to cook something? You pull out the recipe, you write down the recipe. That's mRNA. It goes to the gene for the recipe and writes it down. That's mRNA. But then you've actually got to get all of the ingredients together. So you go to the grocery store and pick up all of your ingredients. That's the TRNA picking up all of the amino acids. And it puts it together on the RNA where it assembles puts all the ingredients together to make your cake, your meal, whatever you're going to eat. That is your protein. All right. Now sometimes you add all right, I'm Italian and I'm Southern. So I never measure anything. So needs a little more salt. Gotta take this out, gotta water it down. That is pre or post translational modifications. If you can explain things to your patients in a way they can understand you're going to be that much more of an effective physician and understanding their barriers helps you. So if we're talking about organic chemistry, I don't know about you guys, but your capability as a TA to explain organic chemistry in a way. And if you can use an example just like I gave you and then you can talk about your outcomes where you raise the passing rates or your students had an average of 14 points improvement on your exam. That shows them that you have one of the core competencies to communicate information to wide populations. All right. I want to use the last part of our time to talk about service. Social's going to be easy. We want to know that you have the capability to work with lots of different people, but service is the one where I see people pre and post application, lay an egg. They go through college, they enjoy college, they're focusing on everything else, but they forget about community engagement. And I literally had somebody last week go, why is service important? I don't want to work with other people and I went then you're not going to be a very good physician. Service is very important because medicine is probably one of the most service driven and careers out there and people often think that all of their service should be all clinical. I prefer to see half clinical, half nonclinical. The sweet spot is three to four service activities. I want to see two clinical, two nonclinical. Wait a minute. I've already been telling you how to get that. Okay, volunteer in that free clinic because you need indigent care. So if you're out volunteering in a free clinic, then you're going to potentially going to get that service, the cultural competency, but doing on a regular cadence, volunteering once or twice a month for at least six months is seen as much more beneficial than I win a couple of times. Okay, volunteering with hospice where you're volunteering and you're giving respite to families who are maybe, you know, just needing a break, understanding the death and dying process. One of my clients literally buys these little $2 books off of Amazon where it's like reflective memories and he sits with his patients and he writes down key memories from his patient for his family, for their family members. So you're showing in a way to bridge barriers, you're showing outreach, you're showing compassion, you're showing understanding of the dying process. There are so many ways beyond I just volunteered and that is I always say services how you change through the service you do that is most importantly the enlightenment that you can share that you understand. You could potentially volunteer on a crisis text line taking somebody from a hot moment of crisis to a cool calm, understanding the vulnerability people feel in that particular moment when they're feeling like they're at their wit's end. But then what about on the other side? It doesn't all have to be clinical service and by the way, volunteering in a hospital is good, volunteering in a hospital, bringing blankets, bringing water, keeping patients company is nice service but everybody volunteers in a hospital and that is not hands on care. My dean used to say that's great if you want to be a flight attendant but we really want you engaging. So what we're looking for is more direct patient interaction such as maybe volunteering with the International Refugee Committee or refugee re-encampment where you're actually helping connect people with healthcare resources or how about tutoring new refugees or new immigrants in English or maybe volunteering with a program for kids with special needs or disabilities or maybe volunteering in a battered women's shelter. Understanding what people who have come from different backgrounds from you experience in different traumatic aspects in their life is very enriching and it shows a committee that you're willing to step outside your comfort zone, work with other people and what you've learned about those people. So quickly volunteering in that free clinic already talked about it. Your work is taking vital signs getting but maybe you also while you're there volunteering in that clinic help develop an informational brochure in a bilingual format. Maybe you put it in Spanish to help with a particular thing you see in that clinic frequently. Maybe you're volunteering and one of the issues we're having right now is vaccine hesitancy. Maybe you develop bilingual material for that clinic. So now you expand your role to hands-on care bridging barriers. Think about the impact of what you're doing. Community health education helping help help literacy to reduce those gaps. Then you truly have rather than just going I want to help underserved people in bridge barriers. You're not just saying it. You're demonstrating what you've done. And then social please don't forget social. Your hobbies you can have your hobbies and list four to five things that you do for hobbies and then break them out. I typically want to see two end one or two indoor hobbies one or two outdoor because med school is very stressful and you need the capability to have outlets of your own but you also need to be relatable to your population. You need to be the physician who comes in the door and doesn't just go okay Mr. Jones you got a rash show it to me. You want to come in and say Mr. Jones your fly fisherman I know tied any new flies recently what that you know I'm a fly fisherman I love to fish so maybe you find a way to establish a rapport with your patient so you see your patient not as a patient but as a person you develop a rapport and a way to establish their trust I cannot under I can't emphasize that enough. So remember clinical leadership academic service and social so for you one of the ways you could use your social attribute is maybe you play the violin or the piano and you volunteer at a nursing home or a retirement center bringing enjoyment to the elderly and spending time with them that is a great way to tie that into your application so in everything you do think what is it what benefit would it have beyond a clinic walls how did I grow and learn from it and try to come up with one example for each of them. Thank you guys so so much and we hope to see you again and another session very very soon. Thanks everybody.