Shihua Chen had a polished answer ready when asked why she wanted to be a doctor in an interview with The News-Letter. After all, she had already prepared for her medical school interviews this past fall. Chen first explained how her father’s doctorate in chemistry encouraged her love of science when she was young, but she became interested in the human mind and behavior as she got older. For Chen, medicine seemed like a way to bridge these two interests together.
Before she said any of this, Chen gave me one disclaimer.
“The road is a lot less linear than the answer I give,” she said.
Chen graduated from Hopkins in May of 2020 with a double major in Molecular and Cellular Biology and Psychology. In the spring of 2021, Chen applied to medical school but ultimately did not receive any admission offers. In the spring of 2022, Chen decided to apply again. Her second try has already been successful, with an acceptance letter arriving this winter.
One major change in Chen’s application from last year to this year involved her extracurriculars and how she presented them.
Hopkins Pre-Health Advising points students towards four important categories of extracurriculars for the medical school application: research, volunteering, shadowing and community service. Because of the time commitments and connections required to secure some of these opportunities, experts on the pre-medical pathway note that students must exert a significant amount of strategy to check off all the boxes while leaving time for other hobbies and self-care. But is sheer strategy what medical schools want out of applicants?
Learning the ropes
When Chen started at Hopkins, the pre-medical pathway felt like her default. Though she didn’t talk to the Pre-Health Advising Office, she did observe what her other pre-med-hopeful friends were doing. When she saw that some of her friends seemed anxious to secure research experience in a lab on campus, she joined a lab that studied prostate cancer.
“All of my friends were also pre-med, and they’re all scrambling to get research, so I applied to research,” Chen said.
Chen engaged in other opportunities during her undergraduate years as well. She was part of the residential advisory board, a Christian campus ministry and a group that taught children about healthy eating. In her senior fall, she volunteered with Child Life Services at the Hopkins Children’s Center.
However, as Chen’s college years came to a close and she looked more into what applying to medical school would look like, she realized that she wasn’t meeting the typical “formula” for a successful pre-med applicant.
“Maybe... if I had known the basic requirements to get into med school... during undergrad I would have been a lot more intentional,“ she said. “Maybe I wouldn’t have [had] to take the gap years that I did.”
The role of capital in extracurriculars
Barret Michalec is an associate professor in the Edson College of Nursing and Health Innovation at Arizona State University. While working on his doctorate in sociology, he began studying the role of empathy in healthcare education and has been focused on medical education since. He spent three years as the director of the University of Delaware’s Evaluation Committee, an office that submits recommendation letters for medical school applicants.
In an interview with The News-Letter, Michalec discussed the complexities of the medical school admission requirements.
“Every time I thought I understood it, I'd be like, ‘Wait, you have to do this too?’ This is all a ton of barriers and hurdles,” he said.
These observations laid the foundation for a study in which his team interviewed 35 pre-med students to find common patterns in their experience meeting application requirements.
Michalec explained that one of the biggest observations from this study surrounded clinical shadowing. Pre-med students are expected to “shadow” physicians for a certain amount of hours before applying to medical school, which often involves following a physician for the day and observing their interactions with patients. However, it often takes special connections with a doctor to secure these opportunities, especially due to limitations on hospital visitors since the COVID-19 pandemic.
“What I was seeing and what I was hearing from other schools as well is that it was remarkably challenging for students to acquire shadowing hours,” he said. “Shadowing is important. I get the point. I understand it. I just think that it’s not as engaging as we try to make it believe.”
Michalec found that students with social capital, possibly through physician relatives, had a much easier time securing shadowing experiences. Beyond this, students with higher social capital might have a better strategy for what extracurricular activities they need and how they will secure them. Not to mention the sheer financial capital that it takes to volunteer for an afternoon instead of working a shift at a paying job.
Because of these observations, he recommended that the American Association of Medical Colleges introduce simulated shadowing opportunities that would be equally available to all students. He also recommended that admissions committees look less at how many shadowing hours a student has completed and more at how a student has contributed to their community.
“This system is perfectly designed to get the results it gets... and that's [why] we keep on having these problems of lack of diversity in the healthcare fields[,] burnout and wellbeing issues,” he said. “It's not just a leaky pipeline. It's the whole plumbing system that needs to be reviewed.”
Doing what you love
Chen began to pursue more clinical experiences after she graduated from Hopkins. She answered an advertisement in the University’s pre-professional newsletter to serve as a caretaker for an older woman with multiple sclerosis. Chen noted that this experience felt different to her. While medicine seemed like the default decision in the past, this was the point where Chen started to understand her why a bit better.
“It allowed me to have this more longitudinal but also intimate perspective into the patient experience,” she said.
Chen didn’t stop there. She decided to study Asian-American health in a summer program at Stanford University and also volunteered with an organization delivering food to seniors. Suddenly, Chen found her interest in geriatric care and Asian-American health, which she hopes to carry with her to medical school.
At first, extracurriculars had felt like a box for Chen to check. Now, she noted how being forced to check a box wasn’t always a bad thing if done while still following one’s own passions or interests.
Michalec asserted similar sentiments as he gave advice to aspiring pre-med students.
“Pre-med students should really think about engaging in extracurricular activities that speak to their larger interests in medicine but also their larger interests of being like a citizen. So do your volunteerism, do your shadowing, but also understand how all of that relates to why,” he said. “Otherwise, if you're just doing it to check a box, they're going to smell it a mile away.”
Ellie Rose Mattoon is a junior from Austin, Texas majoring in Molecular and Cellular Biology and Public Health. Project MD 2027 documents the challenges, inequities and triumphs of Hopkins students applying to medical school for entry in 2023.