Photo by Robert Burroughs
"Do you think they consider who you really are? No. They look at MCATs and GPAs."
Maria Lofftus, manager of the admissions office at the UCSD School of Medicine, had just finished explaining to an irate father why his son's application had been rejected. She has a repertoire of responses to all kinds of complaints — for the angry fathers whose dreams have been dashed, the sobbing mothers who think their child's life has been destroyed, the bigots who say UCSD admits too many colored folk, the people who deliver their "I'm a taxpayer, so you gotta let my kid in" spiel, and so on. Lofftus is usually pretty good at calming them down. But this fellow persisted.
"Sometimes people will have information that could be helpful to others - like last year's lab reports.
"Come on, how much does it cost?" he said.
"You don't understand, sir, it doesn't work that way," replied Lofftus.
"Just tell me who I have to payoff. There's got to be somebody I can pay off." Lofftus assured the man it couldn't be done.
"Okay, listen, I'll tell you what. You let my kid in and I'll donate my body to UCSD. I'll pledge my body to science. What do you say?"
John West. Especially provocative was West's reference to minority students, who have tended, with notable exceptions, to score lower than their classmates.
Everybody, it seems, is trying to get into medical school. Charles Spooner, Associate Dean of Admissions at the UCSD School of Medicine, is in charge of the committee that selects new medical students. He has a big job. This year 3777 young people from across the nation pushed an application across his desk, each having invested untold hours encapsulating his or her entire life in a small file of documents, building a case for acceptance. The competition these applicants face is intense, and their jury is smugly discriminating. It can afford to be, confronted as it is with a brigade of eager and ambitious young minds, thousands strong — all charging after the coveted knowledge and power of medical science. Why? Many reasons. Medicine is a challenging and dynamic field. In the hierarchy of American professions, it is the king of the hill. Medicine is one of the few professions in which realism and idealism can exist in harmony, in which you can earn a great deal of money making people feel better.
Skulls for check-out at Learning Resource Center. The classes of 1982 and 1983 caused a stir among the UCSD School of Medicine faculty when as a group they scored poorly on the national board examinations.
"I'm looking for young people who have integrity; you can usually spot it," says Spooner, a professor of neurosciences at the medical school. "I look for those who know how to and aren't afraid to take risks. I'm looking for the reasonable adventurer." An apt term. Apt because for so many, medical school is the goal at the end of an arduous quest. The applicant who wonders "Will 1 be chosen?" is asking the same question legendary knights must have asked when they dreamed of Excalibur, the enchanted sword embedded in a stone, awaiting the chosen knight who could wrench it free. The scalpel is the modern-day Excalibur, the blade that symbolizes knowledge, status, and power in this more reasonable age. Small wonder that each year as many as one-third of UCSD's approximately 3000 incoming undergraduate freshmen hope that someday they will wield the magic knife.
Rona Hu, Denis Guttridge. "I've been studying for months, I've taken mock exams. If I don't know it by now, what can I do?"
But the UCSD School of Medicine has only 130 scalpels for its 3777 applicants, and they are secured not in stone but bureaucracy. They are defended, really, from the onslaught of applicants by a staff of four administrative assistants, by committee head Spooner, by the admission committee's faculty chairman Dr. Arnold Gass, by Special (minority) Admissions Committee chairman Percy Russell, by some forty other faculty who conduct interviews, and — perhaps most ominous of all — by a computer.
Hand bones from Learning Resource Center. "You let my kid in and I'll donate my body to UCSD."
The admissions committee has devised a very elaborate selection process — it spends more than $100,000 per year — to bring a human element into what could be a strictly mathematical decision. The committee members spend hundreds of man-hours interviewing applicants a poring over letters of recommendation, personal statements, lists of extracurricular activities, and other elements of the application. Nonetheless, two factors rise above others in importance: grade point averages (GPA), and scores on the Medical College Admissions Test (MCAT), the national examination required of all applicants. For far too many undergraduates who wish to become physicians, college is less a matter of learning than it is a matter of building impressive acronyms, high GPAs and MCATs. The result this academic tunnel vision is "pre-med syndrome," an unpleasant, often painful, always debilitating condition.
Model for anatomy study. Aspiring physicians at UCSD follow an undergraduate curriculum that gives the campus a nationwide reputation as a cutthroat pre-med mill.
In their efforts to gain one of 17,200 spots in 128 medical schools in the U.S., pre-meds have taken on a cruel task. They have to measure themselves against the "ideal medical student," whom no one can define but everyone understands to be a cross between Picasso, Mother Teresa, and Louis Pasteur. Here is how this hybrid might look on paper: Sharp as a blade, he (or she) has a 3.8 grade point average (out of a possible 4.0) and scored 13 (out of a possible 15) on the MCAT: he's volunteered in a hospital for two years emptying bedpans for dying geriatrics: he's worked in a lab, washing test tubes and dissecting rats for a Nobel laureate: he strums guitar for fun but his true love is playing cello in the community chamber orchestra: he spent his junior year abroad in France, where he worked on a vendange for a month, harvesting grapes alongside Spanish and Greek laborers; he toured Togo and Upper Volta last summer to study health conditions there; and he was a history major with a minor in biochemistry.
Percy Russel, Arnold Gass. "Then there is the "Hollywood agent. They'll come in and give you a hearty handshake, ask you how you're doing, and do everything but pinch your ass."
What's incredible is that this standard is all too standard. There really are a lot of students applying to medical schools who have irresistible credentials, who look ... well, like young King Arthur might look in a white smock.
Nicole Moran, in charge of the Pre-Medical Advisory Committee, sees irony in the medical school selection process. "Medical schools say they want the guy who plays trumpet in the band, the champion surfer, the marathon runner, the symphony lover, and so on," she says. "But the reality is that the training they get in medical school robs them of these interests."
In one of Charles Spooner's medical school lectures, a second-year medical student stood up and made the same point, criticizing the UCSD medical school for being so "dehumanizing." Spooner says that he told her, "We choose people with high social commitment and altruism because we know their training is going to knock a lot of it out of them, and by the time they get through we want to be sure there's still some left."
The medical school admissions phenomenon has created a tremendous problem in undergraduate education, one for which nobody has an answer. Although undergraduates don't necessarily know precisely how to brew the magic formula that will make them "ideal" candidates for medical school, they have all figured out the basic ingredients. So at UCSD (and elsewhere) there are hundreds of students devoting weeks, months, even years to packaging their images, trying to fit a mold, taking courses they don't like, performing activities they have no interest in, being people they don't want to be — anything to make their resumes look good.
The "pre-med nerd," as he is called, has a wretched reputation, and any UCSD instructor can draw his caricature: the pre-med nerd is driven by a sense of desperation, by the belief that life holds two options - medical school or the death train to Treblinka. His world is framed in the symbolism of stethoscopes and tongue depressors. His excessive emphasis on science courses (so as to score well on the MCAT) is coupled with virtual disdain for - or abject fear of - the humanities. His behavior is characterized by smarmy obsequiousness when in the presence of influential teachers and administrators. In sum, he has pledged mind, body, and soul to medical science.
"We don't want people like that," says Arnold Gass, the admission committee's faculty chairman. "Anyone who would be afraid to take literature, history, and other non-science courses ought not to be a physician. We're not looking for people who just take science courses. If you don't have the willingness to tryout your own mind, to expand your own capabilities, maybe you won't have the drive or the fortitude to continue to learn throughout a lifetime, and to apply yourself as a physician."
Rona Hu, a UCSD senior who will begin medical school at UC San Francisco next year, points out that nobody fits the pre-med nerd caricature perfectly. But the spirit of what she calls this "mythical creature" is alive and well at UCSD. "The pre-med nerd sits in the front row in his classes and asks questions all the time to display his knowledge;' explains Hu. "Usually he already knows the answer. He takes furious notes, carries a tape recorder, and uses one of those four-color pens so he can write examples in red, definitions in blue, explanations in green, and hints for the next exam in black. In a bio course, you'll hear all the pre-meds clicking their pens.
"Pre-meds are usually heavily into caffeine," she continues. "They drink a lot of Cokes and walk around campus with a thermos of coffee in their backpacks. They hang out at the biomed library. -If you go there late at night, you'll see some asleep with their faces in a book. Pre-meds like to wear scrub suits, and when they go to parties they like to drink out of laboratory beakers."
UCSD junior Denis Guttridge, a biochemistry major, had a severe case of the MCAT blues three weeks ago as he sat sipping ice water at TGI Friday's in La Jolla Village Square. The following weekend he was to take the arduous eight-hour test and he was scared. "This whole year has been devoted to MCATs," he says. "I only had one 'real' class in the winter, a bio course. The rest of the time I spent at Stanley Kaplan."
"Stanley Kaplan" refers to an eight-week course given by the Stanley H. Kaplan Educational Center. The nationwide company, which offers several other test preparation courses, has been in business for forty years, but in the recent past it has experienced a boom due to the increasingly competitive nature of graduate school entrance exams, particularly the MCAT. According to the local Kaplan office in Pacific Beach, about seventy-five percent of San Diego medical school applicants take the course, which consists of eight four-hour lectures and unlimited use of instructional tapes that review sample MCAT exams. "I knew people who would spend as much as six hours a day at Stanley Kaplan," says Rona Hu, "Some would go there and study in their beach chairs."
In many ways Guttridge, a tall, athletic fellow with sharp Gallic features, appears the ideal candidate for medical school. He grew up in Djibouti, a tiny former French colony on the east coast of Africa where, he says, his parents instilled in him a deep sympathy for the impoverished and a strong desire to alleviate suffering. He speaks fluent French, works in a hospital and in a lab, plays on the UCSD intercollegiate soccer team, and is "holding a 3.5 GPA." His unusual background, his varied activities, his humility ("It wouldn't be impolite if I didn't order a drink, would it?"), and the sincerity of his "Why I want to be a physician" speech would score high points in an interview. Bui at the moment he's primarily concerned with his "numbers," and he admits he's paying a price to get them. "You have to give medical schools what they want," says Guttridge in frustration.
"You have to sculpt an image of yourself, and create a kind of pseudo-person. I don't like having to do that. When I first came here, I used to let loose, go to parties and have fun. I haven't done that in a year. I've lost touch with what's going on in the world, I don't read newspapers anymore, I don't watch the TV news. On weekends I study from morning till night. We [other pre-meds] are all in the same boat. These past few months, because of the MCATs, people have been giving up everything to study."
Two months ago a young woman jumped off the eleventh floor of Tioga Hall, a student dormitory on Muir campus. She was a medical student at UC Irvine who had done her undergraduate work at UCSD. "Since that happened," Guttridge explains, "everyone has been saying, 'If you screw up on the MCATs, you might do that too.' "
Aspiring physicians at UCSD follow an undergraduate curriculum that gives the campus a nationwide reputation as a cutthroat pre-med mill. Several UCSD medical students commented that those in their class who did undergraduate work at UCSD tend to be different from the others. "They're just intense," said one student, a Stanford graduate. "UCSD graduates are already beaten by the system by the time they get into med school. They're already ready for the grind they're going to have when they get there. Maybe that's good, but I don't think they enjoyed their undergraduate years as much as I did."
Though Guttridge has heard, but cannot verify, stories of zealous pre-meds sabotaging other students' lab experiments or stealing their class notes, he insists that the pressure to get A's creates more subtle, but equally insidious, tensions among his peers. "When you're not involved with course work, you're great friends with people, but when you're doing something related to school, there's all kinds of tensions: You're wondering, 'Is this guy doing something I'm not doing? Does he know something I don't?' Sometimes people will have information that could be helpful to others - like last year's lab reports, or copies of old midterm exams - but they'll withhold it."
One pre-med, who asked that her name not be mentioned, heard through a friend that a certain upper division biochemistry course was "easy" and might be a cinch A. None of her fellow pre-meds had mentioned this course - which seemed strange, because word of such courses normally spreads fast. When this student showed up for the first day of class, she was surprised to see that the room was full of pre-meds. "All these people knew about it and no one had mentioned it!" she exclaims. Every pre-med at UCSD, it seems, had bugged the grapevine.
Denis Guttridge says he, too, has felt this pressure to take "easy" classes rather than interesting ones, and resents it. To hear him tell it, UCSD pre-meds are victims of academic extortion, forced by their choice of career to select a curriculum based on narrowly pragmatic guidelines. When be first came to UCSD, Guttridge took an African history course, which he found fascinating, but in which he could only muster a B. "I love history, but I was competing against history majors," he says with a shrug. "I learned too late. I have a friend, a bio major with a political science minor, who had a 3.3 GPA and who got 11s [a very competitive score] on the MCATs, but he didn't get into any medical schools. He took the poli sci because he liked it, and he didn't get straight A’s. Another guy I know went through easy courses like the drama sequence and he stacked his GPA. He got into every school he applied to."
In 1978 Dr. Lewis Thomas, a well-known physician and writer, wrote a scathing critique of American medical schools in the New England Journal of Medicine. He called the influence of modern medical schools on liberal arts education "baleful and malign, nothing less." He lashed out against the MCAT for its emphasis on the basic sciences. He said that premeds, obsessed with doing well on MCAT, were "poisoning" the atmosphere of liberal arts colleges by putting all their energy into science courses and ignoring the humanities. He even went so far as to recommend that classical Greek be restored as the centerpiece of undergraduate education, including premedical education. "If something is not done;' Lewis wrote, "all the joy of going to college will have been destroyed, not just for that growing majority of undergraduates who draw breath only to become doctors, but for . . . all the students and the faculty as well."
Other physicians criticized Thomas in medical journals for his essay, but his message was heard. The recently published report on the General Professional Education of the Physician (GPEP) echoes some of his conclusions. Written by a group of scholars from many fields, the GPEP report criticizes medical schools for their "excessive emphasis" on the Medical College Admissions Test. It recommends that medical schools accept applicants who have a broad undergraduate education in literature, history, social science, and foreign language. Writing skills should be strongly emphasized, and counselors should refrain from recommending science courses beyond those that are minimally required.
Though UCSD and other medical schools claim to have been applying for years the liberal standards expressed in the GPEP report, they have failed to demonstrate convincingly that there are better ways to gain admission than through high grades and high scores on the MCAT. Though Gass, Spooner, and others on the admissions committee applaud news that the MCAT's science emphasis may soon change - an experimental writing section appeared when the exam was given on April 27 - many UCSD professors think it perfectly appropriate that the exam remain as it is. "The MCAT is a test of how well a student will assimilate information while in medical school, and for that reason it's worthwhile,” says Dr. John West, who teaches a notoriously difficult first-year medical school course called Organ Physiology and Pharmacology. "You can't just go on interviews and letters of recommendation alone. Some people interview well and others don't. We recently had a student, an M.D./Ph.D, who didn't interview well at all. Yet I think he'll make a superb physician."
"That sounds like a contradiction," says Special Admissions Committee chairman Percy Russell. "How could somebody be a poor interviewer and be a good doctor in a job that requires working with people? You can't dismiss a person's poor personal skills just because he has high grades and test scores. Taking hot sandwiches to old ladies counts a lot more to the admissions committee than having your name on a published research paper."
The fact that literature, history, and philosophy majors do not perform as well on basic science exams troubles those who, with all good intentions, wish to populate the world with more well-rounded physicians who treat patients like human beings instead of specimens. This-is particularly true at UCSD, a highly research-oriented medical school known for its tough basic science program, and for its students' high scores on the' examinations of the National Board of Medical Examiners, which medical students take at the end of their second and beginning of their fourth years of medical school. During three of the first six years the school existed, UCSD scored first in the nation on these exams, which meant its students obtained entrance to the most prestigious residency programs after medical school. These two factors helped attract internationally acclaimed faculty, who in turn has assured UCSD a constant flow of research monies, enough to keep the school among the top five or six medical school grantees in the nation.
"Medical schools fight like crazy to be at the top nationally on those board examinations," says chemistry professor Tom Bond. "It makes the faculty and the curriculum look really good. If you take kids into med school who have 13, 14, and 15 on the MCATs, the chances are they'll do well on the boards. It just makes sense. Schools that follow the recommendations of the GPEP report might not do so well. It could lead to investigations of curriculum and faculty and all kinds of problems."
The classes of 1982 and 1983 caused a stir among the UCSD School of Medicine faculty when as a group they scored poorly on the national board examinations. The average student in the class of 1976 scored in the seventy-sixth percentile among all medical students in the country, ranking UCSD's results the highest of all American medical schools. The ranking system has since been abandoned because it created an unhealthy spirit of competition, but one can assume that the class of 1980, which scored in the seventy-ninth percentile, was number-one in the country as well. In the three subsequent years, however, the percentile scores slipped to seventy, fifty-nine, and fifty-five. Some thirteen students from the class of 1983 failed the examination (in a typical year, five failures is said to be average). According to Gass, this poor showing caused the faculty to become "very introspective." Dr. Eric Wahrenbroc, Associate Dean for Curriculum and Student Affairs, stated his feelings more bluntly. "I was scared to death," he said.
At a faculty retreat held in December of 1983 to discuss the adequacy of the school's curriculum, the issue of poor board scores was in the back of everyone's mind. One proposal raised at the meeting was that UCSD reinstitute grades, after years of using the less stressful pass/fail system. Many faculty members feel that students will work harder if graded, and that they will do better on exams and be more competitive when applying to residencies. This measure, which was extremely unpopular among students, was approved by the medical school faculty, but was turned down later by the academic senate. An obvious target of criticism for the weak board scores was the selection committee, which, it could be argued, was not recruiting students who were good enough at taking tests. Gass denies that anyone ever directly confronted him with the committee's shortcomings, but admits that "we did have people come to us trying to sell us on the idea that we should get students who would do better on tests."
Wahrenbroc believes that the reason the scores slipped so drastically was that the two classes in question "weren't properly evangelized. They seemed to have adopted the attitude that the national boards weren't worthwhile for them, and they didn't study hard enough." Wahrenbroc gave a pep talk to the class of 1984, emphasizing how important board scores are, and the average score shot back up to the seventy-seventh percentile, again probably first in the nation. Wahrenbroc, who dislikes talking about board scores, seems to think the good results are a mixed blessing. "There are people on the faculty who are very proud of these numbers," he says. "But they're proud for the wrong reasons. They conclude that our teaching of the subject matter is perfect, when in fact it only shows that we can anticipate the answers on the exams. It doesn't mean our students will be good residents or physicians."
There is, among the medical school faculty, a very conservative faction that places more emphasis on the "science" than the "art" of medicine. Several medical students interviewed for this article named Dr. West as the most outspoken member of this faction. A pulmonary physiologist, West frequently expresses his views to the admissions committee, whose opinions tend to clash with his own. For example, on the issue of what qualities make a good physician: "I agree first and foremost that a physician must be a good scientist," says West. "If I have a pain in the head, I want someone extremely well informed, someone who has the scientific knowledge to diagnose whether it's a cancer, or whatever. If you're a humane person but don't know what's wrong, you're not a good doctor."
About two months ago West addressed the admissions committee and offered a number of suggestions. It seemed to him that certain students who conformed to several different "profiles" were not performing up to par, and that the admissions committee should be discouraged from admitting such students in the future. One second-year medical student obtained the minutes of this meeting and posted a copy on the bulletin board outside the medical school's student affairs office. Though the document was immediately removed by administration officials, word of its content spread quickly, and a lot of students were enraged. Among those targeted by West were older students, non-English-speaking students, graduates of the Stanford Human Biology Department (a science program with a strong liberal arts and social science emphasis), and first-year minority students (these include blacks, Chicanos, American Indians, and mainland Puerto Ricans) who choose not to attend the summer preparatory course offered at UCSD.
Especially provocative was West's reference to minority students, who have tended, with notable exceptions, to score lower than their classmates on school examinations and national boards. However, this is hardly surprising, given that the average minority student at the UCSD School of Medicine has a 3.1 GPA (as opposed to 3.6 among majority students) and scored about 9 (majority average, II) on the MCAT. "A lot of minority students have been economically and academically disadvantaged, and you can't put these people into the melting pot and expect them to compete with the others," said one third-year student who requested anonymity. "There are a lot of pure scientists who don't want minorities in the school. You can push the button and say they're bigots, but I don't think they are. They simply don't want people they think will be incompetent physicians, and they think a good physician is someone good in the basic sciences."
The UCSD School of Medicine boasts comparatively high minority enrollment. Last year's freshman class of 122, for example, had thirteen blacks and twelve Chicanos, which placed UCSD well within the top ten in minorities in the nation. "We're criticized for this," says Arnold Gass. "Every time a minority student doesn't do well in a course, we get criticism from certain professors." The goal of the minority admissions program is to produce minority physicians who, upon completion of their medical training, will practice medicine in their own ethnic communities.
Essentially, minority students pose the same problem as humanities and social science majors: they may make great clinicians someday, but their records show that they are not so good at taking exams and at memorizing what several second-year students called "useless biological bullshit trivia."
"The conservatives on the faculty are concerned that we aren't number one in the country anymore," says the third-year student. "These hard-liners want good test takers who will build UCSD's reputation. The thing is that no one has ever been able to show that good test-taking skills have anything whatsoever to do with being a good physician."
The real victims of this confusion are the pre-meds, who see dizzying contradictions between what medical school admissions committees say they want, and what it actually takes to get in. "They come to me and ask, 'What's the recipe for getting into med school? Just tell me what I need to do!’” says pre-med adviser Nicole Moran.
It's no secret that college students in general are much more conservative, goal-oriented, and self-absorbed than they were even a generation ago. "We seem to have come full circle," says Charles Spooner. "I see students who remind me of my own classmates back in the Fifties." Arnold Gass has his own tripartite typology of contemporary medical school applicants. First there is the "radical." Traditionally, according to Gass, the radical, driven by myths of social transcendence, bucked the medical establishment. "There aren't too many of those left," says Gass with a hint of disappointment in his voice. "There are some students concerned with antinuclear and ecological issues, others have a high social consciousness toward racial issues or toward alternative medicine. But overall we have a rather bland group of students. There are no Mario Savios around to help break the back of the administration. Today a radical is someone who joins the Peace Corps."
Then there are students who choose medicine because they feel it is a Christian imperative to help people. "There's been a strong movement recently on campus toward a fundamentalist viewpoint," remarks Gass. "There are a lot of young people I see who feel they have this mission to be doctors. I have to ask that person certain questions: 'Are you going to use medicine as a means of converting people?' or 'Do you believe in treating non-Christians?' We have a duty to society to take competent people with broad minds. If a person is going to put himself into a category, that's fine, but it's our job to see how far beyond that category they are going to reach,"
And finally, says Gass, there are the "gift-to-the-world types, the kids who believe their own talents befit them to become the God-like creature [Gass snickers) we call a physician. I understand these people myself because I used to be a carpenter, but I decided I had a mind too, and that I would better serve society as a physician. Lots of students say something like that."
Then there is the "Hollywood agent" - a subtype really. "These people think they're in Century City," says Gass. "They'll come in and give you a hearty handshake, ask you how you're doing, and do everything but pinch your ass. They'll use all the right buzz words, tell you all the things they've supposedly done in the past four years, and insist they've done everyone with equal love and intent."
Nicole Moran insists that these precocious wheeler-dealers are rare. But she has seen a few. "We had one kid, a real conniver, whose father was a bigwig in baseball and he'd come in here and offer the secretaries comp tickets to games," she recalls. "He offered tickets to an adviser as well. His father actually got a big-league ballplayer to go to a school back East and offer to donate a lot of money if they'd let the kid in. Which doesn't fly. That kind of underhanded stuff just doesn't work." Moran recalls another student,' a rock musician, who created such a negative impression during a practice interview at UCSD that the interviewer stopped the interview. "This faculty member was so disturbed by this kid that he asked him to go outside," says Moran. "He sensed that the kid was trying to give him a snow job and he couldn't continue." The young man came back the following year with a new application that boasted of his work on a hunger project. "He swore to us that he'd changed," Moran says. "But he'd be real sweet with the faculty and then be rude to the secretaries. I don't think he ever got into med school."
All committee members emphasize the responsibility they feel to select people who have the intelligence, the emotional stability, and the maturity, to be a physician. "My own little devil is this fellow named Schacht, the guy who graduated from UC Irvine and who ended up mixing the potion that killed all the people at Jonestown," says Gass. "He was selected by a UC committee! I don't want to be responsible for selecting a Schacht."
The last place to weed out such a person is the interview, which is the most difficult and most delicate part of the admissions procedure. UCSD, which requires that one of an applicant's three interviews be conducted by a second-year medical student, is known to be casual in its approach to interviewing.
Francis Harris, a second-year student who has participated in this process, tells of other schools that create "stress interviews," nerve-racking affairs in which teams of interviewers gang up on the prospective student, asking difficult questions (often ones with no answer) to see how the student responds. Harris underwent one such trying interview at Columbia. However, the godfather of the stress interview is Dr. F., a Harvard medical professor who, according to local doctors and students familiar with him, employed a series of extreme techniques to create stress. For example, he would place misleading messages on doors and in hallways so that applicants would have difficulty finding the interview room. When they finally showed up - late, of course - he would chide them for their tardiness. During an interview, Dr. F. would excuse himself and have his secretary call his office extension. If the applicant picked up the phone, F. would scold him. If he didn't, the doctor would get angry: "You heard the phone ringing, why didn't you answer it?" He is perhaps best known for nailing the windows shut in his office and then turning the heat up before an interview. If the applicant had the nerve to comment on how hot it was, F. would invite the person to open the window. The frazzled applicant, sweating profusely after trying every possible ruse to pry it open, would be left thinking, "Here I am interviewing to become a doctor, and I can't even open a goddamn window!"
Several medical students said that UCSD exercises a "soft" approach to interviewing. But that doesn't mean interviews aren't stressful. "An interview is always a very strained situation," says Percy Russell. "Some students can't even speak for the first five minutes. We have to look through that nervousness." Russell, who has been interviewing medical school applicants for fifteen years, says that most students are bad actors and even worse liars, and that given the intense stress they are under during the interview, it isn't too difficult to find out where their hearts really are. "I just come right out and ask them why they want to be doctors," he says. "Of course, they all say, 'I want to help people.' None are interested in the money or the prestige. The problem is how do you separate those who are telling the truth from those who are merely telling you what the game requires?"
Some apparently play the game very badly. "I interviewed one young man, an economics major, who started talking about the economics of treating severe burn patients," Russell recalls. "He told me it was a waste of time spending money on people who received burns over eighty percent of their bodies. He was being honest, and what he said sounded logical, but this guy scored a zero with me. It showed he had no feelings for other people, not just burn patients, but me as well. He didn't even know that I might react the way I did."
Arnold Gass is looking for incongruity between a student's perception of himself and the way he comes across in the interview. "Sometimes we'll have a student who is so restricted personally that you know he'll never be able to relate to people in clinical practice, yet he'll say, 'I want to serve humanity.' I'd rather a kid like that come in and say, 'I'm not very good with people, but I think I'll do well in research.' That shows some self-understanding."
To a typical pre-med, all this talk about interviews probably seems frivolous, since well over half of the applicants at many schools, including UCSD, are rejected primarily because of their numbers. Denis Guttridge, like hundreds of other UCSD premeds, wonders if he will ever get an interview. Will he ever even lay his hands on the magic scalpel? "What do you think they look at on the first round in evaluating applications?" he asks, shaking his head. "Do you think they consider who you really are? No. They look at MCATs and GPAs."
He's right, of course. Arnold Gass explains that in order to be "fair,” all applicants are subjected to a point system that yields a rating based primarily on grades, test scores, and the "F factor," a variable that allows for discrepancies in grading systems at various schools. The F factor would insure, for example, that a 3.5 grade point average at Stanford or Harvard would count for more than the same GPA at San Diego State. During this first, essentially numerical, stage of the selection process, almost all of the applicants whose numbers fall in the bottom half of the applicant pool are rejected outright. A few with low numbers are passed on to the next stage if a committee reviewer spots some extraordinary personal attribute or accomplishment. Most of those in the top half are asked to send additional material: letters of recommendation, personal statements, evidence of extracurricular activities. Between 600 and 700 applicants arrive at the final stage of the admissions process, where they are asked to meet separately with three different members of the committee, including one who is a second-year medical student.
Even at the final (interview) stage, test scores and GPAs still playa crucial part in the selection process. The final decision is made based on these "numbers" and additional scores tabulated by each interviewer, who assigns a point value to the interview itself, to the quality of the recommendations, to the personal statements, and to the student's extracurricular activities. Determinations in this last category have been quantified by the selection committee; for example, ten hours of volunteer work per week equals one point, twenty hours equals two points, and so on. Based on the sum of this complex equation, a student is either rejected, accepted, or moved to the deliberation stage, where the committee debates borderline cases. The applicant's "numbers" are flashed onto a screen for the selection committee members to see, then interviewers and other committee members can argue for or against admitting the person. One medical student, who believes that UCSD's selection method is very good, nonetheless stated that he was disappointed to see that very often borderline cases were determined by MCAT scores and GPAs. "When push came to shove, that's what really mattered," he said.
Gass, who considers himself a maverick in the department, admitted with reluctance that this was true. "In these deliberations I felt there were often people looking at the numbers and not listening to what was being said about the candidate. I don't want a selection process driven by test scores and numbers. I don't want people rejected just because they didn't get top-of-the-roof grades and MCATs. That's why I proposed at a meeting recently that at the end of the selection process, we throw out the MCAT scores and the grades and just decide who we think will be the best doctors." Gass says his suggestion was met with silence in the room.
Judging from pre-meds' behavior, that silence speaks louder than encouragement they get to diversity and to take risks. Pre-meds hedge their bets; they play the "numbers game”, and they play it well. Guttridge spent Friday morning April 26, reviewing old notes in preparation for his MCAT exam day. "I'm not nervous yet," he said in a phone call just after lunch. “This afternoon I'm going to the beach. I'm just going to mellow out. I've been studying for months, I've taken mock exams. If I don't know it by now, what can I do?" The week before, Guttridge had gone to San Diego State, where the test would be held, parked his car near the track, then paced his way to the administration building, room 348. "I'll be in the right front corner, with a good view of the clock," he said. "When I arrive in the morning I'll park my car in the same spot. At the lunch break I'll run back to the car, change my clothes, do two miles around the track, shower, and then have twenty minutes left to eat. I've planned the whole day. I don't want any surprises."
Another UCSD pre-med rented a hotel room near SDSU on Friday night. "He wanted to be just a short drive away, in case the car broke down," Guttridge says. "Also, he wanted to get a good night's sleep. He didn't want to get awakened by fire alarms in the dorms or something like that." Unfortunately, the poor fellow spent the night thinking about amino acids and chemical compounds and only slept for one hour. Then during the exam he was so nervous he suffered a nosebleed.