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Let’s Talk a Little Pre-Med Heresy

Let’s Talk a Little Pre-Med Heresy . Keith Bradley, MD CEO/CMO National Alliance of Research Associates Programs (NARAP). Why Listen to this Guy?. West Point Notre Dame St. Clare’s Hospital (Hell’s Kitchen) Tulane University School of Medicine Medical College of Pennsylvania – EM

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Let’s Talk a Little Pre-Med Heresy

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  1. Let’s Talk a Little Pre-Med Heresy Keith Bradley, MD CEO/CMO National Alliance of Research Associates Programs (NARAP)

  2. Why Listen to this Guy? • West Point • Notre Dame • St. Clare’s Hospital (Hell’s Kitchen) • Tulane University School of Medicine • Medical College of Pennsylvania – EM • Norwalk Hospital • Lincoln Med and Mental Health Center (S. Bronx) • Bridgeport Hospital / Yale Emergency Medicine • St. Vincent’s Medical Center

  3. Why Listen to this Guy? • > 30 years as an academic emergency physician • hundreds of medical students and residents • 7 years as a Health Professions Adviser • hundreds of pre-health professional students • Research Associates (RA) Programs x 20 years • thousands of RAs

  4. Agenda • Help you see the process of preparing for a career in the health professions from a different perspective • Recruit you • Line RA as a college undergrad • Chief RA as a college graduate

  5. Heresies • “Pre- Med” • Why you go to medical school ? • Research is very important, but … • Significant clinical experience not optional • Post-Bac is the preferable option

  6. “Pre-Med” • No “Pre- anything” • Career begins with “I think I might want to be a ____.” • you want to be in control of how long or short • Career Building ≠ just getting into medical school • medical school is a means not an end

  7. Why Do You Go to Medical School? • Do you want to go to medical school to become a physician? • Go to medical school to become a resident; finish a residency to become a physician • Only a physician can practice medicine • Trade School ≈ a medieval craft • medical student = apprentice • resident = journeyman/woman • physician = master craftsman/woman

  8. Getting a Residency = Immediate Goal • PG training for 3, 5, 7 years … to “forever” • Competitive Residencies: A RODEO • Anesthesiology • Radiology • Dermatology • Emergency Medicine • Orthopedics, Ophthalmology, Otolaryngology

  9. Getting a Residency = Immediate Goal • PG training for 3, 5, 7 years … to “forever” • Competitive Residencies: A RODEO • The Residency Dilemma

  10. Residency Dilemma – 30% by ‘15 AAMC Statement on the Physician Workforce ↓ Supply • aging work force • retiring, dying, quitting early • working fewer hours … thank goodness ↑ Demand • more health care available • “Baby Boomers” getting older

  11. Residency Dilemma – 30% by ‘15 AAMC Statement on the Physician Workforce Problem: 85,000 doctor shortfall by 2020 Solution: 30% increase in AAMC MS 1 slots by 2015

  12. Residency Dilemma – 30% by ‘15 Benchmark Year = 2002 • 16,000 MD graduates • last med school expansion in 1970’s for physician shortage • end of federal money for med schools in 1980’s for physician oversupply • 24,000 PGY 1 positions • 15% USIMG and 15% FMG

  13. Residency Dilemma – 30% by ‘15 AAMC Statement on the Physician Workforce Problem: 85,000 doctor shortfall by 2020 Solution: 30% increase in AAMC MS 1 slots by 2015 Issue: ask wrong question, get wrong answer Only licensed residency grads practice medicine, not “doctors”

  14. Residency Dilemma - Do the Math 30% by ‘15 • ↑ 2002 AAMC slots by 30% ≈ 5,000 → 21K • Osteopathic ≈ 1/5 of med school grads → 4 K • Off-Shore ≈ 2.5 K 24 K – 27.5 K = - 3.5 K … and no additional physicians!

  15. Residency Dilemma - Consequences • Competition for all residency programs • Earlier decision on specialty of medicine • Medical school > competitive, < collaborative • Off-Shore option has very great risk

  16. Selecting PGY1s • MS1s  MS4s are “smart enough” • able to compete on MCATs → • pass USMLE → • pass Specialty Boards = fully qualified physician master craftsman/woman

  17. Selecting PGY1s • MS1s  MS4s are “smart enough” • How many times can you cut the cream? • More important “other” criteria • hardest workers • nice, interesting, fun to teach • bring something extra to the table?

  18. Research Is Very Important, But … Bench Clinical new less available career-building! >>> clinical career • traditional • more available • discernment >>> research career

  19. Significant clinical experience not optional • Why? • discernment • qualification • development • Shadowing is not significant • short time, little commitment, passive, available • Working with patients is significant • long time, huge commitment, active • usually need “two letters” (e.g., MD, DO, RN, PA, PT) • except …

  20. Getting Clinical Experience RA Programs • Research Associates (RAs) enroll patients and their visitors in clinical studies in the ED

  21. Getting Clinical Experience RA Programs • Research Associates (RAs) enroll patients and their visitors in clinical studies in the ED • SOAP as a physician • Study Protocol as a RA • One, 4-hour shift per week • Clinical + Research

  22. National Alliance of Research Associates Programs NARAP • growing consortium of hospitals around the country

  23. NARAP Member Institutions CT Hartford Hospital/UConn Lawrence & Memorial St. Vincent’s DC Georgetown MA UMass MO St. Louis University NJ Hackensack U. Medical Center NY University of Rochester NV University of Nevada PA Jefferson TX Seton / U Texas, Austin VT UVM WA Pullman Regional

  24. National Alliance of Research Associates Programs NARAP • growing consortium of hospitals around the country • utilizing the RA model • produce large scale, clinical studies over short time frames with minimal cost • Tobacco Cessation study: - > 19,000 participants, thousands of RAs - 4th largest prospective, interventional study ever in U.S.

  25. Post-Bac is the Preferable Option Guiding Concepts • College ≠ getting into medical school • MCATs takes 400 hours of prep for success • Career-building, not just admissions • Residency is the immediate goal

  26. 2nd semester, Junior Year Best Semester of Your Life … Academically • Upper level major courses • Best electives • Cost of Attendance ≈ $___ K per semester • No second chance • Ramping up

  27. MCAT A “Useless” Test, Except … • material you will never use again • format you will never endure again • purpose you should never face again

  28. MCAT Why spend 400 hours getting ready for MCATs? • Get into medical school! • Become an expert test-taker • USMLE • Specialty Boards

  29. MCAT 400 Hour Prep Timeline If ... Graduation --> Medical School ActivityNo later than matriculate August after graduation interview 1st semester, Sr year AMCAS 1 July, after Jr year MCAT mid–May, after Jr year MCAT prep 2nd semester, Jr year

  30. MCAT 400 Hour Prep Timeline Medical School after Graduation Issues • January to mid-May ≈ 20 weeks assume study 5 d/wk = 4 hours of study per day • Out of “best academic semester of your life,” spend 4 hours/day cramming for a test that is only useful if you • get a competitive score for medical school admissions • learn to be an expert test-taker

  31. MCAT 400 Hour Prep Timeline Medical School after Graduation Consequences • Not “the best academic semester of your life” • Not ramping up • Not really do 400 hours prep → Oops on MCAT →forced post-bac year(s)

  32. MCAT 400 Hour Prep Timeline If ... Planned Post-Bac Year ActivityNo later than matriculate August after PB year interview fall semester, PB year AMCAS 1 July of PB year MCAT September, Sr year MCAT prep summer, Between Jr – Sr years

  33. MCAT 400 Hour Prep Timeline Planned Post-Bac Year • MCAT prep from mid-May to mid-September • ≈ 20 weeks, 5 days / week → 4 hours per day

  34. MCAT 400 Hour Prep Timeline Planned Post-Bac Year Advantages • 2nd semester, Junior =“best semester of your life” • better grades, better ramping up • 1 “bad” summer • has to be done sometime! • still time for work, maybe even a little fun • Oops on MCAT, time to take again and stay on schedule

  35. MCAT 400 Hour Prep Timeline Planned Post-Bac Year Advantages • Post-bac year ≠ “year-off,” = YEAR-ON • Apply with • optimal grades • MCATs • accomplishments from YEAR ON

  36. MCAT 400 Hour Prep Timeline If ... Planned Post-Bac Year Advantages • Post-bac year ≠ “year-off,” = YEAR-ON • Apply with • optimal grades • MCATs • accomplishments from a YEAR ON

  37. Post-Bac Year On • Do what you may never have the chance to do again • Career-Build = Clinical Research → Residency • Take 1st year of med school before med school • be an MS1 with time → more clinical research! • Make money • knock down undergraduate debt • Have fun!

  38. Post-Bac Year On NARAP Chief Research Associate • Middle managers of RA Programs at NARAP affiliates

  39. Post-Bac Year On

  40. Post-Bac Year On NARAP Chief Research Associate • Middle managers of RA Programs at NARAP affiliates • Involved in all aspects of clinical research from initial concept through publication • Networking with top clinical researchers at residency programs • Residency application: • published author in a clinical journal • start/help manage a RA program to get their research done

  41. NARAP RA and Chief RA www.theNARAP.org

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