Unconventional Pre-Med Insights: Why Listen to This Expert?

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

22. 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

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

24. 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

25. 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.

26. 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

27. 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

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

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

30. 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

31. 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

32. 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)

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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!

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

40. Post-Bac Year On

41. 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

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