NEAAHP 2013 Conference - Atlantic City, NJ
Practical Tools that promote
core competency training
ALEXANDRA TAN, PHD
DIRECTOR, POST-BAC PREMEDICAL PROGRAM
DIRECTOR, POST-BAC HEALTH SCIENCE INTENSIVE
JOHNS HOPKINS UNIVERSITYPROGRAM
CAROL S WEISSE, PHD
DIRECTOR OF HEALTH PROFESSIONS
UNION COLLEGE
INSIDE THIS MANUAL:
Abstract
This interactive workshop
will highlight ways advisors
and medical educators can
help students to develop their
core competencies.
Attendees will have an opportunity to broaden their own
skill set by learning (and in
some cases practicing) activities designed to help students
enhance their communication
skills, anticipate challenges,
work as a member of a team,
accept failure, exercise leadership, and behave in a culturally sensitive manner. The activities presented will
be drawn from a wide variety of sources including medical school interviews,
health professions courses, the visual arts, film, and theater, but the session is meant
to be hands-on. Participants will practice a couple of communication exercises
with the hope that they will be equipped to perform these activities at their home
institutions while becoming more mindful of their own strengths and weaknesses as
communicators.
Collaboration
Communication
Consideration for Others
Rationale for Organization of Tools
Each tool in this manual has been classified as to its usefulness for teaching one or more of the following categories of core
competencies. Since so many tools can benefit multiple competencies, we classified each based on our intention for use and
within multiple categories where appropriate. For this reason, we have organized a list of possible activities and page num-
COLLABORATION
Leadership
Teamwork
Professionalism
COMMUNICATION
Oral communication
Written communication
CONSIDERATION FOR
OTHERS
Compassion and empathy
Service orientation
Altruism
Cultural competence
bers for each category of competencies. The tools themselves are then
listed in no particular order but are
numbered to make it easier to find
the items on the lists.
The rationale for the categories and
competencies at left are given in the
background material that follows.
EXPLORE AND ENJOY!
PRACTICAL TOOLS (CONTINUED)
Page 2
Background
Preparing students for continuing on to health professions
programs requires deliberate
and conscientious classroom
training in many areas in the
sciences — biology, chemistry, physics, mathematics —
and now psychology and sociology as well.
“Success in
professional
programs and
professions is
not solely based
on academic
strengths.”
Not surprisingly, the 2011
AAMC Analysis in Brief supports the importance of a
strong academic background
during the application process1. Furthermore, aggregated data correlating these metrics to percentage acceptance
rate clearly show an increase
in the percent acceptance rate
with respect to both increasing GPA and increasing
MCAT score2. Not surprisingly, students often focus
heavily on the influence of
their GPA and MCAT score
on competitiveness. Similarly, universities focus on the
academic aspects as well.
The college experience understandably focuses a great
deal on deliberately and diligently ensuring that their
students get the academic
education that will prepare
them for later training. After
all, further training like attending a professional program is fundamentally an
academic pursuit and depends
greatly on the knowledge
established prior.
Yet success in these program
and professions is not solely
based on academic strengths.
Thus, it is logical that programs would consider the
non-academic aspects of student development as well.
From Dunleavy et al3: Percentage of responding admissions officers
who ask questions about personal characteristics during the admissions interview.
Personal CharacterisƟcs
Mo va on for a medical career
Compassion and empathy
Personal maturity
Oral communica on
Service orienta on
Professionalism
Altruism
Integrity
Leadership
Intellectual curiosity
Teamwork
Cultural competence
Reliability and dependability
Self‐discipline
Cri cal thinking
Adaptability
Verbal reasoning
Work habits
Persistence
Resilience
Logical reasoning

Echoing this, a later Analysis
in Brief highlighted 21 personal characteristics focused
on by allopathic medical
school admissions officers
during the interview process3
(see table above).
Interestingly there are significant similarities with the Accreditation Council for Graduate Medical Education’s
(ACGME) six core competencies:


Patient Care
Medical Knowledge



%
98%
96%
92%
91%
89%
88%
83%
82%
80%
76%
74%
72%
70%
70%
69%
67%
66%
66%
65%
65%
56%
Practice-Based Learning
and Improvement
Systems-Based Practice
Professionalism
Interpersonal Skills and
Communication
These competencies are implemented into the residency
curriculum in programs that
are ACGME accredited4.
Although
accreditation is
voluntary, residents must
graduate from an ACGMEaccredited program to be eligible for board certification
examinations. Additionally,
some states require this same
Page 3
Background (continued)
completion for licensure5.
Thus, essentially all students
who complete residencies in
the US receive training in
these six competencies4.
The last two competencies —
Professionalism and Interpersonal Skills and Communication — yield the most obvious overlap with the 21 characteristics highlighted at left.
According to the University
of Maryland School of Medicine explanation, Professionalism is the commitment to
professional responsibilities
and adherence to ethical principles.
Residents are expected to demonstrate: (1)
compassion, integrity, respect
for others; (2) responsiveness
to patient needs that supersedes self-interest; (3) respect
for patient privacy and autonomy; (4) accountability to
patients, society and the profession; and (5) sensitivity
and responsiveness to a diverse patient population (age,
gender, culture, race, religion,
disability and sexual orientation)6.
Interpersonal
Skills and
Communication
encompasses the nuance of communications not only between
health care professionals and
health-related agencies but
also with patients and their
families. These skills are
demonstrated by: (1) communicating effectively with
patients and families across a
broad range of cultural and
socioeconomic backgrounds;
(2) communicating effectively with medical colleagues
and agencies; and (3) work-
ing effectively as a member
or leader of a health care
team7.
Key words taken from these
descriptions directly correlate
with nine out of the top
twelve characteristics —









Compassion & empathy
Oral communication
Service orientation
Professionalism
Altruism
Integrity
Leadership
Teamwork
Cultural competence
— many of which are often
not deliberately focused on in
a classroom setting. Yet,
despite the absence of classroom focus, many universities hope to instill these core
competencies (and the others
listed) in their students almost as a side effect of other
studies.
Why is it that we do not feel
comfortable assuming students will pick up general
biology as a member of campus, yet we assume they will
become good communicators
by being on campus? We
rigorously teach and assess
organic chemistry yet presume that students will become good leaders based
simply on the availability of
leadership opportunity and
sufficient mentors.
It is true that students can
cultivate the core competencies as a side effect of other
academic pursuits. However,
treating these skill sets with
the same deliberate and diligent focus given to content
topics will increase the likelihood that students cultivate
these skills and become the
kind of students, candidates
and practicing professionals
we know they can be.
References:
: Dunleavy et al. Sept 2011.
“Medical School Admissions: More
Than Grades and Test Scores.”
AAMC Analysis in Brief. 11(6).
1
: AAMC. 2012. “Table 24: MCAT
and GPA Guide for Applicants and
Acceptees to US Medical Schools,
2009-2011 (aggregated).”
2
: Dunleavy and Whittaker. Sept.
2011. “The Evolving Medical School
Admissions Interview.” AAMC Analysis in Brief. 11(7).
3
: ACGME. July 1, 2011. “Common
Program Requirements.” (www.acgme.org/acgmeweb/
Portals/ 0/
dh_dutyhoursCommonPR0701
2007.pdf)
“Treating the
core
competencies with
the same
deliberate and
diligent focus
given to content
4
: ACGME website. April 1, 2013.
“Fact Sheet: Is accreditation voluntary
or mandatory?”. (www.acgme.org/
acgmeweb/About/Newsroom/
FactSheet.aspx)
5
: University of Maryland Medical
Center website. April 4, 2013.
“Graduate Medical Education: Professionalism”. (www.umm.edu/gme/
PRO.htm)
6
: University of Maryland Medical
Center website. April 4, 2013.
“Graduate Medical Education: Interpersonal Skills and Communication.” (www.umm.edu/gme/
ISC.htm)
7
topics will
increase the
likelihood that
students will
cultivate these
skills”
PRACTICAL TOOLS (CONTINUED)
Collaboration (♠)
1—Who’s on Your Team? (pg 6)
2— The Narcissist Personality Inventory Quiz (pg 6)
5 — What is Your Moral Foundation? (pg 7)
9 — The Provider’s Guide to Quality and Culture (pg 8)
10 — UCLA David Geffen SOM Video Vignettes (pg 9)
11 — Call to Action for LGBT-Inclusive Care (pg 9)
13 — Improving LGBT Health Care Quality (pg 9)
14 — The Gray Line Between Sane and Insame (pg 10)
20 — Facing Your Mistakes (pg 12)
21 — Helping Students Process International Service (pg 12)
22 — Encouraging Reflection on One’s Career Path and Calling (pg 12)
24 — Everyday Moments (pg 13)
26 — Does Your Body Affect How You Interview? (pg 14)
31 — Impressive Medical Humanities Resources (pg 15)
32 — Another Good Read...or Ten (pg 15)
34 — Cowboys vs. Pit Crews (pg 16)
35 — Team Drawing Exercise (pg 16)
36 — What’s Your Emotional Intelligence? (pg 16)
38 — Gattica: Nature vs. Passion (pg 17)
39 — Sitcom Leadership (pg 17)
41 — Learning about Form and Function with Clay (pg 18)
42 — Art and Medicine: Visual Cues and Disease (pg 18)
Communication (♦)
1—Who’s on Your Team? (pg 6)
2— The Narcissist Personality Inventory Quiz (pg 6)
3 — Quality and Culture Quiz (pg 6)
4 — Comprehensive Overview of Religions and Their Perspective (pg 7)
5 — What is Your Moral Foundation? (pg 7)
7 — Cultural and Spiritual Sensitivity Training (pg 8)
9 — The Provider’s Guide to Quality and Culture (pg 8)
10 — UCLA David Geffen SOM Video Vignettes (pg 9)
11 — Call to Action for LGBT-Inclusive Care (pg 9)
12 — HIV Risk Reduction, Role-Playing Anyone? (pg 9)
13 — Improving LGBT Health Care Quality (pg 9)
14 — The Gray Line Between Sane and Insame (pg 10)
15 — Understanding Termal Illness through Film (pg 10)
17 — Medical Reader’s Theater (pg 11)
20 — Facing Your Mistakes (pg 12)
21 — Helping Students Process International Service (pg 12)
22 — Encouraging Reflection on One’s Career Path and Calling (pg 12)
23 — Talking about Making Mistakes as a Physician (pg 13)
25 — Medical History and Getting to Know Your Patient (pg 13)
26 — Does Your Body Affect How You Interview? (pg 14)
27 — Communicating with a Diverse Patient Population (pg 14)
28 — Defining Unintentional Biases (pg 14)
29 — Physician’s Guide to Culturally Competent Care (pg 15)
31 — Impressive Medical Humanities Resources (pg 15)
33 — Your Language Changes Your Inclination to Save (pg 16)
Page 4
Page 5
Communication continued (♦)
35 — Team Drawing Exercise (pg 16)
36 — What’s Your Emotional Intelligence? (pg 16)
37 — I’m the Only One (pg 17)
39 — Sitcom Leadership (pg 17)
40 — Exploring the Psychosocial Assessment (pg 18)
41 — Learning about Form and Function with Clay (pg 18)
43 — The Art of Perception: Honing Observation Skills (pg 19)
Consideration for Others (♥)
2— The Narcissist Personality Inventory Quiz (pg 6)
3 — Quality and Culture Quiz (pg 6)
4 — Comprehensive Overview of Religions and Their Perspective (pg 7)
5 — What is Your Moral Foundation? (pg 7)
6 — To Treat Me You Have to Know Me (pg 7)
7 — Cultural and Spiritual Sensitivity Training (pg 8)
8 — The Good of One vs. the Good of the Many (pg 8)
9 — The Provider’s Guide to Quality and Culture (pg 8)
10 — UCLA David Geffen SOM Video Vignettes (pg 9)
11 — Call to Action for LGBT-Inclusive Care (pg 9)
12 — HIV Risk Reduction, Role-Playing Anyone? (pg 9)
13 — Improving LGBT Health Care Quality (pg 9)
14 — The Gray Line Between Sane and Insame (pg 10)
15 — Understanding Termal Illness through Film (pg 10)
16 — 203 Days (pg 11)
17 — Medical Reader’s Theater (pg 11)
18 — Morals vs. Behaviors (pg 11)
19 — Understanding Schizophrenia (pg 11)
21 — Helping Students Process International Service (pg 12)
23 — Talking about Making Mistakes as a Physician (pg 13)
24 — Everyday Moments (pg 13)
25 — Medical History and Getting to Know Your Patient (pg 13)
27 — Communicating with a Diverse Patient Population (pg 14)
28 — Defining Unintentional Biases (pg 14)
29 — Physician’s Guide to Culturally Competent Care (pg 15)
30 — The Power of Vulnerability (pg 15)
31 — Impressive Medical Humanities Resources (pg 15)
33 — Your Language Changes Your Inclination to Save (pg 16)
34 — Cowboys vs. Pit Crews (pg 16)
36 — What’s Your Emotional Intelligence? (pg 16)
37 — I’m the Only One (pg 17)
38 — Gattica: Nature vs. Passion (pg 17)
39 — Sitcom Leadership (pg 17)
40 — Exploring the Psychosocial Assessment (pg 18)
41 — Learning about Form and Function with Clay (pg 18)
42 — Art and Medicine: Visual Cues and Disease (pg 18)
43 — The Art of Perception: Honing Observation Skills (pg 19)
44 — The Art of Communication using Modern Art (pg 19)
45—Berg Cultural and Spiritual Assessment Tool (pg 19)
PRACTICAL TOOLS (CONTINUED)
Page 6
1 - Who’s on Your Team? (♠♦)
Leading and being on a team means working with other people. The
choices and reactions those others have to you is directly related to who
they are.
In this exercise, randomly place students into pairs. Ask them to write for
5-10 minutes on the following:
“You are leading a team of eight individuals to (insert appropriate situation
here). Your partner is a member of that team. Based on your current knowledge, how would you
use them to accomplish your goals.”
“If you’ve ever
heard Howard
[Stern], you
might expect his
narcissism score
to be off the
charts. In fact,
he scored a mod-
After 5-10 minutes, discuss the potential difficulties they experienced answering the above prompt.
Have them ask each other questions that explore their strengths, weaknesses, likes, dislikes, accomplishments, etc. You can also have them use some of the assessment tools in this guide instead.
Now give 5-10 minutes to briefly write to the above prompt again. You can extend the prompt by
asking them to “explore the strengths and weakness of their partner in the context of how they
would best use that individual on their team.”
After the writing, discuss the difference between their first and second prompt, the things they
noticed changing their answer, etc.
BONUS QUESTION: In the above prompt, the word use is used in the context of the teammate.
You can also bring this up (or one of your students might on their own) as a way to consider the
following: What is the role of a team? What is the role of a leader? Are team members being used
to further the goals of the leader? What could happen if the leader holds that perspective?
est 15, while
Robin Quivers
scored a 34, one
of the highest of
anyone we tested.”
(#2)
2 - The Narcissist Personality Inventory Quiz (♠♥♦)
Dr. Pinsky has studied celebrities and the general population by administering a widely used screening tool called the Narcissistic Personality Inventory (NPI). Pinsky notes that scoring high on the
narcissism inventory is not a sign of any disorder. No matter how students score, this quiz shows
the grayness of the Narcissist scale from low self-esteem to extreme narcissism with most people
balanced in between. How do you balance healthy self-esteem with empathy for others? This can
be discussed in the context of the field culture (ie medicine is well known for attracting individuals
with narcissist qualities).
Quiz: personality-testing.info/tests/NPI.
Oprah article about the reason and meaning of the quiz:
www.oprah.com/relationships/The-Narcissistic-Personality-Inventory-Dr-Drew-Pinsky/1
Pinsky et al. article on NPI results in reference to celebrity scores and pop culture:
www.csub.edu/~cgavin/GST153/CelebrityStudy.pdf
3 - Quality and Culture Quiz (♦♥)
The Provider’s Guide to Quality and Culture is a website designed to help health care providers
and organizations evaluate and improve cultural competency and ultimately provide better care for
a broad array of patients. Have students take the Quality and Culture Quiz (QCQ) to evaluate
their own cultural competency:
erc.msh.org/mainpage.cfm?file=1.1.1.htm&module=providerquiz&language=English
Answers and an explanation for each are given.
Page 7
4 - Comprehensive Overview of Religions and Their Perspectives (♥♦)
The Handbook of Patient’s Spiritual and Cultural Values for Health Care Providers is an online
resource that provides a comprehensive overview of the major religions and their views on a variety of issues including health and well-being.
www.healthcarechaplaincy.org/userimages/Cultural%20Sensitivity%20handbook%20from%
20HealthCare%20Chaplaincy%20%20(3-12%202013).pdf
5 - What is Your Moral Foundation? (♠♥♦)
The "Moral Foundations Questionnaire" was developed by Jesse Graham and Jonathan Haidt at
the University of Virginia. The scale is a measure of your reliance on and endorsement of five
psychological foundations of morality that seem to be found across cultures. Each of the two parts
of the scale contained three questions related to each foundation: 1) harm/care, 2) fairness/
reciprocity (including issues of rights), 3) ingroup/loyalty, 4) authority/respect, and 5) purity/
sanctity.
The idea behind the scale is that human morality is the result of biological and cultural evolutionary
processes that made human beings very sensitive to many different (and often competing) issues.
Some of these issues are about treating other individuals well (the first two foundations - harm and
fairness). Other issues are about how to be a good member of a group or supporter of social order
and tradition (the last three foundations).
“To treat me, you
Haidt and Graham strives to explore morality in the context of political inclination, but you candiscuss the basis for morality without focusing on politics (although the discussion of how politics
influences or supports cultural morals is an interesting discussion). Scores are shown in reference
to political parties, but one could calculate the average based on the number of each party as stated.
have to know
Results can help students define or understand their perspective and discuss contentious issues
from a culturally/morally-aware perspective — for example, legalizing gay marriage (to be fair and
compassionate), allowing spanking in schools, and making the pledge of allegiance mandatory.
(#6)
To find this and other YourMoral.org quizzes:
www.yourmorals.org/all_morality_values_quizzes.php
More info: www.moralfoundations.org/
Publications: www.moralfoundations.org/index.php?t=publications
Challenges to theory: www.moralfoundations.org/index.php?t=challenges
6 - To Treat Me You Have to Know Me (♥)
The National LGBT Cancer Network created this four minute video as part of a cultural competence curriculum for healthcare providers and staff called “To treat me you have to know who I
am”. Several individuals describe how their sexual identity has altered their experiences with health
care professionals and not for the better.
www.youtube.com/watch?v=XqH6GU6TrzI
who I am”
PRACTICAL TOOLS (CONTINUED)
Page 8
7 - Cultural and Spiritual Sensitivity Training (♥♦)
This is a resource that provides a complete learning module on cultural and spiritual sensitivity
designed specifically for health care providers. This module seeks to: (1) identify and acknowledge
one’s own cultural and spiritual heritage and how it impacts one’s attitudes in providing care, (2)
describe the various components in culture and spirituality, and (3) identify and demonstrate appropriate cultural and spiritual sensitivity in one’s approach to providing care.
www.healthcarechaplaincy.org/userimages/Cultural_Spiritual_Sensitivity_Learning_%20Module%
207-10-09.pdf
Wintz, Sue and Earl P. Cooper. “Learning Module Cultural and Spiritual Sensitivity. A Quick
Guide to Cultures and Spiritual Traditions. Teaching Notes.” Association of Professional Chaplains.
2003.
8 - The Good of One vs. the Good of the Many (♥)
“In our
multicultural
society, the
challenge is
determining how
we can provide
services in a way
that is appropriate
and sensitive to
these
The “Moral Dilemma Survey” examines how people decide what is the right thing to do in difficult
moral situations. In particular, Josh Greene and his team are interested in comparing people's answers about "impersonal" or removed moral violations (e.g., pulling the switch to redirect the trolley) to their answers about "personal" or up-close moral violations (e.g., pushing the man off the
bridge to stop the trolley). These dilemmas measure how acceptable people believe it is to violate
principles of harm in order to prevent some other imminent harm from happening. Research in
moral philosophy and psychology has shown that people generally find impersonal violations morally acceptable but personal violations unacceptable, even thought the actions have the same consequences (killing one person to save five others, for instance).
To find this and other YourMoral.org quizzes: www.yourmorals.org/
all_morality_values_quizzes.php
Takes you through some of the dilemmas : www.wjh.harvard.edu/~jgreene/
Greene, Joshua. 2003. From neural ‘ is’ to moral ‘ought’: what are the moral implications of neuroscientific moral psychology? Nature Reviews, Neuroscience. 4: 847-853.
www.wjh.harvard.edu/~jgreene/GreeneWJH/Greene-NRN-Is-Ought-03.pdf
differences.”
(#7)
Joshua Greene on NPR talking about morality:
www.npr.org/2012/09/20/161440292/why-pictures-can-sway-your-moral-judgment
9 - The Provider’s Guide to Quality and Culture (♠♥♦)
The Provider’s Guide to Quality and Culture, presents examples of ineffective and effective communication centered on the same issue, diabetes compliance, with the
same patient and family. Four videos are available through The Provider’s Guide to
Quality and Culture:
http://erc.msh.org/provider/flash/dci1.html
Page 9
10 - UCLA David Geffen SOM Video Vignettes (♠♥♦)
Video Vignettes from UCLA. UCLA Culture of Medicine Streaming Videos from the David Geffen School of Medicine at UCLA:
apps.medsch.ucla.edu/cultureofmedicine/videos.cfm
11 - Call to Action for LGBT-Inclusive Care (♠♥♦)
The following resource is a “call to action” report geared toward promoting efforts “to provide equitable, inclusive, knowledgeable and welcoming
care to LGBT patients and their families”:
www.hrc.org/files/assets/resources/
health_calltoaction_HealthcareEqualityIndex_2011.pdf
“HIV risk
reduction
12 - HIV Risk Reduction, Role-Playing Anyone? (♥♦)
should be
The following link provides role play videos of patient-physician interactions on HIV risk reduction as a training activity for sensitizing future healthcare providers on LGBTQ issues in
healthcare:
integrated into
optionstraining.chip.uconn.edu/OptionsTraining/activity3300.htm
visits.”
regular office
(#12)
13 - Improving LGBT Health Care Quality (♠♥♦)
The following resource is a free, down-loadable on-line field guide designed “to create a more welcoming, safe, and inclusive environment that contributes to improved health care quality for lesbian, gay, bisexual, and transgender (LGBT) patients and their families”. This document is the result
of inviting an advocacy groups in the area of LGBT health care to convene for a one-day LGBT
stakeholder meeting. The goal of the meeting was to identify and discuss how to advance effective
communication, cultural competence, and patient- and family-centered care specifically for the
LGBT community.
www.jointcommission.org/lgbt/
PRACTICAL TOOLS (CONTINUED)
Page 10
14 - The Gray Line Between Sane and Insane (♠♥♦)
The “Self-Report Personality Scale” is based on the Levenson Primary and
Secondary Psychopathy Scale, created by Michael Levenson, currently at
Oregon State University. This quiz measures the psychopathic personality
traits in non-institutionalized populations. Psychopathy is a disorder characterized by a lack of guilt, empathy, and conscience; psychopaths are often
manipulative, insincere, and violate social and moral norms. Contrary to
popular belief, psychopathy is not limited to the most extreme serial killers,
but can be found in varying degrees everywhere, in all types of industries
and social classes.
Psychopathy is thought to be continuously distributed in the population so
that individuals have varying degrees of psychopathic traits. Overall, psychopathy is often thought of as the epitome of immoral behavior. However, psychopathy has also
been found to correlate positively with other personality traits such as extraversion, adventureseeking, and other characteristics that are often valued in leadership and competitive environments,
so higher scores may not necessarily reflect deviant or immoral behavior, but instead reflect more
outgoing personality styles.
To find this and other YourMoral.org quizzes: www.yourmorals.org/
all_morality_values_quizzes.php
“Brevity is the
soul of wit.”
(#15)
Maibom, Heidi. “Moral Unreason: The Case of Psychopathy”
www.yourmorals.org/Moral%20Unreason.pdf
Jon Ronson, TED Talk, “Strange answers to the psychopath test” gives an interesting intro to the
Psychopathy Test and goes a good job greying the dividing line between ‘sane’ and ‘insane’:
15 - Understanding Terminal Illness through Film (♥♦)
The 2001 film, “Wit,” directed by Mike Nichols depicts a college professor (Emma Thompson)
with ovarian cancer facing the challenge of a terminal illness and enrollment in a clinical trial. This
heart-wrenching film offers a powerful window to a patient’s existential angst and to the problems
patients face battling illness in a hospital setting.
The film can be purchased for under $10.00 on Amazon: www.amazon.com/Wit-Harold-Pinter/
dp/B00005MKKV/ref=sr_1_1?ie=UTF8&qid=1363556862&sr=8-1&keywords=wit
I like to have my students contrast the experience of the main character in the film “Wit” with Ivan
Ilych in Tolstoy’s The Death of Ivan Illych: : www2.sunysuffolk.edu/pecorip/SCCCWEB/ETEXTS/
DeathandDying_TEXT/Death_of_Ivan_Illych.htm
Page 11
16 - 203 Days (♥)
This half hour documentary chronicles a hospice patient over the last 203 days of her life from
entering hospice care living at home with her daughter to her death in a care facility. The following
link allows you to watch the video on-line for free and the website includes discussion questions:
fitsweb.uchc.edu/Days/days.html
17 - Medical Reader’s Theater (♥♦)
Medical Reader’s Theater: A Guide and Scripts (Todd Savitt ed.) provides scripts of poignant and
provocative medical stories meant to be read aloud as a way of stimulating discussions on ethical
and social issues in medicine from both physician and patients perspective.
The book complete with guide and scripts is available for less than $25 on Amazon:
www.amazon.com/Medical-Readers-Theater-Guide-Scripts/dp/0877457999
18 - Morals vs. Behaviors (♥)
The “Behavioral Questionnaire” was created by Pete Meindl, Jesse Graham, Sena Koleva, Ravi
Iyer, Erica Beall, and Kate Johnson at USC. This questionnaire measures the frequency of everyday
experiences, feelings, or behaviors that might be said to relate to morality, values, and/or social
norms. Morality, values, and norms affect the way we interact with others, including our social
relationships. This is why many of the items concern other people, for example, being a good romantic partner.
The idea behind the scale is to help understand where people do not live up to their own subjective
values, what those values are, and eventually, how they may be able to help people live up to their
values. By asking about moral values and ideas both in the general / abstract, as they do on other
surveys on this website, as well as about specific situations and feelings, as they ask in this survey,
they can begin to see the differences and the similarities between people's values and their feelings
about how they do or do not live up to these values.
To find this and other YourMoral.org quizzes: www.yourmorals.org/explore.php
19 - Understanding Schizophrenia (♥)
This 10 minute video clip offers a simulation of what someone suffering from schizophrenia might
hear and see on a visit to the pharmacy to refill a prescription:
www.youtube.com/watch?v=xrcV33gauAM
PRACTICAL TOOLS (CONTINUED)
Page 12
20 - Facing Your Mistakes (♠♦)
The following short 7 minute YouTube clip presents a physician discussing
his mistake and the importance of learning from mistakes:
www.youtube.com/watch?
feature=player_embedded&v=woAcWPUDAcE
Have students write a “Failure Resume”: stvp.stanford.edu/blog/?p=35
Listening Exercise with Groups of 3:
 What is one error that you’ve made?
 What did you learn from it?
 What can others learn from it?
Student #1. Tell 3 minute story of failure
Student # 2. Actively listens, practicing active verbal and non-verbal listening skills
Student #3. Observes listener and provides feedback once time is up
“Studies have
21 - Helping Students Process International Service (♠♥♦)
shown it takes a
Chisholm, L. A. (2000). Charting a Hero’s Journey. New York: The International Partnership for
Service-Learning and Leadership.
physician about
18 seconds to
interrupt a
This is an excellent text for guiding students to reflect on international service work. The book
serves as a self-tutorial prompting students to process their time abroad and their experiences immersing themselves in another culture.
patient.”
(#22)
22 - Encouraging Reflection on One’s Career Path and Calling (♠♦)
Encourage students to write a “This I Believe” statement to help remind them of their core beliefs
and goals.
Guidelines for helping students to compose their own This I Believe statement can be found online at: thisibelieve.org/curricula/ThisIBelieveCollegeCurriculum.pdf
Links to "This I Believe" essays written by physicians and health care professionals:
 Listening is Powerful Medicine by Alician M. Conill (thisibelieve.org/essay/15222/)
 Connecting with My Patients by David Adinaro (thisibelieve.org/essay/6087/)
 The Refashioning of Our World by Paul Farmer (thisibelieve.org/essay/56362/)
 A Goal of Service to Humankind by Anthony Fauci (thisibelieve.org/essay/15/)
 My Duty to Provide Care by Heather (thisibelieve.org/essay/51842/)
 Adapting to the Possibilities of Life by Donald Rosenstein (thisibelieve.org/essay/39519/)
 Making the Correct Diagnosis by Herbert (thisibelieve.org/essay/33897/)
 This I Believe by Richard (thisibelieve.org/essay/44044/)
Page 13
23 - Talking about Making Mistakes as a Physician (♥♦)
Dr. Brian Goldman, an emergency room physician, discusses the physician culture of denial and shame
in response to making mistakes. He discusses the pressure on physicians to be ‘perfect’ and the inevitability of making mistakes. Dr. Goldman presents this call to action to redefine medical culture in a way
that allows physician to be human so that they can learn from their mistakes and help others do the
same. Dr. Goldman calls for an environment that fosters positive responses to everyone on the team
identifying possible mistakes and putting checkpoints in place to help catch mistakes before they become dire.
www.ted.com/talks/brian_goldman_doctors_make_mistakes_can_we_talk_about_that.html
24 - Everyday Moments (♠♥)
The “Judgments of Everyday Actions” Quiz was developed by Benjamin Lovett, Alexander Jordan, and Scott Wiltermuth. This scale is a measure of the tendency to assign moral weight to commonplace behaviors and judge them as morally wrong. The idea behind the scale is that people
vary in the degree to which they see everyday behaviors as relevant to morality.
Some people naturally evaluate a variety of actions in moral terms (i.e. as morally ok or morally
wrong) while others are less likely to view actions this way. This is newly-developed scale so it isn’t
known how it relates to other psychological factors, but it does appear that the tendency to see
actions in moral terms is not related to the major facets of personality such as extroversion or conscientiousness. One reason they are interested in this scale is because they want to see how moral
judgments for everyday behaviors might relate to more abstract moral variables, such as general
moral principles. Ask you students to take this quiz and give their own opinion on the validity of
the scale’s ideology.
To find this and other YourMoral.org quizzes: www.yourmorals.org/explore.php
25 - Medical History and Getting to Know Your Patient (♥♦)
Students can begin to explore taking medical history and getting a patient’s social and psychological context by beginning simply with talking
to eager community members about their lives and health.
The two most easily accessible populations are young children in
schools or day care centers and older individuals in retirement facilities.
In both cases, the story-telling ’patients’ benefits from the activity and
may be surprisingly eager to share. They are also typically forgiving of student foibles, making
them a good starting point for nervous students.
Alternatively, with older subjects, students can begin to explore the history of medicine from a
patient’s perspective. How has medicine changed in that person’s lifetime? They can ask questions
about immunizations, health scares, and illnesses they had at various points in their lives. How has
their care changed from childhood to now? (This is particularly interest for chronic diseases and
how treatment has evolved.) This is a helpful exercise in communication, listening, empathy, and
patience.
As a follow up, have students imagine they are 80 years old and have them write a “medical history” of their own lifetime, covering their childhood and theorizing on how medicine will change
within their lifetime.
“And that’s when
I made my first
mistake.”
(#23)
PRACTICAL TOOLS (CONTINUED)
Page 14
26 - Does Your Body Affect How You Interview? (♠♦)
Amy Cuddy studies body language. This interesting and funny TED Talk discusses
the influence of non-verbal cues on communication and judgment of others. She
also discusses ‘power poses and how changing your physician posture can change
how others view you as well as how you view yourself (great pre-interviews!)
www.ted.com/talks/amy_cuddy_your_body_language_shapes_who_you_are.html
27 - Communicating with a Diverse Patient Population (♥♦)
“30 second
soundless clips
These videos from the American Association of Family Physicians include examples of appropriate
and inappropriate cultural communication in the medical setting, as well as techniques for proper
communication with patients. Topics covered include: limited English proficiency, obesity and
adolescence, women’s health and sexual orientation, immigration health care, cross-cultural end of
life care, and population diversity.
www.aafp.org/online/en/home/clinical/publichealth/culturalprof/qcdpvideos.html
of physician—
patient
interactions can
be used to
predict whether
they will be
sued.”
(#26)
28 - Defining Unintentional Biases (♥♦)
Many people consider themselves to be without prejudices, yet most of us have unconscious biases
that we do not recognize. This exercise is designed to help students recognize these biases within
themselves.
The below questions examine internalized definitions for typical absolute descriptors (questionable,
offensive, inappropriate, disgusting, attractive, cheap, respectful).
Ask your students to answer the following questions (written).







You see a questionable looking man at the airport. Describe him.
Describe a speech that you would consider offensive.
Describe a relationship that you would consider inappropriate.
You go to a formal dinner hosted by someone you don’t know. You are served a meal you
consider disgusting. What is it?
Describe someone who is attractive.
You see a toy at the store that you consider cheap. How much is it?
You witness a kid being respectful to his mother. What is he doing?
If you have multiple social, cultural, socioeconomic, racial backgrounds present, have students read
their answers, and discuss why differences exist. If your group isn’t diverse, feel free to ask students to pick someone else (or give them written description of someone) and repeat the exercise.
Where do this internal standards come from? If they could, would they eliminate them completely? If so, how if at all would that alter their ability to function? If not, what productive role might
these standards play in everyday decision making? What, if anything, can we do about these biases?
Page 15
29 - Physician’s Guide to Culturally Competent Care (♥♦)
This website includes a set of nine video vignettes that progress through both bad and good examples of physician-patient communications. These videos have been designed to “equip health care
professionals with awareness, knowledge, and skills to better treat the increasingly diverse U.S.
population they serve.”
cccm.thinkculturalhealth.hhs.gov/videos/index.htm
30 - The Power of Vulnerability (♥)
Brene Brown, a University of Houston researcher, gives an interesting and funny TED talk about the
role of vulnerability in building connections. She discusses love, worthiness, shame, finding connections, disconnection, empathy and authenticity. Discuss with students these ideas and the role of vulnerability of patients in seeking health care. This can also be discussed in reference to a particular group
of student. The “Treat Me Is to Know Me” video clip (#6), for example, shows shame as a result of
bad health care encounters.
www.ted.com/talks/brene_brown_on_vulnerability.html
“I meant it as a
joke, but
fostering
31 - Impressive Medical Humanities Resources (♠♥♦)
stereotypes
This site, established by New York University School of Medicine, is dedicated to providing a resource for scholars, educators, students, patients, and others who are interested in the work of
medical humanities.
about other
Bibliographies are given for an impressive number of topics: aging, AIDS, alternative medicine,
behavioral science, death and dying, disability, ethnicity and medicine, film and medicine, gender
and medicine, health care policy, history of medicine, law and medicine, literature and medicine,
medical education, medical ethics, medicine and the arts, medicine and technology, mental illness,
physician-patient relationship, professionalism, religion and medicine, science and the humanities,
social issues in medicine, war and medicine, and women and medicine.
funny.”
medhum.med.nyu.edu/
32 - Another Good Read...or Ten (♠)
Leadership in Medicine students at Union College have put together their own website of good
reads. This website lists a set of medically interesting books (fiction and non-fiction).
limbookclub.weebly.com/
people is never
(#29)
PRACTICAL TOOLS (CONTINUED)
Page 16
33 - Your Language Changes Your Inclination to Save (♥♦)
Keith Chen, a behavioral economist, gives an interesting TED Talk discussing how the way our
language works may alter how we view the world and make decisions. In this presentation, Keith
focuses on how our language describing time impacts our concept of time and ultimately our inclination to save money for the future.
Although this talk focuses on the economic implications of a linguistic concept of time, it’s a good
jumping point to ask students whether the same might be true of our concept of time and healthrelated decisions.
www.ted.com/talks/keith_chen_could_your_language_affect_your_ability_to_save_money.html
“We are in the
deepest crisis
of medicine’s
exist due to the
cost of care.
There’s not a
country in the
34 - Cowboys vs. Pit Crews (♠♥)
Dr. Atul Gawande gives a riveting TED Talk on how our expanding knowledge
of the human body and the current complexity of the field result in medicine
needing “Pit Crews” for patients instead of the “Cowboys” of yesterday. Yet
the system is still selecting for “Cowboys” - brave, independent, autonomous
leaders. Do students agree? You can have them just discuss their thoughts on
this off the cuff, or you can ask them to do research either into target schools gauging whether
they are recruiting ‘Cowboys’ or ‘Pit Crews’ or have students read the AAMC information Holistic
Review or changes to medical school curriculum.
Dr. Gawande also discusses the nuances of tackling the cost of health care.
www.ted.com/talks/atul_gawande_how_do_we_heal_medicine.html
world who isn’t
acting if we can
afford what
doctors do.”
(#34)
35 - Team Drawing Exercise (♠♦)
This activity is based on the principles of the team-based station of the Multiple Mini Interview.
Ahead of time, print out reasonable simple black and white outline images of everyday objects (clip
art works well). To do this activity once, you will need half as many images as you have students
doing the activity. Put students into pairs sitting back to back, facing away from each other. Give
one student one image (giver) and the other gets a piece of paper and a pencil (receiver). The giver
will give instructions on how to accurately draw their image (without stating what it is) for the receiver who will draw the image based solely on the givers instructions. The receiver cannot see the
giver’s image, the giver cannot see the receiver’s drawing, but both can talk and ask questions.
Give the students 5 minutes. This is an excellent ice breaker in addition to practicing communication and teamwork skills.
36 - What’s Your Emotional Intelligence (♠♥♦)
Emotional intelligence is the ability to identify, assess and control the emotions of oneself, of others and of groups. Thus, emotional intelligence has implications of leadership and teamwork, communication skills and empathy.
Test: www.globalleadershipfoundation.com/geit/eitest.html
Extensive Wiki Page (description, history, criticisms):
en.wikipedia.org/wiki/Emotional_intelligence
Page 17
37 - I’m the Only One (♥♦)
Give each student an index card. On one side of the card have students answer one of the following questions:
 What do you value most?
 What is your greatest fear (with school, applying, classes, life, might help to specify)?
 Give one goal for college/this year/this program/this class/life.
Have them hold the cards up to their chest (facing out) and mingle with each other. This can work
as a meet and greet or you can have them find everyone that wrote a similar answer as they did.
You can also have them tape or pin them to the wall one at a time (reading them aloud), and
grouping them with similar ideas as they happen.
Follow this with discussion of core similarities across surface differences like valuing family or
honest and integrity. (Works nicely as an icebreaker.)
“There’s no gene
38 - Gattica: Nature vs. Passion (♠♥)
"Gattica", a film written and directed by Andrew Niccol, follows the life of Vincent, a young man
who is a product of natural conception in a world were everyone is genetically maximized. Born
“genetically inferior,” Vincent is part of the underclass automatically subscribed to menial jobs.
This quintessential underdog however dreams of going into space. To achieve his goal, Vincent
takes on the identity of Jerome, a genetically perfect young man who's met with recent person challenges. Armed with a ready supply of hair, blood, and urine, Vincent fights to achieve his goals
before he is caught as a fraud. Is his culture wrong — that we can be more than our biological
destiny?
The nature vs. passion dynamic this movie explores presents a nice way to help students cultivate a
dialog of the biological and human aspects of illness and disease. Students can be asked to find
examples of both sides: cases where mind over matter doesn't result in changes and cases where
the human spirit prevails. Placebo effect could also be discussed.
Available on Amazon:
www.amazon.com/Gattaca-Ethan-Hawke/dp/0767805712/ref=sr_1_3?
ie=UTF8&qid=1365517876&sr=8-3&keywords=gattaca
39 - Sitcom Leadership (♠♥♦)
Have students find examples of good and bad leadership and/or teamwork from sitcoms. If students have learned the different kinds of leadership, good examples can be characterized according
to those standards. If not, a discussion of kinds of leadership can follow, using these examples as
examples.
In an adaptation of this exercise, students can be asked to show a clip of the behavior that can be
used to expand the conversation, discuss motives, intentions, and the effect of the team or project.
This activity can also be adapted to good and bad communication.
for the human
spirit.”
(#38)
PRACTICAL TOOLS (CONTINUED)
Page 18
40 - Exploring the Psychosocial Assessment (♥♦)
The psychosocial assessment is a holistic assessment of a client, often used in social work cases.
This assessment focuses on the biological, social and psychological influences in play when determining treatment.
This exercise can be done in one of several ways:
 Students can work independently to do their own psychosocial assessment
 Students can work in pairs to do each other's assessments
 Students can go out into the community and complete assessments of community members.
Depending on whose cooperation they can get, you can work with an elementary school
teacher to do children or a retirement home for geriatric community members for example.
Campus specialty organizations may also be a good resource.
For detailed material on psychosocial assessments:
www.york.cuny.edu/wac/for-students/discipline-specific-infosheets/social-work-psychosocialassessment
41 - Learning about Form and Function with Clay (♠♥♦)
There are many exercises that can be done with prehealth students using clay. Below are some
examples:
 Blindfold students and ask them to make a simple clay form allows you to address the role
that touch plays in medicine. Physicians must learn to “see” with their fingers when palpating
patients, and practice working in clay can heighten a student’s sensory abilities.
 Students can be asked to research and sculpt anatomical structures as a way of learning about
human anatomy (useful link: health.yahoo.net/human-body-maps/)
 Asking students to reach personal narratives of patients suffering from a condition related to
their sculpted organ is a good way to encourage them to make real life connections.
If you can get students to work on a ceramics wheel, it is a great opportunity for them to recognize
the power of touch and the challenges of working with a moving force with a life of its own. If you
do not have access to a ceramics studio on your campus, there are air dry clays that can be purchased on line that are easy to use, sculpt, and even carve (great activity for predental students!)
To purchase air dry clay:
www.amazon.com/Activa-Natural-Stone-1-1-Pound-Smooth/dp/B002VR7I32
42 - Art and Medicine: Visual Cues and Disease (♠♥)
In conjunction with clay activities or as a stand alone exercise, students can research the role that
texture and color play in identifying disease through the following site that that provides numerous
images of clinical patients portrayed in various art forms, including portraits and photographs capturing the special nuances of particular disease states:
www.artandmedicine.com/
The link offers students a place to begin to think about art, form and function as well as the very
helpful relationship between visual cues and disease in contrast to the less helpful relationship between visual cues and stereotypes/biases/prejudice.
Page 19
43 - The Art of Perception: Honing Observation Skills (♥♦)
Teaching students to learn to discern fact from personal biases and inferences can be done using
portraits and images from an art museum. In this exercise, students are shown portraits and asked
to identify what they see. The facilitator helps students to articulate what they see identifying fact
(i.e. person is smoking) from inferences one might tend to conclude (i.e. person is a smoker). Portrait analysis allows students to reflect on whether they really can tell a person’s age, gender, socioeconomic status, or mental state solely from observation. This exercise can be done by copying art
into power point slideshows and does not require an actual trip to an art museum. Asking medical
students to analyze portraits in art museums has been shown to improve their diagnostic skills.
Naghshineh S et al, (2008). Formal Art Observation Training Improves Medical Students’ Visual
Diagnostic Skills. J Gen Intern Med; 23(7):991-997
44 - The Art of Communication using Modern Art(♥♦)
In this exercise, the facilitator uses images of modern art (the more abstract,
the better!) to challenge students’ communication skills. The goal of the exercise is for students to think about the way they communicate whether it be in
the role as “communicator (teacher/doctor) or as “listener” (student/
patient). Images of abstract art is displayed in a manner that everyone can see
it except the person assigned to serve as “listener” who must draw a picture based on the instructions from the designated communicator. The rest of the group serves as observers of the communication dyad providing feedback on the communication that ensues during a 3 minute interval
in which the “teacher” must get the “student” to draw the image.
45 - Berg Cultural and Spiritual Assessment Tool (♥)
The Berg Cultural/Spiritual Assessment Tool is a guide to a patient- focused, scripted dialogue
between a provider and patient. This assessment process allows a provider to place a patient within their cultural/spiritual context while recognizing their individual uniqueness at the same time. It
assists providers in establishing a trusting therapeutic alliance with their patients, empowers the
patient to become a more active participant in their healing journey and helps patients to give voice
to their own sacred story.
Have students go through the tool first completing it as a patient would. This will allows them to
become familiar with the process and also to begin to recognize their own cultural/spiritual story.
Ask students to contrast this to visits with the doctor they have had without the provider having
this context.
For Tool: : www.csh.umn.edu/Integrativehealingpractices/culture/tool/cf0049.pdf
September 2012
The Advisor
Empowering Students with the Tools
for Their Best Application
Alexandra Tan, PhD
A
s academic advisors, we are
charged with helping students navigate the confusing and
sometimes tumultuous waters
of higher education. We discuss
prerequisites and volunteering, but
what about how students complete the application? Without direction, students answer prompts
thoughtlessly focusing on quantity
rather than considering, “what am
I trying to say about myself ?” In
doing so, applicants fail to present
their portfolio in a way that makes
it easy for admissions committees
to recognize what they have to
offer. Admissions committees are
thus left with a “bunch of stuff ”
application, and advisors are
left hoping that committees will
intuitively know (or figure out)
how it all fits together. Thus, some
students are rejected not because
they weren’t competitive but
rather because it isn’t clear what
they bring to the table.
How the application is completed
can matter as much as what content fills it.
Dr. Tan is currently Program Director,
Post-Baccalaureate Health Professions
Program UC Berkeley Extension but
beginning September 1st will be Director,
Post-Baccalaureate Premedical Program,
Johns Hopkins University. This article
is based on her presentation at the 2012
NAAHP meeting in Baltimore.
Address correspondence to
alextan@jhu.edu
Although any crowd of students
can give a list of ‘what admissions
committees want’ (academically
competent, committed, passionate, culturally sensitive, mature,
empathic problem-solvers), they
often struggle with how to get
themselves across in the application. How do you use a resumelike list, essays and recommendations to show maturity and passion? This, combined with fear of
an unsuccessful application, leads
to students falsely believe that
they need to look like “the ideal
candidate” to gain admissions.
Ultimately this results in many of
the behaviors we dread – checkboxing, over-committing, heavy
class loads, and textbook answers
on applications and in interviews.
None of this is necessary. Every
student can be the perfect candidate. Here’s how I help my students find their own path to medical/dental/veterinary/etc. school.
Explain the Rules
Start by explaining two rules:
First, applications should look like
the student they represent, and
second, nothing in the application
should be included that cannot
be supported. This second point
is key because applications are
essentially an exposition; students
are making the argument that they
are a sure bet for completing a
degree, passing exams, and contributing to the future work force.
With so much competition, there
is no reason for schools to accept
risky ventures (more on this in
Offset Missteps below). The surest way to a good argument is to
support everything with data.
Explore their Motivation
Help students build an application
that looks like them by making
them focus. Start with “you” questions: What do you hope to accomplish
in 10 years? Describe the ideal job.
Less conventional questions like
if you could have any super power, what
would it be? can reveal interesting
things about a student. Avoid
questions that encourage textbook
39
September 2012
The Advisor
Empowering Students with the Tools for Their Best Application continued
answers. Why do you want to be a _ ? and who is your hero?
rarely seem to be fruitful ways to understand a student’s motivation. Encourage students to explore their
most insightful and genuine answers.
Determine Focus Points
Ask them to make a list of 20 things they like about
themselves. Then have them pick five (or four or six)
that they think make them particularly well suited
for becoming a __. There should be some parallels
between their motivations and this list. Again, don’t
accept textbook answers. Then, for each of the five
characteristics, or focus points, ask them to list “evidence” to prove they possess that trait. Evidence may
include awards, experiences, etc. Some focus points
will be easy and well supported. Others will not. Later
on students should have a body of evidence for each
focus point, so unsupported points indicate where
attention should be spent.
Develop a Plan
Help student develop a personalized plan that will
address prerequisite requirements as well as any focus
points lacking in support. Encourage them to focus
their attention towards the experiences that explore
their interest (highlighted during Motivation section
“you” questions). As long as they thoroughly explore
the field and apply appropriately, it is not necessary to
do one of everything. In my experience, students get
very little value from exploring experiences that don’t
interest them. Far more is gained by using that time in
a way that enhances their convictions and motivates
them towards their goals.
Do Maintenance
Check in with students often, and make them responsible for their own competitiveness. They should ask
“where do I have to be in 4 years to be a successful
applicant?” Then, “am I on track at 3/2/1 year(s) to
go? If not, what am I going to change?” This as-yougo approach establishes structure that helps students
set goals and stay on track even when missteps occur.
Offset Missteps
The most important part of a misstep is taking
ownership for it. Although any false step can provide
evidence that a student is a risky venture and may
misstep in the future, it can also be used as proof of
maturity, overcoming obstacles, fortitude and persistence. However, this only works if a student exhibits
40
maturity, fortitude and persistence and overcomes
the obstacle. Again, make the student responsible for
their own competitiveness and reassure them with the
carrot of proof. Ask “how are you going to get on
track and offset this event? How do you plan to show
admissions committees this is an anomaly? What have
you learned from this? And how are you going to use
this to your advantage in your application?”
Build an Application
When students are ready to apply, they should have
evidence to support each focus point already. Then,
rather than answering each prompt in the application,
students should ask “how can I use this prompt to
highlight my strengths or address my weaknesses?”
Most prompts, including secondary essay questions,
are vague enough that students can use them to highlight focus points. Before submitting, students should
ask “have I answer the question(s) asked?” and “have
I said something important about myself ?”
In this age of doing more with less, I begin by doing
the Rules, Motivation, Focus Points and Plan in a
classroom setting. One-to-one meetings are reserved
for exploring Motivations, personalizing the Plan,
Maintenance and Application. It doesn’t work for
everyone, but I find many of my students benefit
from being empowered with the tools necessary to do
well without me. The idea that advisors are the ‘keepers of the tools’ creates more work for us. In contrast,
helping the students to find their own path encourages
maturity and self-awareness as well as ownership of
successes and failures. Additionally, it is far less frustrating than watching good students get overlooked.
There is nothing novel in what I have said here, and it
shouldn’t be. The reason this works is because most
students driven to pursue a career in medicine (or
dentistry or veterinary medicine or…) already possess
the traits necessary to be a respected member of that
community. This isn’t about helping students acquire
those qualities. It’s about helping students build a
portfolio that highlights their strengths; it’s about
helping them to be clear and concise in the application so that it’s explicit and obvious to admissions
committees. As advisors, we hope that our students
will be successful in the application process; however,
if they aren’t, it shouldn’t be because the admissions
committee didn’t take the time to figure out what a
student had to offer.
Walk thru AMCAS ‐ 1 A Walk through the AMCAS Application
A Tan
Introduction
In reviewing the example paper copy of the AMCAS application, the most glaring thing you
might notice when you look at the application is the absence of instructions. That’s because this
is what it looks like when it prints. The actual online application has tons of instructions within
it as well as another 83 page instruction book.
AMCAS website:
https://www.aamc.org/students/applying/amcas/
Instruction PDF:
https://www.aamc.org/students/download/182162/data/amcas_instruction_manual.pdf
AMCAS does not want to answer obvious question for all ~45,000 applicants annually so they try very hard to anticipate any questions you might have. Therefore, it is always a good idea to read the instructions first! Then, if you are not sure, you can always ask me or Ann. That being said, you can also contact AMCAS directly: email: amcas@amcas.org or phone (202)828‐0600 (M‐F 9a‐7p ET; closed Th 11a‐1p) A Warning: AMCAS hires additional staff during the busiest parts of the application year to
handle the massive number of incoming documents. Similar to how department stores hire
additional staff at Christmas. Now imagine asking one of those additional gift wrappers where
tie clips could be found. Now ask a few other people. Likely you’ll get lots of different answers
depending on who you ask and how experienced they are. Same thing with AMCAS
unfortunately, just keep this in mind.
What is AMCAS?
AMCAS, the American Medical College Application System, is just that: a system. While
all the participating medical schools are using the actual application, they don’t necessarily
use it or access it the same way, and the AMCAS staff doesn’t necessarily know how a
particular school uses it. They’re just processors and distributors.
Walk thru AMCAS ‐ 2 What does AMCAS do?
AMCAS handles the logistical aspects of the application – when it goes live or offline, how
to access it, etc. They handle the incoming transcripts (most often done by mail) and
incoming letters of recommendation (most often done online). They process the transcripts
and letters and match them with the correct completed applications. As we will discuss later,
once your primary application is submitted, they use your submitted transcripts to “verify”
that what you’ve entered matches what is on the transcript.
There’s nothing unexpected about the AMCAS application. In fact, it might look oddly familiar
to you. Our post-bac application and those of other post-bac programs mimics the AMCAS
application. This shouldn’t surprise you since we are using similar characteristics in our review
as they use (makes sense, right?).
Let’s divide the AMCAS application into five reasonable chunks:
 Stuff at the Beginning (Biographical Information)
 Academic Metrics
 Experiences Section (I call it the “list of 15”, for those you who are paying attention
when I talk)
 Personal Statement
 Stuff at the End (Letters Writers and Selected Schools)
Stuff at the Beginning (Biographical Information)
The beginning of the AMCAS application includes the same questions you’ve been answering
about yourself since high school. None of it is that interesting, but it identifies you, helps
institutions do statistical analysis (based on race or parent’s education, for example) and
establishes your state residency. The only questions that come up in reference this section is
usually involve “disadvantaged status”. The instructions do not contain any solid definition of
what qualifies you as disadvantaged. It is self-identifying, and you have roughly 1300 characters
to explain why you feel you are disadvantaged. If you do not have “sufficient reason” to claim
it, schools will likely disregard your selection. As an extreme example, if you say you were
disadvantaged because you had to make due with a 5 year old used car in college, that probably
would not be considered disadvantaged. Obviously your situation will be far greyer than this
silly example. In the end, it is up to you to decide whether the conditions you experienced made
you feel that you had a disadvantage over your peers nationally or locally. It’s also up to you to
write a compelling statement to make the case for it.
Walk thru AMCAS ‐ 3 Academic Metrics
This section is probably the most painful to complete and typically results in more questions than
any other. Here you enter all the colleges and universities you’ve attended (community college,
international colleges, undergraduate schools, graduate schools, etc.). You then begin the long
process of entering ALL your academic coursework – the name of course, when you took it,
what department it was in, the course number, the credits and the grade. Yes, ALL the courses.
Even if you have only taken a watercolors class pass/fail at School D, you are obligated to report
it.
Why do I have to enter all the courses and all that information?
AMCAS does this fantastic thing for all the medical schools. On page four of the blank
application I sent you. Your GPA is shown in LOTS of different ways. I can review your
GPA by:
A.
B.
C.
D.
Overall cumulative GPA across all coursework
Cumulative BCPM GPA (BCPM: “biology, chemistry, physics, math”; ie, science GPA)
AO GPA (AO: “all other”; ie non-science GPA)
How your GPA (BCPM or total ) changed over time
This data can only be extracted if the computer has the information to determine whether it is
a BCPM or AO course, what year you took it, how many credits it is worth and what grade
you received.
How do they know I’ve done it right?
Good question. They check. A team of people at AMCAS physically go through every
transcript you send and match it to what you’ve entered to “verify” that what you’ve entered
and that the resulting calculations the computer does are correct. Medical schools don’t want
to check you work, but they do want to take advantage of the finished chart.
Walk thru AMCAS ‐ 4 How do I know whether a particular course is a biology/chemistry/physics/math course?
Again, AMCAS gives explicit instructions of how to fill this section out. They don’t want
you to make mistakes, so they work hard to make sure it is clear. In general, you enter the
information off your transcript exactly as you see it. I would not recommend you make any
judgment calls. Most often, I get question about science courses not technically in science
departments. For example, if the prefix for a microbiology course is PBHLT (public health).
In accordance with the instructions, AMCAS will consider this a “Health Sciences” course,
not BCPM. Yes, I understand it is a science topic. Yes, I understand that public health and
nursing and geology and kinesiology are all science fields. The fact remains that AMCAS
simply doesn’t consider them BCPM courses.
What happens if I didn’t do it right on accident or put that microbiology course mentioned
above in BCPM on purpose even though AMCAS doesn’t agree?
If there is any deviation from your transcripts, AMCAS staff stops the verification to
determine what is correct. Standard verifications can take 2 to 4 weeks to process. Errors
will increase the time spent on this step. Whether on purpose or on accident, you will go
back and forth with AMCAS so that they have enough information to make a ruling on
whether the course does deserve the category you gave it. Let’s take the microbiology course
again. AMCAS may ask for the syllabus for the course to verify the content. You do so,
and, after another month, you get the satisfying response that it is indeed a BCPM course.
You now get three more credits of an ‘A’ added to your BCPM GPA. Unfortunately, your
application is now a full month behind in the review process than it would have been had you
not differed from your transcript. Since we know that it is important to submit your
applications early, have you now compromised the benefit of the three credits with the delay?
How do institutions review the coursework?
It varies from school to school and from applicant to applicant. In general they want to see
that you are academically capable of handling their coursework. Each committee member
will likely have a different perspective on how to determine this. Some will focus on your
latest coursework, others just on your science coursework, and others on the overall trend of
your academic career. Some will look at just one of those. Others will look at the whole
chart to get a sense of your overall trajectory.
What happens with the MCAT?
You need to report your official MCAT scores directly to AMCAS. Technically only ones
taken in the last three years are considered, but schools vary on how they handle this too.
Walk thru AMCAS ‐ 5 Some have minimums for each section while others have overall cumulative expectations.
Some look only at the last time you too it while others take the average all the exams taken.
What happens if I have taken the MCAT once, and then take it again a month after I
submit my completed AMCAS application?
Once verified, AMCAS will send your completed application to all the schools you indicate.
Anything that comes to AMCAS beyond that (MCAT scores and letters of recommendation,
for example) is sent as “updates”. Schools vary on how they handle updates.
Should I enter pass/fail courses and withdrawn courses into AMCAS? What do they do
with them?
You are obligated to enter all your coursework, including pass/fail, audits and withdrawn
courses. AMCAS counts the credits of each and puts them on the bottom on the table.
Schools vary in their opinion of these items, but, in general, it implies something to be
withdrawing from lots of courses or taking content courses that should be for credit as
pass/fail instead.
My undergraduate institution allowed me to “replace” classes I flunked if I retook them
later. Both grades are on my transcript, but only my latter grade in figured into my
institutional GPA. Will AMCAS do the same?
US allopathic medical schools do not honor grade replacement and neither does AMCAS.
This is not unique to allopathic medical schools. In fact, there is only one professional health
care field that does allow grade replacement during application – osteopathic medicine. All
others do not. For AMCAS, you should enter everything that is on your transcript. If you
retook a course, then you enter the course information twice in AMCAS: once with the first
grade and once with the second. Both will count.
Experiences Section
Think of this section as basically like a resume of 15 selected experiences. Notice I said resume
and not CV. Unlike a CV, a resume is a tailored list of your experiences that specifically
addresses the needs of a specific audience. This is the same thing. For each of your experiences,
you will select a category that best describes it:
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Paid Employment – not Military
Paid Employment – Military
Walk thru AMCAS ‐ 6 
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Community Service/Volunteering – not Medical/Clinical
Community Service/Volunteering – Medical/Clinical
Research/Lab
Teaching/Tutoring
Honors/Awards/Recognitions
Conferences Attended
Presentations/Posters
Publications
Extracurriculars/Hobbies/Avocations
Leadership – not listed elsewhere
Intercollegiate Athletics
Artistic Endeavors
Other
There are fifteen categories here. Am I expected to have one of each?
No. This list is meant to capture all the historically likely categories that applicants generally
use. In no way is it meant to imply that you must have something to contribute in each
category in order to be a good candidate.
Then what are the most important categories?
To focus on one category as the most important is to miss the point of this section of the
application entirely. Medical schools are interested in what you, as an individual, bring to
the table. This is an opportunity to showcase all the wonderful things you have done and
have to offer. Your experience should help tell the story of your progression to this point.
Since each applicant will have a slightly different story to tell, it would be foolish for there to
be a most important category.
What information is requested?
In addition to choosing a category, you will name each experience, give a beginning and end
date, number of hours per week, a contact person, a contact phone and contact information,
and a description of the experience. You will have 700 characters to describe the experience.
Contact person? What contact person?
AMCAS recognizes that not all experiences have a supervisor, and they have guidelines on
how to handle it. Check the instructions for what is appropriate for your particular
circumstances.
Walk thru AMCAS ‐ 7 What should the description should be like?
Think about it like a resume. The description should help the reader understand what you did
in that experience.
Can experiences be combined or split?
Sure. The goal here is to give context for your application in a way that is clear and logical.
You should have a good reason for any combinations or splits you do.
Do I need to have fifteen? What if I don’t have fifteen?
Think of it more like a maximum of fifteen. You definitely don’t want to add unnecessary
experiences just to fill the space or split up experiences that would make more sense together
just to reach fifteen. Focus on what’s important to include to tell your story well.
Most Meaningful Experiences AMCAS will allow you to select three of your list of 15 to classify as “most meaningful experiences” for which you get an additional 1325 characters to discuss it. What does this mean? Exactly what it sounds like. Select the three experiences that you would want admissions committees to understand are the most meaningful to you. Personal Statement
Ah, so it has come to this. The person statement is the most painful part of the application for
the majority of students and results in a great deal of agony and stress for most. It doesn’t have
to be painful. Consider this. Your personal statement is the one and only opportunity you have
to tell your own story. The list of 15 is a resume and says nothing about who you are or what
you learned from your experiences. The biography section and academic portion say about as
much about you as a census report. The personal statement is your golden opportunity to tell
Admissions Committees how you got to where you are today and why they should take a chance
on you. Because of the format of the application, the personal statement basically gives context
to the rest of your application and frames your application content…in 5300 characters (roughly
Walk thru AMCAS ‐ 8 about a page and a half). While the content of the personal statement is wide open, generally
speaking you should cover the following:
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Your path – either the long or the short of it, how does you past contribute to your
future?
Medical relevance – I want to hear your story, but make sure you cover why you are
passionate about or interested in medicine.
I learned/I realized – Lots of people have the same experiences, but not everyone
learns the same things as a result. How have your experiences and choices, either
inside or outside of medicine or both, changed how you view the world/life/other
experiences/your career/your relationships/whatever.
What do you think you will contribute to the medical field – no one is asking for major
predictions of what diseases you will cure and when. This is more of a general topic.
What talents and characteristics do you bring to the field that you believe will be
beneficial? They don’t have to be profound or unique, just true. Are you a leader? A
teacher? Do you have a unique perspective? Do you have a desired focus? Are you
passionate about activism? Advocacy? You don’t have to change the world. You just
have to be willing to participate.
Stuff at the End (Letter Writers and Selected Schools)
Through AMCAS, you can have up to ten letters of recommendation submitted on your behalf.
Generally, schools do not want ten letters, but you might feel that you want to use different
letters for different schools (depending on their requirements), and AMCAS will allow you to do
so. For example, if School A and B require a non-science academic letter of recommendation
but School C does not, you might decide that you would rather send letters to these different
schools. Check to see what each school requires for letters and make sure you send exactly what
they want. Once you enter each letter writer and their contact information, AMCAS will allow
you to print a coversheet for that letter that includes both your AAMC ID# and an AMCAS
Letter ID# for each individual letter. Your letter writers will need both these numbers to submit
your letter either online or by mail. Instructions for the letter writer are provided on the AMCAS
website.
When completing the application, you will have the opportunity to checkbox any and all
institutions to which you would like to apply. These are the institutions that will receive your
primary application after verification, and it is indicated on your primary application all the
schools to which you are applying. In other words, if I’m at School A, I can see that you’re also
applying to Schools B and C. You may apply to all the participating schools by checkboxing
them. Please note that not all school participate. There is a list on the AMCAS website that
Walk thru AMCAS ‐ 9 gives this information. The largest category of school that do not participate are Texas schools.
With the exception of Baylor University, all the Texas medical schools use the TMDSAS instead
of the AMCAS. Since Texas schools are only open to Texas residences, this hardly comes up.
However, if you are a Texas resident, you get the lucky task of completing two online
applications. Also note that some medicals schools use the AMCAS application but they do not
use the AMCAS letter service. Again, there’s a list on AMCAS of the institutions that do and
don’t. (At the time of writing this, LSU and Duke where the two noteworthy ones that did not use
the AMCAS letter service.)