University News

Applicants struggle with structural flaws in pre-health advising system

Students, staff cite under-staffing issues in office that supports hundreds of students, alums each year

By
Senior Staff Writer
Friday, October 28, 2016
Brown touts one of the highest matriculation rates for its undergraduate students into medical school among universities in the United States. But interviews with 36 students and alums who have experience with the pre-health advising system, along with six faculty members, indicate that the path to matriculation is complicated by structural flaws in the advising system. Many students and alums said pre-health advising is impersonal and fails to reflect the University’s mission of empowering its students, and several sources pointed to the structure and under-staffing of Health Careers Advising as obstacles to an individualized advising experience.

Small staff, long process

Health Careers Advising is “severely under-resourced” to meet the needs of the many students it serves, said Sarah Taylor, instructional coordinator and science learning specialist at Brown. The lack of personnel in HCA “inevitably leads to people feeling unsupported” and “not recognized individually,” she added.

In the 2015-2016 academic year, there were 258 applicants to medical schools from the University, according to the Association of American Colleges website. Each year, between 700 and 800 students and alums indicate interest in attending medical school, said Dean of the College Maud Mandel.

But there are only two full-time advisors devoted to pre-health advising: Associate Dean of the College George Vassilev and Health Careers Advisor Karen Whittet, who was hired in 2015.

The timeline for applying to medical school from the University may differ depending on gap years and other personal considerations. In general, if a University applicant is applying to MD programs without taking time off, the process begins junior year.

During an applicant’s junior year, the applicant must attend two mandatory seminars — one in the fall and one in the spring. In February, applicants must submit the Health Careers Advising Dossier, which includes a personal statement, activities list and questionnaire. The HCAD is meant to mirror the actual medical school application, which is the application from the American Medical College Application Service. Once the HCAD is submitted to HCA, applicants must sign up for an interview with the Health Careers Advisory Committee that takes place between March and May of junior spring.

Applicants must also take the Medical College Admission Test and obtain three letters of recommendation by June. The AMCAS primary application is available in early May, and applicants should submit it by mid-July, according to the HCA website.

After fulfilling these prerequisites, qualified applicants are considered for a committee letter, which is an institutional letter of recommendation, according to the HCA website.

Though Mandel said that Vassilev writes the committee letters, Vassilev neither confirmed nor denied this. Vassilev said he chairs the committee that interviews applicants, adding that the letter-writing process culminates in his “endorsement, approval and finishing touches.”

Though the HCA website does not explicitly note a grade-point average cutoff to receive a committee letter, several students said that there is practically a GPA cutoff, even if it is not crystallized in policy. According to the HCA website, if a student’s science GPA falls below a 3.6 the office “urge(s) you to consult with us to assess your options.”

Committee letters are sent out beginning in early August and continue to be sent out until application files are complete in September, according to the HCA website.

“The lack of personnel leads to a lack of transparency and open communication,” said Corbyn Nchako ’14, who is currently a medical student. Nchako said the process can become especially frustrating when applicants do not hear back about the status of their applications after repeated attempts to contact HCA.

Nancy, a graduate of the Class of 2015 whose name has been changed because she is applying to medical school, described Vassilev as very unavailable. Nancy said she did not receive important feedback from Vassilev until after her primary application had already been submitted.

In response to a question about whether HCA is understaffed, Vassilev said, “The more resources we have to work with students … to provide the best advising … the better.”

The Office of the Dean of the College recently hired Christopher Carr, writing projects specialist, to assist Vassilev with writing committee letters, though Carr also supports the Fellowships Office, Mandel wrote in a follow-up email to The Herald.

Carr’s position is intended to make someone available to students and alums who are gearing up for the application process in the spring semester. Carr meets with a “significant number of our advisees to help them with their narrative,” Vassilev said.

But while HCA struggles with its lack of personnel, the burden of pre-med advising has shifted elsewhere.

Many students who are pre-med are also biology concentrators, Taylor said. Given the few advisors in HCA, many students come to the biology department for advising, she said. “It puts the biology department and biology advisors in a position where we are often asked or expected by students to offer advising outside of our area of expertise,” Taylor said.

Associate Dean of Biology Undergraduate Education Katherine Smith said that the ties between HCA and Biology Undergraduate Education could be stronger. The University is currently developing a one-page document to give to biology advisors to help them advise pre-med students, Smith said.

The committee letter

Many students voiced frustration with logistics regarding the committee letter process. In particular, some students noted that their committee letters were not sent until late September or early October, which they felt put their applications at a disadvantage because medical schools do not start reviewing their applications until the committee letter is received.

“Brown is pretty infamous for the date that their committee packets are sent,” said Jeremy Wortzel ’16, who has applied to medical school. Wortzel added that waiting for the committee letter is a “nail-biting experience.”

“Medical schools accept applications well deep into the fall semester,” Vassilev said. The timeline for processing applications varies, he said, adding that “thoughtfully” and “thoroughly” compiling a committee letter packet is a “lengthy and time-consuming process.”

“It has never been a hindrance to the admission of our applicants,” Vassilev added.

Several deans of admission from medical schools said that a delay in the reception of a letter delays the admission process, and a letter received in September is late.

Ronak Jani ’15, who is currently a medical student, said that HCA lost his packet of letters of recommendation, and the office did not inform him that they had lost his letters. Jani said he called the office in August, and the staff had no idea where it was.

Nchako, whose committee letter was not submitted until the first week of October of the year he applied, said there is little transparency in the committee letter process.

Nathanael Lee ’10 MA’10, who is currently a resident, said he believes the timing of the submission of committee letters is a “tier-based process,” adding that he believes better applicants get priority in the committee letter process.

While waiting for his committee letter to be submitted, “I felt very powerless,” Nathanael Lee said. “That was probably the worst feeling — feeling hopeless,” he said. “I can send out an email every day to Vassilev. … But until he decides to do it, it’s not going to be done.”

“I think (Vassilev) risk-stratifies applicants” in order to keep the numbers up by supporting students who he thinks can get in, said Zeke, who asked for anonymity given that he has not yet applied to medical school. Zeke said he believes the committee letter is a way for Vassilev to select only people he thinks can get into medical school so that he can reduce the denominator of the University’s matriculation rates.

“There is no rationing of committee letters,” Vassilev said. It’s an “equitable and fully transparent process,” and it is “not a weed out.”

Vassilev is “more the bouncer at a club” than an advisor, said Kevin, a senior whose name has been changed because he is currently applying to medical schools. Vassilev tells applicants if they’re ready to apply, determines if applicants receive a committee letter and writes their committee letters, he added.

“He’s in a position where no one can really call him out on anything,” Nathanael Lee said of Vassilev. Because Vassilev is the only person writing the committee letter, he can “retaliate” by making the letter look bad. “He holds a position that shouldn’t be held alone,” Nathanael Lee added.

While students can apply to medical schools without the committee letter, medical schools see a “red flag” if an applicant’s school writes committee letters and the applicant doesn’t have one, Nchako said. “I don’t think the University should ever have that power over you and your future,” he said.

“There’s so much anxiety as it is that a poorly run department adds even more to it,” Nathanael Lee said of the stress involved in the medical school admission process.

The committee letter system isn’t ubiquitous. Some peer institutions approach pre-health advising differently than Brown.

At Stanford, there is no committee letter, said Ryan Badiee, a senior at Stanford currently applying to medical school. Instead, students just ask faculty members for letters of recommendation.

“They won’t tell anyone not to apply outright,” Badiee said. “If you feel like you’re a compelling applicant to medical school — even if (pre-health advising) disagrees — and you can find (letter writers) to support you, then they will support you in that endeavor,” he said.

Robin Rolader ’15 transferred to the University after a year at Colgate University, where she had already sought out pre-med advising.

“I loved Brown, … and the only thing I didn’t like about Brown was the pre-health advising office,” Rolader said.

At Dartmouth, there is a composite letter similar to a committee letter, but there is no review board to which students must submit materials, said Jayne Caron, who graduated from Dartmouth in 2014 and is currently attending medical school. Students must find composite letter writers whom the pre-med office then contacts to ensure they are trained, Caron said.

“It’s not like the composite letter is judging whether you should apply to medical school,” she said, adding that she chose an English professor who “was the most invested in me going to medical school, knew me the best and could write the best about me.”

Caron said she believes Dartmouth approaches pre-health advising this way for several reasons, one of which is a lack of manpower in the pre-health advising office. “A committee is pretty impersonal,” she added, “and you want someone who is writing your committee letter who knows you and can vouch for you.”


Individualizing advising

The structural issues students see in the pre-medical advising system have led to tangible effects in the content and style of advising. Though Vassilev denied that he approaches advising as a checklist, several sources said he takes a one-size-fits-all approach.

Advising should be driven by a “motivation to learn students’ background and their interests … rather than grabbing a colored sheet and reading off of it,” said Julia Donner ’15 MD’19, who is currently a medical student.

“I feel like he hasn’t actually heard a word of what I say about my individual circumstance,” said Jenny, a senior who asked to remain anonymous because she is currently applying for medical school. Vassilev continues to tell her to take a gap year, but her family circumstances prevent her from doing so, she said.

“Holistic advising is really the structure of the application process, and consequently it’s the heart of what we do,” Vassilev said. “Career is not an event but a process.”

Mandel said pre-professional advising is based on what data indicate makes the most successful applicant. “The statistics speak for themselves,” she said, adding that pre-med students are most likely to get in if they do certain things, such as take a gap year.

But those already prepared to apply do not benefit from a gap year, Donner said, adding that she went to Vassilev her junior year and was strongly advised to take a gap year. But Vassilev couldn’t give her a reason why she should take a gap year, she said, adding that he only gave generic reasons why gap years are good for medical school applications.

Taking a gap year can help a medical school application depending on what the applicant does during the gap year, said Dan Lee, co-founder of Solomon Admissions Consulting.

“Medical schools always like non-traditional students,” Dan Lee said, adding that a gap year doesn’t make an applicant a non-traditional student.

“I’ve always thought that one of the reasons (Vassilev) wants people to take gap years is because the acceptance rates are higher (for those who do),” said Mitchell, who asked to remain anonymous because he is currently applying for medical school.

The admission rate of Brown students into medical schools has ranged from 80 percent to 91 percent in the last few years, according to the HCA website. The national medical school admission rate for the 2015-2016 academic year was 41.2 percent, according to the Association of American Colleges website.

The admission rates on the HCA website only account for students who received a committee letter or a summary letter, which is similar to a committee letter, Vassilev said.

“The focus on numbers is absurd,” said Tom Kishkovich ’15 MD’20, who is currently in medical school. Medical schools are looking for compassionate students and don’t care about the statistics of an institution, he added.

Wortzel said he also perceives Vassilev as “gearing for a high acceptance rate,” which he said can impact advising “for better or for worse.”

Jani believes Vassilev aims to put students into schools that make Brown look successful rather than schools that meet students’ needs, he said. If Vassilev decides he thinks a student will get into medical school, his next question is, “How can we get this person into a place that advertises well for Brown?” Jani said, adding that this doesn’t necessarily match what the student is looking for.

The process should be driven less by metrics than by helping students achieve the best they can and supporting them in attaining their aspirations, Taylor said.

Aside from complaints about the content of the advising itself, several sources also said that the tone of advising is unhelpful and antagonizing.

“Messages are often all in the delivery,” Taylor said. If anyone is being spoken to as an individual, even unpopular and unwelcome advice is better received when it is “delivered in a personal and caring fashion,” she added.

It is an advising team’s responsibility to give applicants an “honest, forthright, supportive assessment of the best plan going forward,” Vassilev said. Some students stand to benefit from taking time off, and HCA needs to tell them that, he said. HCA’s support is “based off of best practices,” he added.

The advice Joshua Sung ’13 received about taking time off and doing post-baccalaureate programs was “definitely helpful,” Sung said.

Vassilev may sound discouraging, but “that’s just him being practical,” said Mary, whose name has been changed because she is not yet enrolled in medical school. “He hurts people’s feelings sometimes when he’s upfront about getting C’s and not getting into med school,” she said. But she asserted that giving frank advice is his job. Vassilev cannot simply lie, she added.

In Jenny’s first meeting with Vassilev, he told her to “travel the world” and “make yourself a better person,” she said. “What a privileged thing to say,” she said, adding that she cannot afford to do that.

I think someone with “more empathy” who could “connect with students” would be a better advisor, said David Deckey ’15, a former Herald photo editor.

Jonathan Ang ’16, who is currently in a post-baccalaureate program, was discouraged by Vassilev from applying to medical school because his GPA was not high enough to receive a committee letter, he said.

Leslie, a graduate of the Class of 2016 and first-generation student of color whose name has been changed for fear of repercussions, said she wanted to be a doctor long before coming to Brown. But she frequently felt out of the loop during her time as a pre-med student. When she met with Vassilev, he looked at her transcript and said she would need to take two gap years, she said, adding that she didn’t even know what a gap year was.

When Leslie met with Vassilev again her sophomore spring, Vassilev told her she would not get a committee letter, she said. Ultimately, Leslie changed her concentration from biology to visual arts because she “didn’t know what the process (of applying to medical schools) looked like no matter who (she) asked,” she said.

“Never at Brown have I felt so like an outsider than when I was going through the process of applying to medical school,” Jenny said. “Brown took me in, and I’m not good enough for my own institution,” she added, referring to the fact that she did not meet the GPA cutoff to be eligible for a committee letter.

“Why did you take me in the first place if you weren’t going to support my dreams?” Jenny added. The entire pre-health advising system feels at odds with the University’s values, she said.

HCA has made strides, said Uma, a senior studying biology whose name has been changed because she plans to apply to medical school. At an HCA workshop in September, the advisors emphasized that “not every student is the same,” and the tone was more encouraging for those who may have had a rough first two years, she added.

“As the face of the University is changing, we need to be thoughtful about the diverse backgrounds and needs of current students,” Taylor said.

“We approach all our students with sensitivity,” Vassilev said. HCA aims to support applicants, not only in specific ways regarding their application, but also in their personal challenges, he said.

“I’m very mindful of how vulnerable students can be,” Vassilev added. HCA specifically dedicates time every winter for students who may have dealt with some challenges to speak with Vassilev so he can give them the best guidance possible, Vassilev said.

The University is seeking to expand outreach to underrepresented students, Mandel said, by bringing in people in medicine who can “model and speak to success in the field from a broad range of backgrounds.” A Diversity and Inclusion Action Plan for HCA is built into the Dean of the College DIAP and is currently under review, Mandel added.

Even before the DIAP process was launched, HCA has “always been mindful of the specific needs of students from different backgrounds,” Vassilev said. HCA has been in communication with students groups such as the Brown Minority Association of Pre-Health Students, the Brown Pre-Medical American Medical Student Association and the Black Pre-Medical Society to give students more “visibility,” he said, adding that HCA invited these groups to the pre-professional fair and meets with them on a regular basis to discuss how to continually support these students.


Alternative advising options

When faced with these hurdles in pre-health advising, students turn to outside resources and each other for help in the application and admission process.

For example, pre-health students who are not pre-med — such as students interested in being veterinarians, dentists, nurses or physician assistants — currently lack support, many sources indicated.

Alisa Berg ’16, who is currently in veterinary school, said she was lucky to have found Jim Harper, a retired professor of pathology and laboratory medicine, who was realistic and presented information in an encouraging way. Berg said if she had relied solely on Vassilev, she doubts that she would have gotten into veterinary school.

Several students also noted that instead of seeking formal advising, they go to their peers for advice. Last spring, a student-written handbook detailing the experiences and advice of students who had been accepted into medical schools was released. Kevin called this one of the “side effects of advising being so poor.”

“There’s no one who is going to do it for us; we’re going to do it for each other,” said Richard, a graduate of the class of 2015 whose name has been changed as he is currently applying to medical school. “This was free work done by students for other students,” he said. “What were the people who we’re actually paying doing?” he added.

“The credit is given to someone who doesn’t really deserve it,” said Elizabeth, a graduate of the class of 2016 who has not yet applied to medical school. “We as Brown students deserve so much more,” she added.

Pre-professional advising is generally at odds with the University’s heart and soul, Jani said. While Brown typically tries to diversify students’ experiences in preparation for a variety of careers, pre-professional advising is best positioned to serve students who already know what career they want to pursue and just need to “check off boxes,” he said.

“A school that prides itself in being about its students could do a better job” supporting them in the medical school application process, Deckey said.

It is not the University’s place to judge whether or not a student can gain admission to medical school and diminish students’ chances before they even apply, Jenny said. “As a student at Brown, I want to feel like my home institution is on my team.”


Correction: A previous version of this article referred to Jeremy Wortzel '16 as a medical student. In fact, he has applied to medical school. A previous version of this article also referred to Nathanael Lee '10 MA'10 as a medical student. In fact, he is a resident. The Herald regrets the errors.