With the dream of ultimately enrolling in medical school at stake, many pre-med students navigate a uniquely stressful undergraduate experience as they fulfill medical school course prerequisites and participate in extracurricular activities that can demonstrate a passion for medicine.
The Herald spoke to four pre-med students who described their experiences preparing for medical school, and how the ongoing pandemic has impacted their paths.
Transitioning back to in-person exams over a year into COVID-19
For Angelo Giannopoulos ’23, organic chemistry is currently one of the particular challenges he faces as a pre-med student. The core four-semester chemistry course sequence is a requirement for all pre-med students, and, for many, it is one of the more difficult academic requirements of the track. While requirements differ slightly across universities, at Brown, some students start with CHEM 0100: “Introductory Chemistry,” depending on their high school chemistry background. Most pre-med students then take CHEM 0330: “Equilibrium, Rate and Structure,” followed by two consecutive semesters of organic chemistry, and lastly, BIOL 0280: “Biochemistry.”
Giannopoulos, who transferred into Brown at the beginning of fall 2021, is currently taking the second semester of organic chemistry. As for many other students, this fall represents a particularly difficult transition for Giannopoulos, because the first half of organic chemistry was taught virtually in spring 2021, while this semester is completely in-person. Last semester, all exams were virtual and untimed, usually spanning an entire weekend. According to Giannopoulos, both of this semester’s midterms have been in-person and timed.
“The first exam we had in this class this fall kind of blindsided a lot of students,” Giannopolous said.
“The main thing that’s killing me is the time restraint,” said Lauren Bonner ’24, who is also currently taking the second semester of organic chemistry. “Going from multiple-day exams to two hours kicks my butt,” she said, continuing that she wasn’t able to finish the most recent midterm exam in time. “I wish (the teaching team) helped us more with that, besides just telling us to do the problem sets with a timer.”
Kathryn Lee ’24 similarly preferred the take-home weekend exams last semester, calling the transition to in-person exams “stressful” and “annoying,” adding that she loses focus more easily in an anxiety-inducing test environment. “I liked being able to take as much time as I needed to work through the questions and make sure I actually understood them, rather than panic,” Lee said.
Lecturer in Chemistry Charles Morton, one of the instructors of CHEM 0360: “Organic Chemistry” this semester, acknowledged that students would likely be more comfortable if he had continued with the virtual, untimed exam format that was used in the previous semester. But he decided to make the transition back to timed exams because he felt like he would be “kicking the can down the road” if he did not have students practice taking timed exams now.
“At some point, they are going to have to sit for a timed MCAT,” Morton said of the pre-med students taking his course. He said that it will ultimately better prepare students for the type of methodological learning and problem-solving that will be required for future-pre-meds.
“Does a practicing physician need to know the mechanism of strange reactions from second semester of organic chemistry? No,” he said. But Morton emphasized that the methods of studying and organizing information learned through organic chemistry will be beneficial for the type of learning that will be required of pre-med students during medical training.
Still, Morton expressed his understanding of the difficulties that students are currently facing as they manage a “jarring” transition to an in-person learning environment. He added that many sophomores, who comprise about 71% of the current organic chemistry class according to Courses@Brown, have a greater amount of stress than first-years since sophomores are adjusting to in-person classes that are no longer introductory level.
Morton pointed to the undergraduate teaching assistants in the course when asked about the support systems in place to help students adjust to this new learning format. “We have a group of very dedicated undergrad TAs who spend a ton of time creating problem packets, running in-person practice sessions,” he said. He mentioned that seeking help from TAs goes beyond just learning technical organic chemistry information but also receiving mentorship from upperclassmen on study and organizational skills that will help students learn how to manage a full-time, in-person course load.
Reconciling pre-med coursework with the Open Curriculum
Students expressed that the required pre-med coursework often inhibits them from taking full advantage of the Open Curriculum. Lee applied to Brown thinking she would be a psychology concentrator, but she later became interested in public health before deciding to pursue computer science. Because of her many interests, she is currently “split 50-50” in deciding whether she will apply to medical school upon graduation, but for now, she has described her method of fulfilling both her pre-med and computer science requirements as a balancing act.
“I’ve made a huge effort to not overload myself with more than three pre-med courses per semester,” she said, adding that if she has too many STEM courses in a semester, she will instead opt to fulfill the pre-med English course requirement.
Victoria Cao ’23, a health careers peer advisor, also noted that pre-med course requirements can be restrictive. “If a student who wants to become a physician is more interested in public health … or they want to pursue anthropology, it becomes really hard to study what you want to study,” she said. “There’s no pre-med major, but it feels like there is sometimes.”
Cao explained that, unlike how a student choosing a concentration could decide to pursue a particular concentration later in their undergraduate career, pre-meds must begin the pathway early on. For students who have not had chemistry exposure in high school, the pre-med chemistry sequence, from introductory chemistry to biochemistry, takes five semesters — meaning that students cannot start later than sophomore fall. “And I think that’s super, super restrictive,” Cao said.
Bonner, though she understands that medical schools want to see students demonstrate proficiency in the natural sciences, said she doesn’t fully understand the relevance of certain courses — such as the two-semester physics requirement — to medical education.
She mentioned that, in addition to taking up class slots, pre-med courses also limit her other classes because of the time consuming nature of pre-med coursework. “So it kind of means that outside of my requirements every semester, I’m taking classes I think will be ‘easy,’” Bonner explained. She said she is also particularly concerned about the physics sequence next year, which she predicts will be time-consuming and therefore force her to “go easy” on herself when choosing her other courses.
Associate Dean of the College and Director of Pre-Professional Advising George Vassilev affirmed what many students expressed. The “demanding journey” of a pre-med student “involves continually developing competencies spanning academics in and outside the sciences, as well as co-curricular activities, particularly in clinical, research, service and leadership contexts,” Vassilev wrote in an email to The Herald. Vassilev is part of a team of staff that supports students and alums who intend to pursue clinical health professions by providing advising, information on resources and advocacy “to the more than 700 advisees at various stages of pursuing this pre-professional path.”
“The baseline coursework health profession schools expect constitutes a third to half of all courses students take in college,” he added. Vassilev recommends that students distribute their pre-health commitments across the undergraduate years so as to be able to both embrace the Open Curriculum and be “strategic” in completing their necessary coursework.
“Checklisting” pre-med activities: The high expectations and exclusivity of medical school
Giannopoulos said he understands why medical schools expect so much from pre-med applicants, but those standards tend to cause anxiety and a lack of confidence among many pre-med students. He also added that the process pushes students to think about “the lore of getting accepted” in the future instead of focusing on the present.
“What ends up happening is people get a checklist of things they need for medical school … and instead of actively engaging with those things, they just see it as a need to have ‘x many of this’ and ‘x many of that,’” Giannopoulos said. “It becomes this sort of equation that they think they can enter into and be pumped out as a fully successful pre-med student.”
Giannopoulos also described difficulties in finding research opportunities at Brown. During his freshman year at the University of Massachusetts Amherst, he began doing research within his first month of enrollment and ended up joining two research labs that year. But since transferring to Brown, he has only received rejections from faculty, which he partially attributed to the pandemic and paused research opportunities.
Cao also characterized some pre-med activities as “checking off a box.” Over the pandemic, she had the opportunity to volunteer virtually with the Red Cross Disaster Action Team, which isn’t a traditional pre-med activity, but she described as nevertheless rewarding.
Despite discussing the check-list nature of engagement with requirements, students also recognized that this tendency was a product of the high expectations that medical schools put upon prospective applicants. According to the American Medical Association, approximately 40% of medical school applicants are accepted to at least one school they applied to, with 18 being the average number of medical schools each applicant applies to, based on data from the Association of American Medical Colleges. The admission rate for Brown applicants is higher, at 85% of students landing an acceptance for fall 2018.
COVID-19 has also exacerbated difficulties in accessing health-related opportunities. Volunteering at hospitals and clinics, for example, were paused during the pandemic.
According to Vassilev, the advising team quickly transitioned to remote advising as the pandemic arrived in the United States. The team also had to help students navigate canceled opportunities, especially for those applying during summer 2020. Students additionally had to contend with canceled MCAT and DAT tests, the standardized admissions tests that are required for applying to medical and dental schools, respectively. On top of everything, Vassilev added, there was an 18% increase of MD school applicants nationally during the same application period.
Cao expanded on the exclusive nature of the medical school application process, mentioning that it costs around $300 to take the MCAT, while the practice tests and review materials can add up to another few hundred dollars. “It’s insane, the barriers to entry,” she said. “Part of the problem is we see this reproduction of wealthy people (going) into medicine.”
“If you make medicine really inaccessible, then of course we’re gonna have a shortage of doctors, of course we’re going to not see people who come from lower socioeconomic backgrounds who actually want to pursue medicine,” Cao added.
“I feel like I’m applying to college again but on steroids”: Pre-med culture, stress and anxiety
Students gave mixed opinions when asked about the competitiveness among pre-med students at Brown.
Bonner came to Brown expecting more of a culture of collaboration among students, but she ended up witnessing the competitive nature of the pre-med track. She frequently heard students talk about grades and exams, and she described a contentious relationship between students and grading systems in an introductory biology course she took freshman year.
“There’s a huge culture of ‘your grades are your worth’ … there’s just a lot of stress going around. I wish that people kept it a little bit more to themselves,” she said. Bonner said that by constantly talking about schoolwork, the stress “spreads” to others and takes the fun out of academics. “I wish there was a school time and then fun time when you wouldn’t talk about school, but it’s kind of all school all the time.”
Cao expressed a different view, saying that she has found the pre-med community here to be very supportive and has never felt like she was being “sized-up” by other students. She also appreciates the mentorship and advice that upperclassmen give to the younger pre-med students.
Students also receive support from Vassilev and his team. He explained that Health Careers Advising at Brown “provides holistic and longitudinal support through individual and group advising, plentiful online resources and a broad range of information sessions and events tailored to our advisees’ needs.” These include general information sessions, which discuss pre-med related activities, and more specific applicant seminars for upperclassmen and alums who are about to enter the application cycle. Pre-health students can also meet individually with advisors throughout the year.
Bonner expressed appreciation for the pre-health advising team at Brown, mentioning that events the team has hosted and their responsiveness have been immensely helpful.
No matter the differing experiences that students have had at Brown, many spoke of the mental toll that being a pre-med student has had on them.
“I feel like I’m applying to college again but on steroids,” Cao said.
“In my choice to (be pre-med), I’ve taken on, for sure, significant mental health effects,” Giannopoulos said. The difficulty that he has faced in trying to start research since transferring to Brown has also been a source of stress. “Up to this point, if I’m being completely honest … I can’t really say I feel 100% confident in my decision to transfer based on being a pre-med,” he said.
Lee described the importance of maintaining a lifestyle balance. Despite being fully aware and “mentally preparing” for the difficulties of being a pre-med student, Lee still expressed the need for frequent adjustment in finding a schedule that works: “It’s a constant cycle of adjusting and being flexible … it’s something that I really had to get used to, and I’m still getting used to it.”
She added that it has been particularly important for her to have other activities and interests outside of being pre-med. “If you really just overload yourself, it’s just going to be so much of a burn,” Lee said. “You just need to prioritize your own interests. You are not just a pre-med student; you are a person with your own interests and you should pursue them whenever you can.”
Giannopoulos echoed Lee’s opinion. “The pre-med experience, because it’s so intense, can sometimes be ingenuine, whereas it should be the most genuine thing possible. You should be coming out of undergrad, ready to present yourself and have this wonderful story of why you want to be a doctor.”