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

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Presentation on theme: "Let’s Talk a Little Pre-Med Heresy Keith Bradley, MD CEO/CMO National Alliance of Research Associates Programs (NARAP)"— Presentation transcript:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

27 2 nd semester, Junior Year Best Semester of Your Life … Academically Upper level major courses Upper level major courses Best electives Best electives Cost of Attendance ≈ $___ K per semester Cost of Attendance ≈ $___ K per semester No second chance No second chance Ramping up Ramping up

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

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

30 MCAT 400 Hour Prep Timeline If... Graduation --> Medical School Activity No later than Activity No later than matriculate August after graduation matriculate August after graduation interview 1 st semester, Sr year AMCAS 1 July, after Jr year MCAT mid–May, after Jr year interview 1 st semester, Sr year AMCAS 1 July, after Jr year MCAT mid–May, after Jr year MCAT prep 2 nd semester, Jr year MCAT prep 2 nd semester, Jr year

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

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

33 MCAT 400 Hour Prep Timeline If... Planned Post-Bac Year Activity No later than Activity No later than matriculateAugust after PB year matriculateAugust after PB year interviewfall semester, PB year interviewfall semester, PB year AMCAS 1 July of PB year AMCAS 1 July of PB year MCAT September, Sr year MCAT September, Sr year MCAT prep summer, Between Jr – Sr years MCAT prep summer, Between Jr – Sr years

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

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

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

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

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

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

40 Post-Bac Year On

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

42 NARAP RA and Chief RA www.theNARAP.org


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