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    Applications to medical school are at an all-time high. What does this mean for applicants and schools?

    As applications spike during COVID-19, candidates are asking how to make their applications stand out, while admissions officers are taking steps to handle the influx.

    A doctor reviews applications at her desk

    At Tulane University School of Medicine in New Orleans, applications for admission to the class of 2025 are up more than 35% compared to the same time last year. At Boston University School of Medicine, they’ve risen by 26%. And at Saint Louis University School of Medicine, admissions officers have seen applications increase by 27%.

    In fact, nearly two dozen medical schools have seen applications jump by at least 25% this year, according to AAMC data.

    Final tallies won’t arrive for another month or so — all schools’ application windows must close first — but early numbers are striking. So far, there are more than 7,500 additional applicants nationwide, according to data from the American Medical College Application Service® (AMCAS®), which processes submissions for most U.S. medical schools. That’s an increase of nearly 17%.

    Consider some edifying context: In the past decade, the year-over-year increase has averaged less than 3%.

    “We’ve been experiencing a leveling off in recent years, so the large increase was quite surprising,” says AAMC Chief Services Officer Gabrielle Campbell. “It’s also inspiring.”

    Experts don't know exactly what's behind the increase, but they point to several likely factors. Some are rather mundane, including students having more time to focus on applications as college classes moved online. But at least some of this year's applicants are driven by COVID-19 patients’ terrible suffering and front-line providers’ extraordinary heroism.

    “I make an analogy to the time after 9/11, when we saw an increase in those motivated to serve this country militarily,” says Geoffrey Young, PhD, AAMC senior director for student affairs and programs. “This certainly seems like a significant factor this year.”

    Even in a usual cycle, applying to medical school is no simple matter. Candidates spend many months preparing for the MCAT® exam, writing essays, and collecting recommendations. Applying for entry in 2021 meant completing the AMCAS application in the spring or summer of 2020, followed by individual schools’ required secondary applications. Once applications are completed, applicants anxiously await interview invitations, which could extend into the spring of 2021.

    “I make an analogy to the time after 9/11, when we saw an increase in those motivated to serve this country militarily. This certainly seems like a significant factor this year.”

    Geoffrey Young, PhD
    AAMC senior director for student affairs and programs

    Now, many candidates wonder if increased competition will make landing a seat tougher than ever. For their part, schools say they’re determined to review all candidates fairly, especially given the upheaval many applicants faced during COVID-19. That means admissions teams are working longer hours, extending timelines, adding interview slots, and offering some sage advice to worried candidates.

    “Schools want to make sure that when they accept someone, it’s a good fit for both the school and the applicant,” Campbell says. “They also want to be sensitive to the many applicants who have been hit particularly hard by the pandemic. That’s a lot of work, but they’re highly committed to it.”

    What’s going on?

    The larger application numbers to date likely stem from several factors, among them that some applicants are seeking a reliable profession in uncertain times. Some aspects of the application process also got easier as medical schools extended deadlines. And of course, there’s the motivation to help patients and communities in a time of crisis.

    “During COVID-19, my hunger to help continues to grow,” says Alan Mauricio De Leon of Houston, who teaches at a majority Hispanic charter school impacted by the pandemic. One student, he recalls, slept in his family’s car to avoid infecting them. “I want to be a change agent to bring equitable, effective care to my community,” he says.

    Creson Lee is among the applicants motivated — at least in part — by the dedication of front-line providers. Lee, 24, was deeply impressed by hospital staff when her research job took her to a Penn Medicine COVID-19 testing site to enroll study participants this summer.

    “Testers would be out there all day under the sun wearing full gear, drenched in sweat,” recalls Lee. “They’d always try to keep positive, sometimes putting on a silly PPE fashion show in the driveway.” Lee, who already knew she wanted to be a doctor, fleetingly considered waiting for a more typical year to apply. Ultimately, though, “it was important to me to run with this inspiration to pursue medicine right now,” she says.

    “During COVID-19, my hunger to help continues to grow. I want to be a change agent to bring equitable, effective care to my community.”

    Alan Mauricio De Leon
    Medical school applicant

    Some candidates likely were influenced by more practical considerations.

    “For some people, the job market looked too uncertain, and a lot more people might not have taken a gap year because there were fewer opportunities,” says Valerie Parkas, MD, senior associate dean of admissions for the Icahn School of Medicine at Mount Sinai in New York. And then there were helpful changes to the application process. For example, most schools decided early on to move this year’s interviews online. “It’s a lot easier and less expensive to put on a nice shirt and log into Zoom than to travel across the country,” she says.

    For her part, Joanna Wasvary appreciated the extended application deadlines. “That, plus my classes going online, means I can give my applications a lot more attention,” says the University of Michigan senior. Wasvary therefore decided to forgo her planned gap year and potential work as a medical scribe. “It’ll be great to be a doctor one year earlier,” she adds.

    Schools step up

    As schools with dramatic application increases figure out how to handle them, they have various options. They can enlist extra reviewers, take more time to process submissions, and add interview slots. They also can simply work a lot harder, which is what many plan to do.

    “We know we’re just going to have to plow through,” notes Mike Woodson, Tulane University’s director of admissions.

    At Boston University, admissions officers have received more than 11,000 applications for 125 spots. Still, Associate Dean of Admissions Kristen Goodell, MD, doesn’t think she’ll need to enlist additional reviewers. One reason is a protocol released last year that guides reviewers to keep certain criteria in mind. “The process was designed for fairness, to reduce unconscious bias,” says Goodell. “But it turns out that knowing what to focus on also helps move through applications faster.”

    Other schools are building in more time to process applications. Tulane University, which has 16,000 applicants vying for 190 seats, is taking longer to extend interview invites. “It just made sense to ensure that we’re reviewing the majority of applications before we give away all our interview spots,” Woodson explains.

    So many people have seen that different groups in our country are facing such different effects from COVID-19 based on their ZIP code or their race. This year, applicants are motivated to get out there and fix societal problems.

    Kristen Goodell, MD
    Associate dean of admissions at Boston University School of Medicine

    Some schools are adding more interviews. The Texas A&M Health Science Center College of Medicine in Bryan, Texas, where applications are up 9%, is one of them. Associate Dean of Admissions Filomeno Maldonado says it hasn’t been a hardship to add extra interviewers since virtual interviews offer more scheduling flexibility. Maldonado also extended his interview time frame, partly to accommodate candidates who faced delays gathering recommendation letters and other application elements.

    One step medical schools don’t plan on taking, though, is greatly increasing class sizes. That’s because substantial expansion requires approval from the medical school accrediting body, the Liaison Committee on Medical Education — no simple matter. Plus, there's the issue of resources.

    “Schools usually decide their class size well in advance because they want to be spot-on in matching spaces with resources like clinical training sites,” says Young. “They don’t want to find that they can’t adequately train any additional students.”

    What students need to know

    As aspiring doctors face more intense competition this year, admissions officers also offer their advice on some of candidates’ key concerns:

    Should I postpone applying?

    “The increased numbers really shouldn’t impact someone’s decision to apply. If they feel ready, they should apply. If they think their application needs bolstering, there’s always next year,” says Parkas. “Careers are marathons.”

    Like many other admissions directors, Ivy Nip Asano, MD, director of admissions at the University of Hawaii at Manoa John A. Burns School of Medicine, reminds applicants that she is sensitive to extenuating circumstances this year. “We understand that we need to take into consideration the effects of the pandemic on students’ ability to secure opportunities and experiences,” she says.

    What are admissions directors looking for in this unusual cycle?

    At Boston University, Goodell emphasizes that she is seeking the same traits and abilities she’s always sought — and never uses some rigid checklist.

    “We’ve already embraced admissions based on competencies. That means applicants don’t need specific courses in a certain area, for example. They just need to demonstrate their abilities in that area,” she says. “This approach offers flexibility, which comes in really handy at a time like this.” In addition, Goodell notes that Boston University uses holistic review, which considers an applicant’s full range of attributes and experiences.

    For his part, Tulane University’s Woodson advises applicants to make clear why they selected his school. “Of course, we want people who will be a good fit for us, but with so many applicants, we also want to focus on those who will actually come here if accepted,” he says.

    Asano sums up her advice simply: “I hope that applicants will share their authentic selves.”

    Should I apply to more schools in this competitive year?

    “If you are a super-strong candidate, you’re always going to get interview invitations. If you’re a bit weak, no matter what the year, you won’t get many. Then there is the group in the middle. For them, applying to more schools might increase the chances of an interview invite,” Goodell says. “A prehealth advisor can help you figure out which group you’re in.”

    Watching out for those hit hard

    Could all the setbacks this year mean that fewer applicants from underrepresented backgrounds wind up in medical school?

    “We were concerned that all the disruptions could discourage people from racial and ethnic minority groups or lower socioeconomic backgrounds from taking the MCAT,” says Cynthia Searcy, PhD, AAMC senior director of MCAT research and development. “But the percent of those examinees actually mirrored those from 2019.”

    So far, application numbers also look encouraging.

    To date, racial and ethnic minorities are applying to medical school in higher numbers compared to the same time last year," says the AAMC’s Campbell. "For example, we’ve seen double-digit increases in the number of Black and Latino applicants.”

    “This could still change, but given the stresses of the pandemic and social unrest that we’ve seen across the country, this is a positive early sign," she adds.

    Once those applications land, holistic review should help ensure that schools consider the full picture of a candidate’s attributes and experiences, Young notes. He encourages admissions teams to use the AAMC’s equity-related resources, including a recent webinar on how to prevent implicit bias in virtual interviews.

    Other steps have helped support lower-income applicants. This year, the AAMC dramatically broadened its Fee Assistance Program, which provided $9.1 million worth of support last year. Qualifying applicants can receive a waiver for all AMCAS fees for one application submission with up to 20 medical school designations as well as MCAT benefits.

    “This year we raised the poverty level cut-off [so more potential candidates could benefit from the program],” says Campbell. “So far, we’ve had a 54% increase in [Fee Assistance Program] applications and a 76% increase in approvals.”

    Meanwhile, Goodell sees a quest for racial and social justice as helping to spur some of the rising application numbers.

    “So many people have seen that different groups in our country are facing such different effects from COVID-19 based on their ZIP code or their race,” she says. “This year, applicants are motivated to get out there and fix societal problems. They’re saying, ‘I need to do something to make this country more equitable, and I think the best way for me to do that is through medicine.’”