How to get into MD/PhD Programs

Part 3: How to get into MD/PhD programs

So now that you’re considering the MD/PhD career path, how do you become a competitive applicant? The answer to this question depends on when you’re starting the process. I didn’t know about the MD/PhD option until my 3rd of 4 years of college, and my university was ill-equipped to provide me with the information needed to apply successfully. I was almost too late to apply competitively for the application cycle, but fortunately I had been conducting research since my sophomore year, which provided me the prerequisites to prepare a strong application in short order.

When is the ideal time to start preparing for the MD/PhD application?

• The sooner, the better. Take time in your 1st semester of college to find your groove and what subjects interest you. By the 2nd semester, and certainty by the summer after your 1st year of college, you should start reaching out to research mentors at your university and find a consistent role in a clinical setting. If you’re a freshman reading this, aim to have a research experience lined up for the summer after freshman year. If you’re a sophomore, don’t delay it any longer. Programs want to see longitudinal experiences and a commitment to research. Plus, starting earlier gives you more time to try out different things if you don’t like the first experience.
• If you wait until your junior year to begin research, you will be hard-pressed to get sufficient experiences in time for the application cycle in your senior year. You will most likely need to pursue post-Baccalaureate research after college to boost your experience (see FAQ in Part 1: What is the MD/PhD career path for details on post-bacc options).
• Forcing your application too soon without adequate experience will cause undue stress, be expensive, and a waste of your time. You’re aiming for a lifetime career in this path, take the time to prepare adequately, especially if you can find a paid research position living in a place that interests you. This life experience is quite valuable and will not be considered a negative attribute.

Let’s breakdown how to proceed in more detail:

It’s the 2nd semester of freshman year and you are motivated to prepare for the MD/PhD path. First, you need to determine what field you might enjoy doing research in. Note that it does not matter much what field you choose, so long as you have opportunities to conduct research projects and learn fundamentals of scientific method. If your institution is not connected to a medical school, you will likely be limited to basic science research. This is fine. I do encourage you, however, to seek summer research programs at a different university with an affiliated medical school to gain exposure to the crosstalk of basic science, clinical, and translational research. For me, I was considering Biology and Chemistry research, so I went to the websites of the Biology and Chemistry departments at my university, scrolled through the various faculty member pages to read their research biography, and reviewed their training background and goals. I made a list of 5 faculty members who did research that matched my interests. There are a few things to keep in mind during this selection process, such as the research topic, size of lab, previous experience with mentorship, and association with biomedical sciences.

After making my selection of top choices, I went to the lab websites of each faculty member to see what publications they had posted recently. I found papers on topics of interest, and read one recent and one older publication (choose a review article if possible to gain a broad overview of the field). Your goal is to get a sense for what questions and problems motivate the PI. I advise you to do this for your top 3 of the 5 first and proceed with the advice that follows. There is no need to get overwhelmed with 10 different papers across different topics. Read the work of one faculty, and then send them an email. Repeat for each of the top 3 and await responses before proceeding.

• One thing I wish I would have considered more earlier, but it is easier said than done…be confident in yourself. Although you might not have any research experience, everyone must start somewhere. Don’t doubt yourself, send the cold email. You will be surprised at how effective a well-crafted, thoughtful, and empathic email can be in academia. It’s important to note that professors receive a lot of emails, some of which are from ambitious students who haven’t fully thought through what “working in their lab” entails. Professors want to know that you are committed and not going to flake and waste everyone’s time. Professors do what they do because, often, they enjoy mentorship. If you are a first-generation student or new to lab research, use this as an opportunity to express your desire to find a mentor who can help you develop your scientific acumen and research skills. Good work ethic, patience, and persistence will take you far.

Sending your first cold emails might cause you some anxiety, so here’s a template similar to what I used:

Hi Dr. T.,

My name is [Jake Khoussine], and I am a [rising sophomore] at [OU] studying [biochemistry]. I recently took a course on [molecular biology], and I felt inspired to explore my interest in [biological] research further. I read your work on [quantitative developmental genetics] and found it to be a compelling match for my current interests, especially your finding on how [specific information from a paper you read].

I am writing you because I want to discuss the possibility of joining your research lab. I am motivated to pursue the combined degrees of MD/PhD, though as a first-generation student, I feel naïve about what it takes to become an effective scientist. I am seeking a research mentor who can help me develop fundamental research skills and become adept with scientific method. Can we meet to see if I would be a good fit for your lab?

I’m usually available [Monday through Thursdays from 1–4pm.]

Thank you for your time and consideration.

Best,

[Jake Khoussine]

You don’t need to send an overly detailed, rambling email. State your genuine interest in their work, demonstrate initiative to learn about their specific research, and propose possible days/times to meet. When you meet, you are trying to see if you would be a good fit for their research group, and more importantly, if the PI’s mentorship style is a good fit for your personality. The last thing you want is to enter a lab with a negative training environment that causes you to lose the spark for research. This could be a real drive killer, so here are a few recommendations to protect against it:

• General gut feeling: how’s the PI’s personality? Can you hold a conversation comfortably?
• What are the PI’s expectations of an undergraduate researcher?
• What experience do they have training undergraduate vs graduate students? Although you might not get an independent project at the beginning, you want to make sure there is space for growth. This can be in the form of techniques you can learn, opportunities to present, etc. You don’t want to just be “washing dishes” or following someone around without much involvement. You must show initiative and determine how involved you want to be. Ask about the specific opportunities available for you as an undergraduate in the lab.
• How busy is the PI? Will you have an opportunity to be mentored by the PI, or will you be handed to a postdoctoral or graduate student?
• What are the current projects in the lab? Note: you should already know this information. Bring up the topic in an informed manner: “I read that your lab is currently focused on projects around x, y, and z. I am especially interested in projects y and z. Can you tell me more how I could contribute to the development of these projects?
• Talk directly with multiple other students in lab to see: 1) do you vibe with the students and 2) are they still happy with their decision to join the lab? Keep in mind that doing undergrad research is quite different from graduate research, but if the other students are unhappy, pay attention.
• Does the PI have experience with MD/PhD? How can they support your career goals?
• Before you make any decisions, ask to spend some time around the lab, seeing the techniques that are used and what a typical day looks like. You must take initiative to evaluate the fit of the lab, no one else can do this for you.
• You should also meet with the other faculty before deciding, to weigh your options and make the best decision for you. While the decision that I made was certainly one that I am quite proud of, in retrospect, I did not take enough time to evaluate the other research options fully. I was so excited to simply be accepted by the PI that I accepted on the spot. It felt right, though.

So, what happens after you receive a position in a research lab? You should plan to be physically present in lab for at least 8–10 hours per week, perhaps more in the summer if your schedule permits. Take it slow, learn the basics by reading relevant literature and work hard to develop the vocabulary to communicate about your research. It will take time to get comfortable. Keep up your clinical experiences concurrently while you take the prerequisite classes for medical school and earn good grades. That first ‘B’ stings (get it?), but I assure you, all is not lost. Look into the requirements for graduating with Honors and writing a research thesis. Set a meeting with your premed advising office, express your interest in MD/PhD and see what resources might be available. By planning ahead, you can check off the boxes with plenty of time and reduce uncertainty at each step. Fortune favors the prepared mind. In December of your sophomore year, start searching for summer undergraduate research programs, determine application cycle timelines, and prerequisites (e.g., letters of rec, personal statement).

Especially if you are an underrepresented student, there are outstanding research programs that will prepare you for graduate school and expose you to high-level research. If you are first-generation student, low income, or underrepresented in science and medicine, this is major key. I pursued the BP-ENDURE Neuroscience Scholars Program at Washington University School of Medicine, and it was a phenomenal experience that I cannot recommend enough. These summer research programs 1) pay a good stipend, 2) provide housing, 3) have an affiliated medical school, 4) offer experienced mentors for MD/PhD preparation, and 5) provide funding and opportunities to present your research at national conferences. There are many programs, and they continue to grow as MD/PhD programs recognize that summer programs are good for recruiting the highly qualified students that would otherwise lack the resources to pursue MD/PhD training. It’s how I got in. It’s how several of my extraordinary friends in MD/PhD programs got in. It’s an opportunity to broaden your perspective of how research is done at different places, access new resources, and network with professionals in your field. You are also likely to earn letters of recommendation, demonstrate a dedication to research, and develop a small project that you will be able to present at conferences (e.g., ABRCMS, SACNAS, SfN). These experiences will give you excellent content for your applications and interview conversations.

• Here is a non-exhaustive list of summer undergraduate research programs to consider: https://www.aamc.org/professional-development/affinity-groups/great/summer-undergrad-research-programs
• Note: pursuing a summer research program does not mean that you drop your undergraduate research project. The summer programs are about 10 weeks long. A good mentor will not only be ok with you doing a summer research program away, but they should provide you with enthusiastic support and a letter of recommendation for your application.

Even if you are a Junior in college, I recommend that you pursue a summer research program as well. If your goal is to go directly from 4 years of college to a MD/PhD program, you would apply during the summer after junior year; therefore, you will be applying concurrently with the summer program. This can become a busy time, because you will be expected to perform in the research lab, write a strong application, and participate in the programmed activities. Leverage the opportunity to get feedback from mentors, graduate students, and peers in your summer program. This is how I spent my summer research program, and this feedback and support was integral for my preparation of a strong application. I will provide a complete example of a how to progress through an application cycle later in this section.

For MD/PhD admissions, research experiences > clinical experiences, but both are necessary. If you must prioritize one, it should be research. This does not mean you spend every day in lab, nor do you need to graduate with a publication (though a publication is valuable to be competitive at top MSTPs) — it more precisely means that you should have a longitudinal research experience (2 year minimum) in one or multiple labs (e.g., 1 undergrad, 1 summer program). Don’t get into the situation where, instead of doing a summer research program, you work as a scribe or medical assistant. This is not advised. Even the medical school would prefer you do the research. The thing about research that is so valuable is that you are likely to experience repeated failure during your project. As I’ve stated throughout my writing, confrontation of failure requires troubleshooting, methodical, critical thinking, and likely, asking for help. Your ability to navigate these requirements and overcome failure will be valuable throughout the application and interviewing process. In addition, anecdotal evidence suggests that more students are taking additional time after college to gain life experience/mature before matriculating to medical school and MD/PhD programs. These individuals are often more competitive because they have more life experience — they have confronted more opportunities for failure, to see other perspectives, and to identify individual strengths/weaknesses. The research lab offers opportunities to develop maturity and get your hands dirty (metaphorically). Overall, you want to ensure that you take the time to get experiences (both medical and research) that can support your expressed interest in doing an MD/PhD.

So, yes, you do still have to find time for clinical experiences — preferably also ones that allow you to work with diverse patients in multiple clinical scenarios for at least 1 year. Again, the number of hours is less important than the quality of experience. Shadowing is fine to get a sense for whether you like clinical work, but it’s rather passive. It’s important to do something that allows you face time with patients in vulnerable situations. You should appreciate the massive responsibility it is to have another person put their wellness into your hands. You don’t need to find a paid position, though this can be helpful to pay for the costs of applications (and college tuition/living). What the medical schools want to know is that you: 1) have taken initiative to engage in diverse patient care, 2) are committed to becoming a physician, 3) possess interpersonal skills, 4) understand how empathy is essential for optimal care, and 5) enjoy the learning process — it’s a long road, you must demonstrate sustainable enthusiasm for education.

In addition, to demonstrate that you are a well-rounded, well-adjusted person with leadership skills, you should pursue extracurricular activities that allow you to work in a team to solve problems. A wide range of organizations could suffice, and it should be on a project that genuinely interests you. Don’t become so hyperfocused on checking the boxes for this career path that you forget to find enjoyable outlets. Developing problem-solving and communication skills outside of the lab and clinical setting will be transferable and offer different perspectives on efficient and effective teamwork. Take on a responsibility to serve your local or undergraduate community, and only if you’re motivated to do a good job. I want to emphasize this point: don’t say ‘yes’ to a position if you’re not motivated to do a good job.

As you progress through college, pay attention to the explicit prerequisites required to apply for medical school — you must, at minimum, complete these if you aim to apply for MD/PhD programs. Make sure you have completed each of the course requirements, and you keep in mind the slight variations that might differ from one medical school to another. Generally, the prerequisites are the same, but there might be a specific preference, for example, that you pursue 2 humanities at one program versus 3 humanities courses at another. Don’t let this catch you by surprise when you are about to submit your application. See this page for details, and this page for even more details.

Finally, you must study for and take the MCAT to apply for MD/PhD programs. This is a rite of passage, and the first of many such exams you will take on this career path. A major key that I’ve learned from taking the MCAT, USMLE STEP1, and USMLE STEP2 board exams, is that doing practice questions is supreme preparation. UWORLD is what I used for the STEP preparation, and what I now highly recommend for MCAT preparation. It has excellent questions banks that simulate representative questions and provides answers with helpful explanations. Go through all the MCAT questions and aim to go through the ones you got incorrect the first time in a second pass. Take multiple full length practice exams to develop attention endurance for the 7.5 hour testing day. Use online and textbook resources for the different subjects to supplement your understanding in areas of weakness based on your UWORLD results. It’s OK if you’re getting the majority incorrect — learn from each one and ensure you save time for a second pass. There are excellent, comprehensive guides on Reddit and across the internet that convey high-yield information. Don’t join r/premed and get sucked into toxicity; I do prefer r/mdphd as a place for genuine support. Develop a consistent study habit and exercise routine — it’s unhealthy to sit that long. Think long-term sustainability.

How does the MD/PhD application cycle flow?

• Let’s use the next application cycle from the time of writing as an example: the 2023–2024 cycle. You have completed the above recommendations and are preparing to apply competitively for MD/PhD programs. You should study for the MCAT and take the exam by spring 2023. After you take the MCAT, you have about 1 month until you learn your score. If you felt it did not go as you planned, you can be proactive and schedule a second exam early in the application cycle, so you have time to update your score, if necessary. If you score below a 507, you will probably be at a disadvantage compared to other applicants and should consider retaking it. Weigh this decision with your overall application in mind, as it might not be necessary if you have excelled in other areas of the application. If you’re in the 507–510 range, assess your research experiences and other application components with an advisor to determine your competitiveness. From what I’ve gathered, aim to score > 513 to be in a solid position.
• Once you are content with your MCAT score, start the primary AMCAS application process, ideally by late April 2023. Identify who will write your letters of recommendation; you can have up to 6 letters. My approach to selecting writers of my letters was: 2–3 from research, 1–2 from medicine, 1 premedical committee letter, and 1 nonacademic letter. If you’re applying to MD/PhD programs, make sure your letter writers are aware so they can write the letter according to your specific traits to become an effective physician-scientist.
• Next, draft a personal statement (then redraft it) — work hard to get this essay right, as it serves as a foundation of the application. Find mentors to read your essay, provide feedback, and suggest areas for improvement. Proceed to do the same with the Why MD/PhD and Significant Research essays. Prioritize these essays early, as you will want time to draft several and polish them. I’ll post specific recommendations and best practices for each essay in a future article.
• Complete all the requirements of AMCAS primary application. Aim to submit a strong primary application by June-early July 2023. Apply broadly to a minimum of 10–15 programs at first. If you want to apply for more, then I recommend submitting the first 10–15 in the primary application, then adding your 2nd tier options about 3 weeks later. This strategy allows you to get your application processed and receive the secondary applications of your top choice programs earlier, allowing you to return secondary applications more quickly after receiving them. Note that this strategy is not necessary and depends on when you are able to submit the primary application, but it can help you stay focused and organized, rather than being inundated with 20+ secondary applications at once.
• You will receive secondary applications from most the schools you applied to in July-August, which consist of several more essay prompts with opportunities for you to identify specific faculty at the program that match your research interests. The secondary applications for MD/PhD programs are longer and more involved than MD-only. Try to submit each secondary by 2 weeks of receipt.
• You will begin to receive invites for interviews around September, and the interview process will continue through February 2024. Practice a minimum of 3 mock interviews before the real interview with friends and a stranger (like me), and see my post and/or video (coming soon) on How To Interview for MD/PhD Programs. You will learn of your acceptance, waitlist, or rejection typically within a month of interviewing.
• Second look occurs in March-April, where you get a final chance to meet people at your programs of interest and decide on your best fit. Accept a position by late April 2024, take a vacation all summer, show up at med school in August 2024 ready to shine.

In summary:

• Cold email research mentors to start your research experience — the earlier, the better
• Read scientific papers, practice experimental design/technique, improve science communication, and be in lab for 8–10 hours/week minimum
• Become involved in a (passion) project that supports your development as a leader
• Find a consistent role in a clinical setting in which you take an active role in patient care
• Apply for summer undergraduate research programs
• Complete medical school prerequisites, maintain good grades, ask for 6 letters of recommendation, and strive to do well on the MCAT
• Submit your primary application in June-early July
• Return secondary applications by 2 weeks of receipt
• Practice a minimum of 3 mock interviews before the real thing